Revise the Roles (and Rules)

This entry is part 2 of 2 in the series Let Curiosity Cross the Chasm: Reducing Physician Resistance

Common sense and our own experience tell us to also look at the velocity of current changes brought about by required compliance with Meaningful Use and other standards. In any industry, the sheer volume of change would be overwhelming – some level of resistance is a natural response. As we cited in the past, over 80% of multi-million dollar IT projects in ALL industries fail – it’s not just a healthcare problem. However, a 2013 article in the Interactive Journal of Medical Research 1 seems to suggest that 80% failure rate is unique to healthcare. That is simply not the case. We have always maintained that applying best practices that work outside healthcare, like proven project management, technology management and change management methodologies, is critical to improving both project success and physician acceptance. In particular, an effective change management strategy breaks down the large amount of required change into manageable segments, measuring organizational and individual capacity for change and responding with appropriate tools and techniques.

But we still have not addressed role and rule conflicts, which may be a place to look for new answers.

Many believe that problems related to who is responsible for what information, i.e., the roles conflict, originate with CPOE, which transfers the bulk of responsibility for data entry to the physician or point-of-care provider. However, Bhattacherjee, Davis and Hikmet 2 find the conflict is caused by a general shift toward managed care in the USA, rather than by the CPOE system. In other words, it is again not so much a tools issue.

As far as rule conflicts, some physicians felt that the … system was changing the way they always practiced medicine, by forcing them to abandon practices that were consistent with the professional norms of their community and adopt practices that were not sanctioned by their professional community. 3  This is not an insignificant hurdle. However, we can mitigate it through the use of effective change management practices so that the changes are more gradual and at a pace suitable for individual caregivers – particularly if they use their input as the basis for designing standard order sets and other key templates.

So we see that effective change management should significantly improve the likelihood of HIT project success, reducing physician resistance and non-acceptance by addressing object, tool, community, role and rule conflicts.

But chances are even after resolving all these roadblocks, we are still likely to encounter either resistance or non-acceptance or both. So what is the real problem that physicians appear to have with adopting HIT, if it is not the physicians themselves or the technology that everyone hopes will improve healthcare?

Perhaps we are managing the wrong change, and in the process overlooking a critical aspect of providing healthcare.

Yes – implementing an EHR definitely shifts record-keeping responsibility, and can impose an uncomfortable or unfamiliar standard in order to maintain consistency and meaningful data sharing. Yes – much of the new responsibility falls on physicians as more and more information is being recorded at the point of care. But the truth is that the physical act of documentation itself has ALWAYS been problematic and often the least liked part of the physician role. Adding the conflicts identified above only amplifies an already tedious, necessary “evil”. No matter how strong a caregiver’s curiosity about any new means for collecting, analyzing and apply patient, illness and treatment information, it may not be strong enough to overcome resistance to already disliked, and now even more time-consuming, activity.

After some additional research, we may find that a key to physician resistance to HIT is not HIT itself. If so, we need to rethink how we approach the problem.

Applying effective change management tools, such as conducting personalized training, holding one-on-one meetings, encouraging hands-on demonstrations and clearly defining and demonstrating the benefits resulting from new documentation practices will help to reduce both resistance and non-acceptance. But we need to make sure our change “arsenal” emphasizes ways to pique physician curiosity, to present historically unpleasant tasks in such a way that we harness that positive energy to overcome hesitation and potential rejection.

  1.  Nambisan P, Kreps GL, Polit S, Understanding Electronic Medical Record Adoption in the United States: Communication and Sociocultural Perspectives, Interact J Med Res 2013;2(1):e5, URL:, doi:10.2196/ijmr.2437, PMID
  2.  Bhattacherjee, Anol; Davis, Christopher; Hikmet, Neset, “Physician Reactions to Healthcare IT: An Activity-Theoretic Analysis,” System Sciences (HICSS), 2013 46th Hawaii International Conference on, vol., no., pp.2545,2554, 7-10 Jan. 2013
  3. Bhattacherjee, Anol; Davis, Christopher; Hikmet, Neset, “Physician Reactions to Healthcare IT: An Activity-Theoretic Analysis,” System Sciences (HICSS), 2013 46th Hawaii International Conference on, vol., no., pp.2545,2554, 7-10 Jan. 2013
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Posted on July 7th, 2014 in Innovating Health Care IT
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