TECHNOLOGICAL DISRUPTIVE CHANGE WITHIN HEALTHCARE ENVIRONMENT: AN EXAMINATION OF CHANGE MANAGEMENT FACTORS THAT INFLUENCE NURSES' ATTITUDES TOWARD IMPLEMENTING DISRUPTIVE CHANGE.

Abstract

Health care organizations are continually confronting many changes that are transformational or disruptive in nature, which compels organizations to regularly re-evaluate their strategies, structures, policies, practices, and processes. Managing and implementing change effectively is however a main challenge in the change management domain because of massive human involvement. Thus, change agents (i.e. managers, and directors) are eager to know how to encourage and effectively prepare change takers (i.e. nurses) for disruptive change situations. The aim of this doctoral study is to examine nurses' attitudes toward disruptive change through individual and organizational change management factors. The objectives are to develop a change-based framework that facilitates evaluation of HIT investment, as well as, to develop and validate a conceptual model in health care setting that links nurses' attitudes toward disruptive change, perceived organizational readiness or unreadiness for change, perceived organizational readiness for change at the individual level, and disruptiveness of introduced innovations. This empirical study was proceeded by a systematic review of literature that led to development of a conceptual model. The results were drawn from respondents in multi-site healthcare organizations. The data was collected from a sample of registered nurses who use Electronic Health Records (EHRs) in their daily work by using a survey questionnaire. In addition to the data from the survey, interviews were used with directors who have a clinical informatics role. Quantitative data was analyzed using descriptive statistics and exploratory factor analysis, run on a statistical package for social sciences, and confirmatory factor analysis on the structural equation modeling as well as on applied analysis of moment structure to assess the model fit of the study and hypotheses testing. Furthermore, between groups comparisons were conducted. Also analysis of the qualitative data was interpreted using Kvale (1996). The findings mainly showed the following. Nurses' attitudes toward implementing, spreading and voicing concerns about the disruptive change can be influenced by high levels of perceived organizational readiness for change, perceived appropriateness of change, and demographic variables such as health care setting, highest educational level, and age. Perceived individual readiness for change (i.e. appropriateness of change) and perceived organizational unreadiness for change factors, such as adverse impact of change on work and poor communication of change were found more related to nurses' attitudes toward disruptive change. The perceived disruptiveness of introduced innovations was not found to predict negative nurses' attitudes toward disruptive change. However, the results suggest that perceived organizational unreadiness for change could predict change takers' perception for appropriateness of change, and disruptiveness of introduced innovations, and consequently organizational ability to introduce more disruptive innovations. Findings of this research may contribute to the change management literature and provide advice to health care organizations with respect to managing disruptive change. Therefore, for the practitioners and change agents, the study provides guidelines with respect to health care organizational actions that need to be emphasized, and would assist change agents in selecting change management strategies that will make health care organizational members believe the organization is ready to implement change successfully. This might lead to an increase in change takers' commitment to the change.