Creating A Healthcare Culture Of Patient Safety: A Retrospective Analysis Of Change Readiness Associated With The Implementation Of Computerized Provider Order Entry

Bonnie Dean

Defense Date

11-9-2006

Graduation Date

Fall 1-1-2006

Availability

Campus Only

Submission Type

dissertation

Degree Name

PhD

Department

Nursing

School

School of Nursing

Committee Chair

Gladys L. Husted

Committee Member

J. Douglas Bricker

Committee Member

L. Kathleen Sekula

Keywords

Computerized Provider Order Entry, CPOE, Medical Errors, Organizational Change, Patient Safety, Retrospective Analysis

Abstract

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). Medical mistakes, and in particular, the medication error dilemma has come to the forefront of most hospitals' improvement agendas (Sengstack and Gugerty, 2004). One of the most frequently cited solution to the problem has been computerized provider order entry (CPOE) systems (IOM, 2000, 2001). 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 and 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, therapists, technicians, and other 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.

Format

PDF

Language

English

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