Paper
Friday, July 13, 2007
Creating a Healthcare Culture of Patient Safety: A Retrospective Analysis of Change Readiness Associated with the Implementation of Computerized Provider Order Entry
Bonnie S. Dean, PhD, RN, Nursing Administration, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
Learning Objective #1: Understand the human change dynamics associated with the implementation of Computerized Provider Order Entry (CPOE) in a healthcare setting. |
Learning Objective #2: Idntify where nurses are positioned in the readiness realm compared to physicians and other ancillary healthcare professionals following the implementation of CPOE. |
President George W. Bush has called for a strong commitment to computerization as a means of reducing the 98,000 avoidable deaths a year that the report presented by the Institute of Medicine (2000) has said might be caused by mistakes of doctors, nurses, and other clinical hospital personnel (Freudenheim, 2004). The President’s Information Technology Advisory Committee released a report entitled, “Revolutionizing Health Care Through Information Technology,” in June 2004 and lists computerized provider order entry as one of the four essential elements of the framework for a 21st century healthcare information infrastructure (PITAC, 2004). CPOE has been reported to significantly improve the levels of safety, quality, and efficiency within healthcare organizations (Chinn, 1999), by diminishing errors resulting from illegible handwriting, inappropriate drug use, drug dosing, and drug interactions (Sengstack & Gugerty, 2004). However, a predominant hurdle in any organization, including healthcare, is to overcome the tradition of resistance to technology by affected stakeholders that include: physicians, nurses, pharmacists, and other healthcare professionals. A recent survey of healthcare chief information officers revealed that more than 80 percent believed that information technology projects failed due to “organizational resistance to change” (HIMSS, 2003). Technology introduction requires not only a great deal of financial capital, it requires human change. Preparing for such a profound change requires that multiple issues be successfully managed, including organizational support, clear and constant communication, sensitivity to the impact on work processes, collaboration across disciplines, and effective just-in-time training.This study examined whether there was a significant increase in the change readiness of professional stakeholders following CPOE introduction in a large urban pediatric healthcare setting and where nurses are positioned in this readiness realm compared to physicians and other professional stakeholders.