Barriers to reforming the U.S. health care system for patient safety: A study of ten years of policy implementation for three Health Information Technology (HIT) strategies

Agatha Louise Nolen, Tennessee State University


Purpose: This dissertation research attempted to examine the first 10 years of policy implementation for Health Information Technology (HIT) in three patient safety systems (Barcode Medication Administration (BCMA), Computerized Prescriber Order Entry (CPOE), and Electronic Health Records (EHRs), since the landmark IOM report, To Err Is Human showed that 98,000 deaths occur in hospitals each year due to preventable medical errors. After ten years, there are still relatively few hospitals that have implemented these strategies. Research Questions: What implementation barriers exist, which policies have impacted HIT implementation, and what potential policies would impact HIT implementation. Data and Methodology: A mixed methods design incorporated a quantitative model: an electronic survey administered to key executives in 164 Hospital Corporation of America (HCA) hospitals to determine barriers and perceptions of policy impacts and a qualitative model with telephone interviews to key executives at six facilities in Florida, Tennessee and Texas to determine why barriers exist, why policies have impacted implementation and to determine recommendations for future policies. Quantitative data was analyzed with Mann-Whitney U tests and Kruskal-Wallis Ranks Test for non-parametric data. Qualitative data was combined during the analysis phase with the quantitative results for each hypothesis. Findings: Descriptive statistics were examined of the means as an aggregate, and for each system, to determine a rank order for implementation barriers and policy impacts. Thirteen null hypotheses were constructed and tested for each system, a total of 39 hypotheses. Within each hypothesis we tested 14 implementation barriers and 7 policy impacts. We failed to reject all hypotheses with the independent variable of age. We found significant findings at the p<.05 level (reject the null hypothesis) for other hypotheses, particularly for implementation barriers by executive group. Qualitative data were most revealing with significant findings particularly from the group of nurses interviewed. Limitations: A low rate of electronic survey return and potential investigator bias as an HCA employee is discussed as well as generalizability to other health systems. Future Studies: This research design serves as a baseline for a 10-year period and should be used to track and analyze new HIT policy implementations as well as provide feedback when policy modifications are appropriate.

Subject Area

Public administration|Public policy|Health care management|Information Technology

Recommended Citation

Agatha Louise Nolen, "Barriers to reforming the U.S. health care system for patient safety: A study of ten years of policy implementation for three Health Information Technology (HIT) strategies" (2011). ETD Collection for Tennessee State University. Paper AAI3468688.