Health IT Usage Behavior and Patient Safety

I recently read a report that offered a theoretical model of health it usage behavior and implications for patient safety.   The authors chose to focus on theories that could explain clinician HIT usage behavior because of the widely observed underuse and misuse of HIT and the associated patient safety consequences.  They claim it is important to understand that poor system design, through its effect on behavior, is the root of the problem.  That is, poorly designed systems facilitate or even encourage behaviors that may be contrary to expectations, policies or goals, and the models presented here make clear that the exogenous variables are system design factors.

Perhaps the most obvious case of a HIT whose efficacy suffers from underuse is that of medical error/incident reporting systems: up to 96% of medical errors are estimated to go unreported. Briefly, reporting systems are paper-based or electronic systems used by health care providers to report in some detail the occurrence of safety-related events. These events, depending on the system, may be instances of patient harm, near-misses, preventable errors that lead to harm, detected hazards that may lead to future harm, or combinations of these. Although reporting can have various purposes, the two main ones are learning and system improvement. As an example, consider a health care organizations that foster a culture of blame and shame, not only are needs not being met, but reporting may threaten vital needs. This is illustrated in Figure 1 below, where primary needs on the hierarchy are jeopardized when one reports in a blame culture. Examining Figure 1 provides a motivational explanation as to why many studies find that fear of punitive consequences deters many clinicians from reporting, whereas ethical obligations, small rewards, and a positive reporting culture tend to be motivators.

Figure 1. Needs met and jeopardized by the reporting of medical errors in a blame culture 

Here is a video that explains what happens when cultures move from blame to identifying root causes of the problem.