Managing change during an information systems transition

AORN Journal,  June, 2002  by Barbara J. Barr

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A number of studies have been conducted to measure nurses' attitudes toward computers and computerization, and results generally are positive. (9) There is a need, however, to understand how the diffusion of new information technology occurs among nurses and how their attitudes are translated into the behaviors of adoption and use.

In the literature, many studies focus on nurses' computer knowledge, attitudes, age, and skills as key variables that present significant obstacles to the adoption of new technology. (10) In a meta-analysis, researchers predict that the quality of nursing care should improve with increased use of computers and information technology. (11) Another author suggests that computers offer many benefits for nurses, including increased accountability and efficiency in patient documentation; (12) however, developing nurse-computer interaction depends on each nurse's rate of learning.

One researcher found that using bedside computer terminals resulted in a significant increase in appropriate and necessary charting. In addition, errors that had been occurring in 25% of handwritten flow sheets were virtually eliminated. (13) Although there are studies that indicate a negative relationship between computers and the quality of nursing documentation, most concerns identified in these studies relate to computer software that lacks programming options to prohibit nurses from closing out the documentation screen before completing the required fields. (14)

All the above factors identify barriers to successfully implementing an information system in the health care setting; however, leaders also must understand what effect change has on nurses. This is key to facilitating adoption of technology that supports nurses in their practice.

THEORETICAL FRAMEWORK

Having the best computer system on the market serves no useful purpose if the end user is not motivated to learn how to use the system. Innovation-diffusion theory involves examining, via social channels in a particular group or organization, the process by which innovation is communicated. This theory has several phases including the

* knowledge phase,

* persuasion phase,

* decision phase,

* implementation phase, and

* conformation phase.

This theory considers social change an innovation when it generates widespread consequences for individuals and organizations.

The intrinsic power of innovation to affect change, in conjunction with its movement through diffusion channels, does not imply passivity or powerlessness on the part of the change agent, which is identified in this context as those advocating for information systems technology. Rather, the change agent actively facilitates and regulates the diffusion process by recognizing and capitalizing on group strengths and identifying and managing factors that may impede diffusion. When communicating information and interacting with nurses involved in the change, educators must establish a rapport with nurses, share information via a user-centered orientation, and establish compatibility between the information available and nurses' needs.