Organizational and Cultural Change Considerations

The implementation process by organizations for clinical decision support (CDS) programs might best be viewed as a delicate balancing act. Acceptance of CDS depends a great deal on the type of decision support, the reason for its use, how good it is, and the value the clinician places on it at any particular point in time. The balancing act is an organizational management and change management challenge. The challenge can be met only if sufficient staffing resources are available. Planning, prioritization, training, implementation, and evaluation are activities that need talented, committed, and high-level staff members-and there must be enough of them. The organization must be willing to dedicate significant ongoing financial resources to this endeavor. This chapter discusses organizational and cultural impediments to widespread CDS adoption. It describes how the type of hospital or health care institution may influence acceptance and implementation strategies concerning decision support, how issues of organizational and personal control and autonomy are associated with decision support, how different stakeholders view decision support, and how an analysis can be done to assist development of implementation and maintenance strategies.