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The purpose of this paper is to explore physician sensemaking and readiness to implement electronic medical records (EMR) as a first step to finding strategies that enhance EMR adoption behaviors.

The case study approach provides a detailed analysis of individuals within an organizational unit. Using a theoretical lens of sensemaking and readiness for change gives a framework for triangulated inquiry.

Findings reveal that physicians' key sensemaking factors are alignment, expectations, symbols (i.e. voice activation technology), outside influences, emotional arousal, trust, faith, forced implementation, controlled influence, and clarification of identity. These factors collectively describe how physician derive meaning through innovation.

The findings elucidate physicians as autonomous learners utilizing innovative thought processes to prepare for EMR implementation. Physicians used innovation in EMR implementation as a method of controlled influence to clarify their identity as efficient, competent professionals who demand performance excellence.

These findings have implications for EMR implementation strategies and future research in innovation and EMR adoption behaviors.

This study provides needed information about how physicians grasp EMR technology in the practice of medicine and how it impacts their readiness to use EMR. Much is known about the barriers, difficulties, and benefits of EMR, but little is know about how physicians construct meaning from the use of this new technology.

Purpose – To offer a theoretical explanation for observed physician resistance and rejection of high reliability patient safety initiatives.

Design/methodology/approach – A grounded theoretical qualitative approach, utilizing the organizational theory of sensemaking, provided the foundation for inductive and deductive reasoning employed to analyze medical staff rejection of two successfully performing high reliability programs at separate hospitals.

Findings – Physician behaviors resistant to patient-centric high reliability processes were traced to provider-centric physician sensemaking.

Research limitations/implications – Research, conducted with the advantage that prospective studies have over the limitations of this retrospective investigation, is needed to evaluate the potential for overcoming physician resistance to innovation implementation, employing strategies based upon these findings and sensemaking theory in general.

Practical implications – If hospitals are to emulate high reliability industries that do successfully manage environments of extreme hazard, physicians must be fully integrated into the complex teams required to accomplish this goal.

Social implications – Reforming health care, through high reliability organizing, with its attendant continuous focus on patient-centric processes, offers a distinct alternative to efforts directed primarily at reforming health care insurance. It is by changing how health care is provided that true cost efficiencies can be achieved. Technology and the insights of organizational science present the opportunity of replacing the current emphasis on privileged information with collective tools capable of providing quality and safety in health care.

Originality/value – The fictions that have sustained a provider-centric health care system have been challenged. The benefits of patient-centric care should be obtainable.