Continuous Technology Implementation and Sustainability of Sociotechnical Change: A Case Study of Advanced Intravenous Infusion Pump Technology Implementation in a Hospital

  • Pascale Carayon
  • Tosha B. Wetterneck
  • Ann Schoofs Hundt
  • Steve Rough
  • Mark Schroeder
Part of the Contributions to Management Science book series (MANAGEMENT SC.)

Recently, much public attention has been on medical errors and patient safety. Healthcare organizations are being pressured to improve their systems and processes and implement various technologies in order to prevent or mitigate medical errors. This focus on the implementation of technology for patient safety has not necessarily achieved all of the expected patient safety benefits, probably because of insufficient consideration for the human factors of technology implementation and use. This paper describes the implementation of advanced intravenous infusion pump technology in a teaching hospital. Emphasis is placed on the understanding of the effects and impact of the technology after the actual implementation. The implementation of the technology can be interpreted in the conceptual framework of episodic versus continuous change proposed by Weick and Quinn (1999). The emphasis on continuous change requires organizations to focus on continuous system adaptation and improvement; this new focus can contribute to sustainable technology implementation and use.


Technological Change Healthcare Organization Continuous Change Computerize Physician Order Entry Technology Implementation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Ash JS, Berg M, Coiera E (2004) Some unintended consequences of information technology in health care: The nature of patient care information systemrelated errors. Journal of the American Informatics Association 11(2):104-112CrossRefGoogle Scholar
  2. Ash JS, Sittig DF, Dykstra RH, Guappone KP, Carpenter JD, Seshadri V (2007) Categorizing the unintended sociotechnical consequences of computerized provider order entry. International Journal of Medical Informatics 76 (Supplement):21-27CrossRefGoogle Scholar
  3. Bates DW, Gawande AA (2003) Improving safety with information technology. The New England Journal of Medicine 348(25):2526-2534CrossRefGoogle Scholar
  4. Bates DW, Teich JM, Lee J, Seger DL, Kuperman GJ, Ma’Luf N, Boyle D, Leape LL (1999) The impact of computerized physician order entry on medication error prevention. Journal of the American Medical Informatics Association 6 (4):313-321Google Scholar
  5. Berg M (1999) Patient care information systems and health care work: A sociotechnical approach. International Journal of Medical Informatics 55:87-101CrossRefGoogle Scholar
  6. Carayon P (2006) Human factors of complex sociotechnical systems. Applied Ergonomics 37:525-535CrossRefGoogle Scholar
  7. Carayon P, Hundt AS, Karsh BT, Gurses AP, Alvarado CJ, Smith M, Brennan PF (2006) Work system design for patient safety: The SEIPS model. Quality and Safety in Health Care 15 (Suppl I):50-58CrossRefGoogle Scholar
  8. Carayon P, Smith MJ (1993) The balance theory of job design and stress as a model for the management of technological change. Paper presented at the Fourth International Congress of Industrial Engineering, Marseille, FranceGoogle Scholar
  9. Carayon P, Smith MJ (2000) Work organization and ergonomics. Applied Ergonomics 31:649-662CrossRefGoogle Scholar
  10. Carayon P, Smith P, Hundt AS, Kuruchittham V, Li Q (2007) Implementation of an Electronic Health Records (EHR) system in a small clinic: The viewpoint of clinic staff. Behaviour and Information Technology (to be published)Google Scholar
  11. Carayon P, Wetterneck TB, Hundt AS, Ozkaynak M, DeSilvey J, Ludwig B et al. (2007) Evaluation of nurse interaction with bar code medication administration technology in the work environment. Journal of Patient Safety 3(1):34-42CrossRefGoogle Scholar
  12. Chapanis A, Safren MA (1960) Of misses and medicines. Journal of Chronic Diseases 12(4):403-408CrossRefGoogle Scholar
  13. Cornford T (2003) Information systems and new technologies: Taking shape in use. In: Avgerou C, La Rovere R (eds) Information Systems and the Economics of Innovation. Edward Edgar, LondonGoogle Scholar
  14. ECRI (2002) New perspectives on general-purpose infusion pumps. Advances in the technology, changes in our ratings. Health Devices 31:354-384Google Scholar
  15. Hundt AS, Carayon P, Wetterneck TB, Love T, Haack B, Schroeder M, Enloe M (2005) Evaluating design changes of a smart IV pump. In: Tartaglia R, Bagnara S, Bellandi T, Albolino S (eds) Healthcare Systems Ergonomics and Patient Safety. Taylor and Francis, Florence, pp 239-242Google Scholar
  16. Institute of Medicine Committee on Quality of Health Care in America (2001) Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press, Washington, DCGoogle Scholar
  17. Karsh BT (2004) Beyond usability: Designing effective technology implementation systems to promote patient safety. Quality and Safety in Health Care 13:388-394CrossRefGoogle Scholar
  18. Kohn LT, Corrigan JM, Donaldson MS (eds) (1999) To Err is Human: Building a Safer Health System. National Academy Press, Washington, DCGoogle Scholar
  19. Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, Strom BL (2005) Role of computerized physician order entry systems in facilitating medications errors. Journal of the American Medical Association 293 (10):1197-1203CrossRefGoogle Scholar
  20. Korunka C, Carayon P (1999) Continuous implementations of information technology: The development of an interview guide and a cross-national comparison of Austrian and American organizations. The International Journal of Human Factors in Manufacturing 9(2):165-183CrossRefGoogle Scholar
  21. Kotter JP (1996) Leading Change. Harvard Business School, Boston, MAGoogle Scholar
  22. Lin A, Cornford T, Foster J (2003) Implementing and sustaining infrastructures: A question of when not what. Paper presented at the UKAIS Conference, WarwickGoogle Scholar
  23. McDonald CJ, Overhage JM, Mamlin BW, Dexter PD, Tierney WM (2004) Physicians, information technology, and health care systems: A journey, not a destination. Journal of the American Medical Informatics Association 11 (2):121-124CrossRefGoogle Scholar
  24. Overhage JM, Perkins S, Tierney WM, McDonald CJ (2001) Controlled trial of direct physician order entry: Effects on physicians’ time utilization in ambulatory primary care internal medicine practices. Journal of the American Medical Informatics Association 8:361-371Google Scholar
  25. Rothschild JM, Keohane CA, Cook EF, Orav EJ, Burdick E, Thompson S, Bates, DW (2005) A controlled trial of smart infusion pumps to improve medication safety in critically ill patients. Critical Care Medicine 33(3):533-540CrossRefGoogle Scholar
  26. Safren MA, Chapanis A (1960a) A critical incident study of hospital medication errors - Part 2. Hospitals, 34:53, 65-68Google Scholar
  27. Safren MA, Chapanis A (1960b) A critical incident study of hospital medication errors - Part 1. Hospitals 34:32-34, 57-66Google Scholar
  28. Schroeder ME, Wolman RL, Wetterneck TB, Carayon P (2006) Tubing misload allows free flow event with Smart intravenous infusion pump. Anesthesiology 105 (2):434-435CrossRefGoogle Scholar
  29. Smith MJ, Carayon-Sainfort P (1989) A balance theory of job design for stress reduction. International Journal of Industrial Ergonomics 4:67-79CrossRefGoogle Scholar
  30. Smith MJ, Carayon P (1995) New technology, automation, and work organization: Stress problems and improved technology implementation strategies. The International Journal of Human Factors in Manufacturing 5(1):99-116CrossRefGoogle Scholar
  31. Weick KE (2001) Making Sense of the Organization. Blackwell Publishers, OxfordGoogle Scholar
  32. Weick KE, Quinn RE (1999) Organizational change and development. Annual Review of Psychology 50:361-386CrossRefGoogle Scholar
  33. Wetterneck TB, Skibinski K, Schroeder M, Roberts TL, Carayon P (2004) Challenges with the performance of failure mode and effects analysis in healthcare organizations: An IV medication administration HFMEATM. Paper presented at the Annual Conference of the Human Factors and Ergonomics Society, New Orleans, LAGoogle Scholar
  34. Wetterneck TB, Skibinski KA, Roberts TL, Kleppin SM, Schroeder M, Enloe M, Rough SS, Hundt AS Carayon P (2006) Using Failure Mode and Effects Analysis to plan implementation of Smart intravenous pump technology. American Journal of Health-System Pharmacy 63:1528-1538CrossRefGoogle Scholar
  35. Zink KJ (2002) A vision of the future of macroergonomics. In: Hendrick HW, Kleiner BM (eds) Macroergonomics: Theory, Methods and Applications. Lawrence Erlbaum Associates, Mahwah, New Jersey, pp 347-358Google Scholar

Copyright information

© Physica-Verlag Heidelberg 2008

Authors and Affiliations

  • Pascale Carayon
    • 1
  • Tosha B. Wetterneck
    • 1
  • Ann Schoofs Hundt
    • 1
  • Steve Rough
    • 2
  • Mark Schroeder
    • 3
  1. 1.University of Wisconsin-MadisonUSA
  2. 2.University of Wisconsin School of Medicine and Public HealthUSA
  3. 3.University of Wisconsin Hospital and ClinicsUSA

Personalised recommendations