Making Sense of Health Information Technology in an Academic Medical Center

描述（由申请人提供）：医院采用卫生信息技术系统（HIT）被认为是减少医疗错误和减少每年约44,000例死亡和170亿美元与该错误相关的医疗保健费用的关键。然而，由于医院护理环境的复杂性，医院对HIT的采用仍然缓慢且不一致。因此，实施电子护理文件系统等新做法往往很困难，因为在医院提供护理的高度协调、相互依赖的过程（如信息交换、沟通、关系）受到破坏。作为一项重要的组织功能，意义构建被定义为寻找驱动行动的答案和意义的社会过程，它导致统一的理解、学习和有效的问题解决；研究表明，这些策略与成功的改变有关。项目团队合作是医院越来越多地使用的一种变革策略，它通过为团队成员提供一种正式的机制来分享想法、构建事件的意义并采取下一步行动，从而促进了意义的产生。我的长期目标是从事护理研究的职业，为床边和医院的实践改进做出贡献。我提出的研究将探讨项目团队在三级医疗医院实施新信息技术过程中的作用。目的包括：描述和比较在层次角色和成员门徒方面不同的多学科项目团队的意义构建；描述多学科项目团队的意义是如何随时间变化的；描述多学科项目团队的意义构建如何影响团队采取的行动；并确定哪些团队成员的行为促进或抑制了项目团队的意义构建。纵向案例研究设计将有助于发现意义的演变；提供查看跨组织边界关系的机会；捕获事件发生时的丰富数据；请允许我收集同一事件在一段时间内的不同观点。通过直接观察和组织文件分析收集意义数据。参与者的人口统计数据将用于探索语义模式的变化。本研究的结果将是关于项目团队的语义构建模式的新知识；在多学科项目团队准备实施过程中，意义制定和行动是如何变化的；并确定促进或抑制项目团队意义构建的团队成员行为。这些发现将导致在医院实施HIT的新方法。

DESCRIPTION (provided by applicant): Hospital adoption of health information technology systems (HIT) is promoted as essential to decreasing medical error and reducing the estimated 44,000 annual deaths and $17 billion in healthcare costs associated with that error. Yet, adoption of HIT in hospitals continues to occur slowly and inconsistently, due in large part to complexity of the hospital care environment. Implementing new practices, such as an electronic nursing documentation system therefore, is often difficult due to the disruption of the highly coordinated, interdependent processes (e.g. information exchange, communication, relationships) of providing care on in hospitals. As a critical organizational function, sensemaking, defined as the social process of searching for answers and meaning which drive action, leads to unified understanding, learning and effective problem solving; strategies which studies have linked to successful change. Project team work, a change strategy increasingly used by hospitals, facilitates sensemaking by providing a formal mechanism for team members to share ideas, construct the meaning of events, and take next actions. My long term goal is to engage in a career of nursing research, contributing to knowledge that facilitates practice change improvements at the bedside and in hospitals. My proposed study will explore the role of project teams' sensemaking during the implementation of new information technology in a tertiary care hospital. Aims include: describe and compare sensemaking across multidisciplinary project teams that differ in terms of hierarchical role and disciple of members; describe how sensemaking of multidisciplinary project teams changes over time; describe how multidisciplinary project teams' sensemaking influences the actions taken by the teams; and identify which team member behaviors facilitate and or inhibit project team sensemaking. The longitudinal case study design will facilitate the detection of meaning as it evolves; provide an opportunity to view relationships across organizational boundaries; capture rich data of events as they occur; and allow me to gather several different perspectives of the same event over the course of time. Sensemaking data will be collected through direct observation and organizational document analysis. Participant demographics will be used to explore variation in sensemaking patterns. Outcomes of this research will be new knowledge about sensemaking patterns of project teams; how sensemaking and action vary across multidisciplinary project teams as the team prepares for implementation; and identify team member behaviors which facilitate or inhibit project team sensemaking. These findings will lead to new methods of implementing HIT in hospitals. PUBLIC HEALTH RELEVANCE: Outcomes from this study will help healthcare project teams identify the needs of hospital personnel in order to customize software and therefore improve the likelihood that new systems will meet healthcare workers needs and improve patient outcomes.