Administrators at Kingston General Hospital in Ontario, Canada are using Icek Ajzen's Theory of Planned Behavior to help with the enterprise-wide and community-wide adoption of EHR.
Briefly, Ajzen's theory model combines attitudes toward behavior, subjective norms, and perceived behavioral control in combination with behavioral intention and actual behavioral control to predict behavior.
Ajzen's theory also suggests that it is not information or knowledge about how EHR will help outcomes that will motivate change; rather, intention and actual behavioral control. How do you get intention? You must first change belief systems.
Utilizing the Theory of Planned Behavior, administrators at KGH hope to tackle opposition from non-adopters. Enabling providers to switch to a paperless system, demonstrating that this change will improve outcomes, and creating a standard in the community should create the intention needed for change. KGH feels that if providers percieve that they have the ability to succeed and should transition to electronic health records by community norms then they will do so.
This theory has strength. In fact, many change management agencies use this theory to assist large corporations with implementation of global changes.
One area that the Theory of Planned Behavior does not clearly address is emotion such as threat or fear. Now that payors and government agencies are threatening reduced reimbursement for noncompliance, providers now also fear a negative financial impact if they do not comply.
The US could glean a lot from observing this theory. Currently, it seems that the focus is on threat and fear. Maybe the focus should be shifted to identifying Champion Physicians in the community that are paving the way for adoption. That should help change belief systems.
Jonathan S. Ware, MD
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HI Jonathan - this is a fascinating issue - Ajzen is very well known in the sociology/psychology "health behavior" field - he even has an interesting special interest group that comes up on google - the real master that I have followed in this area is Everett Rogers who wrote the diffusion of innovations - which is available on amazon as a paperback - a real classic that is still unsurpassed - have you read it .........Peter
ReplyDeleteJonathan,
ReplyDeleteIndeed an important topic. I agree that Everett Rogers is the master of the empirical literature concerning diffusion of innovations. Ajzen is well known as well, but I always found social psychology a little bit atheoretical. Often what they describe as a theory is a summary of data.
Way cool! Some very valid points! I appreciate you penning this write-up and the rest of the site is extremely good.
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