View source for From cacophony to harmony: A case study about the IS implementation process as an opportunity for organizational transformation at Sentara Healthcare

== First Review ==

This is a review for Chon Abraham and Iris Junglas’s ''From cacophony to harmony: A case study about the IS implementation process as an opportunity for organizational transformation at Sentara Healthcare''. <ref name="Abraham 2011"> Abraham, C., & Junglas, I. (2011). From cacophony to harmony: A case study about the IS implementation process as an opportunity for organizational transformation at Sentara Healthcare. The Journal of Strategic Information Systems, 20(2), 177-197. doi:10.1016/j.jsis.2011.03.005. http://www.sciencedirect.com/science/article/pii/S0963868711000217</ref>

=== Abstract ===

“The cacophony of criticisms emanating from an organization facing an information technology-enabled transformation can be deafening and deleterious. This is especially true in healthcare in the US, where information systems investments are typically huge and often perceived by change resistant stakeholders as disruptive or even potentially life threatening. We describe how the IS implementation process itself contributed to organizational transformation in terms of changes in coordination, culture, and learning at a successful organization, Sentara Healthcare, which transformed the discordant cacophony of the change process into a harmonious implementation” (p. 177,<ref name="Abraham 2011"></ref>).

=== Research Design and Methods ===

An in-depth case study was conducted using an established framework (business process change model (BPCM)) and employed qualitative, open-ended, extensive interviews with representatives from all stake-holder levels. 

=== Venue ===	 

Sentara Healthcare within North Carolina and Virginia – a network of 87 sites including seven hospitals and multiple outpatient facilities supporting over 319,000 members.

=== Findings ===

Analysis of interview results, observations, relevant documents and artifacts resulted in a set of eight insights valuable for managing the organizational transformation and process redesign that are necessarily parts of every Electronic Medical Record ([[EMR]]) implementation.

{| class="wikitable"
|+ Summary of Insights Adapted from Abraham and Junglas (2011) Table 2. 
|-
! BPCM Phase
! Insight
|-
| Link with strategy
| (1) Linking the IS implementation with the organizational strategy forefronts the need and requirements for information interdependence and efficient processes to bring about changes in coordination 
|-
| Plan the change
| (2) The planning strategy that stresses collaboration and involvement at all stakeholder levels is foundational for changes to come in professional and organizational culture
|-
| Analyze process problems
| (3) Analyzing problems collectively amongst stakeholders uncovers role and process transparency and accountability issues that need to be addressed to change culture
|-
| Process re-design
| (4) Process re-generation is an opportunity for educating and raising the collective medical acumen to promote changes in learning
|-
| Continuous Improvement
| (5) Improvement is an opportunity to ensure the appropriateness of the process owners for enhanced coordination
(6) Improvement is an opportunity to deter complacency or reliance on the system as a complete replacement for needed communication for enhanced coordination

(7) Improvement is an opportunity to understand the limitations of codification of data and compromise system requirements to afford better data analysis with necessity to articulate freely the art form of medicine

(8) Improvement is an opportunity to provide a means for enriched and continual learning that can be the basis for innovation
|}

=== Conclusion ===

[[Change management|Change management]] is an essential part of EMR implementation projects.  The EMR is a catalyst for organizational transformation.  Such transformations in healthcare settings impact patient well-being, system efficiencies and professional satisfaction.  The application of process change management tools and frameworks support successful project execution outcomes.   

=== Limitations ===

There may be limited generalizability of the findings because the case study focused on only one venue and, although this EMR implementation was deemed successful, many other factors aside from the stated insights contribute to implementation success, such as organizational culture, clinical champions, and experience of change agents.

=== Comments ===

I chose this article because I am aware of the immense challenges facing any organization implementing a new EMR or major redesign of an existing clinical information system.  The article includes a number of direct quotes from system users regarding "user assumptions" that cause workflow process bottlenecks and miscommunication, which I find illuminating.

== Second Review ==

Add next review here.

== References ==
<references/>


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