J Am Med Inform Assoc 14:746-755 doi:10.1197/jamia.M2462
  • Original Investigation
  • Model Formulation

Multimethod Evaluation of Information and Communication Technologies in Health in the Context of Wicked Problems and Sociotechnical Theory

  1. Johanna I Westbrook,
  2. Jeffrey Braithwaite,
  3. Andrew Georgiou,
  4. Amanda Ampt,
  5. Nerida Creswick,
  6. Enrico Coiera,
  7. Rick Iedema
  1. Affiliations of the authors: Health Informatics Research and Evaluation Unit, Faculty of Health Sciences, University of Sydney (JIW, AG, AA, NC), Sydney, Australia, Centre for Clinical Governance Research in Health, Faculty of Medicine (JB), Centre for Health Informatics (EC), University of New South Wales, New South Wales, Australia, Faculty of Humanities and Social Sciences, University of Technology Sydney (RI), Sydney, New South Wales, Australia
  1. Correspondence: Johanna I. Westbrook, PhD, Health Informatics Research and Evaluation Unit, Faculty of Health Sciences, University of Sydney, Sydney, Australia; e-mail: <J.Westbrook{at}>
  • Received 2 April 2007
  • Accepted 29 July 2007


Objective Few research designs look at the deep structure of complex social systems. We report the design and implementation of a multimethod evaluation model to assess the impact of computerized order entry systems on both the technical and social systems within a health care organization.

Design We designed a multimethod evaluation model informed by sociotechnical theory and an appreciation of the nature of wicked problems. We mobilized this model to assess the impact of an electronic medication management system via a three-year program of research at a major academic hospital.

Measurements Model components include measurements relating to three dimensions of system impact: safety and quality, organizational culture, and work and communication patterns.

Results Application of the evaluation model required the development and testing of purpose-built measurement tools such as software to collect multidimensional work measurement data. The model applied established research methods including medication error audits and social network analysis. Design features of these tools and techniques are described, along with the practical challenges of their implementation. The distinctiveness of doing research within a unique paradigm of complex systems, explicating the wickedness and the dimensionality of sociotechnical theory, is articulated.

Conclusion Designing an effective evaluation model requires a deep understanding of the nature and complexity of the problems that information technology interventions in health care are trying to address. Adopting a sociotechnical perspective for model generation improves our ability to develop evaluation models that are adaptive and sensitive to the characteristics of wicked problems and provides a strong theoretical basis from which to analyze and interpret findings.


  • Supported by an Australian Research Council Linkage grant LP0347042 in partnership with NSW Health; Nerida Creswick is supported by an Australian Postgraduate Award-Industry (APAI). Dr. Westbrook is supported by a National Health and Medical Research Council (NHMRC) fellowship.

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