PERCEPTIONS OF PERSONAL POWER AND THEIR RELATIONSHIP TO CLINICIAN'S RESISTANCE TO THE INTRODUCTION OF COMPUTERIZED PHYSICIAN ORDER ENTRY

The implementation of computerized provider order entry (CPOE) across the health care system has been slow in realization. In addition to the inherent financial burden, a significant cause for this delay is the high number of system failures resulting from clinicians' resistance. Changes in workflow and communication, time demands, system complexity, and changes to power structures have all been identified as consequences of CPOE systems that can cause resistance among clinicians. Of these, I believe that perceived changes in a person's power in the workplace can be more difficult to overcome than changes in the work routine.Perception of the power or control that clinicians have in the workplace and their attitudes toward CPOE are precursors to behavior, and if these perceptions and attitudes are negative, can result in resistive behavior. Based on psycho-social theories of power, resistance, and organizational information technology (IT) implementation in business, I applied these concepts to healthcare IT implementation. Qualitative studies have looked at power and resistance, but no previous study has measured the degree or direction of power change, or confirmed that a relationship exists between power perceptions and CPOE attitudes. One reason for this is that no instruments existed to obtain this data. I developed the Semantic Differential Power Perception (SDPP) survey as an electronic survey to measure power perception and CPOE attitudes, and established reliability and validity of the instrument in a measurement study. The SDPP was used to collect data from 276 healthcare workers in two different hospitals before and after implementation of CPOE. I identified a significant correlation between power perceptions and attitudes toward CPOE. Examining the direction of change by healthcare position, we found that the power perception values decreased for all positions and that attitudes toward CPOE varied based on use of the system. Understanding the relationship between power perceptions and CPOE attitudes is the first step in determining causative relationships. This understanding will enable system developers to modify implementation processes and training methods to enhance waning power and support positive power changes, therefore minimizing power related resistance