Introduction: Computerized Decision Support Systems (CDSSs) connect health care professionals with high-quality, evidence-based information at the point-ofcare to guide clinical decision-making. Current research shows the potential of CDSSs to improve the efficiency and quality of patient care. The mere provision of the technology, however, does not guarantee its uptake.This qualitative study aims to explore the barriers and facilitators to the use of CDSSs as identified by health providers. Methods: The study was performed in three Italian hospitals, each characterized by a different level of familiarity with the CDSS technology. We interviewed frontline physicians, nurses, information technology staff, and members of the hospital board of directors (n=24). A grounded theory approach informed our sampling criteria as well as the data collection and analysis. Results: The adoption of CDSSs by health care professionals can be represented as a process that consists of six "positionings," each corresponding to an individual's use and perceived mastery of the technology. In conditions of low mastery, the CDSS is perceived as an object of threat, an unfamiliar tool that is difficult to control. On the other hand, individuals in conditions of high mastery view the CDSS as a helpful tool that can be locally adapted and integrated with clinicians' competences to fulfil their needs. In the frst positionings, the uptake of CDSSs is hindered by representational obstacles. The last positionings, alternatively, featured technical obstacles to CDSS uptake. Discussion: Our model of CDSS adoption can guide hospital administrators interested in the future integration of CDSSs to evaluate their organizational contexts, identify potential challenges to the implementation of the technology, and develop an effective strategy to address them. Our findings also allow reflections concerning the misalignment between most Italian hospitals and the current innovation trends toward the uptake of computerized decision support technologies.
I sistemi di supporto decisionale computerizzati (SSDC) collegano le informazioni specifiche di ogni paziente alle evidenze scientifiche disponibili in selezionate banche dati, offrendo un immediato supporto ai clinici durante i processi decisionali. Diversi studi suggeriscono che i SSDC hanno la potenzialità di migliorare l’efficienza e la qualità delle cure. Tuttavia, la loro disponibilità nei contesti di cura non ne garantisce l’adozione in pratica. Il presente studio qualitativo è finalizzato a esplorare le barriere e i facilitatori all’adozione dei SSDC così come percepiti dal personale ospedaliero chiamato a farne uso. Metodi. I dati empirici sono stati raccolti attraverso interviste qualitative semi-strutturate, condotte e analizzate secondo il metodo grounded theory. La rilevazione ha coinvolto tre ospedali del Nord Italia, caratterizzati da diversi livelli di familiarità con i SSDC. Le interviste (n=24) sono state sottoposte a diverse figure professionali: medici, infermieri, membri dello staff IT (Information Technology) e membri delle direzioni ospedaliere. Risultati. L’adozione dei SSDC si configura come processo articolato in sei “posizionamenti”, che rappresentano sei possibili esperienze di utilizzo dei SSDC: a un estremo, il sistema è percepito come un oggetto minaccioso e incontrollabile e, all’estremo opposto, come uno strumento a servizio dei clinici. I primi posizionamenti sono connotati da ostacoli rappresentazionali mentre i posizionamenti più vicini all’utilizzo sono connotati da gli ostacoli tecnici . Discussione. Il modello consente a decisori e manager di collocare i propri contesti di riferimento in uno (o più) dei posizionamenti descritti, “diagnosticando” così il rispettivo livello di maturità nei confronti dei SSDC e identificando le leve su cui agire per avvicinarsi a un’integrazione soddisfacente dei SSDC. I risultati sono discussi anche alla luce degli attuali trend innovativi in sanità, consentendo alcune riflessioni riguardo allo status quo e al potenziale di sviluppo degli ospedali italiani.
Barriere e facilitatori all'implementazione dei sistemi di supporto decisionale computerizzati in ospedale: uno studio "grounded theory" / E.G. Liberati, L. Galuppo, M. Gorli, M. Maraldi, F. Ruggiero, M. Capobussi, R. Banzi, K. Kwag, G. Scaratti, O. Nanni, P. Ruggieri, H. Polo Friz, C. Cimminiello, M. Bosio, M. Mangia, L. Moja. - In: RECENTI PROGRESSI IN MEDICINA. - ISSN 0034-1193. - 106:4(2015 Apr), pp. 180-191. [10.1701/1830.20032]
Barriere e facilitatori all'implementazione dei sistemi di supporto decisionale computerizzati in ospedale: uno studio "grounded theory"
F. Ruggiero;M. Capobussi;L. MojaUltimo
2015
Abstract
Introduction: Computerized Decision Support Systems (CDSSs) connect health care professionals with high-quality, evidence-based information at the point-ofcare to guide clinical decision-making. Current research shows the potential of CDSSs to improve the efficiency and quality of patient care. The mere provision of the technology, however, does not guarantee its uptake.This qualitative study aims to explore the barriers and facilitators to the use of CDSSs as identified by health providers. Methods: The study was performed in three Italian hospitals, each characterized by a different level of familiarity with the CDSS technology. We interviewed frontline physicians, nurses, information technology staff, and members of the hospital board of directors (n=24). A grounded theory approach informed our sampling criteria as well as the data collection and analysis. Results: The adoption of CDSSs by health care professionals can be represented as a process that consists of six "positionings," each corresponding to an individual's use and perceived mastery of the technology. In conditions of low mastery, the CDSS is perceived as an object of threat, an unfamiliar tool that is difficult to control. On the other hand, individuals in conditions of high mastery view the CDSS as a helpful tool that can be locally adapted and integrated with clinicians' competences to fulfil their needs. In the frst positionings, the uptake of CDSSs is hindered by representational obstacles. The last positionings, alternatively, featured technical obstacles to CDSS uptake. Discussion: Our model of CDSS adoption can guide hospital administrators interested in the future integration of CDSSs to evaluate their organizational contexts, identify potential challenges to the implementation of the technology, and develop an effective strategy to address them. Our findings also allow reflections concerning the misalignment between most Italian hospitals and the current innovation trends toward the uptake of computerized decision support technologies.File | Dimensione | Formato | |
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