The Culture of HealthcareSociotechnical Aspects:
Clinicians and Technology
Lecture c
This material (Comp2_Unit10c) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Sociotechnical Aspects: Clinicians and Technology
Learning Objectives• Describe the concepts of medical error and patient safety (Lecture
a, b)• Discuss error as an individual and as a system problem (Lecture a)• Compare and contrast the interaction and interdependence of social
and technical “resistance to change” (Lecture c)• Discuss the challenges inherent with adapting work processes to
new technology (Lecture c)• Discuss the downside of adapting technology to work practices and
why this is not desirable (Lecture c)• Discuss the impact of changing sociotechnical processes on quality,
efficiency, and safety (Lecture a, b)
2The Culture of Healthcare
Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Sociotechnical Systems
• Sociotechnical system:• System that involves interaction between people
and technology• Organizational characteristics are modified by
this interaction for better or for worse• Optimization of one element without attention to
the other may be detrimental to the organization
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Clinicians And Technology
• Medicine is dependent on technology for progress– Microscope invented in 1590– In 1675 Anton van Leeuwenhoek uses a microscope
to examine blood, cells, and bacteria– In 1938 Ernst Ruska develops electron microscopy – Researchers now have a detailed understanding of
structure of organs in health and disease
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
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Clinicians And Technology
• Clinicians integrate technology into their medical practice– Example: In 1816 Rene Laennec invents the
stethoscope– Refined since then– Clinicians have adopted iterative
modifications of technology into their practice
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Technology In Medicine• Technology is the primary driving force of
medicine• A vast array of technological resources are now
available in clinical practice• Availability of an electronic health record has
changed the paradigm of information collection, storage, and recovery in medicine
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Technology In Medicine• Technology has assisted evolution of the scientific
method– Example: complex statistical calculations in
studies• Technology helps advance reproducible scientific
breakthroughs– Example: Use and production of penicillin
• Technology essential to practice some forms of medicine– Example: in vitro fertilization
7The Culture of Healthcare
Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Technology In Medicine• Clinicians need to constantly update their
knowledge base– Example: In the past, clinicians relied on textbooks
and on other clinicians– Now, reliance on an online database of medical
literature• Advances in technology require clinicians to learn
new skills– Example: changes in cardiac pacemaker technology– Invasive cardiologists need to update skills as
technology advances
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Technology In Medicine• The primary focus of clinical medicine is the
clinician-patient relationship• Now there is a new focus in the exam room in
addition to the clinician and the patient – the computer
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Change• Change is an alteration in organizational structure and/or
function• Implementation of technology may be entirely
transparent and may be welcomed by individuals and groups – Example: most physicians embraced pagers and cell
phone technology because it allowed them to be reached (and respond) remotely
• However some technologies are intrusive and significantly change the workflow– Example: EHR implementation in the clinical setting
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Intersection of social and technical changes
• Change occurs simultaneously and in parallel with the delivery of healthcare
• In the past the clinical workflow of physicians was independent of technology
• Now, with the advent of the EHR, there is interdependence between social and technical aspects of patient care
• Changes in technology require clinicians to make substantial changes to the way they deliver patient care, and vice versa
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Resistance To Change• Resistance to change is the action taken by
individuals and groups when they perceive that the change is a threat to them– Three phases of change– Inertia– Transition– Achieving the new model
• Resistance to change is promoted by defenders of the status quo
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Overcoming Resistance To Change
• Involve all stakeholders• Create effective lines of communication• Identify champions• Alleviate fears• Collaborate to solve problems• Elicit feedback
13The Culture of Healthcare
Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Work Processes And Technology• Clinicians have developed their own work
processes• Healthcare professionals use multiple tools and
technologies to assist their work• Technology has become an essential
component of workflow• Implementing new technology requires clinicians
to adapt their work processes
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
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Unintended Consequences of Technological Change
• Changes in workflow may not improve overall system efficiency
• Clinicians may be unable to adapt to the change• Outcome measures may not be positive• The implementation is just as important as the
technology or the system
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
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Managing Sociotechnical Change
• Organizations look for the right people for the right tasks at all levels to lead change
• Organizations make a fundamental choice -- either adapt work processes to new technology, or adapt technology to current workflow
• New technology can be designed to improve work processes• Adapting work processes requires leadership to carefully manage
change• But adapting technology to current work processes is
counterproductive in most cases– No significant long term improvements in care– Less agile– Less adaptable to future changes
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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The Impact Of Sociotechnical Change
• Improvement in quality and process improvement• Improved process and outcome measures• Improvement in efficiency• Enhanced workflows• Improved efficiencies of procedures dependent on
technology• Improvement in safety• Reduction in errors
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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The Impact Of Sociotechnical Change
• Changes in job descriptions• Role for new experts in healthcare IT• Role for clinicians who are technologists, and
technical specialists who have exposure to the clinical environment
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Sociotechnical Aspects: Clinicians and Technology
Summary – Lecture c• Role of technology in healthcare• Social and technical “resistance to change” in
the context of sociotechnical interdependence• Adaptation of work processes to new technology • Changing sociotechnical processes in the
context of quality, efficiency, and safety
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Sociotechnical Aspects: Clinicians and Technology
Summary• Medical error and patient safety • Adaptation of work processes to new technology • Changing sociotechnical processes in the
context of quality, efficiency, and safety• Resistance to change among clinicians
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Sociotechnical Aspects: Clinicians and TechnologyLecture c
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References• Doherty NF, King M. (2005). From technical to socio-technical change: tackling the human and organizational
aspects of systems development projects. European Journal of Information Systems .14, 1–5• McGlynn, E., Asch, S., et al. (2003). The quality of healthcare delivered to adults in the United States. New
England Journal of Medicine, 348: 2635-2645.• Miller, T., Brennan, T., et al. (2009). How can we make more progress in measuring physicians' performance to
improve the value of care? Health Affairs, 28: 1429-1437.• Sociotechnical systems at http://en.wikipedia.org/wiki/Sociotechnical_systems • Tang, P., Ralston, M., et al. (2007). Comparison of methodologies for calculating quality measures based on
administrative data versus clinical data from an electronic health record system: implications for performance measures. Journal of the American Medical Informatics Association, 14: 10-15.
• Timeline of medicine and medical technology at http://en.wikipedia.org/wiki/Timeline_of_medicine_and_medical_technology
• Vonnegut, M. (2007). Is quality improvement improving quality? A view from the doctor's office. New England Journal of Medicine, 357: 2652-2653.
• World Health organization 55th World Health Assembly. Quality of care: patient safety. Report by the Secretariat, 2002 http://apps.who.int/gb/archive/pdf_files/WHA55/ea5513.pdf
21The Culture of Healthcare
Sociotechnical Aspects: Clinicians and TechnologyLecture c
Health IT Workforce Curriculum Version
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Sociotechnical Aspects: Clinicians and Technology
References – Lecture c
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