Canada Research Chair in Information Technology in Health Care, HEC Montreal 3000 Cote-Ste-Catherine Road, Montreal, H3T 2A7, Quebec Canada.
Implement Sci. 2011 Feb 28;6:15. doi: 10.1186/1748-5908-6-15.
The adoption and diffusion of clinical information systems has become one of the critical benchmarks for achieving several healthcare organizational reform priorities, including home care, primary care, and integrated care networks. However, these systems are often strongly resisted by the same community that is expected to benefit from their use. Prior research has found that early perceptions and beliefs play a central role in shaping future attitudes and behaviors such as negative rumors, lack of involvement, and resistance to change. In this line of research, this paper builds on the change management and information systems literature and identifies variables associated with clinicians' early perceptions of organizational readiness for change in the specific context of clinical information system projects.
Two cross-sectional surveys were conducted to test our research model. First, a questionnaire was pretested and then distributed to the future users of a mobile computing technology in 11 home care organizations. The second study took place in a large teaching hospital that had approved a budget for the acquisition of an electronic medical records system. Data analysis was performed using partial least squares.
Scale items used in this study showed adequate psychometric properties. In Study 1, four of the hypothesized links in the research model were supported, with change appropriateness, organizational flexibility, vision clarity, and change efficacy explaining 75% of the variance in organizational readiness. In Study 2, four hypotheses were also supported, two of which differed from those supported in Study 1: the presence of an effective project champion and collective self-efficacy. In addition to these variables, vision clarity and change appropriateness also helped explain 75% of the variance in the dependent variable. Explanations for the similarities and differences observed in the two surveys are provided.
Organizational readiness is arguably a key factor involved in clinicians' initial support for clinical information system initiatives. As healthcare organizations continue to invest in information technologies to improve quality and continuity of care and reduce costs, understanding the factors that influence organizational readiness for change represents an important avenue for future research.
临床信息系统的采用和推广已成为实现多项医疗保健组织改革优先事项的关键基准之一，包括家庭护理、初级保健和综合保健网络。然而，这些系统经常受到预期从中受益的同一社区的强烈抵制。先前的研究发现，早期的看法和信念在塑造未来的态度和行为方面起着核心作用，例如负面谣言、缺乏参与和抵制变革。在这一研究领域，本文基于变革管理和信息系统文献，确定了与临床医生对临床信息系统项目中组织变革准备情况的早期看法相关的变量。
进行了两项横断面调查来检验我们的研究模型。首先，对问卷进行了预测试，然后分发给 11 个家庭护理组织中移动计算技术的未来用户。第二项研究发生在一家大型教学医院，该医院已批准预算用于购买电子病历系统。使用偏最小二乘法进行数据分析。
本研究中使用的量表项目具有足够的心理测量学特性。在研究 1 中，研究模型中的四个假设联系得到了支持，变革适宜性、组织灵活性、愿景清晰度和变革效能解释了组织准备就绪程度的 75%的方差。在研究 2 中，也支持了四个假设，其中两个与研究 1 中支持的假设不同：有效的项目负责人和集体自我效能的存在。除了这些变量外，愿景清晰度和变革适宜性也有助于解释因变量的 75%的方差。提供了对两个调查中观察到的相似性和差异性的解释。
组织准备就绪情况可以说是临床医生最初支持临床信息系统计划的关键因素之一。随着医疗保健组织继续投资于信息技术以提高质量和连续性护理并降低成本，了解影响变革准备就绪的因素代表了未来研究的重要途径。
