Portal de Periódicos da CAPES

Darbyshire P (2004) ‘Rage against the machine?’: nurses’ and midwives’ experiences of using computerized patient information systems for clinical information.Journal of Clinical Nursing13, 17-25

2006; Wiley; Volume: 15; Issue: 2 Linguagem: Inglês

10.1111/j.1365-2702.2006.01180.x

1365-2702

Tonya L DeZarn,

Primary Care and Health Outcomes

This is a response to ‘‘‘Rage against the machine?’’: nurses’ and midwives’ experiences of using computerized patient information systems for clinical information’ (Darbyshire 2004), a study published in this journal. The study determined nurses and midwives’ perceptions and experiences using a computerized patient information system (CPIS). The consensus of the nurses was that the CPIS was cumbersome, did not reflect their practice, data entry was a manager's responsibility and did not yield or retrieve useful data to measure outcomes. It occurred to me while reading this study that these nurses were exhibiting a great deal of resistance to using the new system and that, perhaps, effective change management was not in place to facilitate the introduction and implementation of this new system. Lorenzi and Riley (2000) offer many reasons for the failure of an information system. For a system implementation to be successful, there must be effective change management. Based on the work of Lorenzi and Riley, I would like to discuss three of their reasons that I consider the foundation for effective change management: communication, organizational aspects, and leadership. Change management is the responsibility of all parties affected by the new system. Communication must be ingoing and outgoing. For the staff, it includes communicating problems with the system, offering suggestions for improvement and communicating exactly what is desired of the system (i.e. record keeping, charting, data analysis, outcomes measurement, etc.). Change managers also have a responsibility to listen to identified problems, provide positive feedback regarding suggestions and address or implement suggestions made by the staff. Without active communication, staff may not be prepared for the new system. Organizational aspects are the second layer of the foundation. Organizations bear a responsibility to benchmark existing research and use that information to make informed judgments as to the needs of the facility (Lorenzi & Riley 2000). Many successful systems are analyzing data and using the information to measure patient outcomes (Nelson et al. 2003). Identifying a clear vision as to where this information system is going to take the facility and how it will improve practice is essential. Implementing a system without knowing what the goals are for the system in relation to the goals of the organization is only going to lead to inevitable failure of the system. Leadership is the third layer of the foundation. Leaders must take an active role to ensure complete ownership of the system before implementation (Lorenzi & Riley 2000). If the nurses do not feel like they have any input and feel like they do not own the system, resistance to the system will be much higher. Leaders must ‘know how to manage the organizational impact of information systems’ in order to ‘sharply reduce the behavioral resistance to change’ (Lorenzi & Riley 2000, p. 117). In doing this, leaders will facilitate a smoother and faster implementation process. In summary, I would like to suggest that closer attention to these three aspects of change might still yield a successful implementation. Failure does not have to be complete, unless nothing is done. By focusing more on some of these strategies, and using the literature to effect a change in culture, there is still hope that the CPIS can be a successful and useful tool for the organization, the nurses, and the patients.