An Integrative Review of the Literature on Technology Transformation in Healthcare

Healthcare transformation through technology is a core objective of health reform. It is important for decision makers to understand the likelihood that reform policies will in fact transform. This study evaluates evidence of technology transformation in healthcare through an integrative review of the healthcare and business literature, guided by the theory of punctuated equilibrium (TPE). TPE describes the process of transformation within organizations, markets, and groups. The theory explains transformation as a pattern of long periods of incremental change (equilibrium) punctuated by short periods of dramatic change (revolution). An underlying deep structure defines the environment of the organization, market, or group. Radical change in the deep structure of the environment is necessary for transformational change. This integrative review covered the period January 2004 through April 2012. The inclusion criteria required that the article or study address both the implementation of health information technology in the United States and describe one of the three components of TPE. Five hundred twenty articles focusing on transformational change were identified through structured database searches of MedLine/PubMed, Business Source Complete, Social Science Research Network, and others. The articles were reviewed, and coded using the three elements of TPE. A directed content analysis of the coded data produced 10 themes describing the three TPE elements: variations in the environment, market complexity, regulation, flawed risk and reward, theories of technology acceptance, barriers, ethical considerations, competition and sustainability, environmental elements of revolution, and internal elements of revolution. The results describe a healthcare market exhibiting strong equilibrium and substantial resistance to change from HIT. Minimal descriptions of the revolutionary element of TPE were evident. The deep structure of healthcare indicates that the historical provider and hospital-centered market prevails. Conditions that might encourage alteration of this deep structure were: empowering and engaging patients; updating care delivery models; and reducing market uncertainty. The revolutionary changes seen in other complex markets from banking to travel to manufacturing relied heavily on the power of the consumer to alter deep structure. Although the concept of patient centeredness was present in the literature there was little clarity regarding the patient as an agent of structural change. To our knowledge this is the first application of TPE to investigate technology transformation in healthcare. Others have demonstrated TPE as a viable model for explaining transformational change in other markets. The study is limited by the study timeframe and the absence of newer literature reflecting the impact of recent policy changes. Despite this limitation the findings suggest that TPE presents a potentially valuable framework to guide evaluation of the progress of policies that encourage transformation from technology. Some propose that altering the complex deep structure of healthcare may require a complete destruction of existing processes before new processes, innovations, and technologies can emerge. The Affordable Care Act (2010) and the meaningful use provisions of the HITECH Act (2009) are moving healthcare toward new patient centered models of care. Uncertainty around the future of reform policies from possible repeal or amendment likely contributes to resistance to transformational change. This may perpetuate the historical rational and incremental pattern of HIT advancement. Patients as consumers have the potential to influence change given the appropriate tools. The importance of consumers to the transformation process suggests that policies fostering technologies that integrate patients into new care delivery models are likely paramount to realizing technological transformation

St. Louis Currents: The Bi-State Region after a Century of Planning

This collection of essays by leading scholars examines urban issues facing the St. Louis region in the 2010 era, which is 100 years after the first city plan in the US in 1907

An Investigation into the Implementation of National Curriculum Design and Technology in a State Secondary School

The thesis deals with the process of curriculum change initiated by the British government's decision to include a national curriculum requirement in its Education Reform Act of 1988. The particular focus is on the development of the subject of Design and Technology, which was the only new subject in the national curriculum, and which, in the secondary phase, was required to be taught cooperatively by teachers of several existing subjects. The thesis demonstrates the need to combine two approaches to curriculum change in order to understand the process. The first is that typified by the work of Goodson, who maintains that subjects develop through the activities of disparate interest groups. The second is that typified by the work of Fullan, who maintains that change will only be successful if those involved are enabled to construct their own meaning for the change. Combining these two approaches at school level (which is a development of the approach of Goodson, who deals mostly at national level), demonstrates the complexity of the change process, and the need for a change strategy that handles this complexity. In summary, the thesis is that the existence of many interest groups in the new area of design and technology in the national curriculum makes the processes of specifying the subject at national level, and implementing it at school level, difficult and controversial. For the processes of curriculum change to take place effectively, a strategy for change is required that recognizes the conditions within which teachers work, and the structures of organization and meaning that support their work. In the case of subject teachers in secondary schools, this means recognizing the influence of subject and departmental interest groups, as well as the influence of school organizational structures. Failure to apply such a strategy inhibits the change process and may result in outcomes that are less satisfactory then is desired

The end of stigma? Understanding the dynamics of legitimisation in the context of TV series consumption

This research contributes to prior work on stigmatisation by looking at stigmatisation and legitimisation as social processes in the context of TV series consumption. Using in-depth interviews, we show that the dynamics of legitimisation are complex and accompanied by the reproduction of existing stigmas and creation of new stigmas

Corporate Social Responsibility

This Edited Volume Corporate Social Responsibility is a collection of reviewed and relevant research chapters, offering a comprehensive overview of recent developments in corporate behavior. The book comprises single chapters authored by various researchers and edited by an expert in the field. All chapters are complete in themselves but united under a common research study topic. This publication aims at providing a thorough overview of the latest research efforts by international authors and opening new possible research paths for further novel developments

Research on social policy : proposals for a future agenda

Spanish version available in IDRC Digital Library: Investigación en política social : propuestas para una agenda futur