Guest Editorial

The best laid schemes o’ mice and men
Gang aft a-gley;
And leave us naught but grief and pain
For promised joy.

by Robert Burns, "To a Mouse".

The "Critical Success Factor" concept was first introduced in a Harvard Business Review article entitled: "Chief Executives Define Their Own Data Needs". In this edition of HCIRO, two papers illustrate the implementation of clinical information systems in New Zealand and analyse the emergent critical success factors. Both papers highlight the importance of recognising the human factors that are at play when implementing a technology project. The involvement of the users of the system cannot be over-emphasised. Apart from the valued input, this ensures early, useful buy-in and ownership of the final product.

Orr and Day look at the role of learning in innovation diffusion within this setting. For the uninitiated, a great deal of innovation research has been based on the foundations laid by Rogers in 1995¹,  who defined diffusion of innovation as the process by which innovation is communicated through certain channels over time among the members of a social system. The successful adoption of new technology implies the successful diffusion of innovation by people within an organisation.²  Rogers (2001) suggests a five-stage model for the process of adoption consisting of a series of actions and decisions as illustrated in Figure 1.³

Figure 1: Five-stage model for the process of new technology adoption

Orr and Day weave an erudite discussion of knowledge and learning that is associated with innovation diffusion into a case history of health information technology (IT) implementation in New Zealand.

Delany provides excellent insights from another local implementation. The importance of leadership with the ability to corral a capable and experienced project team is clearly articulated. A real critical success factor of any implementation project is the ability to break through “fixed ideas.” Delany describes the coming together of the informaticians and clinicians, facilitated through sound leadership and a strong sense of community prevalent in the hospital, as probably having been the most significant single factor in the success of the project. Hauschildt⁴  has identified seven key sets of talents and abilities that must be present on the project leadership team to ensure success. The ability to organise in a situation in which there is some conflict and/or criticism and, experiential knowledge of the appropriate procedures, as found by Delany, are featured high on this list.

Both papers make excellent arguments for continued research into innovation diffusion and its contribution to successful implementation of health IT. Although embodied within innovation diffusion, the concept of a “marketing factor” or “socialisation” should not be forgotten on its own merit (in addition to the human and technology factors). Care must be given in the marketing process not only to promote the project but also to avoid raising expectations to unrealistic heights. If something is promised, it needs to be delivered; otherwise, the credibility of the project and its ultimate product may be jeopardised

References

1.  Rogers EM. Diffusion of Innovations, 4th Edition. 1995. New York: The Free Press; 1995. ISBN 0-02-926671
2.  Baskerville R, Pries-Heje J. A multiple-theory analysis of a diffusion of information technology case. Info Systems Journal 2001; 11:181-212.
3.  Rogers 2001
4.  Hauschildt J. Project Management Journal, September, 2000.