Editorial - Success in Health Care – Making IT Work

Welcome to the June edition of Health Care and Informatics Review Online which focuses on successful information system (IS) implementations in health care.

The two papers presented in this edition, provide evidence of successful implementations of electronic patient records in major health providers in New Zealand. However, each takes quite a different focus when evaluating the reasons for the success.

It is widely acknowledged that clinician participation and direction in the process of new clinical information system design and implementation is critical to ensure that a system is extensively adopted and accepted. Yet, engaging clinicians in the design, leadership and adoption of system change initiatives can be a significant challenge for most organisations.

In “Smiling All the Way”, Ray Delany, Management Consultant, Auckland, New Zealand, presents a case study of an electronic patient record implementation in a New Zealand public hospital. Clinician engagement was a strong focus in the project; the requirement for close involvement of a clinical user group in project development was recognised as so critical to the project’s success that the IS Manager was willing to abandon the project in the absence of effective clinician involvement and commitment.

Effective clinician involvement was achieved and the project progressed, its success evident in terms of cost efficiency, system quality and user acceptance. The highly effective process used to achieve clinician participation involved clinicians’ hands-on involvement in process execution from a very early stage, the devolvement of decision-making responsibility to this clinical user group, and genuine ongoing clinician involvement throughout the life of the project. This process used ensured strong ownership of the final system within the hospital’s clinical community.

The involvement of a clinical user group that was prepared and able to engage constructively with the IS team and the willingness of the IS team to respond to requirements of the clinical user group is regarded to be the single most important factor in the project’s success.

Other key factors contributing to the project’s success are discussed with a focus on the positive impact of strong IS governance in the process and extraordinary executive support that both supported the project and empowered the clinical user group.

In “Knowledge and learning in “successful” IT projects: A case study”, Martin Orr, Clinical Director of Information Services, Waitemata District Health Board, Auckland, New Zealand and Karen Day, Change and Communications Manager, healthAlliance Information Services, Auckland New Zealand, focus on the roles of reflective learning and innovation diffusion on successful implementation of a clinical information system.

Orr and Day consider the implementation of an EPR in a large New Zealand district health board. The paper presents an overview of related literature and then goes on to describe how knowledge and learning contributed to the IT implementation. The discussion is framed in six key domains of learning identified by the authors: Innovation, Innovators, Implementers, Individuals, “Invironment”, and Investors.

Orr and Day argue that breakthroughs in IT implementation result once there is development of appropriate capacity in each domain; it is easy to focus on development in one domain but there is a need for at least minimal capacity development across all domains in order to deliver effective change.

While the project has only recently finished, it has already been judged as successful in a number of dimensions, such as widespread clinician uptake and full implementation of the software suite has been achieved. However, it is acknowledged that there is a need to further review the project over time to evaluate its overall success.

Despite the very different focus taken in each of these papers in terms of success factors, it can be argued that both, albeit from different perspectives, support the fact that success in IT implementation is related to the management of human behaviour and resistance to change which is still widely regarded to be the largest obstacle to the successful implementation of information systems in health.

The engagement of clinicians via the clinical user group outlined in the Delany paper and the application of action research to ensure learning in all domains described in Orr and Day both serve as effective tools to help users to adapt to the complex changes that are required for system acceptance, improvement and adoption.