Table 7 Table illustrating professional identity threats and professional identity enhancements as perceived by health care professionals across implementation phases
Author | Professional group | Examples |
|---|---|---|
Perceived professional identity threats | ||
Exploration phase | ||
[1] | Physicians | “… the more reliant we become on technology even with [the CDSSS] and things you de-skill a bit.”; “… the clinical judgement aspect of prescribing vancomycin will go down.” |
[2] | Physicians | “You want to be free to decide what you are prescribing, when you are prescribing it and you want to be free to decide if you are going to get the information or not.” |
[3] | Physicians | “The digital clinic that steal our patients, we experience that.” |
[4] | Physicians | “[Physicians] were concerned about the deskilling of future doctors through the use of [CDSSs].” |
[5] | Physicians | “Clinical decision making is still my primary role, like, so it’s up to me.“ |
[6] | Physicians and nurse practitioners | “I mean, I know it’s not mandatory to follow the recommendations, but it still feels that way. Sometimes, you’re just happy that somebody is using the medication you prescribe at all, and then you get the recommendation to switch the medication. [The CDSS] seems to always tell you that it’s not good enough. It’s never good enough.” |
[7] | Physicians | “I am opposed to [the CDSS], as I see it as another task being delegated to physicians that can better be done by those trained and experienced in it. I would prefer to concentrate on those things I do well rather than spending time doing secretarial work. Some of us do not round frequently in the hospital anymore, which will make staying competent in the system difficult…” |
[8] | Physicians | “The computer system should be allowed to block you. I have my reasons to do what I do and maybe I will think about its suggestions, but I do not want [the] IT [department] to block me at those moments. … I always want to do what I want.” |
[9] | Physicians | “CDSS technology enforces strict working according to guidelines and thus may deprive physicians from their sense of added value. This (…) makes physicians feel less valuated.” |
[10] | Nurse practitioners | The nurse practitioners complained that “…critical thinking [is lost] once the tool is embedded into [the] workflow.” |
Adoption decision, implementation preparation, active implementation phase | ||
[11] | Physicians and other healthcare professionals | Physicians and nurse practitioners mentioned being threatened in their own clinical practice and autonomy and they were reluctant to use a CDSS when it interfered too much with clinical practice: “When the CDSS becomes leading and the clinical view of the practitioner is subordinated”, “When my role as a care provider is undermined or becomes more complicated.”, and “I would like to keep my own clinical reasoning without a CDSS.” |
[12] | Physicians, pharmacists, general practice staff | “Pharmacists saw the dashboard component as offering opportunities to demonstrate their skills and to further develop their role working within general practice settings.”; “I think it’ll give us a useful tool to be able to perhaps design our programmes of work, and also thinking about if we’re going to run any quality programmes in the future, it will hopefully help us to design what we’re working on because it will give us that information, give us that baseline that we need so often.” |
Sustainment phase | ||
[13] | Cardiologists, heart failure nurses | “Seventy-nine percent stated that they are responsible for the treatment of ‘their’ patients and not a CDSS.” |
[14] | Physicians | “The professionals who participated in this study’s in-depth interview were dissatisfied with this integrated management system and wanted the ability to customize and adjust the alerts they received.” |
[15] | Nurse practitioners | “… I should be able to order that if I think it’s indicated without needing further approval.” |
Perceived professional identity enhancements | ||
Exploration phase | ||
[16] | Physicians and nurse practitioners | The physicians expressed that the CDSS could enhance their control and confidence in their work: “Off hand, I would say that I would get a better feeling of what I do – and an overview of the patients, especially when we take over each other’s patients.” (physician); Nurses appreciated the CDSS recommendations, protocols and checklists to support monitoring activities: “I think it would be great to know what is recommended because we have tuberculosis patients” (nurse practitioner). |
[10] | Nurse practitioners | “If a [CDSS] is designed well, it could empower nurses to advocate for patients and contribute to treatment decision-making.” |
[6] | Physicians and nurse practitioners | “We think that the traditional treatment relationship between patient and clinician is fundamentally changing, it is becoming more horizontal, not in every aspect but in many. That is where it is supposed to go. I really think [the CDSS] can facilitate this because it increases commitment and a feeling of ownership.” |
Adoption decision, implementation preparation, active implementation phase | ||
[20] | Physicians and nurse practitioners | “As a consequence of a reminder for drug dosing in renal malfunction, I reduced the methotrexate dose, which I had forgotten” (physician); “Once when my doctor was away, I used the warfarin assistant to define the dosing” (nurse practitioner). |
[21] | Physicians | “[The CDSS] is integrated in the workflow because after talking with the patient, the physician always returns to the computers and goes into the EHR. The [CDSS] fits in this workflow. If the physician is unsure on what to order, they will go to [the CDSS].” |
[22] | Pharmacists | “Despite the fact that these evaluations would represent an added responsibility, pharmacists felt that this was in line with why they chose the profession in the first place, and welcomed any [CDSS] that would increase their role in patient care.” |
Sustainment phase | ||
[13] | Cardiologists, heart failure nurses | “A total of […] 55% stated that a CDSS supplements their independency as a [heart failure] care expert.” |
[23] | Nurse practitioners | “Some nurses thought that [the CDSS] could supplement their clinical reasoning to facilitate decision-making; …” |
[24] | Nurse practitioners | “After the implementation of the CDSS, we are now more focused on the kind of food we order for the residents”, and “When screening a new resident, I can see from using the CDSS the new interventions that are necessary, what we can work on and what can wait.” |