Two years of unintended consequences: introducing an electronic health record system in a hospice in Scotland

Snowden, Austyn; Kolb, Hildegard

Abstract

Aims and objectives
The aim of the study was to explore the impact of implementing an electronic health record system on staff at a Scottish hospice.
Background
Electronic health records are broadly considered preferable to paper based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice.
Design
Naturalistic prospective repeated measures mixed methods approach.
Method
Data on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, qualitative from Concurrent Analysis of free text comments and focus group. Participants were all 150 employees of a single hospice in Scotland.
Results
Both system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges:
1.Technical issues, with subthemes of accessibility and usability.
2.Cultural issues, with sub themes of time, teamwork, care provision and perception of change.
Conclusion
It took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless this process of change was found to be consistent with the ‘J curve’ theory of organizational change, and as such is both predictable and manageable for other organizations.
Relevance to practice
It is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity (‘J’ curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically.

Citation

Snowden, A., & Kolb, H. (2017). Two years of unintended consequences: introducing an electronic health record system in a hospice in Scotland. Journal of Clinical Nursing, 26(9-10), 1414-1427. https://doi.org/10.1111/jocn.13576

• Journal Article Type: Article
• Acceptance Date: Aug 24, 2016
• Online Publication Date: Sep 7, 2016
• Publication Date: 2017-05
• Deposit Date: Sep 12, 2016
• Publicly Available Date: Oct 27, 2017
• Journal: Journal of Clinical Nursing
• Print ISSN: 0962-1067
• Electronic ISSN: 1365-2702
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 26
• Issue: 9-10
• Pages: 1414-1427
• DOI: https://doi.org/10.1111/jocn.13576
• Keywords: Caring; Computerised; Health Services Research; Implementation; Nursing Information Systems; Nursing Workforce; Organisational Behaviour; Palliative Care; Technology
• Public URL: http://researchrepository.napier.ac.uk/Output/378676
• Contract Date: Oct 27, 2017