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J Biomed Inform. 2011 Jun;44(3):497-504. doi: 10.1016/j.jbi.2010.02.007. Epub 2010 Feb 20.

Ranked Levels of Influence model: selecting influence techniques to minimize IT resistance.

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  • 1Health and Community Systems, University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261, USA.


Implementation of electronic health records (EHR), particularly computerized physician/provider order entry systems (CPOE), is often met with resistance. Influence presented at the right time, in the right manner, may minimize resistance or at least limit the risk of complete system failure. Combining established theories on power, influence tactics, and resistance, we developed the Ranked Levels of Influence model. Applying it to documented examples of EHR/CPOE failures at Cedars-Sinai and Kaiser Permanente in Hawaii, we evaluated the influence applied, the resistance encountered, and the resulting risk to the system implementation. Using the Ranked Levels of Influence model as a guideline, we demonstrate that these system failures were associated with the use of hard influence tactics that resulted in higher levels of resistance. We suggest that when influence tactics remain at the soft tactics level, the level of resistance stabilizes or de-escalates and the system can be saved.

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