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In Ghana, as with other developing countries, there are several health information technology (HIT) initiatives as interventions to improve healthcare delivery. HIT implementation undoubtedly results in change. However, most studies relating to HIT implementation readiness have constantly neglected the role of change in successfully implementing HIT. This study intends to identify factors affecting successful change management as part of preparation towards successfully implementing HIT in public hospital in Ghana. To carry out this study, we conducted in-depth interviews with a matrix of HIT senior managers and thematically analyzed the data. The data was transcribed and uploaded into a Nvivo 11 software for analysis using thematic analysis techniques. Five (5) themes were discovered. They are: 1) Stakeholder participation; 2) Proof of experience in similar project; 3) Availability of committed change agents/all-levels-change representatives; 4) Clearly articulated change implementation strategy; and 5) Training and improvement mechanism (post-implementation). A fresh call is made for more attention to be paid to change as part of preparatory measures towards the adoption of HIT in Ghana using the five cardinal approaches identified as a guide.

We examine how interpersonal behavior and social interaction influence team sensemaking and subsequent team actions during a hospital-based health information technology (HIT) implementation project.

Over the course of 18 months, we directly observed the interpersonal interactions of HIT implementation teams using a sensemaking lens.

We identified three voice-promoting strategies enacted by team leaders that fostered team member voice and sensemaking; communicating a vision; connecting goals to team member values; and seeking team member input. However, infrequent leader expressions of anger quickly undermined team sensemaking, halting dialog essential to problem solving. By seeking team member opinions, team leaders overcame the negative effects of anger.

Leaders must enact voice-promoting behaviors and use them throughout a team’s engagement. Further, training teams in how to use conflict to achieve greater innovation may improve sensemaking essential to project risk mitigation.

Health care work processes are complex; teams involved in implementing improvements must be prepared to deal with conflicting, contentious issues, which will arise during change. Therefore, team conflict training may be essential to sustaining sensemaking.

Future research should seek to identify team interactions that foster sensemaking, especially when topics are difficult or unwelcome, then determine the association between staff sensemaking and the impact on HIT implementation outcomes.

We are among the first to focus on project teams tasked with HIT implementation. This research extends our understanding of how leaders’ behaviors might facilitate or impeded speaking up among project teams in health care settings.

Numerous studies have identified various unintended adverse consequences (UACs) of implementing health information technology (HIT). For example, UACs identified in the context of Computerized Physician Order Entry (CPOE) implementation include unfavorable workflow issues, generation of new types of errors, untoward changes in communication patterns, and problems of paper persistence.

However, gaps remain in understanding why UACs from HIT implementation occur, and how they may be overcome. The technology-in-practice (TIP) framework emphasizes the role of human agency (or individual action) in enacting structures of technology use (or technologies-in-practice) and other social structures within the organization. As such, given a set of UACs from HIT implementation, the TIP framework can help trace them back to specific actions (types of HIT-in-practice) and institutional conditions (social structures).

However, insofar as the TIP framework can help understand causes of UACs, it does not shed light on how they may be overcome through strategic action. By contrast, the knowledge-in-practice (KIP) framework, which emanates from both human resource and knowledge management literatures, helps understand how information and communication technologies (ICTs) such as “Intranets” and the “Virtual Office” can be used alongside existing HIT systems (e.g., CPOE) to create new social structures, generate new KIP, and transform HIT-in-practice.

This chapter integrates the TIP and KIP literatures to develop an integrated framework for understanding and overcoming the UACs from HIT implementation. The framework is applied to existing evidence on UACs from CPOE implementation, to explain why they occur, and how they may be overcome. The application and ensuing discussion provide insight into strategies for successful HIT implementation in healthcare organizations, as well as recommendations for future research.

Although resilience is heavily studied in both the healthcare and organizational change literatures, it has received less attention in healthcare information technology (HIT) implementation research. Healthcare organizations are consistently in the process of implementing and updating several complex technologies. Implementations and updates are challenged because healthcare workers often struggle to perceive the benefits of HITs and experience deficiencies in system design, yet bear the brunt of the blame for implementation failures. This combination implores healthcare workers to exercise HIT resilience; however, how they talk about this construct has been left unexplored. Subsequently, this study explores healthcare workers' communicative constitution of HIT resilience.

Twenty-three physicians (N = 23), specializing in oncology, pediatrics or anesthesiology, were recruited from one healthcare organization to participate in comprehensive interviews during and after the implementation of an updated HIT system DIPS.

Thematic analysis findings reveal physicians communicatively constituted HIT resilience as their (1) convictions in the continued, positive developments of newer HIT iterations, which marked their current adaptive HIT behaviors as temporary, and (2) contributions to inter-organizational HIT brainstorming projects in which HIT designers, IT staff and clinicians jointly problem-solved current HIT inadequacies and created new HIT features.

Offering both practical for healthcare leaders and managers and theoretical implications for HIT and resilience scholars, this study's results suggest that (1) healthcare leaders must work diligently to create a culture of collaborative HIT design in their organization to help facilitate the success of new HIT use, and (2) information technology scholars reevaluate the theoretical meaningfulness a technology's spirit and reconsider the causal nature of a technology's embedded structures.

Over the last few decades, information technology (IT) has significantly altered the nature of work and organizational structures in many industries, including health care. The purpose of this analysis is to compare how system-level differences affect IT implementation in health care (HIT) and the implications of these differences for health care equity.

We critically analyzed selected claims concerning the capacity of HIT to provide better care to more individuals at lower costs, thus contributing to health care equity, in the context of current health care reform efforts in the United States. We used the case of HIT implementation in Taiwan’s National Health Insurance system as a contrasting case.

We argue that however much HIT may yield in quality improvements or savings in the context of a universal and publicly financed single payer system, such savings simply cannot be accrued by a system of multiple health plans competing for better customers (i.e., less costly patients) and driven by profit.

It is important to define the level of analysis in debates about the potential of HIT to produce better health care at lower costs and the equity implications of this potential. In these debates, US policy makers should consider the commitment to health care equity that informed the design of Taiwan’s health care system and of HIT implementation in that country. HIT merely provides enabling tools that are of little value without major systemic changes

To our knowledge, the health IT expert literature has overlooked when not ignored the ethical principles informing health care systems, an omission which makes it difficult if not impossible to evaluate the potential of HIT to increase equity in health care.

The purpose of this paper is to further adaptive structuration theory (AST) by associating technological appropriations with health information technology workarounds. The author argues that appropriating electronic health record (EHR) technology ironically – in a way other than it is designed to be used – and divergently across an organization results in enhanced perceptions of EHR technology and its implementation.

Data were collected from 345 healthcare employees in a single healthcare organization that was switching to EHRs from paper records. Two major constructs of AST – unfaithfulness and dissension in appropriation – were operationalized and analyzed using multivariate regressions to test the relationship between the type of appropriation and perceptions of EHR technology’s relative advantage and implementation success.

Results reveal that both ironic (unfaithful) technological appropriation and dissension in technological appropriation across the organization predicted employees’ perceptions of EHR’s relative advantage and perceptions of EHR implementation success. Furthermore, physicians are the least likely to perceive EHR’s relative advantage or EHR implementation success. These results exemplify that EHR workarounds are taking place and reaffirm AST’s principle that employees evolve technology to better suit their working environments and preferences.

The survey and scales used in this study further demonstrate that there are meaningful statistical measures to accompany the qualitative methods frequently used in the AST literature. In addition, this paper expands AST research by exploring the positive outcomes that follow ironic and divergent technology appropriations.

Existing research on the organizational implications of the introduction of new information technology (IT) has neglected to focus on the anticipation of organizational change. In this paper, the author examines the extended pre-implementation phase prior to the introduction of the largest-ever health IT (HIT) implementation in Denmark. The purpose of this paper is to expand the conceptualization of organizational change to include the neglected pre-implementation phase preceding large-scale organizational change projects.

The research is based on qualitative data consisting of interviews, documents and observations gathered during a three-year research project in the Danish health sector. An important source of methodical inspiration has been grounded theory, which has allowed the pertinent interview themes to evolve and allowed for the gradual development of a theoretical framework.

The main finding of this paper is that the anticipatory pre-implementation phase is not simply passive waiting time for organizational members. Evidence from a three-year research project demonstrates how organizational members engage in recurring patterns of sensemaking, positioning and scripting of possible futures in preparation for the organizational changes that next generation HIT imposes. The study argues that resistance to organizational change may be better understood as resistance to having to give up institutionalized rights and responsibilities.

The paper offers a conceptual model—the anticipation cycle—that enables the systematic analysis of the relational mechanisms at work when organizational members are preparing for pending organizational change. Early analysis based on the anticipation cycle enables organizations and scholars to bring previously black-boxed anticipatory patterns into the equation of organizational change.

This paper aims to validate an initially developed e-Health readiness assessment model.

The authors thematically analysed an initial qualitative data collected and used the outcome to develop survey instruments for this study. To collect the quantitative data, the authors used the drop and collect survey approach given the research setting. The quantitative data was analysed using factor and regression analyses of SPSS 23 in which hypotheses formulated were tested.

The results suggest that the model [R² = 0.971; F (5, 214) = 1414.303], which is made up of readiness assessment factors (constructs) and measuring tools explain about 97% of the variance of the overall health information technology/e-Health adoption readiness at Komfo Anokye Teaching Hospital. The measuring tools were reliable for assessing the composite variables (constructs): technology readiness; operational resource readiness; organizational and cultural readiness; regulatory and policy readiness; and core readiness, which have significant influence on eHealth adoption readiness assessment..

This study has successfully validated empirically developed eHealth readiness assessment model with complete reliable indicators given that existing eHealth readiness assessment models have not been effective due to a general lack of standard indicators for measuring assessment factors. The study also contributes to the growing research on the adoption of information technology/systems in health-care environment using the Technology–Organization–Environment framework.

In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) was signed into law. This Act, part of the broader “stimulus” legislation, represents the U.S.'s largest investment in health information technology (HIT) to date. More importantly, it sets a vision and provides a plan intended to transform the U.S. health care system to a safer, more efficient place to receive care. To that end, the Act seeks to fundamentally change the path HIT applications' adoption and implementation was taking to ensure that “meaningful use” and interoperability are achieved. However, such bold and sweeping changes will not come without unintended consequences, and their broad scope makes measuring the new public policy's success a challenge.

This paper aims to systematically review the literature on roles of physicians in virtual teams (VTs) delivering healthcare for effective “physician e-leadership” (PeL) and implementation of e-health.

The analyzed studies were retrieved with explicit keywords and criteria, including snowball sampling. They were synthesized with existing theoretical models on VT research, healthcare team competencies and medical leadership.

Six domains for further PeL inquiry are delineated: resources, task processes, socio-emotional processes, leadership in VTs, virtual physician-patient relationship and change management. We show that, to date, PeL studies on socio-technical dynamics and their consequences on e-health are found underrepresented in the health literature; i.e. no single empirical, theoretic or conceptual study with a focus on PeL in virtual healthcare work was identified.

E-health practices could benefit from organization-behavioral type of research for discerning effective physicians’ roles and inter-professional relations and their (so far) seemingly modest but potent impact on e-health developments.

Although best practices in e-health care have already been identified, this paper shows that physicians’ roles in e-health initiatives have not yet received any in-depth study. This raises questions such as are physicians not yet sufficiently involved in e-health? If so, what (dis)advantages may this have for current e-health investments and how can they best become involved in (leading) e-health applications’ design and implementation in the field?

If effective medical leadership is being deployed, e-health effectiveness may be enhanced; this new proposition needs urgent empirical scrutiny.