Implementing e-Health solutions in hospitals and medical environments can lead changes in processes, organization behavior and even organization chart. Since staffs have inertia against changes in their daily work, it can cause a range of behavior that called user resistance. The user resistance can be shown as, not using a new system or even make damage to system.
This assignment report has summarized some literatures about user resistance, reasons and strategies to overcome user resistance and some my own discussion and conclusions.
User resistance is a subjective process psychologically based at individual level. During implementation of information system, users may adopt or resist it based on their evaluation of change associated with the system (Montpellier). Several theories are introduced to estimate and examine systems usage and user resistance:
- Theory of Reasoned Action (TRA)
- Technology Acceptance Model (TAM)
- Theory of Planned Behavior (TPB)
- Diffusion of Innovation (DOI)
- Unified Theory of Acceptance and Use of Technology (UTAUT)
TRA explain that individual behavior is caused by behavioral intentions and behavioral intentions are a function of an individual's attitude. The attitude is defined as the positive or negative feelings about performing a behavior. (Furneaux 2005)
TAM is a version of Theory of Reasoned Action (TRA) in Information System filed. TAM posits that perceived usefulness and perceived ease of use determine an individual's intention to use a system with intention to use serving as a mediator of actual system use. Perceived usefulness is also seen as being directly impacted by perceived ease of use. (Furneaux 2005)
TPB like TRA suppose that behavior is driven by behavioral intentions. Behavioral intentions are a function of an individual's attitude toward the behavior. TPB suppose behavioral control that defined as one's perception of the difficulty of performing a behavior while TRA assume that each individual can act without limitation.(Furneaux 2005)
Diffusion of Innovation (DOI) describe the mechanism that innovation become successful. Important characteristic of innovation are relative advantage (the degree to which it is supposed to be better than old one), compatibility (consistency with existing values, past experiences and needs), complexity (difficulty of understanding and use), trialability (the degree that it can be experimented) and observability (the visibility of its outcomes). (Clarke May 1991)
The UTAUT explain user intention to use an Information System and following behaviors. This theory has four main areas: performance expectancy, effort expectancy, social influence, and facilitating conditions. User properties like gender, age, experience, and voluntariness of use. (Furneaux 2005)
Many researches had been done due to these theories to determine the user resistance or adaptation behaviour with information systems.
According to (Shang and Su 2004) the main reasons of user resistance summarized as below :
- Parochial self-interest (resist to prevent losing something of value)
- Losing power, role or status
- Loss of autonomy, control or specific skills
- Reduced scope for improvement or job insecurity
- Misunderstanding and lack of trust (misconceptions about benefits and gains)
- Confusion about changes during implementation
- Lack of knowledge in using new systems
- Different assessment (users see more costs than benefits unlike managers)
- Thinking that the no benefits will come with the new system
- Systems cannot provide real good experience
- Low tolerance for change (fear of not sufficiently developing the skills and behaviour required)
- Be afraid of losing certain aspects of the current situation
- Role conflict and ambiguity within the organization
- Change of relationships
- Higher skill levels need for a job
- Increased efforts (additional efforts or abilities needed for the job)
- More effort in performing tasks in view of increased in monitoring ability
- Need to spend more time for work
User Resistance can observe as several behaviours, Non-destructive like request for job transfer, increase absenteeism or delays Proactively-destructive like making careless mistakes, consciously disrupt work process and Passively destructive like refuse cooperate with other users, neglect work assignments, waste time and make little effort to improve work related knowledge and skills, accept lower quality performance, conflict with consultants.(Shang and Su 2004)
Several strategies that proposed for dealing with user resistance in (Shang and Su 2004; Nasir, Kamal et al. 2008; Tavassoli and Toland 2008) can categorize to Participative , Directive and Consultative as below:
- Directive (Using managerial authority)
- Power redistribution
- Job elimination for those do not use the new system
- Reward ideas about new system
- Arrange for voluntary job transfer for users with no interest in new system
- Participate (Using participation of users )
- User Participation to increase user ownership
- End-User Training
- End-User Support
- Using User Cantered Design (UCD)
- Using Human Computer Interaction (HCI) to increase usability
- Consultative (Provide information and moral support for users)
- Provide individual discussions
- Provide group therapy to increase user adjust
- Listen to emotions and provide support
- Perform orientation sessions to prepare for new system
(Tavassoli and Toland 2008) investigates an effectiveness of these strategies by surveys from IT project managers in New Zealand. This research shows that different forms of communications, end-user participation, training and support are frequently uses to overcome end-user resistance. Those project managers ranked effectiveness of those strategies as depicted in Figure 1.
As summarized in Literature study part, several researches study about the end-user resistance in IT projects or other changes in organization processes and provide the ideas about dealing with user resistance. However each project and health organization like hospitals and clinics may need another specific strategy depend on their users and organizational behavior.
Different approaches in implementing IT projects exists, for instance the hospital can buy a Hospital Management System (HIS) as a product or design and implement a new system. It?s clear that in first case (buy a product), some organizational process need to compatible with HIS system and these changes will introduce more user resistance. For second case (design a new system) using Big-Bang methodologies like waterfall methods can introduce more resistance compare to iterative methodologies like Rational Unified Process (RUP). Big-Bang methodologies users participate in analysis and design phase and then face the ready system after finishing the implementing phase, in other hand iterative methodologies provide an executive prototypes in number of iterations to get feedback of users.
Another parameter of end-user resistance is familiarity of user with product and power of its brands. For example forcing most users to use MS Office 2007 could be simpler than Star Office, even if Star Office has better usability and cost so using unfamiliar brands in organization probably needs more effort to overcome user resistance.
Is User Resistance Useless? The positive or negative answer depends on view of individuals. It can consider as reason of project failure, source of increasing project cost and time or even the reason of increasing quality of the system. User resistance in different views summarized in Table 1.
- View of User Resistance
- Project Manager
- Project Failure (Negative)
- Increase Effort and Cost (Negative)
- Increase Time (Negative)
- Project Owner
- Project Failure (Negative)
- Increase price (Negative)
- Increase time (Negative)
- Increase Quality and Usability (Positive)
- End-User resistance exists towards any changes in organization like implementing an IT project.
- Several factors like innate resistance to change, loose of power, low usability of system, insufficient training, lack of support and etc are the source of user resistance.
- Different approaches like user participation, training, support, communication and consultant can use for dealing with user resistance.
- User resistance can consider positive or negative in different views.
- Clarke, R. (May 1991, ? Xamax Consultancy Pty Ltd). "A Primer in Diffusion of Innovations Theory ". Retrieved 7 Apr 2010, from http://www.rogerclarke.com/SOS/InnDiff.html.
- Furneaux, B. (2005). "Technology Acceptance Model (TAM)." Retrieved 7 Apr 2010, from http://www.istheory.yorku.ca/Technologyacceptancemodel.htm.
- Furneaux, B. (2005). "Theory of Planned Behavior (TPB)." Retrieved 5 Apr 2010, from http://www.istheory.yorku.ca/theoryofplannedbehavior.htm.
- Furneaux, B. (2005). "Theory of Reasoned Action (TRA)." Retrieved 7 Apr 2010, from http://www.istheory.yorku.ca/theoryofreasonedaction.htm.
- Furneaux, B. (2005). "Unified Theory of Acceptance and Use of Technology (UTAUT)." Retrieved 7 Apr 2010, from http://www.istheory.yorku.ca/UTAUT.htm.
- Montpellier, F. "?AVOIDING MANAGEMENT? OF RESISTANCES DURING IT PRE-IMPLEMENTATION PHASE: A LONGITUDINAL RESEARCH IN A HIGH TECH CORPORATION."
- Nasir, M., M. Kamal, et al. (2008). "Human Computer Interaction Approach in Developing Customer Relationship Management." Journal of Computer Science 4(7): 557-564.
- Shang, S. and T. Su (2004). Managing User Resistance in Enterprise Systems Implementation.
- Tavassoli, L. and J. Toland (2008). "Strategies for Dealing with End-User Resistance." ACIS 2008 Proceedings: 88.