Leadership within business systems thinking ethical 10-18-12Dr. Oris Guillaume
Leadership is a process whereby an individual influences a group of individuals to achieve a common goal (Northouse, 2010). To be an ethical leader, then, is not a matter of following a few simple rules. The leader's responsibility is complex and multi-dimensional, rooted less in technical expertise than in simple human integrity. "To do this to the right person, to the right extent, at the right time, with the right motive, and in the right way, that is not for everyone nor is it easy; wherefore goodness is both rare and laudable and noble." (Aristotle, Ethics II.9). This study quantitative study observed a multiple workplace that leaders practice business systems thinking and face ethical dilemmas in today’s workplace. The finding from this study revealed that ethical issues were given little attention in applying business systems thinking.
Describe the family life cycle
Distinguish the shift from linear to circular thinking.
Describe the influence of Bateson
Describe the core concepts of systemic therapy: phase 1 & 2
Presented at the Health Informatics and Health Information Technology Course, Doctor of Philosophy and Master of Science Programs in Data Science for Health Care (International Program), Faculty of Medicine Ramathibodi Hospital, Mahidol University on October 12, 2017
Leadership within business systems thinking ethical 10-18-12Dr. Oris Guillaume
Leadership is a process whereby an individual influences a group of individuals to achieve a common goal (Northouse, 2010). To be an ethical leader, then, is not a matter of following a few simple rules. The leader's responsibility is complex and multi-dimensional, rooted less in technical expertise than in simple human integrity. "To do this to the right person, to the right extent, at the right time, with the right motive, and in the right way, that is not for everyone nor is it easy; wherefore goodness is both rare and laudable and noble." (Aristotle, Ethics II.9). This study quantitative study observed a multiple workplace that leaders practice business systems thinking and face ethical dilemmas in today’s workplace. The finding from this study revealed that ethical issues were given little attention in applying business systems thinking.
Describe the family life cycle
Distinguish the shift from linear to circular thinking.
Describe the influence of Bateson
Describe the core concepts of systemic therapy: phase 1 & 2
Presented at the Health Informatics and Health Information Technology Course, Doctor of Philosophy and Master of Science Programs in Data Science for Health Care (International Program), Faculty of Medicine Ramathibodi Hospital, Mahidol University on October 12, 2017
Information Technology Management in Healthcare Organizations: Part 2 (Octobe...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 20, 2021
Case Studies in Health IT Implementation & Sociotechnical Aspect of Health In...Nawanan Theera-Ampornpunt
Presented at the 7th Healthcare CIO Certificate Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on September 15, 2016
IT Governance & Management in Healthcare Organizations: Part 2 (October 16, 2...Nawanan Theera-Ampornpunt
Presented at the Data Science for Healthcare Graduate Programs, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 16, 2019
IT Governance & Management in Healthcare Organizations: Part 2 (October 19, 2...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 19, 2020
People & Organizational Issues in Health IT Implementation (February 24, 2021)Nawanan Theera-Ampornpunt
Presented at the 11th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 24, 2021
People & Organizational Issues in Health IT Implementation (February 26, 2020)Nawanan Theera-Ampornpunt
Presented at the 10th Healthcare CIO Certificate Program, Ramathibodi School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 19, 2020
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 13, 2018
Oragnization development OD (INTRODUCTION)shagun jain
Organization development is the study of successful organizational change and performance. OD emerged from human relations studies in the 1930s, during which psychologists realized that organizational structures and processes influence worker behavior and motivation.
DII - Mapping Organizational Readiness Assessments to an Implementation Frame...UCLA CTSI
November 1, 2017
Isomi Miake-Lye, PhD
VA Greater Los Angeles Healthcare System
“Unpacking Organizational Readiness for Change: Mapping Organizational Readiness Assessments to an Implementation Framework”
A presentation of the Southern California Regional Dissemination, Implementation and Improvement Science Webinar Series
Provided by the UCLA CTSI
Information Technology Management in Healthcare Organizations: Part 2 (Octobe...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 20, 2021
Case Studies in Health IT Implementation & Sociotechnical Aspect of Health In...Nawanan Theera-Ampornpunt
Presented at the 7th Healthcare CIO Certificate Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on September 15, 2016
IT Governance & Management in Healthcare Organizations: Part 2 (October 16, 2...Nawanan Theera-Ampornpunt
Presented at the Data Science for Healthcare Graduate Programs, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 16, 2019
IT Governance & Management in Healthcare Organizations: Part 2 (October 19, 2...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 19, 2020
People & Organizational Issues in Health IT Implementation (February 24, 2021)Nawanan Theera-Ampornpunt
Presented at the 11th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 24, 2021
People & Organizational Issues in Health IT Implementation (February 26, 2020)Nawanan Theera-Ampornpunt
Presented at the 10th Healthcare CIO Certificate Program, Ramathibodi School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 19, 2020
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 13, 2018
Oragnization development OD (INTRODUCTION)shagun jain
Organization development is the study of successful organizational change and performance. OD emerged from human relations studies in the 1930s, during which psychologists realized that organizational structures and processes influence worker behavior and motivation.
DII - Mapping Organizational Readiness Assessments to an Implementation Frame...UCLA CTSI
November 1, 2017
Isomi Miake-Lye, PhD
VA Greater Los Angeles Healthcare System
“Unpacking Organizational Readiness for Change: Mapping Organizational Readiness Assessments to an Implementation Framework”
A presentation of the Southern California Regional Dissemination, Implementation and Improvement Science Webinar Series
Provided by the UCLA CTSI
Presented at the BDMS Golden Jubilee Scientific Conference 2022 "BDMS Beyond 50 years: Looking towards the centennial," Bangkok Dusit Medical Services Public Company Limited (BDMS), Bangkok, Thailand on October 19, 2022
Presented at The Thai Medical Informatics Association Annual Conference and The National Conference on Medical Informatics (TMI-NCMedInfo) 2021, Bangkok, Thailand on November 26, 2021
Presented at the Master of Science Program in Medical Epidemiology and the Doctor of Philosophy Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 25, 2021
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 15, 2021
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
1. TMHG 526
CHANGE
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Faculty of Medicine Ramathibodi Hospital
Mahidol University
October 10, 2014
http://www.slideshare.net/Nawanan
2. Introduction
2003 M.D. (1st-Class Honors) Ramathibodi
2009 M.S. (Health Informatics) University of Minnesota
2011 Ph.D. (Health Informatics) University of Minnesota
Currently
Faculty of Medicine Ramathibodi Hospital
• Instructor, Department of Community Medicine
• Deputy Executive Director for Informatics (CIO/CMIO)
Chakri Naruebodindra Medical Institute
Contacts
nawanan.the@mahidol.ac.th
SlideShare.net/Nawanan
www.tc.umn.edu/~theer002
groups.google.com/group/ThaiHealthIT
3. Outline
• Change & IT
• Theories on Change
•Change Management
• Change Management & Sociotechnical
Issues in Informatics
• Bad Changes: Unintended Consequences
of Health IT
• Usability & Human Factors
• Case Studies
8. Class Exercise #1
Discuss with your neighbor:
• What changes does an
IT implementation bring about?
• What are the risks of those changes?
• What are the implications of those
changes for implementers?
9. Reasons for Change
•Fix existing problems
•Add more desirable features
•Process improvement
•Address a specific policy/strategy
•Business needs
•Keep up with new technologies
•Regulatory compliance
•Could be internal or external
15. Theories on Change
•First-order change
• “A variation in the way processes and
procedures have been done in a given
system, leaving the system itself relatively
unchanged.”
• E.g. creating new reports, new ways to
collect same data, refining existing
processes
Watzlawick, Weakland, & Fisch (1974), cited in Lorenzi & Riley (2000)
16. Theories on Change
• Second-order change
• The system itself is changed
• Usually a result of a strategic change or a
major crisis such as a threat against system
survival
• Involves redefinition or reconceptualization
of the organization’s business and how it’s
conducted
• E.g. changing from paper to electronic
medical records, automated teller machines
Watzlawick, Weakland, & Fisch (1974), cited in Lorenzi & Riley (2000)
17. Theories on Change
•Middle-order change
• “Represents a compromise; the
magnitude of change is greater than first-order
change, yet it neither affects the
critical success factors nor is strategic in
nature.”
Golembiewski, Billingsley, & Yeager (1976), cited in Lorenzi & Riley (2000)
18. Theories on Change
• Lewin’s Field Theory: 3 fundamental types of
conflict situations in a person (“force fields”)
• Standing midway between 2 positive goals of
approximately equal strength
• When there are 2 good systems to purchase
• Standing between 2 approximately equal negative
goals
• Make a choice of a system that will not completely
meet the needs
• Opposing positive and negative forces
• System users vs. IT people
Lorenzi & Riley (2000)
20. Change Resistance in the News
Washington Post (March 21, 2005)
“One of the most important lessons learned to date is that the complexity
of human change management may be easily underestimated”
Langberg ML (2003) in “Challenges to implementing CPOE: a case study of a work in progress at Cedars-Sinai”
21. Cost of Change in IT
• Time & effort to learn
• Sense of control / sense of belonging of
workers
• Sense of control of middle managers
(information systems increase ability of
executives to know what’s going on and have
more direct control)
• Loss of position, power, networks
“Power shift”
Lorenzi & Riley (2000)
22. “The changes we dread
most may contain our
salvation”
Barbara Kingsolver, in Small Wonder
24. Change Management
•“The process by which an organization
gets to its future state, its vision.”
•Starts with creating a vision for change
and empowering people as change
agents to achieve the vision.
•“Change management encompasses
the effective strategies and programs
to enable those change agents to
achieve the new vision.”
Lorenzi & Riley (2000)
25. Change Management Process
•Assessment
•Feedback and Options
•Strategy Development
•Implementation
•Reassessment
Lorenzi & Riley (2004)
26. Types of Change
• Operational changes
• Changes that affect the way the ongoing business
operations are conducted
• Strategic changes
• Changes in strategic business direction
• Cultural changes
• Affect basic organizational philosophies by which the
business is conducted (e.g. implementing CQI)
• Political changes
• Staffing changes, primarily for political reasons
Lorenzi & Riley (2000)
27. Types of Change
• Microchanges
• Differences in degree
• E.g., modifications, enhancements, improvements, &
upgrades of information systems
• Megachanges
• Differences in kind
• E.g., a new system or a very major revision
Lorenzi & Riley (2000)
29. • Administrative
Leadership Level
–CEO
Ash et al. (2003)
• Provides top
level support and
vision
• Holds steadfast
• Connects with
the staff
• Listens
• Champions
– CIO
• Selects champions
• Gains support
• Possesses vision
• Maintains a thick skin
– CMIO
• Interprets
• Possesses vision
• Maintains a thick skin
• Influences peers
• Supports the clinical
support staff
• Champions
The Special People
30. • Clinical Leadership
Level
–Champions
• Necessary
• Hold steadfast
• Influence peers
• Understand other
physicians
–Opinion leaders
Ash et al. (2003)
• Provide a balanced
view
• Influence peers
–Curmudgeons
• “Skeptic who is
usually quite vocal
in his or her disdain
of the system”
• Provide feedback
• Furnish leadership
–Clinical advisory
committees
• Solve problems
• Connect units
The Special People
31. • Bridger/Support level
–Trainers &
support team
• Necessary
• Provide help at the
elbow
• Make changes
• Provide training
• Test the systems
Ash et al. (2003)
–Skills
• Possess clinical
backgrounds
• Gain skills on the
job
• Show patience,
tenacity, and
assertiveness
The Special People
33. Sociotechnical Systems
• Coined in 1960s by Eric Trist, Ken Bamforth &
Fred Emery
• “An approach to complex organizational work
design that recognizes the interaction between
people and technology in workplaces.”
(Wikipedia)
• “Interaction between society's complex
infrastructures and human behaviour.”
(Wikipedia)
http://en.wikipedia.org/wiki/Sociotechnical_system
35. “People & Organizational Issues” (POI)
• POI focuses on interactions between people
and technology, including designing,
implementing, and deploying safe and usable
health information systems and technology.
• AMIA POIWG addresses issues such as
• How systems change us and our social and clinical
environments
• How we should change them
• What we need to do to take the fullest advantage of
them to improve [...] health and health care.
• Our members strive to understand,
evaluate, and improve human-computer
and socio-technical interactions.
http://www.amia.org/programs/working-groups/people-and-organizational-issues
36. “People & Organizational Issues” (POI)
•We bring varied perspectives, methods, and tools
from
• Humanities, Social science, Cognitive science
• Computer science and informatics
• Business disciplines
• Patient safety
• Workflow
• Collaborative work and decision-making
• Human-computer interaction & Usability
• Human factors
• Project and change management
• Adoption and diffusion of innovations
• Unintended consequences
• Policy.
http://www.amia.org/programs/working-groups/people-and-organizational-issues
38. Health IT Successes & Failures
What success is
• Different ideas and definitions of success
• Need more understanding of different stakeholder
views & more longitudinal and qualitative studies
of failure
What makes it so hard
• Communication, Workflow, & Quality
• Difficulties of communicating across different
groups makes it harder to identify requirements
and understand workflow
Kaplan & Harris-Salamone (2009)
39. Health IT Successes & Failures
What We Know—Lessons from Experience
• Provide incentives, remove disincentives
• Identify and mitigate risks
• Allow resources and time for training, exposure,
and learning to input data
• Learn from the past and from others
Kaplan & Harris-Salamone (2009)
40. Considerations for a successful CPOE
implementation
Ash et al. (2003)
Considerations
Motivation for implementation
CPOE vision, leadership, and personnel
Costs
Integration: Workflow, health care processes
Value to users/Decision support systems
Project management and staging of implementation
Technology
Training and Support 24 x 7
Learning/Evaluation/Improvement
41. Minimizing MD’s Change Resistance
• Involve physician champions
• Create a sense of ownership through
communications & involvement
• Understand their values
• Be attentive to climate in the organization
• Provide adequate training & support
Riley & Lorenzi (1995)
43. Reasons for User Involvement
• Better understanding of needs & requirements
• Leveraging user expertise about their tasks & how
organization functions
• Assess importance of specific features for
prioritization
• Users better understand project, develop realistic
expectations
• Venues for negotiation, conflict resolution
•Sense of ownership
• Pare & Sicotte (2006): Physician ownership
important for clinical information systems
Ives & Olson (1984)
44. The Missing Piece in IT Adoption
Theera-Ampornpunt (2011)
Technological Sophistication
Functional Sophistication
Integration Sophistication
Managerial Sophistication
Proposed Addition
45. Critical Success Factors in Health IT
Projects
Communications of plans & progresses
Physician & non-physician user involvement
Attention to workflow changes
Well-executed project management
Adequate user training
Organizational learning
Organizational innovativeness
Theera-Ampornpunt (2011)
46. Theory of Hospital Adoption of
Information Systems (THAIS)
Theera-Ampornpunt (2011)
47. Gartner Hype Cycle
Image source: Jeremy Kemp via http://en.wikipedia.org/wiki/Hype_cycle
http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp
51. Unintended Consequences of Health IT
• “Unanticipated and unwanted effect of health IT
implementation” (ucguide.org)
• Must-read resources
• www.ucguide.org
• Ash et al. (2004)
• Campbell et al. (2006)
• Koppel et al. (2005)
53. Unintended Consequences of Health IT
• Errors in the process of entering and retrieving information
• A human-computer interface that is not suitable for a highly
interruptive use context
• Causing cognitive overload by overemphasizing structured and
“complete” information entry or retrieval
• Structure
• Fragmentation
• Overcompleteness
Ash et al. (2004)
54. Unintended Consequences of Health IT
• Errors in the communication and coordination process
• Misrepresenting collective, interactive work as a linear, clearcut, and
predictable workflow
• Inflexibility
• Urgency
• Workarounds
• Transfers of patients
• Misrepresenting communication as information transfer
• Loss of communication
• Loss of feedback
• Decision support overload
• Catching errors
Ash et al. (2004)
55. Unintended Consequences of Health IT
• Errors in the communication and coordination process
• Misrepresenting collective, interactive work as a linear, clearcut, and
predictable workflow
• Inflexibility
• Urgency
• Workarounds
• Transfers of patients
• Misrepresenting communication as information transfer
• Loss of communication
• Loss of feedback
• Decision support overload
• Catching errors
Ash et al. (2004)
63. Human-Computer Interaction
• “A discipline concerned with the design, evaluation and
implementation of interactive computing systems for
human use”
evaluation implementation
• Interdisciplinary
design
– Computer Science; Psychology; Sociology; Anthropology; Visual
and Industrial Design; …
From University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen
64. Foundations of UI Design (1)
• Human psychology
• Short-term & long-term memory
• Problem-solving
• Attention
• Design principles
• Conceptual models; knowledge in the world; visibility; feedback;
64
mappings; constraints; affordances
From University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen
65. Foundations of UI Design (2)
• Understanding users and tasks
• Tasks, task analysis, scenarios
• Contextual inquiry
• Personas
• User-centered design
• Low, medium, and high-fidelity prototypes
• visual design principles
• Evaluating designs
• Without users: cognitive walkthroughs; heuristic
evaluation; action analysis
• With users: qualitative and quantitative methods
65
From University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen
66. Human Factors
• “The study of designing equipment and devices that fit the
human body and its cognitive abilities” (Wikipedia)
• Also known as “Ergonomics”
• Specialties
• Physical ergonomics
• Cognitive ergonomics (including HCI)
• Organizational ergonomics (including workplace design)
• Environmental ergonomics
http://en.wikipedia.org/wiki/Human_factors_and_ergonomics
67. Usability
• “Refers to how well users can learn and use a product to
achieve their goals and how satisfied they are with that
process” (Usability.gov)
• “The ease of use and learnability of a human-made object”
(Wikipedia)
• “The extent to which a product can be used by specified
users to achieve specified goals with effectiveness,
efficiency, and satisfaction in a specified context of use
(ISO)
• Key methodology: user-centered design
http://en.wikipedia.org/wiki/Usability
68. Usability & Usable Systems
• Usefulness = Usability + Utility (Jakob Nielsen)
• Dimensions of usability
• Learnability: How easy it is for users to accomplish basic
tasks the first time?
• Efficiency: Once learned, how quickly can users perform
tasks?
• Memorability: When returned after a period of non-use,
how easily can users re-establish proficiency?
• Errors: Frequency, severity, recoverability
• Satisfaction: How pleasant it is to use?
http://en.wikipedia.org/wiki/Usability http://www.useit.com/alertbox/20030825.html
69. User Experience
• “The way a person feels about using a product, system or
service” (Wikipedia)
• Focuses on the feelings and perceptions of users
• Subjective
http://en.wikipedia.org/wiki/User_experience
70. HCI & Usability Resources
• Usability.gov
• Useit.com
• Edwardtufte.com
• National Institute of Standards and Technology
(NIST)
• http://www.nist.gov/healthcare/usability/index.cf
m
• Technical Evaluation, Testing, and Validation of
the Usability of Electronic Health Records
• NIST Guide to the Processes Approach for
Improving the Usability of Electronic Health
Records
http://en.wikipedia.org/wiki/User_experience
71. Summary (1)
• All IT implementations are change
• Changes differ in nature, scale, and magnitude
• Change resistance is common and natural
• Overcoming change resistance requires a good
change management strategy
• Pay attention to the “POI” or sociotechnical aspect
• Balance between People, Process, & Technology
72. Summary (2)
• Shared vision & commitment, user engagement,
communication, workflow considerations, &
training are key
• Understand the Adoption Curve
• Health IT can have unintended consequences:
bad changes, requiring change management &
project evaluation
• Attention to usability & human factors will help
manage changes
74. Case Studies on Change Management
Leviss (Editor)
(2010)
Leviss (Editor)
(2013)
75. References
• Ash JS, Berg M, Coiera E. Some unintended consequences of information
technology in health care: the nature of patient care information system-related
errors. J Am Med Inform Assoc. 2004 Mar-Apr;11(2):104-12.
• Ash JS, Stavri PZ, Dykstra R, Fournier L. Implementing computerized
physician order entry: the importance of special people. Int J Med Inform. 2003
Mar; 69(2-3):235-50.
• Ash JS, Stavri PZ, Kuperman GJ. A consensus statement on considerations for
a successful CPOE implementation. J Am Med Inform Assoc. 2003 May-
Jun;10(3):229-34.
• Campbell, EM, Sittig DF, Ash JS, et al. Types of Unintended Consequences
Related to Computerized Provider Order Entry. J Am Med Inform Assoc. 2006
Sep-Oct; 13(5): 547-556.
• Ives B, Olson MH. User involvement and MIS success: a review of research.
Manage Sci. 1984 May;30(5):586-603.
• Kaplan B, Harris-Salamone KD. Health IT success and failure:
recommendations from the literature and an AMIA workshop. J Am Med Inform
Assoc. 2009 May-Jun;16(3):291-9.
76. References
• Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, Strom BL.
Role of computerized physician order entry systems in facilitating medication
errors. JAMA. 2005 Mar 9;293(10):1197-203.
• Lorenzi NM, Riley RT. Managing change: an overview. J Am Med Inform Assoc.
2000 Mar-Apr;7(2):116-24.
• Paré G, Sicotte C, Jacques H. The effects of creating psychological ownership
on physicians’ acceptance of clinical information systems. J Am Med Inform
Assoc. 2006 Mar-Apr;13(2):197-205.
• Riley RT, Lorenzi NM. Gaining physician acceptance of information technology
systems. Med Interface. 1995 Nov;8(11):78-80, 82-3.
• Theera-Ampornpunt N. Thai hospitals' adoption of information technology: a
theory development and nationwide survey [dissertation]. Minneapolis (MN):
University of Minnesota; 2011 Dec. 376 p.