Adoption of New Technology Systems
One of the aspects of the role of a nurse facilitator is to prepare the team of nursing care providers for the adoption of a new electronic health records (EHR) system. It is expected that resistance from nurses can be faced in the process (Hyrkäs & Harvey, 2010), which is why a nurse facilitator should develop a strategy for adoption that will guide him or her in working with nurses. Such a strategy can be based on the theory designed by Rogers (2003) that states that there are five major concerns observed in individuals who are to adopt new technology: relative advantage, compatibility with existing values and practice, simplicity, trialability, and observable results. The general idea behind this theory is that practitioners are unlikely to adopt something new, albeit a technology, a policy, or a practice, unless they genuinely believe that the innovation will bring them remarkable benefits; however, to apply this theory to real-life situations, all five concerns listed above should be examined.
The concept of relative advantage refers to the perception that a new way of doing things will be better compared to the old way. The key notion in this perspective is a comparison, and it should be used in developing the strategy for preparing nurses for the adoption of a new EHR system. It should be recognized that the nurses with whom a nurse facilitator will work are used to a certain set of procedures related to recording patients’ health information; if they are offered to change them to a new system just because the proposed system is more advanced or because it has been adopted in other health care facilities, they (nurses) are unlikely to make substantial efforts to switch to the new system. In his or her communication with the nurses, the nurse facilitator should be specific and refer to those aspects of the current system that have been challenging or troubling for the nursing care team. To reveal those aspects, the facilitator can primarily conduct a study among nurses. In explaining what the new EHR system is and how it works, the facilitator should particularly stress the aspects identified in the study, i.e. it should be shown to the nurses how the new system will be more user-friendly, more convenient, or more efficient in doing those things that the old system addressed poorly.
The second aspect is compatibility, and the importance of this concern in building the nurse facilitating strategy will depend on how different the new EHR system is from the one used currently. It should be recognized that an EHR system requires certain procedures practiced by nursing care providers that are not part of the system itself, e.g. certain data collection methods. To collect data in a way that allows inputting it in the system conveniently, nurses need to commit to certain behaviors; their schedules, and planning of their work depending on the features of these procedures.
In case the new system will require collecting data (or doing any other things that are related to EHR but are not part of the electronic system itself) in a remarkably different way, the nurse facilitator should strive to preserve the existing procedures or modify them to the minimum possible extent to make the transition smoother. However, Rogers (2003) stresses that not only practices but also values incorporated in the new technology should be aligned with the current ones. This aspect should be addressed, too: if the facility is strongly committed to patient-centered care, the nurse facilitator should explain to the nurses how the new EHR system will promote this value. If the new technology complies with the existing values, the nursing care providers will be more likely to adopt new practices and procedures, too.
The third concern is simplicity, and it should be taken into consideration long before the adoption process, i.e. during the process of selecting the new EHR system. It is acknowledged that the more difficult a technology is, the greater the resistance to adopting it will be. In case the new system is considerably more user-friendly than the old one, it will facilitate the adoption process; however, if the new system is more complicated and contains many features and functions that can be confusing and overwhelming, it will be a challenge for the nurse facilitator. To overcome it, the facilitator should rely more on other concerns, e.g. relative advantage and compatibility. Even with the most complicated technologies, users appear to be more willing to adopt them and dedicate efforts to the adoption process in case they (users) clearly understand the benefits that the new technology will bring.
The fourth concern is trialability; what Rogers (2003) means by this is the technology’s capacity for being “experimented with on a limited basis” (p. 258), i.e. “played around” with. It is stressed that the adopter’s ability to try a new technology out in a particular training situation will help the adopter develop a liking for the system and assign certain meanings to it. Promoting the meaningfulness of change should be part of the nurse facilitator’s plan; for example, sessions can be scheduled during which nurses are not only lectured and explained how the new system works but also asked to try it for themselves. It is important to conduct these sessions in the early stages of the adoption process because high trialability promotes the adoption among early adopters to a greater extent than among later adopters.
Finally, there is the concern of observable results. Even if the new system is beneficial in comparison with the old one, compatible with the existing practices and values, simple, and provides opportunities for trying it out individually, the chances of a successful adoption are reduced if the results are not presented that the system is effective. For the nurse facilitator responsible for preparing nurses for the adoption of the new system, it is important to provide examples of how the system works and evidence of its benefits. For this, the facilitator should study the experience of other facilities that have adopted the same system and present findings to the adopters. In case the system is newly introduced to the market and has not earned success stories yet, the facilitator should simulate a set of clinical situations and show how the new system contributes to successful problem solving or makes the nurses’ work easier. The important aspect of this simulation is observability: the situations to which the facilitator will refer should be realistic and appeal to the nurses’ imagination, i.e. details should be provided. For example, instead of referring to abstract patients, the facilitator should include in his or her presentation detailed descriptions of patients so that the adopters vividly picture the described situation.
Upon reflecting on the five concerns and incorporating them in the adoption facilitation plan, the facilitator should turn to the concept of a nurse as a change agent. In this regard, it should be primarily recognized that EHR systems are not “simple automation of clinical documentation” (McGonigle & Mastrian, 2015, p. 249); instead, health records systems should be viewed as part of the “circulatory system” of a health care facility. Based on the way health records are collected, stored, and accessed, the work of nurses is planned, scheduled, and regulated (Bates, 2010). As it was explained above, EHR systems are connected to many processes that are not part of those systems per se but are aligned with them and designed according to them. Therefore, a new EHR system presents many possibilities for changing and improving processes and practices in a facility that are not directly linked to keeping health records.
However, this recognition of EHR systems as a change agency presents not only benefits described above but also challenges; Cresswell and Sheikh (2009) stress that the uncertainty of health records systems’ responsibilities leads to confusion as per the role of nurses. This confusion can be dispelled by assigning the role of change agents to nurses themselves and not to EHR systems whose adoption may lead to innovation in other spheres of health care provided in a facility. In the process of adoption, nurses themselves have opportunities to see what practices or policies in their facility need to be improved. To promote their role of change agents, the nurse facilitator should build an environment in which nurses are encouraged to provide feedback on the process of adoption and suggest improvements not only concerning the new EHR system but also concerning any other aspects of the facility’s operation that they feel are connected to keeping health records.
References
Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174–176.
Cresswell, K., & Sheikh, A. (2009). The NHS care record service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160.
Hyrkäs, K., & Harvey, K. (2010). Leading innovation and change. Journal of Nursing Management, 18(1), 1–3.
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Rogers, E. M. (2003) Diffusion of innovation (5th ed.). New York, NY: Free Press.