Question

A good friend of yours is director of patient services at a 220bed community hospital. Last year the hospital merged with a much larger medical center. One of the upsides, as well as one of the challenges, is the rapid introduction of new health information systems. The goal is to bring the hospital "up to speed" within 3 years. At present, CPOE is being implemented. The general medical and surgical units went live last month. The intensive care unit and pediatrics and obstetrics units are scheduled to go-live next month. The plan is to work out any kinks or problems on the general units and then gulive in the specialty units. Most of the physicians, nurse practitioners, and physician assistants initially complained but are now becoming more comfortable with the computers and are beginning to integrate the CPOE process into their daily routines. Several physicians are now requesting the ability to enter orders from their offices, and others are looking into this option. However, three physicians have not commented during this process but are clearly resisting. For example, after performing rounds and returning to their offices, they called the unit with verbal orders. After being counseled on this behavior, they began to write the orders on scraps of paper and put these in the patient's charts or leave them at the nurses' station. When they were informed that these were not "legal orders," they began smuggling in order sheets from the nonactivated units. In addition, they have been coercing the staff nurses on the units to enter the orders for them. This has taken two forms. Sometimes they sign in and then ask the nurses to enter the orders. Other times they ask the nurses to put the orders in verbally and then they confirm the orders. The nurses feel caught between the hospital's goals and the need to maintain a good working relationship with these physicians.

Discussion Questions
1. How would you use the theories presented in this chapter to diagnosis the problems demonstrated in this case. List your diagnoses and explain your analysis.
2. What actions would you recommend to your friend and what reason (theories) would you use as a basis for your recommendations?

Answer 1

The resistance encountered during the CPOE implementation at a community hospital can be analyzed using organizational change theories, focusing on open communication, understanding individual concerns, creating a supportive environment, and enforcing compliance.

Step-by-step explanation:

The issues faced at the 220bed community hospital undergoing rapid health information systems integration, specifically the implementation of CPOE, can be understood through the lens of organizational change theory. Resistance to change by healthcare professionals, such as the three physicians resorting to non-compliant methods to enter orders, underscores a complex dynamic between adherence to protocols and individual adaptability. This resistance can be both a cognitive and emotional response to the changes being imposed. Theories such as Lewin's Change Management Model, which includes unfreezing, change, and refreezing stages, and Kotter's 8-Step Change Model that emphasizes the importance of communication, building support, and removing obstacles, could help diagnose and address the problems.

To address these challenges, it is important to:

1. Ensure open communication and education about the benefits and the necessity of the new systems to the hospital staff.
2. Engage the resisting physicians directly and understand their concerns and barriers to adopting the new system.
3. Create a supportive environment where staff can gain confidence and proficiency with the new systems.
4. Consider the establishment of consequences for continued non-compliance.

By understanding and addressing the root causes of resistance to change, leaders can facilitate a smoother transition and better integration of the new health information systems.