What is one way that technology acts as a change agent in the nursing process?

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An internal change agent is usually a team member such as a manager, senior executive, leader, HR professional, or another team member who understands organization development, behavioral sciences, and human intervention. 

An external change agent is an outside consultant or third-party change practitioner with relevant expertise to drive change initiatives. Company rules, regulations, and policies do not apply to them, allowing them to deeply analyze varied scenarios and suggest suitable change management models and strategies that help prevent change failures. 

A noteworthy aspect here is that internal change agents are aware of the organization’s history of change initiatives and social politics, and will work diligently to establish strong relationships to strengthen attitudes and cultural views towards change – even after the implementation process is complete. However, if an organization lacks an internal employee with change management skills, organizations must opt for external change agents to support their initiative. 

Though external change agents provide a fresh perspective, their presence can threaten the existing employees, and their appointment can add a costly expense for lengthy change implementations.

Here’s a typical scenario in today’s fast-paced hospital environment: The hospital is at risk for not hitting its targets on meaningful use and must quickly determine the underlying factors. Where exactly are the breakdowns? Is it a documentation challenge or a technology issue? Enter the nurse informatacist – chief trouble shooter and hospital change agent.

Today’s chief nursing informatics officer (CNIO) plays a crucial role in not only helping to lead the charge in applying best-practice nursing techniques but also in leveraging technology to measure the impact efforts are having on outcomes. The pursuit of meaningful metrics to assess technology’s impact on nursing practice and on bending the cost curve is the next frontier for these executive nursing informatics professionals.

The job is not an easy one given the variability in nursing documentation and in terms of efficiency. As leaders who bring together nursing expertise with clinical information technology knowledge, there is an opportunity for CNIOs to assume the role of IT-enabled process engineers within highly complex health systems. This is especially important given the proliferation of non-standardized electronic health records (EHRs), systems and apps. CNIOs understand that systems and process consistency require good governance – in particular clinical governance.

CNIOs also add value by measuring how changes in practices – such as nursing documentation – are being used. By collaborating with the chief nursing officer, the CNIO can uncover where problems are encountered and then work with IT to achieve efficiencies. But where CNIOs really maximize their influence is in understanding the metrics and bringing those insights to the nursing staff so they can derive information from it and take action in targeted areas.

With deep technology knowledge and soft skills around relationship building, CNIOs are poised to act as natural change agents within their organizations. As one CNIO put it during a recent industry roundtable, ‘if you can connect the person’s self to the mission, you will improve morale. That’s an invaluable skill for any health system to leverage.’

The emerging field of agent technology however, poses a much different configuration � one where technology acts in the role of proxy, where intelligent technological action occurs in lieu of human activity.

The Promise and Consequences of Agent Technology

One of the most contemporary, dynamic, promising and yet somewhat alarming developments in information technology is the advent of agent technology. �An agent is a computer system capable of flexible autonomous action in a dynamic, unpredictable and open environment� (Luck, McBurney & Preist, 2003, p. 8). Agent technology is considered the foundation for next generation technology.

�As the computing landscape moves from a focus on the individual, stand alone computer system to a situation in which the real power of computers is realised through distributed, open and dynamic systems, we are faced with new technological challenges and new opportunities. The characteristics of dynamic and open environments in which, for example, heterogeneous systems must interact, span organizational boundaries, and operate effectively within rapidly changing circumstances and with dramatically increasing quantities of available information, suggest that improvements on the traditional computing models and paradigms are required. In particular, the need for some degree of autonomy, to enable components to respond dynamically to changing circumstances while trying to achieve over-arching objectives, is seen by many as fundamental� (Luck et al, 2003, p. 9).

Figure 3: Agent Technology within Context
Autonomy is one characteristic that needs to be considered carefully when designing agent technologies. Chalupsky, Gil, Knoblock, Lerman, Oh, Pynadath, Russ. & Tambe (2001) described a sophisticated group of agent technologies they created called the Electric Elves, that services the Intelligence Systems Division in their workplace, which consisted of �a system of about 15 agents, including nine proxies for nine people, plus two different matchmakers, one flight tracker and one scheduler running continuously� (p.1). �In the process of building the applications... we addressed a number of key technology problems that arise in any agent-based system applied to human organizations. In particular we described how to use Markov Decision Processes to determine the appropriate degree of autonomy for the agents, how to use knowledge-based matchmaking to assign tasks within an organization, how to apply machine learning techniques to ensure robust access to the data sources, how to combine knowledge-based and statistical matchmaking techniques to derive knowledge about the participants both within and outside an organization, and how to apply multi-agent teamwork coordination to dynamically assemble teams� (p. 10).

The Electric Elf proxy agent acted like a personal assistant, always aware of the assigned human's location using a Global Positioning System (GPS), their calendar and other information sources. The agent could perform routine duties such as scheduling meetings, give reminders about appointments and events, communicate with other humans on the user's behalf by email, wireless messaging or faxes, and so on. �When a proxy agent notices that someone is not attending a scheduled meeting or that they are located too far away to make it to a scheduled meeting in time, then their agent sends them a request using a wireless device asking if they want to cancel the meeting, delay the meeting, or have the meeting proceed without them. If a user responds, their decision is then communicated to the other participants of the scheduled meeting. If they are unable to respond, the agent must make a decision autonomously� (Chalupsky et al, 2001, p. 2).

Chalupsky et al. (2001) described the agents as �...autonomous, heterogeneous, and distributed over a variety of platforms and research groups. Yet, these diverse agents must work together to accomplish the complex tasks required by Electric Elves. By interfacing with Teamcore proxies, existing agents become team-ready and thus able to rapidly assemble themselves into a team to solve a given problem� (p.7). Although this type of sophisticated technology is still a fantasy in health care, it already exists and will likely be part of the health care landscape within the next few years. Their efficiency, ability to attend to redundant tasks, and the various ways they can support organizational functioning will make them too valuable to ignore for long. �Our agents go beyond simply automating tasks that were previously performed by humans. Because hardware and processing power is cheap, our agents can perform a level of monitoring that would be impractical for human assistants, ensuring that activities within an organization runs smoothly and that events are planned and coordinated to maximize the productivity of the individuals in the organization� (p. 10). Agent technology �...enable the aggregation of different functionalities that have previously been distinct (such as planning, learning, coordination, etc. ) in a conceptually embodied and situated whole� (Luck et al. 2003, p. 9).

This radical new wave of information technology demands new ways of thinking of technology in the context of nursing. Since agents are �autonomous entities capable of exercising choice over their actions and interactions� (Luck et al. 2003, p. 17), the complexities of applying agent technology to nursing poses both promise and threat. Promise in the fact that these technologies could potentially perform many of the mundane duties that keep nurses occupied in operational

procedures that maintain the organizational system but detract from potential time spent in meaningful exchanges with clients. But they also pose a threat in other ways: their ability to exercise choice and interact could be relied on as a reliable decision making source that could deter nurses from providing individualized care. They also could present the threat of potentially replacing humans in the workplace. Agent technology in nursing could provide many benefits, but as with all technologies, nurses would need to be involved in their design, in the choice of their assigned applications, and retain control of any actions that directly impact on providing individualized client care.

Nurses and technologies interact to form actor networks within the workplace arena. New technologies are also used to facilitate networks between nurses and other health care professionals. These networks manifest as virtual nursing and interdisciplinary work teams, interest groups, communities of practice, and other collaborative configurations.

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