A Tale of Four Cultures

This entry is part 2 of 2 in the series When Worlds Collide: The Cultural Side of HIT Failure

In an insightful essay 1 Chuck Friedman, a physicist and educator, described his growing interest in the “soft side” of informatics. He observed that solid code and reliable systems were often insufficient to successfully adopting HIT in clinical environments. Even with the best of technologies, “people” got in the way – and understanding these “people” issues in HIT required examining culture.

Wikipedia defines culture as “…that which distinguishes life in one group from life in another group, including language, beliefs, customs, institutions, and physical objects, among other qualities.” 2 Members of a particular culture become a part of that culture through a process of socialization “…through a series of experiences that collectively shape what they know, what they believe to be important, and their sense of right and wrong.” Friedman adds to that definition arguing that a culture’s very nature makes it highly stable: “Culturally ingrained beliefs, and the practices that derive from these beliefs, are enormously resistant to change.” This resistance flies in the face of what should be obvious. He notes that cultures “…bring consistent and predictable viewpoints to planning and decision making in information technology.” Further, these viewpoints arise from culturally ingrained beliefs that are “…rooted in individual cultures [and] often transcend logic and usually cannot be influenced by evidence.”

There is some research on the cultural difference among those responsible for HIT implementations. Lynn Crawford and her colleagues 3 discuss some of the ways in which project management and change management differ. They state that project management is in essence an engineering domain with a focus on planning and control. Change management, on the other hand, is an offshoot of the discipline of organizational development. Different parent domains logically lead to distinct bodies of knowledge. The PMBOK® Guide is a clearly developed standard. Change management, conversely, has far fewer defined practice standards. As a result, managers from each discipline likely have corresponding strengths and weaknesses. Change managers emphasize qualitative attributes in their work, compared to project managers who focus on the quantitative.

Experience shows that cultural differences often prevent these three key players from working well together on a day-to-day basis. They each have different ways of measuring success, communicating and solving problems. When you add the additional stress and responsibility of defining and achieving common objectives for HIT project success, it is no wonder they often fail to address clinician and administration cultural challenges.

Further, simply including change management in the equation presents a dilemma. Excluding change management presents significant risks to project success, and almost guarantees failure. However, including change management without understanding and accommodating its cultural differences from project and IT management results in equal or greater risks of project failure.

Awareness of the issue is only the beginning of the solution. Organizations need to work to bring attention to and honor the differences between each of these cultures in order to understand how they can work together effectively and successfully. Part of that work is finding ways to demonstrate that they do in fact share a common goal – to provide services to each other and then to their clients or customers to improve the likelihood of HIT success. Only by changing the way we change can we increase the likelihood of real project success.

Most of us have directly experienced the ways in which these disparate values and beliefs come into conflict. How might we overcome these conflicts? Friedman proposes we become “culture weavers.” “Successful leadership may be seen as an exercise in weaving representatives of…diverse cultures into a cohesive team, and dealing creatively and constructively with conflicts that inevitably arise as a consequence of cultural coexistence.” We believe that through such “culture weaving,” health care organizations can create a truly multidisciplinary approach to HIT success.

  1. Friedman, C. P. (1999). Information technology leadership in academic medical centers: A tale of four cultures. Academic Medicine : Journal of the Association of American Medical Colleges, 74(7), 795-9
  2. http://en.wikipedia.org/wiki/Culture, accessed 8/17.2012
  3. Lynn Crawford and Anat H. Nahmias. (2010) “Competencies for managing change” International journal of project management, 28 (4), 405-412
Series Navigation<< The Culture of HIT Implementation
Posted on January 12th, 2013 in Innovating Health Care IT
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