Abstract
Organizational readiness for change is a key factor in success or failure of electronic health record (EHR) system implementations. Readiness is a multifaceted and multilevel abstract construct encompassing individual and organizational aspects, which makes it difficult to assess. Available tools for assessing readiness need to be tested in different contexts. To identify and assess relevant variables that determine readiness to implement an EHR in oncology in a low-and-middle income setting. At the Uganda Cancer Institute (UCI), a 100-bed tertiary oncology center in Uganda,we conducted a cross-sectional survey using the Paré model. This model has 39 indicator variables (Likert-scale items) for measuring 9 latent variables that contribute to readiness. We analyzed data using partial least squares structural equation modeling (PLS-SEM). In addition, we collected comments that we analyzed by qualitative content analysis and sentiment analysis as a way of triangulating the Likert-scale survey responses. One hundred and forty-six clinical and non-clinical staff completed the survey, and 116 responses were included in the model. The measurement model showed good indicator reliability, discriminant validity, and internal consistency. Path coefficients for 6 of the 9 latent variables (i.e. vision clarity, change appropriateness, change efficacy, presence of an effective champion, organizational flexibility, and collective self-efficacy) were statistically significant at p < 0.05. The R2 for the outcome variable (organizational readiness) was 0.67. The sentiments were generally positive and correlated well with the survey scores (Pearson's r = 0.73). Perceived benefits of an EHR included improved quality, security and accessibility of clinical data, improved care coordination, reduction of errors, and time and cost saving. Recommended considerations for successful implementation include sensitization, training, resolution of organizational conflicts and computer infrastructure. Change management during EHR implementation in oncology in low- and middle- income setting should focus on attributes of the change and the change targets, including vision clarity, change appropriateness, change efficacy, presence of an effective champion, organizational flexibility, and collective self-efficacy. Particularly, issues of training, computer skills of staff, computer infrastructure, sensitization and strategic implementation need consideration.
Highlights
Change management during Electronic health record (EHR) implementation in oncology in low- and middle- income setting should focus on attributes of the change and the change targets, including vision clarity, change appropriateness, change efficacy, presence of an effective champion, organizational flexibility, and collective self-efficacy
Holt et al [14]discuss four facets of readiness covering (i) the change process, i.e. the steps and strategies followed during implementation of the change, e.g., extent of stakeholder involvement, (ii) the content of the change, i.e. the particular initiative being implemented such as the EHR system and its characteristics, (iii) the context of the organization including the conditions and environment under which staff work, e.g., dynamic, learning organizational culture, financial and human resource capacity, and (iv) individual attributes of the staff or those affected by the change, e.g., their skills, biases and prejudices
Only 6 of the theorized 9 latent variables are supported by our findings as significantly contributing to measurement of organizational readiness based on p-values
Summary
EHR implementation is a complex and challenging organizational change which is often resisted with planned or actual boycotts, and workarounds by medical staff to state-ofthe-art systems [3,4]. failures are not commonly reported in literature [3], it is estimated that 50–75% of implementations of EHRs and other health information technologies fail–i.e. they overrun budgets or implementation time, do not provide end user satisfaction, or are completely abandoned [3,4,5,6,7].Implementation of EHRs is difficult because it is not merely a technological change, but rather a socio-technical change process that affect many aspects of the organization [8,9,10]. Available tools for assessing readiness need to be tested in different contexts
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