A qualitative study of variations in participation

The Change readiness research method (CRR) has become a wellknown method in Denmark to identify issues needed to be discussed on a hospital ward before implementation of a new IT-system and to start a dialogue. A precondition for a constructive dialogue, however, is a high degree of participation. The latest experiences of the CRR method were gained from its use in eight wards in the Danish Gepka project during 2003-4 (The Gepka project was established by The Danish Ministry of the Interior and Health, The National Board of Health, the County Council Society and H:S. Its purpose is to validate the ”Basic Structure for The Electronic Health Record” (B-EHR) using prototypes. http://medinfo.dk/epj/proj/gepka/). In the Gepka project the participation varied from 33.3% to 78.9%. The objective of this study is to set out themes by which this variation can be studied. A qualitative explorative research design has been applied, where four instructions from the “Instruction for use” (Instructions for using the CRR method. Can be downloaded the Internet: (http://www.epjobservatoriet.dk/publikationer/forandringsparathed.pdf)) have been studied as themes. The methods used have been telephone interviews and direct observations. The results showed that the seven wards (one was excluded) followed the “Instructions for use” to different degrees. It was found that one instruction, in particular, seems to be especially important to follow to motivate the employees on a ward to participate in the CRR; the management of the ward must be engaged/actively involved in the project, as they are key figures when it comes to motivating the other ward employees. The aim of this study is not to prove a causal relationship between the degree to which the “Instructions for use” are followed and the degree of participation – it is to suggest a qualitative relationship between the two. Neither does this study try to generalize the results, as further research on more wards would be needed to do so. This study does, however, set out themes that can be a useful tool in future CRR projects in order to maximize the degree of participation. In a modified way, these themes can probably be used as a tool in other studies of human – machine interactions.