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.