On February 16th, a new book by Chip and Dan Heath, Switch: How to Change Things When Change is Hard will be released. Authors discuss the psychological impact of change and its relationship to the environment. TechCrunch describes this phenomena as "The War on Interruptions."
... people behave differently when their environment changes. When we’re in
a place where people are quiet (church), we’re quiet. When we’re in a
place where people are loud (stadiums), we’re loud. When we’re driving
and the lanes narrow, we slow down. When they widen, we speed up again.
This may seem obvious, but when we try to make change at work, we often
make the mistake of obsessing about the people involved rather than
their environment. Often the easiest way to drive change is to shape
The excerpt continues with discussion about the relationship between change and the environment. A researcher at Kaiser Permanente studied the effect of "quiet time" for medication dispensing by nurses. Nurses wore a bright colored vest (which they hated) when dispensing medications and all other personnel at the hospital were instructed not to disturb nurses wearing these vests. During the research period, medication errors were down for all groups, except for the group that did not participate in the study; their error rate increased.
I participated as a researcher in the effects of working conditions on nurses. We found that working conditions affected the ability of nurses to perform. When things were not quite right, nurses found workarounds to meet their objectives. Problems were often encountered in areas that were noisy, filled with multiple interruptions and/or distractions, and when supplies were not readily available, among other things. Depending on the magnitude of the workaround, patients could have been at risk for adverse events.
As a nurse, I encountered similar problems. So, when I was dispensing medications I permitted no distractions. Interestingly, here's how it was interpreted by at least one nurse. She said, "People think you are rude when you hold up your hand at the medication dispense unit."
I thought that was interesting, so I asked her what she thought would be a better indicator of the fact that I did not wish to be interrupted at that moment. She said, "Hold up 1 finger to let them know you will be available in 1 minute." On my way home from work that day, I chuckled....which finger should I hold up? Now that would be rude!
The bottom line is that change, in any environment, is a wicked problem due to its inherent social complexity and the fact that every person, in every environment, is unique. Change is slow. The ability to affect changes in the way that people interact in their environment will take, among other things, time and patience.
We face these challenges now, in the life cycle of EHR adoption and from the HITECH Act.