Table 4 Review findings relating to organizational factors
Author | Professional type | Examples |
|---|---|---|
Collaboration and communication | ||
[145] | Physicians and managers | Successful CDSS adoption requires involvement of physicians and nursing professionals in CDSS customization: “… what they [managers] need to do is sit down with the people in each department and work out what are the processes that are critical for that department because the paper processes that have evolved in each individual section of the hospital have been … refined over years … and if you just provide a generic template (there is) no way of replicating any of that.” |
[178] | Pharmacist | Communication and collaboration were seen as important for the intervention and for embedding the intervention into routine practice. Pharmacists adopted different ways of communication with clinicians, in order to engage them with the intervention: “It’s difficult, … when’s the best time to approach doctors to discuss things, … when the surgery is not on, they’re on home visits or they’re in meetings, it’s quite a different way of working. So that’s probably one barrier …, so it’d be difficult probably to get everybody together unless you went to the practice meeting on another day.” |
(Top) management and leadership support | ||
[72] | Manager | High importance of communication and follow-up on nursing professionals’ roles and tasks; top management needs to reward users for their self-sufficiency and motivation to use CDSS: “… Some people take it and run with it—the medical assistant and doctor are working together, and some just don’t really see it as their job. Part of what physicians have to do is understand they need to make it known to their MA [medical assistant] that this is an expectation. Some doctors have gotten that and some say they can’t or don’t know how to make their MA [medical assistant] do anything.” |
[24] | Physicians | CDSSs should not be introduced like an imposition, as it has the potential to affect clinical autonomy and decision-making. If the use of CDSSs is perceived as a top-down order, clinicians will reject it. Strong endorsement from the top management is essential. |
[167] | Physicians | Physicians emphasized the role of leadership in overcoming negative perceptions, fear, and resistance to change by highlighting benefits of CDSSs for the patient. |
Innovation culture, climate for innovation, and psychological safety | ||
[171] | Junior physicians | A cultural barrier exists where junior health care professionals believe “… that the use of [CDSS] in front of a patient is perceived as being unprofessional. They, therefore, chose not to use devices in plain view. This concern was also raised in relation to senior colleagues considering junior physicians’ use of their mobile device in front of patients or on the ward as being unprofessional.” |
[70] | Junior physician | “I think we hit all the 5 rights of CDS on this one. It’s coming at the right time, to the right person, with the right information, using the right channel, and in the right situation…. There is been no interest in turning it off …” |
Organizational silos and hierarchies | ||
[69] | Junior and senior physicians | Senior physicians influence the practices of junior physicians. Junior physicians need organizational support in order to adopt CDSSs due to clinical hierarchy. |
[77] | Junior and senior physicians | The implementation of CDSSs leads to changes in professional boundaries: “It’s more hierarchical whether or not we look at the recommendations. Often, I look at guidelines, but after my superiors told me to do something else.” (junior physicians) “The nurses put the residents in a somewhat inferior position because of their confidence and their experience….” (senior physician). |
[82] | Junior and senior physicians | Senior physicians emphasize that they should not surrender their autonomy to the CDSS whereas junior physicians perceive a sense of greater clinical autonomy when using the CDSS as it reduces their reliance on senior colleagues |
[24] | Physicians and nursing professionals | Disputes over power and control between physicians and nursing professionals arise as the CDSS allows widespread access to scientific evidence, which lead to nursing professionals’ control over medical decisions: “… If we want to implement it it’s key to discuss the rules of access for each profession” (surgeon). |
Social norms and endorsement | ||
[154] | Physicians and pharmacists | Uncertainty about the accuracy of the CDSS is mitigated by invoking expert: “… if I was recommended by the pharmacists and by ID [infectious disease] and micro [microbiology] then I am more than happy to use [the CDSS]”; “… I want someone from pharmacology or someone that we trust to tell us that the [CDSS recommendations] are accurate if not more accurate than doing it by hand.” |
[192] | Physicians | Physicians sought support from colleagues: “… probably more important have been colleagues sharing tips and kind of best practice or best use. Those are the most useful...” |