Organizational understanding breaks down resistance to PACS

Facilities that overlook a radiology department's organizational and political nuances during PACS implementation do so at their own risk, according to researchers at Children's Hospital in Boston. Understanding a department's organizational structure is key to implementation success.

Financial justification, vendor selection, installation timelines, interface coordination, and acceptance testing are all well-worn components of PACS implementation. But these alone are not sufficient for success.

A recent study reports that the ability of radiology managers to view organizational issues from multiple perspectives is equally important in determining the success of PACS or voice recognition projects (AJR 2005;184(6):1727-1730).

"Radiology leaders who implement a new technology that affects the way people work must pay attention to how the new system affects the organizational structure, the human resource issues of the organization, the organizational politics, and the organization's culture," said Dr. Robert T. Bramson, a radiologist at Children's.

Attention to organizational details is important because resistance to change can lead to prolonged, failed, or inefficient implementations.

Bramson's research applies to four organizational perspectives:

• structure: addresses formal duties and roles

• human resources: relates to interpersonal and group dynamics

• politics: deals with developing an agenda in an environment of differing interests

• symbolic: looks at the organization's culture, or the stories, symbols, rituals, and customs that unite a group around shared assumptions, values, and beliefs

Radiologists, who are trained in technical skills, may be inclined to look primarily at change in structural terms, focusing on workflow reorganization and who does what. This is a risky strategy, according to Bramson.

"Looking at an organization and trying to change it by using only one or two perspectives, as many leaders do, invites failure," he said. "The ability to step back and examine an organizational situation from different perspectives allows a radiology leader to better understand the challenges of implementing new technologies like PACS and to develop a more varied set of potential strategies for avoiding or overcoming problems."

Resistance to changing work procedures may not come exclusively from any one group. It may stem from frontline workers, radiologists, other radiology leaders, or people entirely outside the department.

"Using these four perspectives will help implementers design strategies for overcoming that resistance," Bramson said.