Safety,quality, innovation–the role that an organisational communication perspective can play in enhancing the impact of health information technology

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Andrew Georgiou
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Senior Research Fellow
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Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, University of New South Wales, Australia
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Introduction: Organisational communication perspectives present communication as a constitutive element of the way that organisations plan, manage and create their environment. Rather that viewing organisations as fixed entities or “containers,” organisational communication researchers present organisations as complex entities which rest on communications to undertake the dynamic and interconnected tasks and outcomes they set out to achieve. Organisational communication perspectives are highly relevant for the implementation, sustainability, quality and safety of health information technology (HIT).  This is because health care consists of complex collaborative activities that rely on communication within and between groups to establish, coordinate and sustain effective patient care.  It is these communication activities that HIT will have its most disruptive impact.

Aim: The aim of this paper is to outline an organisational communication framework as a practical tool that can be used to enhance the design and application of HIT.  This framework was developed from an extensive body of empirical research that investigated the adoption of HIT systems within a pathology service and hospital setting.

Methods: The organisational communication framework was developed from research that evaluated the impact of new HIT systems (Computerised Provider Order Entry and Laboratory Information System) in a major Sydney metropolitan hospital and its pathology service. The research was carried out during the period 2005 to 2008 and involved 143 participants that were involved in a total of 141 interviews, 16 focus groups and 43 hours of observation. The framework was iteratively refined and developed in the course of the research.

Findings: Three case studies from: i) Central Specimen Reception department; ii) the Emergency Department; and iii) the Microbiology department are presented as exemplars to illustrate three key dimensions of the framework: i) the way that information is exchanged, processed and stored; ii) the way that the organisation plans, controls, staffs and coordinates its work; and iii) the way that information and work are scheduled, synchronised and allocated.  The study findings showed how the new HIT system impacted on the organisational capacity of the Emergency Department and affected how it went about  coordinating its workload in the face of major shifts in responsibility and data accessibility.  In Central Specimen Reception there were significant changes in the way that work was synchronised and sequenced as a consequence of the introduction of electronic ordering.  The Microbiology department provided examples of the way that the exchange of meaningful information affected the delivery of patient care including the choice of test, its urgency and even the way it was processed.

Discussion and conclusion: Communication failures, problems and misalignments are widely seen to be a major reason for poor quality healthcare, unintended consequences and adverse events.  HIT-enabled innovation is a collective process which involves numerous stakeholders, materials and actors.  It is also the product of complex and dynamic interactions that involve communication as a central organisational and temporal element.  Organisational communication perspectives are therefore valuable in unlocking the innovative potential of HIT and enhancing their contribution to safe, effective and quality healthcare.