Introduction

There has been considerable increase in the implementation of electronic medical health records in hospitals around the globe. They hold a great potential by improvisation of patient safety and care quality being provided by the medical professionals. As specified by a report on Data Standards for Patient safety by the Institute of Medicine, the basic components of the electronic medical health record systems include, but are not limited to: longitudinal collection and management of health information electronically; making immediate access to these electronic records possible for the authorized users at both individual as well as population levels; improvisation of care quality by providing decision support and knowledge provision; and, providing appropriate support for efficient delivery of health care (Institute of Medicine (US) Committee on Data Standards for Patient Safety, 2003; Kukafka et al., 2007; Simon et al., 2005).

There are several important factors contributing towards the ever-increasing need of electronic medical records software among medical groups as well as hospitals. One of the most prominent among these is the ever-growing complexity of the medical organizations. Also, this complexity itself can be attributed to a variety of factors that have been steeply emerged especially during the past two decades such as: continuous efforts by medical organizations in reducing and controlling the costs of patients’ care; an increase in the time demanded by patients due to affliction with chronic diseases and hence augmented workload on the relevant staff. Moreover, to achieve better management of patient care, it is necessary to share clinical information between primary care medical staff and specialist medical physicians as well as their practices which can be achieved quite efficiently using electronic systems of medical records (Hillestad et al., 2005; Miller & Sim, 2004; Simon et al., 2005).

The most robust evidence about the value of using electronic medical record keeping comes from studies which have specifically focused on the its two vital components namely computer physician order entry and computerized decision support systems. According to one study focused on the later of these mentioned components, an improved performance of physicians was found upon encouragement to use electronic system (Balas et al., 2000). Similarly, another study investigated the effects of computer-aided dosing, reminder systems for preventive care, and achievement of quality assurance via computer-assisted decision support systems and found a significant reduction of errors in the clinical data (D. L. Hunt et al., 1998; Dereck L. Hunt et al., 1998).

Due to lack of the technical expertise in hospitals, it is often challenging to carry out the successful implementation of the of the electronic health record system. This urges the need for the development of appropriate strategies by healthcare management teams for enactment of information technology for electronic health records (EHR) processing. In this design, nursing leaders and managers consist of the target population in the development of a ‘change plan’ for applying HER system in a hospital having capacity of two hundred beds. The implementation of the plan will take six months where the computer hardware and systems will be available within the first two months. Furthermore, the HER plan will be build and executed on a 3 step Lewin’s change theory as a basis to formulate theoretical framework (Mehrolhassani & Emami, 2013).

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Plan of change according to Lewin’s model

For the analysis of the currently given situation for change plan in shifting the nursing practices towards electronic system, the most important thing which has to be done on priority basis is the characterization of the entire situation and that too should include the entire context instead of mere isolated essentials. For the identification of the driving and restraining forces to come in the way of a plan, it is imperative to determine the psychological air of the working staff which holds an indispensable importance in the scenario to come. A good and thorough understanding of the making of project decisions as well as the governing principles of the individual units can also make the change plan implementation easy and effective. Moreover, due to the autonomy of the rules made to facilitate the changes, an awareness of the decision making factors will help the processes of unfreezing, moving and refreezing (Bozak, 2003).

Unfreezing

The unfreezing step is known most commonly by the identification of the underlying problem, which, in this case, is the poor communication between the health care providers and the resulting patients’ care. This trending increase in the communication errors needs a replacement of the communication system with a new and advanced information system. After this, the next milestone is the identification of the individuals who will be most affected by this change and the immediate users of the system as well i.e., the management, administration and information technology support staff. Also, an essential factor is the open communication between the teams to establish a sense of trust and security by being punctual, prepared and an active listener to affirm nurses that they are being heard, valued and understood (Arab-Zozani et al., 2018, 2019; Raikundalia & Gogler, 2011).

It is also important to identify both the driving and restring forces during this phase. Some of the driving forces for the current situations can be: viewing of change plan by the management and staff positively; prior knowledge and experience with computer; awareness of the improvement needed in the system; positive past experiences; desire to learn; appropriate financial resources; and constructive social norms. On the other hand, the aspects of potential resistance can be: viewing of the plan by management and staff negatively; no prior knowledge and experience with computer; lack of motivation for learning new things; negative past experiences; lack of financial resources and negative community cultures (Manchester et al., 2014; Raikundalia & Gogler, 2011).

Let us now discuss about two of the resistances which might arise in view of the given scenario, those are: lack of previous computer knowledge and lack of desire to learn new things. The former of these can be dealt with establishing a computer training system for the nurses in the first two months of the plan during which the hardware will be ingrained in the hospital. This can be accompanied with some friendly and competitive activities to not only further incite the deep involvement in the learning process but also to make it enjoyable (Xu, 2016).

A mandatory requirement in nursing field is the acquirement of the continuing education and training throughout the career of a nurse in most of the countries. Also, the traditional methods of in person educational training can sometimes be difficult to catch up by the nurses and hence can lead to the development of the lack of interest in learning new things, which, in our scenario, can also be a factor towards learning computer education, and posing resistance towards electronically upgrading the health system. However, this can be addressed by introducing an online learning system which can be further optimized in terms of interactivity based on the feedbacks on learning gains through this system to further help improve the process (Hughes et al., 2014; Liu & Mao, 2020; Xing et al., 2018).

Moving

After the change plan has been well accepted and recognized by the nursing management and staff, the planning process and implementation of the new electronic information system can move forward. In this period, it is essential to boost both cluster discussions and open communications as well. Moreover, encouragement of the nurses should be done to participate and assist in the decisions related to the design, layout and enactment of the electronic health record management. This would be continued till the staff and management feels personally committed to the project. During this phase, it is also important to keep an eye on the resistance creating factors and their proper management so that the project keeps moving (Aguirre et al., 2019; Fields et al., 2015).

Refreezing

After the successful planning of all the strategies and implementation of the electronic information system for nursing, the final step of the planning according to the Lewin’s model is known as refreezing. This phase is characterized by the evaluation and checking activities to make the system more stable followed by the provision of continuous sustenance and support to people in direct use of the information system till the process is complete and stable (Aguirre et al., 2019; Fields et al., 2015).

Comparison of Lewin’s plan with Kotter’s plan

Since the Lewin’s model is simple descriptively, it also easier for the team to understand it’s structure and thus easing its implementation. Also, the steps involved are also simpler and straightforward to act upon thus not only helping in the change but also maintain the evolving status of the system. The Kotter’s plan, on the other hand, consists of an eight-step process for leading an organizational modification. Under the given scenario, the Kotter’s plan will be implemented via establishing an urgency for electronic implementation of the health care system, creation of the guiding partnerships, vision and strategy developments, communications and empowerments, generating short term successes on which gains are consolidated leading to more changes ultimately resulting in the anchorage of the new system in the work culture. Although more complex than the former plan, it can be more convincing for the staff as the change urgency is declared by the leaders (Aziz, 2017; Kumar et al., 2015; Mahmood, 2018; Shirey, 2013).