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Matrix linking barriers to change strategies addressing the barriers
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Barriers summarycount
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Team 1: Holly Witteman, François Lauzier, Rémi Blanchette
Lack of recognition for efforts in wiki/Perte de l'auteurship
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5
BarriersChange Strategies/SolutionsScope creep1
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1- Lack of recognition for efforts in wiki.1.1 Professional recognition (list on CV, director acknowledges & approves)
Difficult to use, difficult to access/Difficulté d'utilisation des ressources IT/Complexity of use/Usability
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1.2 Reputation systems (may need to consider issues related to power imbalances, roles, gender, etc.)Fully bilingual system2
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1.3 Feedback (116 people used your protocol, 7 people liked your comment, thank you notes: "I had a patient with this problem last week and your page was really helpful!")Different needs1
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1.4 Upvoting/downvoting (helps with 1.2 & 1.3 and may also help with validity of content)Cost/Sustainability3
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1.5 Gamification ("Level up!")Legal issues/Liability3
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2- Scope Creep2.1 Phase design & implementionControl access to content (secure)1
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2.2 Prioritize on acute care protocol sharing
Managing both open and closed access to content
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2.3 Focus on low hanging fruit and patient outcomesValidity7
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3- Difficult to use, difficult to access (hardware, network access, NEEDING TO LOG IN ALL THE TIME, cross-platform functionality, COST)3.1 User-centred design process (with users on board to test -> developers need access to health care professionals!)No clear objectives1
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3.2 Prioritize always-on (e.g., can always consult content without needing to log in)Lack of added value1
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3.3 Ensure good network accessLack of time3
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3.4 Consider hardware (e.g., mobile devices with biometric fast login)Coordination1
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4- Fully bilingual system (users may speak only one of French or English)4.1 Design user interface in both English and French
Competition/Reluctance to team work
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4.2 Provide content in both languages (machine translation?)Cultural issues1
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5-Different needs (roles, institution, platforms, etc.) which increase costs5-1 Standardization? (Holly hates mandated standardized hardware)Too technical content1
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5-2 Modular design (as per Mandl et al.)Lack of motivation3
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5-3 Multiple Apps might be necessary for each role
Editing wars/différence d'opinion entre professionnels
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6-6-Crédibilité des auteurs2
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7-7- Boston1
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8-8-Need for ontology/semantic markup2
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9-9-Access to computer1
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10-10-
frustration of having someby edit my content
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Data silos to break to make interoperable/EMR integration
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Having to consult multiple ressources
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Team 2 - Jean-Luc, Amélie, Christian
Common user experience (UX)/WikiDesign/Visual experience
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Technical BarriersChange Strategies/Solutions
Complicated access rights management
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1- Complexity of use1- Respond to the needs of 1 or 2 group(s) (focus, less functionalities)Need for page access restriction1
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2- Control access to content (secure)2- identify the content to secure and peoples who has access to it
Management of multiple protocol versions
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3- Costs3- find existing tools that address most of the needsIT access and support1
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4- Managing both open and closed access to content4- toll must manage access. Gives support to usersWriting skills-self efficacy1
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5- Validity of the resource5- to have a clear process of content generation : identify sources and peoples who edit, shareChallenge to autonomy1
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Organizational barriers
Technological literacy/Unfamiliarity with ICT
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6- No clear objectives6- Survey and/or focus group to keep a limited number of goalsDiffusion of innovations1
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7- Lack of added value7- Link internal processes to Wikitrauma platform and outputLack of Incentive2
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8- Barrier language8- Content translated, available in french and englishTrust1
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9- Lack of time9- Need to proove the gain in efficiency by using the Wikitrauma platformIntegrate in workflow1
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10- Coordination10- Identify a leader and the tasks of every peoples involvedServer reliability1
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Personnal BarriersLack of organizational support1
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11- Competition11- Begin with a theme (subject) complementary to everyone
Rapid decision making vs learning tool
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12- Reluctance to team work12- seeking a project (or a task) which will bring peoples together, users will meet each othersDiscordance with guidelines1
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13- Cultural aspects13- pilot project with early adapters and opinions leaders
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14- Too technical content14- Simplified language used in content, explaining concepts (vulgarized)
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15- Lack of motivation15- Support by the executives: gives time, recognition, feedback
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Team 3
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BarriersChange Strategies/Solutions
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1- Editing wars1- Établir des règles de discussions, limiter le nombre d'éditeurs possibles, intégration obligatoire des évidences disponibles, possibilité d'exclusion de certains éditeurs/utilisateurs à comportement inadéquat, identification d'un modérateur
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2- Crédibilité des éditeurs2- Déclaration des conflits d'intérêt
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3- Manque de temps des utilisateurs 3- Stimuler l'intérêt des utilisateurs (behavior modification): en bout de ligne on sauvera du temps et les patients seront mieux soignés.
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4- Différence d'opinion entre les différents professionnels utilisateurs4- Tenter de converger les différents intérêt des divers utilisateurs et inclures différentes sections dans le wiki (sectoin md, infirm, inhalo, patients)
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5- Difficulté d'utilisation des ressources informatiques5- Audit d'utilisation pour indentifier les problèmes précocément et apporter solutions (les cycles !)
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6- Difficulté d'utilisation des ressources informatiques6- Vidéos (tutoriels) pour utilisateurs et forums de discussion pour les utilisateurs
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7- Manque de motivation7- Reconnaître le contribution des utilisatuers qui ajoute des éléments (utilisateur du mois!), l'inlcure comme activité de FMC: inclure les liens vers les sites de comptablilisation des "heures de FMC"
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8- Perte de l'auteurship
8- Garder l'historique des contribution des différents utilisateurs
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9- Validité de l'information9- Intégration obligatoire des évidences cliniques lorsqu'elles sont disponible
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10- Boston10- Gagner le 7eme match !
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Team 4 Tom, Mathieu, François et France
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BarriersChange Strategies/Solutions
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1- Technical - Legal issues1- Write a clear disclaimer and put it on a website + have offical bodies to support your wiki
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2- Technical - Scientific Quality 2- Mark validated and/or non-validated information + have offical bodies to support your wiki
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3- Organizational -time constraints3-Try to show that overall time will be saved
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4- An Ontology is needed to share the Knowledge representation in traumatology4-
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5- personal: access to computer5-give access to computer at the work station
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6-timely access to computer6-give access to computer in your pocket or in your glasses (eg googleglass)
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7- legal issues7- ask advice to CPMA
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8-frustration about having someone else edit personal contribution8- have an open forum space to discuss diverse opinions and identify a coordinator
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9- Data silo need to be broken to make data integration possible9-
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10-10-
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Team 5
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BarriersChange strategies/Solutions
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Technical barriers
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1- Having to consult many sources (e.g. EAST, INESSS, AQESSS)1- Concentrate relevant information as much as possible on one platform that is endorsed by recognized organization
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2- Common User Experience (UX) 2- Put in place rules or templates for a common GUI / page ergonomy
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3- Access rights management can easily get complicated3- Assign users to groups and roles.
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4- Is there a need for page access restriction? Wiki platform vs stakeholders requirements.4- Need to evaluate correctly the stakeholders needs and use case before chosing the wiki platform. How good, to what percentage can it address the requirements? Do a gap analysis between the requirements and the different platforms.
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5- Management of the multiple versions of the same protocols 5 -Feasability would need to be analyzed with specific uses cases (single or multiple database?). User needs to be directed to the right version for his hospital in an efficient manner. Dashboard per hospital linking to pages? Semantics?
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Personal barriers5- Need to evalute correctly the stakeholders needs and use case before chosing the wiki platform. How good can it address the requirements?
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6- How to ensure credibility6- Endorsement of posted protocols-guidelines by recognized authorities - organizations
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Organizational barriers7-
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8-Cost to develop, train, implement, maintain the platform - sustainability8-Proof the concept before wide implementation to demonstrate that it worth the efforts and money.
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9-9-
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10-10-
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Team 6
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BarriersChange Strategies/Solutions
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1- Validity of the resource1- Editorial committee: updates and reviews
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2- Wiki Design (appearance, userfriendly format and organization2- Proper design and testing
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3- IT access and support3- More computers and appropriate IT system
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4- Lack of motivation4- Recognize contribution with incentives and rewards (scientific contribution); improve the body of evidence supporting the effectiveness of wiki utilization on outcomes and process-of-care improvement
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5- Writing skills (self-efficacy)5- Editorial board and writing support
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6-Challenge to autonomy6- Behaviour change and gradual implementation
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6- 7-