Department of Health Policy and Management, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA.
Health Care Management Department, The Wharton School, The University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, 19104, USA.
Soc Sci Med. 2020 Jun;255:113002. doi: 10.1016/j.socscimed.2020.113002. Epub 2020 Apr 22.
Implementation of health information technology fails at an alarming rate because intended users often choose not to use it. Implementation theory and frameworks suggest that social networks may influence individuals' use, but empirical study remains limited. Furthermore, neither theory nor research has identified whose beliefs within the network matter most for implementation. We examine the relationship between an individual's system use and the beliefs of his or her peers. We assess the relationship for two peer groups: the entire group of peers and the subset that shares the individual's beliefs about the system. We used data collected from an academic hospital in the United States that had recently implemented a bar code medication administration system, a technology meant to increase medication safety. We administered a survey to nurses (N = 207) in six clinical units approximately 3-5 months (April-June 2013) after the "go-live" of the system to identify peer groups and beliefs about system usefulness. We calculated mean peer belief for the entire peer group and sharedness of belief using a homophily measure. From the hospital's electronic health record system, we obtained nurses' system use during the 3-month data collection period. We used multivariable linear regression to examine relationships. We found no effect of mean peer beliefs on individual system use. However, sharedness of belief about usefulness was positively associated with individual system use. Individuals' own positive belief was only associated with greater system use when shared with peers. Our findings indicate a significant role of social networks in implementation, and specifically that shared beliefs between an individual and his or her peer network may be critical to implementation success, more so than the beliefs across the entire peer group. Reinforcement by the social network appears to dictate whether individuals' own beliefs translate into system use.
由于预期用户经常选择不使用，医疗信息技术的实施失败率令人震惊。实施理论和框架表明，社交网络可能会影响个人的使用，但实证研究仍然有限。此外，无论是理论还是研究都没有确定网络中谁的信念对实施最重要。我们研究了个体系统使用与同伴信念之间的关系。我们评估了两个同伴群体之间的关系：整个同伴群体和共享个体对系统信念的子集。我们使用了从美国一家学术医院收集的数据，该医院最近实施了条形码药物管理系统，这是一项旨在提高药物安全性的技术。我们向六个临床科室的护士（N=207）进行了一项调查，大约在系统“上线”后 3-5 个月（2013 年 4 月至 6 月），以确定同伴群体和对系统有用性的信念。我们使用同质性度量来计算整个同伴群体的平均同伴信念和信念共享。我们从医院的电子健康记录系统中获得了护士在 3 个月数据收集期间的系统使用情况。我们使用多变量线性回归来检验关系。我们没有发现平均同伴信念对个体系统使用的影响。然而，对有用性的信念共享与个体系统使用呈正相关。只有当个体的积极信念与同伴共享时，个体的积极信念才与更大的系统使用相关。我们的研究结果表明社交网络在实施中起着重要作用，特别是个体与其同伴网络之间的共享信念可能对实施成功至关重要，比整个同伴群体的信念更重要。社交网络的强化似乎决定了个体自身的信念是否转化为系统使用。
