Organizational Leader Sensemaking in Healthcare Process Changes: The Development of the Electronic Medical Records Expectation Questionnaire

Physicians play a unique role in the adoption of electronic medical records (EMR) within the healthcare organization. As leaders, they are responsible for setting the standards for this new technology within their sphere of influence while concurrently being required to learn and integrate EMR into their own workflow and process as the recipients of this change. This dynamic is distinctive such that physicians serve in two roles, one as leaders of change and the other as recipients of change. The EMR Expectations Questionnaire (EEQ) was developed to measure physicians' expectations about change within the sensemaking theoretical framework. The purpose of this research was to develop an instrument to measure physicians' expectations about healthcare organizational process changes, specifically the change from paper medical records to EMR. The sensemaking framework provides a theoretical perspective on how expectation forms and shapes behaviors that lead to enactment. This study is the first of its kind to attempt to measure how physicians as leaders make sense of change. After face validity of the EEQ was established, a principal components analysis was conducted to determine content validity. Internal consistency reliability was measured using Cronbach's alpha coefficients. The principal components analysis revealed that the EEQ has two unique factor patterns with high factor loadings. Factor 1 interpretation suggests a scale that measures expectations about EMR as a clinical tool. The loadings for Factor 2 reflect variables that measure expectations about EMR and professional identity. The results show that the EEQ has adequate internal consistency reliability for the entire scale (alpha = .73) and strong internal consistency reliability for Scale 1 (alpha = .83) and low internal consistency reliability for Scale 2 (alpha = .66). The manuscript provides the methods of scale development followed by a discussion about leaders' expectations in process changes.