Interactive sociotechnical analysis: Identifying and coping with unintended consequences of IT implementation

Many unintended and undesired consequences of healthcare information technologies (HIT) are generated by interactions between newly introduced HIT and the existing healthcare organization's sociotechnical system--its workflows, culture, social interactions, physical environment, and technologies. This chapter presents and illustrates a model of these interactions that we call interactive sociotechnical analysis (ISTA). ISTA places special emphasis on recursive processes (i.e., feedback loops that alter the uses of the newly introduced HIT) promote second-level changes in the social system, and sometimes lead to changes in the new HIT systems themselves. We discuss ISTA's implications for improving HIT implementation practices and suggest how clinicians, IT specialists, and managers can better anticipate likely consequences of introducing HIT; more effectively diagnose unforeseeable consequences which emerge during implementation; and better respond to these emerging consequences.