An examination of the antecedents and consequences of organizational IT innovation in hospitals

Assessing the maturity and performance of the IT function in acute-care hospitals: a configurational view

This study aims to characterises the maturity of IT management in hospitals, to identify the IT management configurations needed to achieve greater performance and to characterise the organisational and strategic IT contexts in which these configurations evolve. Drawing on survey data from 72 Canadian acute-care hospitals with the CIO as the main respondent, we used a configurational approach to assess the maturity of their IT functions. We classified participating hospitals in two distinct groups, each related to different levels of performance. Hospitals in the first group are characterised by a rather "immature" IT management model and presented low levels of IT performance. Hospitals in the second group showed more maturity in their IT management model and high levels of IT performance. Importantly, both the strategic influence of the CIO and the centrality of IT to the hospital's strategic goals were found to be significantly greater in the mature group.

Adopting Artificial Intelligence in Public Healthcare: The Effect of Social Power and Learning Algorithms

Although the use of artificial intelligence (AI) in healthcare is still in its early stages, it is important to understand the factors influencing its adoption. Using a qualitative multi-case study of three hospitals in China, we explored the research of factors affecting AI adoption from a social power perspective with consideration of the learning algorithm abilities of AI systems. Data were collected through semi-structured interviews, participative observations, and document analysis, and analyzed using NVivo 11. We classified six social powers into knowledge-based and non-knowledge-based power structures, revealing a social power pattern related to the learning algorithm ability of AI.

The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data

Background

Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations’ innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes.

Objective

The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQ_HIT model, to help determine how better information provision in health organizations can be achieved.

Methods

We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects.

Results

The resulting empirical IQ_HIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model’s statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities.

Conclusions

The proposed sociotechnical IQ_HIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT.

Information communication technology, knowledge management, job and customer satisfaction: a study of healthcare workers in Lebanon

Purpose

The paper aims to identify, analyze and discuss the links between information and communications technology (ICT) and knowledge management (KM), on the one hand, and job satisfaction (JS) and customer satisfaction (CSAT), on the other hand, in hospitals in Lebanon.

Design/methodology/approach

A mixed-methods approach has been adopted that utilizes both quantitative and qualitative primary data, along with supportive and peripheral secondary ones. Specifically, a survey measuring variables was conducted among health-care professionals, with whom interviews were also conducted for greater depth and to refine the findings and relationships under study.

Findings

The results of the quantitative study find no statistically significant relationships between the variables. The qualitative study suggests that this is likely because of the subjectivity of the evaluations and/or their mutual canceling. This is further partly explained not only through technical/functional deficiencies of the system but also through the impact of implicit and peripheral forces, adjacent to contextual aspects.

Originality/value

The research adds significant and focused knowledge on the subject of the linkage of ICT and KM with JS and CSAT, in the context of emerging economies.

Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation

Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads. Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation). Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation. What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care. What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care. What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.

Exploring the Effect of Digital Investment on IT Innovation

Using the technology-organization-environment framework, this study examines three antecedents of digital investment as well as the influence of digital investment on IT innovation. The empirical evidence from a sample of Chief Information Officers (CIO)from US firms suggests that IT competence, competitive pressure and organizational agility are key factors that influence digital investment. Furthermore, the findings confirm the positive relationship between digital investment and IT innovation. Contrary to prior research, IT competence did not have a significant relationship with IT innovation. However, the results revealed that digital investment mediated the relationship between IT competence and IT innovation.

Diffusion dynamics of electronic health records: A longitudinal observational study comparing data from hospitals in Germany and the United States

BACKGROUND

While aiming for the same goal of building a national eHealth Infrastructure, Germany and the United States pursued different strategic approaches - particularly regarding the role of promoting the adoption and usage of hospital Electronic Health Records (EHR).

OBJECTIVE

To measure and model the diffusion dynamics of EHRs in German hospital care and to contrast the results with the developments in the US.

MATERIALS AND METHODS

All acute care hospitals that were members of the German statutory health system were surveyed during the period 2007-2017 for EHR adoption. Bass models were computed based on the German data and the corresponding data of the American Hospital Association (AHA) from non-federal hospitals in order to model and explain the diffusion of innovation.

RESULTS

While the diffusion dynamics observed in the US resembled the typical s-shaped curve with high imitation effects (q = 0.583) but with a relatively low innovation effect (p = 0.025), EHR diffusion in Germany stagnated with adoption rates of approx. 50% (imitation effect q = -0.544) despite a higher innovation effect (p = 0.303).

DISCUSSION

These findings correlate with different governmental strategies in the US and Germany of financially supporting EHR adoption. Imitation only seems to work if there are financial incentives, e.g. those of the HITECH Act in the US. They are lacking in Germany, where the government left health IT adoption strategies solely to the free market and the consensus among all of the stakeholders.

CONCLUSION

Bass diffusion models proved to be useful for distinguishing the diffusion dynamics in German and US non-federal hospitals. When applying the Bass model, the imitation parameter needs a broader interpretation beyond the network effects, including driving forces such as incentives and regulations, as was demonstrated by this study.

Evaluation of health information systems research in information systems research: A meta-analysis

Given the importance of the health-care industry and the promise of health information systems, researchers are encouraged to build on the shoulders of giants as the saying goes. The health information systems field has a unique opportunity to learn from and extend the work that has already been done by the highly correlated information systems field. As a result, this research article presents a past, present and future meta-analysis of health information systems research in information systems journals over the 2000–2015 time period. Our analysis reviewed 126 articles on a variety of topics related to health information systems research published in the “Senior Scholars” list of the top eight ranked information systems academic journals. Across the selected information systems academic journals, our findings compare research methodologies applied, health information systems topic areas investigated and research trends. Interesting results emerge in the range and evolution of health information systems research and opportunities for health information systems researchers and practitioners to consider moving forward.

Extended dependency network diagrams: adding a strategic dimension

Purpose

Organizations increasingly form or join collaborations to gain access to resources paramount for achieving a sustained competitive advantage. This paper aims to propose an extension to the established dependency network diagram (DND) technique to better facilitate analysis, design and, ultimately, strategic management of such collaborations.

Design/methodology/approach

Based on the resource dependence theory, the constructs of power and secondary dependency are operationalized and integrated into the original DND technique. New rules and an updated algorithm for how to construct extended DNDs are provided.

Findings

The value of the proposed extension of the DND technique is illustrated by analysis of an application hosting collaboration case study from the Australian financial service industry.

Research limitations/implications

This study provides preliminary evidence for strategically managing resource collaborations. Future research could further test empirically the usefulness of the proposed extension of the DND technique and how much it contributes to better understanding resource collaborations.

Practical implications

The proposed extension of the DND technique enables managers to perform a broader analysis of dependencies among participants in a collaboration, helping them to more accurately comprehend the relationships between the entities in their collaborative environment and, thus, being in a better position of strategically managing resource dependencies.

Originality/value

The proposed extension of the DND technique makes a central contribution to the extant literature by adding a strategic dimension to a visualization technique used to represent collaborative environments.

What is the extent of research on the characteristics, behaviors, and impacts of health information technology champions? A scoping review

Background

Although champions are commonly employed in health information technology (HIT) implementations, the state of empirical literature on HIT champions’ is unclear. The purpose of our review was to synthesize quantitative and qualitative studies to identify the extent of research on the characteristics, behaviors, and impacts of HIT champions. Ultimately, our goal was to identify gaps in the literature and inform implementation science.

Methods

Our review employed a broad search strategy using multiple databases—Embase, Pubmed, Cinahl, PsychInfo, Web of Science, and the Cochrane library. We identified 1728 candidate articles, of which 42 were retained for full-text review.

Results

Of the 42 studies included, fourteen studies employed a multiple-case study design (33 %), 12 additional articles employed a single-case study design (29 %), five used quantitative methods (12 %), two used mixed-methods (5 %), and one used a Delphi methodology (2 %). Our review revealed multiple categories and characteristics of champions as well as influence tactics they used to promote an HIT project. Furthermore, studies have assessed three general types of HIT champion impacts: (1) impacts on the implementation process of a specific HIT; (2) impacts on usage behavior or overall success of a specific HIT; and (3) impacts on general organizational-level innovativeness. However the extent to which HIT projects fail even with a champion and why such failures occur is not clear. Also unclear is whether all organizations require a champion for successful HIT project implementation. In other words, we currently do not know enough about the conditions under which (1) a health IT champion is needed, (2) multiple champions are needed, and (3) an appointed champion—as opposed to an emergent champion—can be successful.

Conclusions

Although champions appear to have contributed to successful implementation of HIT projects, simply measuring the presence or absence of a champion is not sufficient for assessing impacts. Future research should aim for answers to questions about who champions should be, when they should be engaged, what they should do, how management can support their efforts, and what their impact is given the organizational context.

From Innovative I.S. Strategy to Customer Value

While information systems (IS) have traditionally been used primarily for firm-wide operational efficiency, emerging theoretical perspectives have shifted scholarly focus to IS as a force that can drive value through business innovation. This study examines how IS strategy creates customer value through an innovative business orientation and how IS leadership and the organizational context can influence the relationship between innovative IS and business strategies. Integrating several research streams under the umbrella of the IS strategic management literature, we develop and empirically validate a research model based on confirmatory analysis and structural equation modeling applied to survey data collected from senior IS executives in 165 organizations based in the United States and India. Our results suggest that organizations that have an innovative IS strategy are well positioned to engage in business innovation, which in turn yields greater customer value. Furthermore, we find that strong IS leadership and a creative organizational climate enhance the relationship between an innovative IS strategy and innovative business orientation.

Examining the pre-adoption stages of healthcare IT: A case study of vital signs monitoring systems

Pervasive healthcare systems can reduce the costs and improve the quality of healthcare. However, insufficient care in managing the process before the organizational decision to adopt information technology (IT) can result in poor outcomes. With most previous research focusing on IT adoption, this paper develops a multi-stage theoretical framework for the pre-adoption phase of healthcare IT to address this practical challenge and gap in the literature. With a priori concepts identified from previous multi-stage models, our framework was developed by analyzing two cases of the introduction of vital signs monitoring systems in hospitals to identify the important stages and influencing factors for healthcare IT pre-adoption.

Important factors for success in hospital BPR project phases

PURPOSE

Business process reengineering (BPR) is touted in the literature as the dramatic improvements necessary for competitiveness, but in practice there are many unsuccessful cases. A more systematic and rigorous factor-assessment deemed important to each BPR phase and overall project success is needed. This paper aims to assess the extent to which proposed success factors in a hospital contribute to each BPR phase's success..

DESIGN/METHODOLOGY/APPROACH

Based on the relevant literature, desirable results from each project phase were defined. Overall project success was defined as the benefits hospital managers derive from BPR according to manager opinions. A total of 192 hospital administrators shared their last BPR experience, where changes were operational for at least one year.

FINDINGS

Recommendations are made for hospital managers to focus attention and resources on factors important to BPR success. Hospital managers are not emphasizing the most important activities and tasks recommended in the BPR literature, such as changes to customer/market related business processes, every business activity's value-added element and applying the right innovative technology. Based on the whole findings, top managers should not engage BPR before ensuring that important success factors are present.

ORIGINALITY/VALUE

While many researchers identified and/or tested factors important to BPR success, this is the first study to explore BPR success factors' importance to each project phase, from inception to overall project success assessment phase.