The behavioral side of information technology
Introduction
Information technology (IT) is becoming more prevalent in healthcare, with healthcare workers and organizations being exposed to many new technologies. Many of these technologies are implemented and adopted to varying extents. To this end, various implementation strategies have been used. None of these strategies guarantees successful adoption. Even if adopted, expected changes may not occur.
IT can be approached as a change tool. Implementers frequently assume that change will occur with the introduction of IT. However, inertia is powerful and can lead to a path of least resistance and a minimum of change being realized. Implementation needs to be planned to overcome resistance and allow the desired change to occur.
IT is an enabler of technology. It enables, but doesn’t require, both task and process changes. In some instances, task and process change is required to precede the IT. The changes can be viewed from the organizational position or the individual position. In this paper, individual change will be the focus. The goal of this paper is to examine some of the theories behind implementation from the individual’s viewpoint. It will also attempt to identify methods to evaluate implementation strategies and identify potential process and outcome measures. It is hoped that by better evaluating the implementation process, it will be easier to guide the changes enabled by IT.
Section snippets
Implementation and evaluation
Implementation and evaluation are intertwined at all stages. Fig. 1 illustrates the design – implementation – evaluation triangle. This demonstrates the chicken and egg connection between the processes of the innovation’s design, its implementation and evaluation. Good design involves end-user, system, and organizational evaluations and incorporates those into the design and implementation strategies. Likewise the other arms of the triangle also interact.
To complicate matters, IT changes often
Implementation
To be successful, implementation of an innovation requires attention to many people and organizational issues. In health care, change is becoming common. Change can be overwhelming, and if not well managed, can lead to undesirable outcomes [1].
There is a history of research on IT use in the management information systems research. The primary theories are Rogers’ innovation diffusion theory [2] and Davis’ [3] technology acceptance model (TAM). The TAM is related to the theories of reasoned
Perceived usefulness
Perceived usefulness appears to be a powerful influence in individual adoption behaviours. The construct includes four items that will be briefly described. These elements are relative advantage, compatibility, subjective norms, perceived behavioral control, and feedback.
Relative advantage describes how the innovation is seen compared to that which is currently used. This includes items such as cost effectiveness, price, outcomes, side effects, job performance, productivity, quality, and
Perceived ease of use
Usability describes the ability to effect change by adopting an innovation. Such things as confidence that adopting the innovation will cause the desired change, and the adopters self-efficacy are included. Support is used to describe the support available during the implementation process.
Perceived behavioral control, also described as complexity, is a perception of how difficult the innovation is to adopt or use. The construct includes items such as understandable use, logistical concerns,
Implementation and evaluation strategies
A large number of strategies have been employed to enhance individual behaviour changes and adoption. During the implementation, the individual can be affected directly, the individual’s group can be affected, or the organization as a whole can be affected. For each construct described by the ITAM model, and implementation intervention can be developed. Similarly, each construct can be evaluated to either assist in the development of the implementation intervention or assess the effects of the
End user fit
Typically, when described in the literature, IT requirements and user capabilities are described in light of an implementation failure. When assessing requirements, one can assess the technical components, such as computer availability, computer access, offsite access and general IT knowledge. One can also assess the knowledge and skills required to interact with the technology, both physical (such as keyboarding, interface familiarity), and information related (such as operating the
Perceived usefulness
This is an important component of the implementation process, and typically does not get much evaluation. Implementation elements are common within this area. There have been some scales developed to assess various elements of this construct [3], [9]. Further development of these scales may provide richer information to assist the implementation process.
Relative advantage is typically highlighted, with various capabilities of the innovation highlighted. Unfortunately, this can build
Perceived ease of use
Many of the items affecting this area relate directly to end user fit issues or training and knowledge. If individuals do not have required skills or knowledge, they are less likely to adopt an IT innovation. Again, scales have been developed to measure this construct [3], [7], [9] although further development is required for healthcare applications.
Work flows are often changed with the implementation of IT. Assessment of these flows may allow the implementation team to address changes and
Adoption
Evaluating the adoption of IT innovations by individuals is difficult in many systems. Adoption is defined here as any usage of the innovation. An individual may adopt only a subset of available features of the innovation, or may delegate interaction to others. Accurate assessment of adoption and reasons for not adopting the innovation is vital to allow retraining, technical upgrades, system redesign, or other remedial intervention.
When assessing adoption, one can assess either process changes
Summary
The ITAM model is designed to provide a structure for designing and evaluating strategies for IT implementation. There are many questions raised by the model that have not been addressed here.
Areas for specific IT measures need to be identified and the actual measures developed. Measures for expected change need to be developed. Methods to identify and measure unexpected change are also needed. It would be beneficial to develop a system to differentiate between changes enabling IT and changes
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