Critical examination of the evidence The impact of clinical leadership on health information technology adoption


This essay has been written from a perspective of a staff nurse who is working on her leadership skills and has questioned many times the importance of information technology incorporation in the healthcare organizations. I believe that the increased life average, the extension of patient’s past medical history in combination with the chronic diseases and the urgency to keep up with all the changes happening in our daily life have set the fleur of IT need in all the aspects of health sector. I work in an Intensive Care Unit, where information technology is highly demanded. Due to the unit’s acuity and also the general incidents we accept, good IT knowledge is a very important skill not only for the leader of the nurse or medical team, but also from the staff. Being a leader is generally difficult, but it is my firm belief that a leader in intensive care has to deal with extremely serious and life threatening conditions, as any decision has impact on the provided care. This opinion is also supported since the late ‘90s stated as following, “ within the professional nursing literature there has been general agreement that good nursing leadership is required to achieve good quality nursing care, (Cunningham & Whitby 1997, Allen 2000)’. In our field, IT is obviously needed for simple procedures, as the access of the electronic health record or the insertion of a new patient to the system. It is very frequently needed to check or double check guidelines and relevant protocols in order to provide the correct treatment to our patients. Time waits are reduced as blood result, drug’s levels, electrolytes and other supplements, can be easily accessible, plus X-Rays, CT and MRI scans results which are of great importance for a patients’ life can be delivered in minutes. A nurse leader of an intensive care unit needs to be knowledgeable and confident to use and deal with all this equipment and all the different programs, so that he/she can be effective, efficient and will also make the staff feel safe in the working area. It is his/her responsibility to support and educate the junior staff, so that fetal mistakes will be avoided.

I have chosen to appraise the systematic review by Tor Ingebrigtsen, Andrew Georgiou, Robyn Clay-Williams et al. (2014): “The impact of clinical leadership on health information technology adoption: Systematic Review”. The authors’ aim is to provide information and examine the associations between clinical leadership and information technology adoption.
The paper was appraised by using the CASP tool for systematic reviews.
To begin with, the paper appears to have a clearly defined question. The population has been correctly described; clinical leaders are mentioned as these who have been responsible/accountable for leadership in an organization that provides care. The authors clarify the kind of leaders who were included and also those who were excluded. In our systematic review, health IT and adoptions (???) appear to be the interventions and both have been nicely described. The first one is defined as any clinical information system used to deliver care or support its delivery and the second as the decision to obtain a system, its development, implementation, consolidation, ongoing use and iterative improvement. The outcomes were referred as degrees of success from the adaption and were also defined as organizational or clinical and examples of each one were given; but this term could have been analyzed more. Exclusion criteria were also clearly described.
It is stated that empirical studies have been included, while later on, the authors specify that most of them were qualitative and some results were combined with quantitative researches too. It is also clarified that all the studies were observational; and from those some were comparative studies (25%), longitudinal (9%) and cross-sectional (66%). However there was no referral of randomized controlled trials. So, it can be assumed that the studies, that were used, were sufficiently corresponded to the paper’s needs. We mentioned that no review questions were present, but good and correct variety of keywords, like health informatics, information systems, diffusion of innovation, decision making organizational, clinical competence, was used.
The inclusion criteria and the way the research of the literature was conducted appear to be quite thorough. According to the information given from the paper the authors checked for articles in Medline, Embase, Cinahl and Business Source Premier in a time scale from the January 2000 to May 2013 by using keywords and terminology associated with healthcare provider organization, health information technology, adoption and leadership, which cover the aspects of the topic. Also, supplementary files were provided. In addition, the authors have a section referred as “Data Collection Process” where the way data were categorized and organized by setting inclusion criteria is explained. Personal contact via in-depth discussions or e-mails was conducted in order to eliminate any vague points or differences. It is reported that 3,121 were reclaimed, but only 34 articles met the criteria from which two happened to overlap with two already recorded articles, so the paper was focused on the remaining 32. Furthermore, English, German and Scandinavian literature was searched, but only the English appeared to meet the research’s criteria. The included studies origin was from a variety of countries across the world, such as US, Western Europe, Canada, Asia or South America and Australia or New Zealand. Last but not least, it is highlighted that “grey literature” was not explored while snowball searching came up with a few new references.
As far as the quality of the results is concerned, the authors explain in depth the guidelines they used, which is the GRADE guidelines. They interpret exactly the terminology of it, mentioning that this is the most appropriate for quantitative studies. The discriminated categories were the following: Low observational studies, very low which had a serious risk of bias and moderate if there was a large intervention effect. The way the studies were appraised was thoroughly explained, as well. However, they were aware of the risk of the guidelines not being the suitable one, as our paper was mostly based (75%) on qualitative studies and they also refer that, by providing another source of improving the evaluation of studies which is the STARE-HI. They conclude by reporting that their estimation of quality of their studies was moderate and also justifying the statement. Overall, the authors provide a holistic picture of their method of assessing the quality of their results and they also justify all of their findings. {?????????????????? Need to look at the paper}
The authors aptly commented that the results of the studies complemented each other and they also classified the studies in groups depending on the similarities that were detected between them. They have described the associations, which were mainly positive between the variables of the studies and have clearly explained the kind of association and influence that was found. They , also provided the quality of the evidence, which was moderate in all the presented examples. Only two studies appeared to have negative impact and that was because the intervention was not supported successfully. The classification of the studies was interpreted by using tables and providing the common characteristics between the studies.
Considering the whole presentation of the results, we can assume that the interpretation of them was clear enough, as it was thoroughly explained. There was no display of percentages, odds ratio or any numerical evidence to support the evidence but the organization, the explanation of the results and the analysis of the risk of bias concluded in the best possible analysis of the outcome.

My aim is to enrich my knowledge on the field of clinical leadership in order to provide better skills and care when it will be needed. After searching in PubMed, Cochrane Library, Wiley Library, Journal of Research in Nursing I came up with a very interesting paper.

The better knowledge of the information technology and the adoption of the correct use of it will not only benefit the leader in their own practice but also the colleagues and the patients of my area. It will provide us with safer practice standards. as many significantly ill patients will be helped. As I already said, my practice is based in a general intensive care unit and the IT is closely associated with the nature of our job and has always been providing better results in decision making conditions, the delivery of care and also in the velocity of the treatment was provided.

expand my understanding on the topic and investigate more the association of clinical leadership and information technology according to the articles’ results.+++++++
In order to help my progress with the assignment and answer my question and find relevant studies to support good practice a literature search was completed using the data bases Pubmed, British Nursing Index, Ejournals and Medline Complete. (????????)

I will begin by critically appraising the Weaver (2014) paper. (???) The authors aim was to provide a review of the current state of team training science and practice in acute care settings and aim to seek if patients receive safer higher quality care when staff work as a highly effective team

1. “Learning for clinical leadership” Cook MJ1, Leathard HL. (2004)