For this assignment, you will go through a process of inquiry as you determine the methodology and evaluation for the Electronic Health Record (EHR) Practicum Project.

To Prepare:

· Review the attached articles and think about which project methodology and model are appropriate for your Practicum Project. How can you best evaluate the success of your project? 

· Conduct additional research to facilitate your analysis for your project. Evaluate the who, what, how, where, and when associated with each objective: Who will make what change, by how much, where, and by when? Consider the methods you could use to meet each objective. Devise your methodology in as much detail as possible to identify how you could meet each objective. For example, identify which professional organizations or regulatory bodies you would consult (by viewing their websites or contacting them directly) to gather evidence.

· Review the information on formative and summative evaluation in this week’s Learning Resources, and conduct additional research to facilitate your analysis for your project. How could you evaluate achievement of your Practicum Project objectives using formative and/or summative evaluation? Begin to develop an evaluation plan for your Practicum Project. View the Practicum Project Plan Overview document provided in this week’s Learning Resources. Consider the project planning guidelines included in the document as you prepare for this Discussion.

Assignment details:

Page length – 2 pages

– A description of your proposed Practicum Project. 

– Identify a project methodology that is appropriate for your project and explain why it will be valuable to use. 

– Then select the model you will use during your project and explain why it is appropriate for your project. 

– Next, summarize two theories that relate to your Practicum Project and evaluate their application to your experience.

– Explain how you will evaluate your Practicum Project. Specifically, describe a formative evaluation plan and a summative evaluation plan you will use. 

– Detail what the evaluations will measure and what information you can gain from the evaluations. 

– Then, describe any potential ethical issues that may occur as you complete your Practicum Project. 

– Explain how you will avoid or address these issues.

Possible references attached. 

Summative Evaluation

In: The SAGE Encyclopedia of Educational Research,

Measurement, and Evaluation

By: Anthony Jason Plotner

Edited by: Bruce B. Frey

Book Title: The SAGE Encyclopedia of Educational Research, Measurement, and Evaluation

Chapter Title: “Summative Evaluation”

Pub. Date: 2018

Access Date: June 19, 2022

Publishing Company: SAGE Publications, Inc.

City: Thousand Oaks,

Print ISBN: 9781506326153

Online ISBN: 9781506326139


Print pages: 1636-1637

© 2018 SAGE Publications, Inc. All Rights Reserved.

This PDF has been generated from SAGE Research Methods. Please note that the pagination of the

online version will vary from the pagination of the print book.

An evaluation is a systematic and purposeful collection and analysis of data used to document the

effectiveness of programs or interventions. Rigorous evaluation can determine if programs or interventions

should be maintained, improved, or eliminated. The term summative evaluation (sometimes referred to as ex-

post evaluation or outcome evaluation) was first introduced in the mid-1960s by Lee Cronbach and Michael

Scriven and refers to a process of evaluating a program’s or intervention’s impact or efficacy through careful

examination of program design and management. It is often used to assess the accountability of a program

or intervention. As such, summative evaluation is outcome focused more than process focused and most

often undertaken at the end of the project, when the program or intervention is stable and/or when program

services are implemented with consistency (otherwise known as fidelity). Furthermore, there are some types

of summative evaluation that require the collection of baseline data in order to provide a before and after

understanding; thus, it is important to factor this into the evaluation. Summative evaluation is undertaken to

determine whether the program or intervention achieved its goals, objectives, or outcomes; how the program’s

impact compares to different programs; and to better understand the process of change, what works, what



In: The SAGE Encyclopedia of Educational Research,

Measurement, and Evaluation

By: Dominica McBride

Edited by: Bruce B. Frey

Book Title: The SAGE Encyclopedia of Educational Research, Measurement, and Evaluation

Chapter Title: “Evaluation”

Pub. Date: 2018

Access Date: June 19, 2022

Publishing Company: SAGE Publications, Inc.

City: Thousand Oaks,

Print ISBN: 9781506326153

Online ISBN: 9781506326139


Print page: 624

© 2018 SAGE Publications, Inc. All Rights Reserved.

This PDF has been generated from SAGE Research Methods. Please note that the pagination of the

online version will vary from the pagination of the print book.

Evaluation is a process, discipline, and, in some cases, an intervention in and of itself. It entails the systematic

application of social science research to plan for and learn about the impact of policy, performance, programs,

or initiatives in order to create, further, or sustain social change. The policies, performances, and initiatives

being evaluated are called evaluands. Evaluation is performed in sociopolitical environments and political

influences, and their implications must be considered throughout the process.

From struggles to provide quality education and public health, to environmental dilemmas, societies across

the world face issues that often require planning, policy, and subsequent action to address. Unfortunately,

strategies often do not obtain the desired effect because projects are not implemented as planned, policies

are disconnected from the communities they are supposed to benefit, or programs are not well planned.

According to evaluation expert Michael Scriven, evaluation examines the merit and worth of the evaluand.

However, the examination is often not the end but the means to making change through contributing to a

decision or using the results for advocacy purposes, as in the transformative paradigm, a framework for

evaluation that places importance on groups that have been marginalized. For example, the purpose of an

evaluation of a school district’s new progra

Evaluation of People, Social, and

Organizational Issues – Sociotechnical

Ethnographic Evaluation


Yale Center for Medical Informatics, Yale University, New Haven, CT, USA

Abstract. Sociotechnical approaches are grounded in theory and evidence-based.

They are useful for evaluations involving health information technologies. This

contribution begins with an overview of sociotechnical theory and ethnography.

These theories concern interactions between technology, its use, people who use or

are affected by it, and their organizational and societal situations. Then the

contribution discusses planning and designing evaluations, including frameworks

and models to focus an evaluation, and methodological considerations for

conducting it. Next, ethical issues and further challenges and opportunities are

taken up. Concluding case examples, referenced throughout, illustrate how good

evaluations provide useful results to help design, implement, and use health

information technologies effectively.

Keywords. Evaluation studies, organizational studies, ethnography, medical

informatics, qualitative research, qualitative evaluation, organizational culture,

organizational case studies.

1 Introduction

Successful implementation involves interactions and mutual adjustments among an

information technology application and the organization, people, and practices where it

is used. Sociotechnical evaluation analyzes this interplay between technologies and

social and technical systems. It emphasizes how people, organizations, professions,

culture, work practice, ethical issues, social and political environment, and the like, all

interact and change each other over time. Sociotechnical analyses assess how

information technology and workflow influence each other; how clinical and patient

roles relate to technological use; how useful and usable health information technologies

are; and what consequences, patient safety issues, or user responses might occur. They

involve considering these interdependent elements as a holistic dynamic network rather

than as fixed pre-defined separate domains [1,2,3,4].

For example, Example 1 indicates that using images, and incorporating clinical

images into on-line electronic patient records, depends not only on the computer

system, but also on interwoven issues of expertise, trust and relationships among

colleagues, clinical knowledge of individual patients, institutional priorities, how

Corresponding author: Prof. Dr. Bonnie Kaplan, Yale Interdisciplinary Center for Bioethics, Box

208293, 238 Prospect

‘‘Learning’’ From Other Industries
Lessons and Challenges for Health
Care Organizations

Amer Kaissi, PhD

Although it is true that health care has several distinguishing characteristics that set it apart,
analysts both within and outside the industry point to several similarities with other fields and
suggest opportunities for health care to learn from other industries. Applications from other
industries have been described in the literature, but the transfer of learning at health care industry
level has not been examined. This article investigates health care learning from other industries in
the recent decade, focusing on aviation, high-reliability organizations, car manufacturing, tele-
communication, car racing, entertainment, and retail; evidence suggests that most innovative
practices originate with these fields. The diffusion of innovations from other industries appears to
start with a few early adopter organizations (hospitals and health systems) and influential other or-
ganizations (The Joint Commission, Institute of Medicine, Agency for Healthcare Research and Quality,
or Institute for Healthcare Improvement) pushing for the innovations. Once the trend becomes
accepted, consultants and copying behavior seem to contribute to its spread across the industry. An
important question to explore is whether the applications in the early adopter organizations are
different (in terms of their effectiveness) from those in the rest of the industry. Another intriguing issue
is to examine whether other industries learn from health care organizations. Key words: health care,
innovation, knowledge transfer, learning

HEALTH CARE MANAGERS typically de-scribe their organizations as ‘‘unique’’
and ‘‘different’’ and rave about the distinctive
aspects of working in an industry where

actions directly impact patients’ lives.


agement guru Peter Drucker


health care as the most difficult, chaotic,

and complex industry to manage and sug-

gested that the hospital is ‘‘altogether the

most complex human organization ever


Although it is true that health
care has several distinguishing characteristics

that set it apart, analysts both within and

outside the industry point to several similar-

ities with other fields and suggest opportu-

nities in which health care can learn from
other industries.

In the last 10 years, a number of popular

books have stressed similarities with other

industries and recommended learning oppor-

tunities for health care organizations. In Why

Hospitals Should Fly? Nance

stressed prin-

ciples from aviation that health care organiza-

tions must instill as a foundation for safety.

Lately, Gawande

in The Checklist Manifesto

investigated the finan

The Triangle Model for evaluating the effect of health
information technology on healthcare quality
and safety

Jessica S Ancker,1,2,3 Lisa M Kern,2,3,4 Erika Abramson,1,2,3,5 Rainu Kaushal1,2,3,4,5

With the proliferation of relatively mature health
information technology (IT) systems with large numbers
of users, it becomes increasingly important to evaluate
the effect of these systems on the quality and safety of
healthcare. Previous research on the effectiveness of
health IT has had mixed results, which may be in part
attributable to the evaluation frameworks used. The
authors propose a model for evaluation, the Triangle
Model, developed for designing studies of quality and
safety outcomes of health IT. This model identifies
structure-level predictors, including characteristics of: (1)
the technology itself; (2) the provider using the
technology; (3) the organizational setting; and (4) the
patient population. In addition, the model outlines
process predictors, including (1) usage of the
technology, (2) organizational support for and
customization of the technology, and (3) organizational
policies and procedures about quality and safety. The
Triangle Model specifies the variables to be measured,
but is flexible enough to accommodate both qualitative
and quantitative approaches to capturing them. The
authors illustrate this model, which integrates
perspectives from both health services research and
biomedical informatics, with examples from evaluations
of electronic prescribing, but it is also applicable to
a variety of types of health IT systems.

The potential for health information technology
(health IT) to improve the quality and safety of
healthcare is the primary impetus behind the
federal electronic health record (EHR) incentive
program.1 2 However, previous research on the
effects of health IT on healthcare delivery has had
mixed results, with some studies finding improve-
ments and others showing no effect or adverse
effects on quality or safety.3e8

Mixed findings such as these may be in part due
to the evaluation frameworks that have been used
to assess associations between the quality and
safety outcomes and the predictor variabledthat is,
the health IT itself. For example, several of these
studies were beforeeafter studies, which examined
the outcomes of interest before and after the
introduction of a technology. However, it may not
be sufficient simply to categorize a study period by
whether or not a specific technology was present.
For example, two similar healthcare delivery
settings with EHRs or computerized provider order
entry (CPOE) systems may be very different from
each other, because even the same product will be

customized with site-specific configuration of
features such as order sets and interfaces with other
clinical systems. Training and implementation
procedures also differ between institutions and
time periods. Furth























i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 8 2 ( 2 0 1 3 ) e1–e13

j o u r n a l h o m e p a g e : w w w . i j m i j o u r n a l . c o m

rganizational framework for health information technology

elga E. Rippen ∗, Eric C. Pan, Cynthia Russell, Colene M. Byrne, Elaine K. Swift
estat, 1600 Research Blvd, Rockville, MD 20850, United States

r t i c l e i n f o

rticle history:

eceived 21 June 2011

eceived in revised form

0 October 2011

ccepted 26 January 2012



ealth information technology


rganizational framework


a b s t r a c t

Purpose: We do not yet know how best to design, implement, and use health information

technology (IT). A comprehensive framework that captures knowledge on the implemen-

tation, use, and optimization of health IT will help guide more effective approaches in the


Methods: The authors conducted a targeted review of existing literature on health IT imple-

mentation and use, including health IT-related theories and models. By crosswalking

elements of current theories and models, the authors identified five major facets of an

organizational framework that provides a structure to organize and capture information on

the implementation and use of health IT.

Results: The authors propose a novel organizational framework for health IT implementation

and use with five major facets: technology, use, environment, outcomes, and temporality.

Each major facet is described in detail along with associated categories and measures.






Conclusion: The proposed framework is an essential first step toward ensuring a more con-

sistent and comprehensive understanding of health IT implementation and use and a more

rigorous approach to data collection, measurement development, and theory building.

© 2012 Elsevier Ireland Ltd. All rights reserved.

and to indicate gaps where further knowledge is needed.

. Introduction

ow can we maximize the benefits and minimize the risks
f health information technology (IT)? We do not yet know
ow best to design, implement, and use health IT. Although

here are stellar applications that are implemented success-
ully on all fronts within a given organization [1], it is too often
he case that applications are partially implemented, imple-

ented but never used, or implemented with d

Formative Evaluation

In: The SAGE Encyclopedia of Educational Research,

Measurement, and Evaluation

By: Theodore J. Christ & Jessie Kember

Edited by: Bruce B. Frey

Book Title: The SAGE Encyclopedia of Educational Research, Measurement, and Evaluation

Chapter Title: “Formative Evaluation”

Pub. Date: 2018

Access Date: June 19, 2022

Publishing Company: SAGE Publications, Inc.

City: Thousand Oaks,

Print ISBN: 9781506326153

Online ISBN: 9781506326139


Print pages: 697-699

© 2018 SAGE Publications, Inc. All Rights Reserved.

This PDF has been generated from SAGE Research Methods. Please note that the pagination of the

online version will vary from the pagination of the print book.

Evaluation is the process of examining a program, procedure, or product to estimate its function, effect,

and worth. There are two main functions of program evaluation in education. The first is to inform the

development and implementation of the program. The second is to estimate the outcomes and program

effects. Formative evaluation is the use of data before and/or during instruction or the implementation of

an intervention. These data are specifically used to improve and inform curriculum planning, instructional

design, and learning. The goal of formative evaluation is to meet the specific needs of students by identifying

those objectives that have and have not been mastered by the student and determining what needs to

be taught, individualizing educational programs for all students. Most importantly, formative evaluation is a

cyclical process that includes planning, managing, delivering, and evaluating instruction, learning, programs,

and interventions.

Formative evaluation allows for ongoing, real-time adaptations and modifications to aid in the development

of empirically developed and empirically informed instruction or intervention practices. While formative

evaluation aims to ensure that specific goals and objectives are being met, it also allows for improvements

to be made. Formative evaluation can involve the use of both quantitative


Understanding innovators’ experiences of barriers
and facilitators in implementation and diffusion of
healthcare service innovations: a qualitative study
Julie Barnett1, Konstantina Vasileiou1*, Fayika Djemil2, Laurence Brooks1 and Terry Young1


Background: Healthcare service innovations are considered to play a pivotal role in improving organisational
efficiency and responding effectively to healthcare needs. Nevertheless, healthcare organisations encounter major
difficulties in sustaining and diffusing innovations, especially those which concern the organisation and delivery of
healthcare services. The purpose of the present study was to explore how healthcare innovators of process-based
initiatives perceived and made sense of factors that either facilitated or obstructed the innovation implementation
and diffusion.

Methods: A qualitative study was designed. Fifteen primary and secondary healthcare organisations in the UK,
which had received health service awards for successfully generating and implementing service innovations, were
studied. In-depth, semi structured interviews were conducted with the organisational representatives who
conceived and led the development process. The data were recorded, transcribed and thematically analysed.

Results: Four main themes were identified in the analysis of the data: the role of evidence, the function of inter-
organisational partnerships, the influence of human-based resources, and the impact of contextual factors. “Hard”
evidence operated as a proof of effectiveness, a means of dissemination and a pre-requisite for the initiation of
innovation. Inter-organisational partnerships and people-based resources, such as champions, were considered an
integral part of the process of developing, establishing and diffusing the innovations. Finally, contextual influences, both
intra-organisational and extra-organisational were seen as critical in either impeding or facilitating innovators’ efforts.

Conclusions: A range of factors of different combinations and co-occurrence were pointed out by the innovators
as they were reflecting on their experiences of implementing, stabilising and diffusing novel service initiatives. Even
though the innovations studied were of various contents and originated from diverse organisational contexts,
innovators’ accounts converged to the significant role of the evidential base of success, the inter-personal and
inter-organisational networks, and the inner and outer context. The innovators, operating themselves as important
champions and being often willing to lead constructive efforts of implementation to different contexts, can
contribute to the promulgation and spread of the novelties significantly.

The ability to innovate is considered as a major compe-
titive advantage in organisations, enhancing their effec-
tiveness, efficiency, a

Sociotechnical Analyis of a Neonatal ICU

Leanne CURRIE,a,b,e Barbara SHEEHAN,a Phillip L. GRAHAM III,c,e
Peter STETSON,b,d,e Kenrick CATO, a and Adam WILCOX b,d,e

aSchool of Nursing, bDept of Biomedical Informatics, cDept of Pediatrics,
dDept of Medicine,Columbia University;

and eNew York Presbyterian Hospital, New York, N.Y, USA

Abstract: Sociotechnical theory has been used to inform the development of computer systems in the
complex and dynamic environment of healthcare. The key components of the sociotechnical system are the
workers, their practices, their mental models, their interactions, and the tools used in the work process. We
conducted a sociotechnical analysis of a neonatal intensive care unit towards the development of decision
support for antimicrobial prescribing. We found that the core task was to save the baby in the face of
complex and often incomplete information. Organizational climate characteristics were pride in clinical and
educational practice. In addition, the structure of work identified interdisciplinary teamwork with some
communication breakdown and interruptive work environment. Overall, sociotechnical analysis provided a
solid method to understand work environment during the decision support development process.

Keywords: Sociotechnical analysis, Clinical decision support

1. Introduction

Clinical information systems are gradually being integrated into the healthcare
environment. Many systems have shown improvement in preventing medical errors[1],
however, some systems have resulted in increasing medical errors [2]. One of the main
reasons attributed to failed systems is lack of understanding of the sociotechnical
environment before, during and after system implementation [2, 3]. Sociotechnical
theory has been used to inform the development of systems in the complex and
dynamic environment of healthcare [4]. The key components of the sociotechnical
system are the workers, their practices, their mental models, their interactions, and the
tools (or artefacts) that are used in the work process. Proponents of sociotechnical
theory posit that with a deep understanding of the work processes and work
environment of the workers, technologies can be developed to support the work, rather
than having technologies replicate poorly designed non-technical systems.

2. Objective

The purpose of this study was to examine the sociotechnical environment of the
neonatal intensive care unit prior to the development of a clinical decision support
system for antibiotic prescribing and management. Ethnographic observations, focus
groups and key informant interviews were conducted with clinicians responsible for
antimicrobial prescribing with the goal of understanding the sociotechnical

3. Background

Safety scientists have used sociotechnical theory to understand complex systems such
as work related



The Technology
Acceptance Model
Predicting Nurses’ Intention to Use
Telemedicine Technology (eICU)



Information technology has been used in healthcare de-
livery systems to improve patient safety and patient
care outcomes worldwide.1–3 The importance of infor-
mation technology was recognized by the Institute of
Medicine4 in 2000 when they released the report entitled,
To Err Is Human; the report recommended increased
efforts to incorporate information technology into the de-
livery of patient care, and since that time, there has been
a remarkable effort on the part of many organizations
(Leapfrog Group, the National Patient Safety Foundation,
the Institute for Healthcare Improvement, and the Joint
Commission) to improve patient safety by supporting the
use of information technology. All of these organizations
have encouraged the implementation of information tech-
nology to prevent human error.5

A high incidence of adverse events and medical errors
has been found in critical care settings (ICUs).6–8 The
Leapfrog Group, the National Quality Forum, and the
Agency for Healthcare Research and Quality have all
recommended that the ICUs be staffed exclusively with
board-certified critical care physicians (intensivists) who
will respond immediately to provide patient manage-
ment, thus decreasing medical errors and adverse events
and reducing hospital mortality rates.7,8

A shortage of critical care physicians and nurses makes
it difficult to comply with the recommendation. During
the night shift and weekend hours, it is more difficult
to have critical care physicians covering for the ICU
patients.8 Therefore, it has been proposed that tele-
medicine technology, eICU (remote ICU or electronic

ICU) be used as a possible alternative solution that allows
critical care nurses and physician intensivists to monitor
ICU patients from off-site locations. The rationale is that
patients can be more intensively monitored, thus decreas-
ing adverse events and improving patient outcomes.5,6,8

As of 2008, this technology, eICU, was implemented
in 28 states covering more than 200 hospitals and 40
healthcare systems.9 According to several studies,6,8–11

the eICU technology system has many advantages over

CIN: Computers, Informatics, Nursing & July 2011 411

CIN: Computers, Informatics, Nursing & Vol. 29, No. 7, 411–418 & Copyright B 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

The purposes of this study were to determine

factors and predictors that influence nurses’ in-
tention to use the eICU technology, to examine
the applicability of the Technology Acceptance

Model in explaining nurses’ intention to use the
eICU technology in healthcare settings, and to
provide psychometric evidence of the measure-