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Cited by 37Electronic Health Records SystemsHealth Policy Implementation ScienceClinical practice guidelines implementation

Addressing the sociotechnical drivers of quality improvement: a case study of post-operative DVT prophylaxis computerised decision support

Open access
Lesselroth, Blake J, Yang, Jianji, McConnachie, Judy, Brenk, Thomas, Winterbottom, Lisa·2011·BMJ Quality & Safety
DOI 10.1136/bmjqs.2010.042689PMC PMC3088464
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Abstract

Background: Quality improvement (QI) initiatives characterised by iterative cycles of quantitative data analysis do not readily explain the organisational determinants of change. However, the integration of sociotechnical theory can inform more effective strategies. Our specific aims were to (1) describe a computerised decision support intervention intended to improve adherence with deep venous thrombosis (DVT) prophylaxis recommendations; and (2) show how sociotechnical theory expressed in ‘Fit between Individuals, Task and Technology’ framework (FITT) can identify and clarify the facilitators and barriers to QI work. Methods: A multidisciplinary team developed and implemented electronic menus with DVT prophylaxis recommendations. Stakeholders were interviewed and human factors were analysed to optimise integration. Menu exposure, order placement and clinical performance were measured. Vista tool extraction and chart review were used. Performance compliance pre-implementation was 77%. Results: There were 80–110 eligible cases per month. Initial menu use rate was 20%. After barriers were classified and addressed using the FITT framework, use improved 50% to 90%. Tasks, users and technology issues in the FITT model and their interfaces were identified and addressed. Workflow styles, concerns about validity of guidelines, cycle times and perceived ambiguity of risk were issues identified. Conclusions: DVT prophylaxis in a surgical setting is fraught with socio-political agendas, cognitive dissonance and misaligned expectations. These must be sought and articulated if organisations are to respond to internal resistance to change. This case study demonstrates that QI teams using information technology must understand the clinical context, even in mature electronic health record environments, in order to implement sustainable systems.

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  • Educational campaigns developed to support peer-to-peer influences and sociopolitical forces proved to be relatively ineffective.

    “Peer-to-peer influences and sociopolitical forces: Educational campaigns were developed to support these social forces (these proved to be relatively ineffective)”

    From Demystifying theory and its use in improvement (2015) · cites this paper as [67]

  • The intervention in the DVT example led to an increase in the facility's deep vein thrombosis prophylaxis performance to a level that met the Veterans Administration External Peer Review Programme national target.

    “This intervention led to an increase in the facility's deep vein thrombosis prophylaxis performance to a level that met the Veterans Administration External Peer Review Programme national target.”

    From Demystifying theory and its use in improvement (2015) · cites this paper as [67]

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Research works printed but not linked: 3

  1. [4]Reason J Human Error. Cambridge: Cambridge University Press, 1990
  2. [27]Institute for Healthcare Improvement Improvement methods. Cambridge, 2009. http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/ (accessed 10 Mar 2009).
  3. [35]Venkatesh V Morris M Davis G User acceptance of information technology: towards a unified view. MIS Quarterly 2003; 27: 425– 78

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Authors
Lesselroth, B. J., Yang, J., McConnachie, J., Brenk, T., & Winterbottom, L.
Affiliations
  • Oregon Health & Science University (US)
  • Portland VA Medical Center (US)
Corresponding author
Lesselroth, Blake J
ORCID
Venue
BMJ Quality & Safety
Publisher
BMJ
Published
2011-01-05
Volume
20
Issue
5
Pages
381-389
ISSN
  • 1475-3898 (ISSN-L)
  • 2044-5415
  • 2044-5423
DOI
10.1136/bmjqs.2010.042689
PMC
PMC3088464
OpenAlex
W2119677489
Cited by
37
References
32
Citations by year
2025: 2 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 3 · 2019: 4 · 2018: 1 · 2017: 1 · 2016: 3 · 2015: 5 · 2014: 3 · 2013: 2 · 2012: 3
FWCI
4.63
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Quality & Safety (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
deep vein thrombosis prevention, computerised decision support, electronic health records, socio-technical systems theory, quality improvement, guideline adherence, postoperative care, implementation barriers, workflow analysis, human factors, resistance to change
MeSH terms
Humans, Postoperative Care, Practice Guidelines as Topic, Guideline Adherence, Decision Support Systems, Clinical, Venous Thrombosis, Quality Improvement

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