Critical Analysis of Sue Whetton and Andrew Georgiou’s 2010 article ‘Conceptual Challenges for Advancing the Socio-Technical Underpinnings of Health Informatics.
Whetton S. Conceptual challenges for advancing the socio-technical underpinnings of health informatics. Open Med Inform J. 2010;4:222-4.
About the document:
I have structured the essay into four parts:
Abstract: I have explained the topic in brief here and presented the aim of the topic and summarised the key findings of the author.
Introduction: I have summarised in brief about the author’s intentions/purpose and also the ideas and perspective contained in the article.
Critique: Here I have expressed in detail my views and evaluation of the article along with examples. This section also contains my analysis of the strengths and weakness of the views expressed in the article.
Conclusion: I have restated the overall opinion along with my evaluation of the article.
his discussion paper of Sue Whetton and Andrew Georgiou considers the influence of sociotechnical perspectives, research and practice within the Health Informatics discipline. The main purpose of the authors throughout this discussion is to argue that instead of a solid theoretical base from which to describe study and understand human and information technology interactions we continue to have fragmented and limited knowledge about the sociotechnical aspects and its applications within the Health Informatics discipline. This has in turn led to more focus on the technical system performance neglecting the social or cultural aspect of the organisation. Finally the paper analyses that the focus of socio-technical perspectives in Health informatics still remains at the level of the immediate environment.
To begin with the authors reflect upon the values and principles of the pioneers of Tavistock who designed and developed the approach and methodology called ‘Socio-technical’. The authors convey more conflicting set of values of sociotechnical aspect by Land, 2000 and Morris. The first is a belief in the importance of humanistic principles. The second set reflects it as instruments for achieving primarily economic objectives. These conflicts have led to suspicion of sociotechnical ideas by managers and employees, which suggest that much more research needs to be done to understand sociotechnical principles with an understanding of human factors which persist in a multidisciplinary field such as that of Health Informatics.
The authors argue that poor uptake or adoption of Information management system into a healthcare system and its performance in a complex healthcare setting emphasized the need to understand the complex cultural and organisational aspect of a Healthcare environment. According to the authors there are various topic also addressed in literature about focus on work practices, teamwork issues, user attitudes and perceptions, user satisfaction and usability and of utilising the sociotechnical aspect in work culture however there still remains on technology system and that the sociotechnical analysis is being used to minimise resistance arising due to technology changes. This techno centric attitude has led to changing in clinical workflows and managing staff resistance as reported in literature.
The discussion paper finally concludes on the note to broaden the scope of sociotechnical aspect in Health informatics. This is because any impact in the immediate local healthcare environment could affect the outer environment of healthcare consisting of healthcare regulatory bodies and other funding bodies and thus could affect the broader economic, political and cultural system.
CRITIQUE (MY EVALUATION OF THE ARTICLE)
Throughout the discussion paper the authors have very strongly recommended for the consideration of Sociotechnical perspectives in Health informatics with an urge to broaden its focus beyond the immediate environment. The paper highlights the different views which the health community holds on sociotechnical aspects in Health. The urge for discussions to question the principles and values with respect to the application of sociotechnical perspectives in Health informatics is strongly recommended in order to exploit the potential of this belief for efficient adoption of Health information systems. The discussion strongly conveys the absence of a solid theoretical base of the sociotechnical beliefs have resulted in limited or fragmented knowledge about this concept which has in turn resulted in mere focus on technical aspects of a system performance rather than the focus on social aspects and the interaction between both social and technical.
I would highlight the following points below as strengths of this discussion paper:
- The need to consider the influence of sociotechnical perspective research and practice in Health informatics;
- The absence of discussions on this aspect has resulted in mere focus on technical aspect and the application of sociotechnical perspective in health informatics remains still limited and rarely articulated;
- The urge to have discussions and debate on the sociotechnical principles and beliefs to exploit its potential use broaden its focus even beyond its immediate environment in healthcare; and
- The authors Sue Whetton and Andrew Georgiou have indicated that multidisciplinary inputs generate an in-depth understanding of sociotechnical aspects and help in identify solutions for the ever challenging issues surrounding the adoption of information systems in a healthcare setting. Though the authors have managed to indicate the benefits of sociotechnical perspectives in health informatics, in my opinion there could have been a solid base to justify the purpose behind the reason to adopt the sociotechnical perspective.
Perhaps the discussion paper could have been supported with the following points discussed below which also indicated my analysis and views on the paper:
- Illustrations on scenarios of Health Information system implementation failure on account of not adopting the sociotechnical principle while designing or implementing the system;
- Probably the paper could have described benefits of sociotechnical perspective to ease the adoption of health information systems in any healthcare setting;
- Illustrations of couple of current research or work in sociotechnical perspective in the Healthcare environment and brief information on the steps probably helpful to adopt the sociotechnical approach; and
- Benefits of using the sociotechnical approach at a broader level with respect to employment opportunities.
Why has Implementation of Electronic Implementation Systems Failed?
The implementation and thereby adoption of Electronic Information systems has been considered very complex process. The reasons being several which range from technical to software incompatibility to cost and people. However to I would invite the readers to spend some time on reflecting upon one such reason involving human interaction while implementing electronic information systems and that is the sociotechnical aspect.
Let us consider the example where the Organisational culture and behaviour had a major impact in the introduction of Physician Order Entry at a Major Academic Centre. In 1998 the University of Virginia Medical Centre began implementation of medical information systems based on mandatory Physician order entry. However the implementation process delayed and the cost seem to rise more than expected, however these were considered to be minor pitfalls than those which arose from cultural and behavioural issues.
Later on detailed analysis four factors were found to be contributing towards this implementation stress at the organisational level:
- The alteration of established workflow patterns and practices;
- The inability of the computer system to define the whole purpose of aim;
- The ambiguity of governance policies; and
- Lack of clear understanding within the Physician community.
The major lesson learnt by all the stakeholders in this process was that technology fixes alone cannot solve implementation problems; however it required a broader outlook. The communication between all the stakeholders involving the study to understand the current workflow and in turn exchange views on the benefits of having a medical information system in place could have solved the problem. .
The following case study highlights the failure of an Integrate Children’s System in England. The implementation of which led to high profiles of child deaths. The reason being that users were not involved during the system design and the organisation workflow was not considered at the time of design and development of the system. The views of senior management was not considered as well to understand the work practices and the organisation culture which led to development of a system not purposeful and neither aligned towards the work practice of the hospital .
Success Scenario of EMR Design Using The Sociotechnical Approach And Benefits
This is a case study of designing an EMR system particularly for the emergency department of a large urban hospital in Chicago. In her discussion paper Julia Hanes chooses a variety of frameworks to analyse the medical information system at the emergency department of the hospital. These frameworks include the Action theory, Distributed cognition, situated action, structuration theory, boundary objects, articulation work, genre repertory, remediation and multitasking . In this case Julia Hanes tries to address the readers about the framework chosen and how they span across a broad landscape of sociotechnical perspectives and together form a mosaic to view the various and overlapping ways a system an account for social and organisational practice. She concludes that such an approach of sociotechnical thinking could help in designing an efficient medical information system beneficial to the professionals to help deliver quality care to the patient. This hospital is now in the implementation process of this new system in its emergency department and developers form everywhere are vying for large contracts within the hospital.
In a Manifesto for sociotechnical approach to NHS and social care IT-enabled business change, the importance of sociotechnical thinking is highlighted .According to the Manifesto involving all stakeholders of the IT enabled project including those from senior management to the common staff could help to bring about constructive ideas. This joined-up sociotechnical approach would help in successful implementation of electronic information systems in a healthcare
The Manifesto summarises the example of an IT enabled project of that of a Clinical Portal to support the Victorian hospitals in 2009 which was a success the main reason being the user (staff from all disciplines) involvement right from system design to its implementation .
As a sociotechnical system approach requires involvement of people from the organisation to discuss technology and get their inputs develop better system, it has led to Job enrichment. This job enrichment is giving the employees of the organisation a higher and wider level of responsibility with a decision making authority by including them to get their inputs during system design. This is indeed one of the biggest benefits of adopting a sociotechnical approach which could be a source solve unemployment issues .
Current Research work
As understood from the above scenarios, the implementation of any IT project within the Healthcare domain is not a cake walk but involves lot of complexity. This complexity arises due to the fact that Health Informatics in itself is a special case which involves users from all disciplines. All the users of different disciplines have different perspectives towards their job and that any one IT solution easy to one member may be viewed as a complex system to work with for the other. In order to address these issues with respect to implementation of electronic information systems within the healthcare arena it is vital to design health information systems with a sociotechnical approach. The Centre for Health Informatics and Computing [CHIC] is in the process of developing sociotechnical approaches for addressing issues within the healthcare that mandate the integration of information systems with clinical and managerial development . In this research the centre has come up with three approaches the Soft Information Systems and Technologies methodology, Participative Simulation Modelling and Stakeholder Analysis. This research on integrated Sociotechnical approach argues that as a ‘Nature of healthcare, any health informatics intervention, if has to be effective, needs to be based on the integrated sociotechnical approach. ’
Hence it is evident that Health information system implementation failures arise as a result of due to lack of communication, incorrect goal perception and lack of awareness of the complexity of the project with unsatisfactory management control.
In order to tackle this problem perhaps the critical success factors such as these could be adopted towards developing a sociotechnical approach :
- To select a leadership team within the healthcare organisation planning to implement an IT enabled project. These members could consist of administrative staff, clinicians and other people who serve important role within the organisation. Multidisciplinary inputs from all these members could add value to the system design and help address cultural challenges in system design;
- To initiate communication with all the stakeholders to understand their roles and perspective job roles to help design efficient and user friendly systems suiting individual needs;
- To identify the correct goal by analysing the existing workflow of the healthcare setting with concurrent discussions with stakeholders to get a bigger picture and thus ease the deleveopment of system design; and
- To discuss probable workflow changes that would be necessary to adopt as a part of the implementation aligned with the existing workflow.
The urge to have a strong research base to support the theory and practice of sociotechnical approaches in Health informatics is acknowledged. It also accepted that lack of a theoretical base about sociotechnical approaches and their application in Health informatics has resulted in fragment and unelaborated knowledge about the aspect and its application. The result has led to more focus on technical performance of the system. The need to debate and discuss sociotechnical perspective in healthcare arena is vital to fully explore its potential and broaden the focus in the complex environments of contemporary healthcare. The failure and success scenarios of health information systems also suggest the need to adopt an integrated sociotechnical approach in healthcare. The probable way of achieving this goal towards this could be to embark an initial step towards involving all the stakeholders of an organisation during system design. This could probably help to understand the workflow and help to develop better health information systems. The job enrichment benefits of adopting sociotechnical approach while system design cannot be ruled out. In my evaluation one needs to understand that the net outcome of any healthcare system design depends between the interaction of people and technology it is important to design systems based on socio-technical perspectives to help identify the issues and overcome health information system design challenges . Focus on one element without attention to the other would be detrimental to the organisational values and would not help to build an efficient healthcare information management system. Apart from an understanding on why information systems fail, Sociotechnical approach can help to demonstrate how to find synergy between health care work and
technology . Their application to designing the health information systems could help to restructure the traditional ways of practicing primary care and thus promote quality healthcare. Now the dilemma is that by allowing technology to restructure our traditional ways of healthcare practice, are we still encouraging a techno centric focus?
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