Human Factors: Changing Systems, Changing Behaviors

In its 1991 report advocating the computer-based patient record as “an essential technology for health care,” the Institute of Medicine (IOM) acknowledged the problems caused by clinician resistance, suggesting mechanisms to encourage clinician input and recommending programs to educate students and practitioners in computer use (Institute of Medicine 1997). In two more recent, high-profile studies on medical errors and quality of care, the IOM clearly assigned information technology (IT) to a supporting role. Its report calling for a safer health system (2000) described technology (not just IT) as “a ‘member’ of the work team.” And this technology was “not restricted” to technology used by health care professionals, but included non-health professionals and “people at home” (p 62–63). The IOM made the supporting role of IT clearer still in its second report calling for a new health system. There, using information technology was given billing equal to that accorded to four other areas: building organizational supports, applying evidence to healthcare delivery, aligning payment policies with quality improvements, and preparing the workforce. Both organizational and workforce issues involve “interrelationships between humans, the tools they use, and the environment in which they live and work,” or what is defined as human factors (Institute of Medicine 2000, p 63). These factors received growing attention throughout the 1990s. By 1998, a prize-winning system implementer, Reed Gardner, formulated the 80/20 rule, stating that “the success of a project is perhaps 80% dependent on the development of the social and political interaction skills of the developer and 20% or less on the implementation of the hardware and software technology” (Gardner 1998). Nancy Lorenzi and Bob Riley offered a corollary of sorts, noting that “people who have low psychological ownership in a system and who vigorously resist its implementation can bring a ‘technically best’ system to its knees” (Lorenzi and Riley 2000).

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