Sociotechnical Systems (STS)
The works of the Tavistock Institute of Human Relations, London, UK, are considered to be the origin of the sociotechnical system underpinnings. (Emery, 1959) The Tavistock Institute was formally founded as a registered charity in September 1947, bringing together staff from different disciplines to find ways to apply psychoanalytic and open systems concepts to group and organizational life. (The Tavistock Institute, 2007) One of the Tavistock Institute’s pioneering approaches was the socio-technical systems design for joint optimization of both technical and psycho-social resources, initially developed through collaboration in English coalmines (Trist & Bamforth, 1951) and Indian textile mills (Rice, 1953) (The Tavistock Institute, 2007)
The socio-technical system (STS) is a system whose interacting components are the people and the technology. Therefore, the interaction and relationships between the components of the system will be those in between the people (social), in between the technology elements (technology) and across between the people and technology (socio-technical). STS is an open system and, therefore, it is also concerned with the interaction of the system as a whole with the external environment. As the case in any system, the behavior of the whole system cannot be predicted by solely examining any of the components.
Before the Travistock research results were published, the dominant form of management was the classic hierarchal Taylorism, that is, scientific management. In response to the rigid structure of such a management, there was a general lack of enthusiasm among workers. As sophistication of enterprises increased with more automation and mechanization and expansion of scales, enterprises reacted by an increase in bureaucracy and a lack of proportionate increase in efficiency. In the meanwhile, to respond to the near complete ignoring of the social needs of workers, a strong post-world war II movement swept Europe, demanding focus on the social issues, and blaming the lack of attention to the social issues as the main reason for failure of productivity. The Tavistock Institute’s contributions were to postulate an open system approach, and to bring both the components of the system, that is, the social and the technical, into the light of analysis. Such analysis produced knowledge and models that became applicable beyond the coalmines and the textile industries. To paraphrase van der Zwaan, the sociotechnical approach objected to the closed approach to organization that characterized both the Taylorian scientific management approach and the human relations movement. (Zwaan, 1975)
STS can be viewed both as a framework for examining or analyzing entities such as enterprises or workplaces, and as a framework for developing new architectures and designs that follow the same principles of incorporating the technical and the social components into the organizational structure.
Applications of, and Current Issues with, STS in the context of health informatics
That organizations or systems (or entities at higher or lower levels of sophistication) should be looked at as open systems with interacting human and technical components sounds in this time and era as obvious. Modern management in general, healthcare included, has in its architecture both the technical and the human social components accounted for. In the 50’s and 60’s such ideas were considered innovative, and were being propagated and tested on the ground. The 70’s witnessed wider scale adoption. According to Mumford, “In 1972, the socio-technical movement was formally internationalized by the creation of a Council for the Quality of Working Life.” (Mumford, 2006)
Conceptually, healthcare is different from the disciplines that generated the sociotechnical systems approach in a major way. While in the coalmines and in the textile and other industries the “system” input and output are materials, the healthcare “system” has in its input and output human-related services. The human element has been the center of the healthcare system all the time. Medical literature, academic research, and public health as a discipline, all are in a sense a reflection of studying the influences of interventions and therapies (technical) on humans. Therefore, it is no surprise that the healthcare system is so well suited to expand on its own tradition by adopting the STS principles and giving it the name of “sociotechnical systems”.
In the 21st century, there is no question that the sociotechnical systems approach is a valid model. Some of the questions now are trying to cope with the evolution of the components as newer technologies and more people (customers and patients, not only providers and technicians) introduce additional challenges and new grounds for research. An online search by the writer of this wiki entry in PubMed.org <http://www.ncbi.nlm.nih.gov/pubmed/>, the United States National Library of Medicine database, using the key-word “sociotechnical OR socio-technical” returned 310 results on May 22, 2012. On March 10, 2013 the same keywords returned 357 results. This is not a huge number, but does indicate that it is a topic of consideration in biomedical research and literature.
Implementing information technology (IT) in healthcare has been pushed by high-level politicians in several countries, including the USA, aiming at realizing its theoretical potentials. Arguably, the most valid model of evaluating the new environment of healthcare is the sociotechnical system (STS) model.
Sittig from Houston, Texas, introduced “an 8-dimensional model designed to address the socio-technical challenges involved in design, development implementation, use, and evaluation of HIT within complex adaptive healthcare systems.” (Sittig & Hardeep, 2010) Those sociotechnical dimensions are: Hardware and software infrastructure (the technology), clinical content, human-computer interface (HCI), people, workflow and communication, internal organizational policies/procedures/culture, external rules/regulations/pressures, and system management/monitoring. (Sittig & Hardeep, 2010)
In a study from Denmark, while developing a conceptual framework for addressing transformations of communication and workflow in the Danish health care as a result of implementing IT, the researchers chose to draw a matrix of infrastructural transformations from human–computer interaction, with examples of general problem areas including performance loss, cognitive overload, coordination problems, and errors in patient treatment and care. (Wentzer & Bygholm, 2007)
In a recent report on behalf of the NHS Care Records Service Evaluation Team, the authors suggested that, in large-scale technology-led projects such as England’s national EHR initiatives, the usual study designs (systematic reviews, descriptive theory-based case studies, observational, quasi-experimental, before-after, and randomized controlled trials (RCTs)) run the risk of over-simplifying the complexities. (Takian, Petrakaki, Cornford, Sheikh, & Barber, 2012) Therefore, they chose “sociotechnical evaluation framework which is presented as a matrix of Donabedian’s concepts of structure, process and outcome, set against dimensions of system functions, human perspectives and organizational settings.” (Takian, et al., 2012)
Emery, F. (1959). Characteristics of Socio-technical Systems. London: Tavistock Institute of Human Relations. Retrieved March 08, 2013, from http://moderntimesworkplace.com/archives/archives.html
Mumford, E. (2006). The story of socio-technical design: reflections on its success, failures and potential. Info Systems J, 16, 317-342.
Rice, A. (1953). Productivity and Social Organization in an Indian Weaving Shed: An Examination of the Socio-Technical System of an Experimental Automatic Loomshed. Human Relations, 6, 297-329.
Sittig, D. F., & Hardeep, S. (2010). A New Socio-technical Model for Studying Health Information. Qual Saf Health Care, 19(Suppl 3), i68-i74. Retrieved March 08, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120130/pdf/nihms297306.pdf
Takian, A., Petrakaki, D., Cornford, T., Sheikh, A., & Barber, N. (2012). Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems. BMC Health Services Research, 12, 105. Retrieved March 08, 2013, from http://www.biomedcentral.com/content/pdf/1472-6963-12-105.pdf
The Tavistock Institute. (2007). Our History. Retrieved March 08, 2013, from The Tavistock Institute: http://www.tavinstitute.org/about/our_history.php
Trist, E., & Bamforth, K. (1951). Some Social and Psychological Consequences of the Longwall Method of Coal-getting. Human Relations, 4, 3-38.
Wentzer, H., & Bygholm, A. (2007). Attending unintended transformations of health care. Int J Integr Care, 7, e41. Retrieved March 08, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2092400/pdf/ijic2007-200741.pdf
van der Zwaan, A. (1975). The sociotechnical systems approach: A critical evaluation. International Journal of Production Research, 13(2), 149-163. Retrieved March 08, 2013, from http://alexandria.tue.nl/repository/freearticles/334270.pdf
Baxter, G., & Sommerville, I. (2011). Socio-technical systems: From design methods to systems engineering. Interacting with Computers, 23(1), 4-17. Retrieved March 10, 2013, from http://archive.cs.st-andrews.ac.uk/STSE-Handbook/Papers/SociotechnicalsystemsFromdesignmethodstosystemsengineering-BaxterSommerville.pdf
Harrison, M. I., Koppel, R., & Bar-Lev, S. (2007). Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis. J Am Med Inform Assoc, 14, 542-549. doi:10.1197/jamia.M2384
Caulkin, S. (2007, September 22). Many happy socio-technical returns, Tavistock. The Observer. Retrieved March 10, 2013, from http://www.guardian.co.uk/business/2007/sep/23/6
Mumford, E. (1983). Designing Human Systems for New Technology - The ETHICS Method. Manchester: Manchester Business School. Retrieved March 10, 2013, from http://www.enid.u-net.com/C1book1.htm
Submitted by Hanafy M. Hanafy (first submission was March 10, 2013)