3 RESEARCH METHODS
3.4 Analysis of the data
After gathering the data, the data was analyzed by conducting a content analysis with a deductive approach. According to Eriksson and Kovalainen (2008), deductive ap-proach has theory as its starting point. Theoretical aspects of a phenomenon act as a basis on which researchers can deduce a single hypothesis or various hypotheses. This approach is seen linear, as it proceeds from theory to empirical research.
According to Eriksson and Kovalainen (2008), content analysis is one of the analysis methods for textual analysis. Content analysis is more concerned with the contents and frequencies of the text rather than form, structure and meanings of the text. It is further concentrated on finding themes and patterns. Weber (1990) notes that content analysis includes classifying pieces of text into fewer content categories, which is done through coding. These pieces of text may include words, phrases or other units of text. They are places in the same categories based on the similar meanings they share. The process of content analysis can be done by following the process intro-duced by Weber (1990): 1) Define the recording units, 2) Define the categories, 3) Test coding on sample test, 4) Assess accuracy or reliability, 5) Revise the coding rules, 6) Return to step 3, 7) Code all the text, and 8) Assess achieved reliability or accuracy.
After conducting the interviews, the data was transcribed in Finnish language. There-after, the transcribed data was read through several times to get an overview of the data. After that key issues were extracted from the data – for example the issues af-fecting the commitment, usage and perception of the system outside of the Weick
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1995 scheme. After extraction, a theme was given for each extraction according to the main point of it. Finally, these themes were divided in the categorizations by Weick.
Here is an example of themes and categories were derived in the analysis process.
Table 2. Results of the content analysis: examples, themes and categories
Example from the interviews Theme Category Some feel that they are
complete-ly handicapped”
Reflection to
col-leagues Identity construction If my leader had very negative
attitude towards the change, it would be very difficult to help the process of this change myself.”
Leader’s attitude Social
Things do not happen at once, but they change constantly, like the previous system changed along the way. It is constant learning.
Big things happen at once, but then there will be all small changes.
Constant learning Ongoing
When people get access to their own health records, the profes-sionals need to adopt a new role.
Professionals work together with the patients to treat the patient; it is not anymore a relationship where professionals decide. It might be very different starting point.
External stakeholders Enactive of sensible environments
Even though I said in the begin-ning that the previous EPR change was kind of bigger, but now I see that this change is as big, just in an alternative way.
This change has different ele-ments.
Reflection to past Retrospective
47 3.5 Ethical considerations
In conducting academic research there are various ethical considerations, of which some have already been considered. These issues include for example voluntary par-ticipation, informed consents and anonymity of the participants. (Eriksson and Ko-valainen, 2008).
The participants in the study were involved voluntarily. According to Eriksson and Kovalainen (2008), research should not make the participants believe that they are required to participate to the research as study objects, for example because of their position in the organization. The organization that was chosen for this study was very large, thus having various participants available for this type of research.
It is also important to get informed consents from the participants of the study (Hirsjärvi and Hurme, 2010; Eriksson and Kovalainen, 2008; Koskinen et al., 2005).
The basic idea is that participants of the research have given their consents based on appropriate information. This may raise the problem of reactivity of the participants.
The information the researcher has to give for ethical consent from the participant may affect the results or affect the behavior of the participants. (Hirsjärvi and Hurme, 2010; Koskinen et al., 2005) Information about the topic and context of the interview was given to the interviewees for acquiring their consents. However, the themes of the interviews were not given beforehand in order to avoid affecting the results of the study.
Anonymity, privacy and confidentiality of the participants are important to maintain.
Anonymity of the participants is considered to be the first priority in the research.
(Eriksson and Kovalainen, 2008) These issues can be considered by keeping personal information confidential and the data has to be stored where unauthorized access can be avoided. Personal identification from the data was deleted and the anonymity was extended to include the case organization. After transcription, the anonymity of the participants was ensured by removing any identification. The anonymity of the mu-nicipality/health care district was also be ensured by avoiding the disclosure of the exact time and place of the change occurring.
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4 RESULTS OF THE EMPIRICAL RESEARCH
This section provides an examination of the results of the research. In examining the results, some identification is provided after the sample quotations. The participants are identified in here as employee 1 (E1), employee 2 (E2) etc. The quotations pre-sented in this section are the ones that are seen to represent the view of the partici-pants’ best. The quotations are free translations of the interview data that were con-ducted in Finnish.
4.1 The change process
The interviews showed that this process started from planning the change. Most of the interviewees felt that the planning was done solely by a special task force that had been comprised to go through this change in the information system. The work of the task force was left unclear for most participants of this research. However, they all knew who were involved in this task force and that it has a multi-professional group consisting of various professionals from different units of the organization.
Two of the participants took part in the planning phase of the process, which included a special task force from various organizations. The task force discussed about the requirements of building a Kanta-compatible system and about the need for structural reporting. An employee who participated in this phase told that here employees were asked concrete suggestions on how to design the system and what type of features should be involved in the EPR system.
After the planning stage there was a distinctive testing phase. There was a special test group formed for this purpose. This group was multi-professional that was given cer-tain parts of the system for testing. They were also asked for input in forms of feed-back and suggestions for further development.
All of the employees were included in the process at least at the education phase. The organization arranged a special day for educating the personnel for the usage of this new program. There were also employees educating the other employees, which al-lowed participation in the process as well. One of the interviewees told that she was
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asked to participate more, as a part of the education group. However, she felt she re-jected the invitation due to her work responsibilities. She felt that there have been opportunities to participate for all who have been willing, and that the organizers wanted even more educators that they found. However, contradictory she also noted that in these types of big organizations, it may be difficult to give enough opportuni-ties to participate.
After implementing the EPR system in the organization, there constant discussion about the problems in the system had taken place, and the employees were asked about these issues. This can also be found as a way for participation.
All in all, the interviewees felt that there was only little participation to the process before implementation of the system. This was even though all of the interviewees took part in some phases of the process, perhaps not in the planning stage. Surprising-ly, even the employees who participated in planning stages felt that their participation in the process was only minor. Many felt that their participation consisted mainly of the usage of the system and some suggested that the participation in the development of the program was rather informal.
“Some single things have been asked by some people, but definitely not everyone has been asked anything. It has been more as individual dis-cussions in the hallways.” (E1)
Another interviewee also felt that employees did not have many possibilities to partic-ipate or to affect the change:
“Employees do not have much to say, if the decision is made that the system is to be changed, then it is changed.” (E4)
However, this participant seemed to feel that the lack of participation comes from the nature of the change. This was a planned change that was forced in the entire organi-zation.
The main theme in the interviews was commitment to change. The employees were asked what factors they saw affecting their commitment to this change. This was asked to find some common factors amongst the employees. Related to the commit-ment, employees were asked about factors affecting their commitment towards usage
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of the system. The responses of the employees varied highly, indicating a highly indi-vidual process towards commitment. There were both external and internal factors affecting the employees. Surprisingly, the individuals were either affected by internal or external factors, not both when asked specifically. Thus, the employees could be divided to externally and internally motivated employees towards the usage of the system. Internal factors included one’s own character and professionality, while ex-ternal factors arose from the needs of the organization. The inex-ternally motivated inter-viewees seemed to be the ones stating also explicitly that change is constant in this era, and it cannot be avoided. Thus, people should accept that and perhaps even take changes as chances to develop professionally.
“I like to learn new things, and I like to keep up with the trends.” (E3) The employees were also asked to characterize their commitment to change according to the categorization by Meyer and Herscovitch (2001), who categorized commitment as affective commitment, continuance commitment and normative commitment. Here, the responses followed similar division as the responses in the previous section. There was a clear division to the interviewees that were internally motivated and the ones that were feeling external pressure to use the system.
Two of the employees identified themselves as affectively committed. They showed internal motivation and willingness towards the change.
“I have positive attitude towards implementing this new system. It would be terrifying if things always remained the same.” (E3)
“It is part of the professionalism that you have skills in information sys-tems. You cannot distance yourself from the systems if you are involved in patient work.” (E5)
In comparison three other participants felt that there is no choice but to use the sys-tem, which is often the case with information systems in organizations. Two of the participants identified themselves possessing features of both continuance and norma-tive commitment.
“It is not about my internal will, I use the system if I need it at my work.” (E4)
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Throughout the interviews, the participants referred to various factors that they felt affected their usage of the EPR system and attitudes towards this change. These both are related to commitment to this change – commitment to use the EPR system. The factors could be divided into factors affecting commitment positively and to negative-ly affecting factors.
The positive factors in this case could be categorized in five themes. These themes included usability related factors, personal traits of the employees and organizational support. Other themes included communication and external pressure.
Table 3. Factors affecting commitment positively Factors affecting commitment positively
responsibilities for external parties External pressure education such as will and motivation affect their commitment. They also suggested that if they
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are skilled to use the program they are more likely to commit. Same participants also suggested that information systems are embedded in their professional identities.
Some of the interviewees also noted that they are more responsible for external pties, which leads to commitment to this system. As patients get access to their ar-chives, the professionals are pushed to accept this new system. All of the participants noted, that organizational support plays an essential role in committing to change.
This comes both in forms of education and support.
Finally, communication was found as the biggest factor affecting commitment. The communication takes place with both colleagues and leaders. Leaders need to com-municate the need for the change and thus make it justified. They are also expected to inform employees throughout the process e.g. about progress and make employees feel that change is normal and nothing to be afraid of. Commitment is also enhanced through positive enforcement, referring to emphasizing the positive sides and positive communication atmosphere.
Similarly, the factors affecting commitment negatively could be categorized to five themes. These themes included personal traits, usability and nature of the change.
Also process related factors and work related factors were mentioned.
One of the main issues affecting commitment also negatively was the usability of the program. The many issues in workability, such as flaws, enforced a negative attitude towards the change process. Affecting the usability was also the magnitude of the change – the new system was more complex than the previous system. The reactive-ness to the flaws also caused issues in usability. Related to the usability issues were also personal traits – referring to people’s skills and readiness for the change.
There were also process and work-related challenges. The change process was seen troublesome in this organization, since leaders had given false perceptions about the program. The employees were given false impression that this new program was easi-er and fasteasi-er to use. Theasi-ere weasi-ere also issues in implementation conceasi-erning the time management, which caused also uncertainty of whether the system was even going to be implemented. The employees also felt that this new system was burdensome and time consuming, which decreased the willingness to use the system.
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Finally, one of the main issues for one of the interviewee was the nature of the change. This was a forced changed, thus commitment to this change lacked.
Table 4. Factors affecting commitment negatively Factors affecting commitment negatively
not as expected false expectations
process related uncertainty in implementation
problems in implementation hurry in implementation
forced change forced change nature of the change
nature of the work (work load)
burdensome
According to Weick (1995), sensemaking is an individual process where individuals build their identity upon upbringing and experiences. The identity of individuals is determined constantly in interaction with surrounding environment, which here was the working environment – for example colleagues and patients.
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The participants of this study were indirectly constructing their identity during their interviews. This was seen in as they compared themselves to other employees, thus describing themselves indirectly or directly. Here as examples one of the participants built her identity as a person accepting and encouraging change.
“I always think in the working life that I am given with some tools and said that work with these tools. I have never thought that I do not want to work with these tools that I am given. Now I have been seen that other do not accept the tools that are given.” (E5)
“But it is also good that change is a topic of discussion. Many people still hold the thought that why things cannot be as they used to be and why there are always changes and more changes. In my opinion it is the trend nowadays that you cannot avoid change. That world does not exist anymore. Many have not thought about that or accepted that this is all about adjusting.” (E5)
The change situation had also changed their view on themselves and their skills. One of the participants experienced insecurity and was questioning her professional abili-ties, while other participant noted this to take place in other employees.
“Perhaps because the program has been incomplete, I know that many think that they do something wrong when the program does not work.
Perhaps you first question yourself and your abilities as an user, but in this case the program has been flawed – which it should not have been.”
(E5)
An interviewee also mirrored her identity through the eyes of the customers. It was seen, that the system is essential part of the work and professional skills, thus it could be seen critical in determining also their professional identities.
“Others clearly need instructions only to the small and straightforward issues, so that they can hide behind the instructions – this is the instruc-tion, these is nothing else we can do.” (E1)
There seemed to be some construction of identity due to the changed tasks and work allocation, which is then seen to reflect in ones’ own work. One interviewee
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lighted her own personality in this process. She mentioned various times that she had a positive attitude towards the change, reinforcing the sense of herself.
“From the patients’ view it must be a bit rude when they are there and the professional starts to interact only with the computer, it is not a good thing.” (E1)
“Some feel that they are completely handicapped” (E1)
One of the participants indirectly discussed her identity issues. As reflecting to a pre-vious EPR change she has faced, she suggested that younger employees are better with IT-issues and thus they take system changes more lightly. In this, she viewed her identity changed over times and noting that older employees have stronger negative reactions to IT system changes. She also seemed to mirror herself to the possible reac-tion of her colleagues. This was done perhaps to give herself acceptance to the feel-ings she was experiencing – I can feel this way, because this is normal to others as well.
“Probably everyone experiences resistance at the beginning, I think.”
(E4)
Furthermore, the change and introduction of new EPR-system has forced the employ-ees to think about their own role. This has happened through making clear lines of one’s tasks and responsibilities and what is expected from them.
“There is lot to wright and it takes a lot of time, so I have started think-ing what is the most important ththink-ing in my job – it is treatthink-ing the pa-tients.” (E1)
“I haven’t thought that this change would have an impact to my work.
There are distinctive support personnel, whose task is to help and ad-vice.” (E4)
The employees seemed to have distanced themselves from the system and felt that it
The employees seemed to have distanced themselves from the system and felt that it