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van Dijk TS, Felder M, Janssen RTJM, van der Scheer WK. For better or worse: Governing healthcare organisations in times of financial distress. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:926-947. [PMID: 38153907 DOI: 10.1111/1467-9566.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
Due to processes of financialisation, financial parties increasingly penetrate the healthcare domain and determine under which conditions care is delivered. Their influence becomes especially visible when healthcare organisations face financial distress. By zooming-in on two of such cases, we come to know more about the considerations, motives and actions of financial parties in healthcare. In this research, we were able to examine the social dynamics between healthcare executives, banks and health insurers involved in a Dutch hospital and mental healthcare organisation on the verge of bankruptcy. Informed by interviews, document analysis and translation theory, we reconstructed the motives and strategies of executives, banks and health insurers and show how they play a crucial role in decision-making processes surrounding the survival or downfall of healthcare organisations. While parties are bound by legislation and company procedures, the outcome of financial distress can still be influenced. Much depends on how executives are perceived by financial stakeholders and how they deal with threats of destabilisation of the network. We further draw attention to the consequences of financialisation processes on the practices of healthcare organisations in financial distress.
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Affiliation(s)
- Tessa S van Dijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Martijn Felder
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Richard T J M Janssen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Wilma K van der Scheer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Healthcare Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Price C, Suhomlinova O, Green W. Researching big IT in the UK National Health Service: A systematic review of theory-based studies. Int J Med Inform 2024; 185:105395. [PMID: 38442664 DOI: 10.1016/j.ijmedinf.2024.105395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To identify and discuss theory-based studies of large-scale health information technology programs in the UK National Health Service. MATERIALS AND METHODS Using the PRISMA systematic review framework, we searched Scopus, PubMed and CINAHL databases from inception to March 2022 for theory-based studies of large-scale health IT implementations. We undertook detailed full-text analyses of papers meeting our inclusion criteria. RESULTS Forty-six studies were included after assessment for eligibility, of which twenty-five applied theories from the information systems arena (socio-technical approaches, normalization process theory, user acceptance theories, diffusion of innovation), twelve from sociology (structuration theory, actor-network theory, institutional theory), while nine adopted other theories. Most investigated England's National Program for IT (2002-2011), exploring various technologies among which electronic records predominated. Research themes were categorized into user factors, program factors, process outcomes, clinical impact, technology, and organizational factors. Most research was qualitative, often using a case study strategy with a longitudinal or cross-sectional approach. Data were typically collected through interviews, observation, and document analysis; sampling was generally purposive; and most studies used thematic or related analyses. Theories were generally applied in a superficial or fragmentary manner; and articles frequently lacked detail on how theoretical constructs and relationships aided organization, analysis, and interpretation of data. CONCLUSION Theory-based studies of large NHS IT programs are relatively uncommon. As large healthcare programs evolve over a long timeframe in complex and dynamic environments, wider adoption of theory-based methods could strengthen the explanatory and predictive utility of research findings across multiple evaluation studies. Our review has confirmed earlier suggestions for theory selection, and we suggest there is scope for more explicit use of such theoretical constructs to strengthen the conceptual foundations of health informatics research. Additionally, the challenges of large national health informatics programs afford wide-ranging opportunities to test, refine, and adapt sociological and information systems theories.
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Affiliation(s)
- Colin Price
- University of Leicester, School of Business, 266 London Road, Leicester LE2 1RQ, United Kingdom.
| | - Olga Suhomlinova
- University of Leicester, School of Business, 266 London Road, Leicester LE2 1RQ, United Kingdom
| | - William Green
- University of Leicester, School of Business, 266 London Road, Leicester LE2 1RQ, United Kingdom
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Vale MD, Perkins DW. Discuss and remember: Clinician strategies for integrating social determinants of health in patient records and care. Soc Sci Med 2022; 315:115548. [PMID: 36403352 DOI: 10.1016/j.socscimed.2022.115548] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
There is growing interest in standardizing data about social determinants of health (SDOH) in electronic health records (EHRs), yet little is known about how clinicians document SDOH in daily practice. This study investigates clinicians' strategies for working with SDOH data and the challenges confronting SDOH standardization. Drawing on ethnographic observation, interviews with patients and clinicians, and systematic review of patient EHRs-all at an urban teaching hospital in the US Midwest-we analyze three strategies clinicians deploy to integrate SDOH data into patient care. First, clinicians document SDOH using "signal phrases," keywords and short sentences that help them recall patients' social stories. Second, clinicians use other technology or face-to-face conversations to share about patients' SDOH with colleagues. Third, clinicians fold discussion of SDOH with patients into their personal relationships. While these local strategies facilitate personalized care and help clinicians minimize their computer workload, we also consider their limitations for efforts to coordinate care across institutions and attempts to identify SDOH in EHRs. These findings reveal ongoing tensions in projects of standardization in medicine, as well as the specific difficulty of standardizing data about SDOH. They have important clinical implications as they help explain how clinicians may attend to patients' SDOH in ways that are not legible in patient records. This paper is also relevant for policy at a time when mandates to include SDOH data in health records are expanding and strategies to standardize SDOH documentation are being developed.
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Affiliation(s)
- Mira D Vale
- Department of Sociology, University of Michigan, 500 S. State St., Ann Arbor, MI, 48109, USA.
| | - Denise White Perkins
- Department of Family Medicine, Henry Ford Health System, One Ford Place, 3E, Detroit, MI 48202, USA.
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Daskalopoulou A, Palmer M. Persistent institutional breaches: Technology use in healthcare work. Soc Sci Med 2021; 289:114399. [PMID: 34583147 DOI: 10.1016/j.socscimed.2021.114399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/30/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
Various mobile phone applications (hereafter apps) challenge instituted ways of working in healthcare. This study explores the institutional breaches arising from the use of apps in doctor-patient interactions. This paper argues that institutional breaches, however small, are important occasions for observing the contextual intersections between healthcare, regulation and technology in a hospital setting. Based on healthcare professionals' normative judgements, the paper offers an empirically grounded understanding of institutional legitimacy-claiming; safeguarding responses deployed by the instituted regime, and the case-building responses deployed by the instituting persuaders. Institutional breach persistence arises from the moral dimension of legitimacy and is grounded in asymmetrical dynamics between two virtuous healthcare narratives. The paper concludes with a discussion of the contextual intersections between healthcare, regulation and technology, paying particular attention to institutional breaches as experimentation, the contestation of normativity and patterns of technology indulgency in healthcare work.
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Affiliation(s)
- Athanasia Daskalopoulou
- University of Liverpool Management School, Chatham Street, Liverpool L69 7ZH, United Kingdom.
| | - Mark Palmer
- Queen's University Belfast, University Road, Belfast, BT7 1NN, Northern Ireland, United Kingdom.
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Scheibner J, Sleigh J, Ienca M, Vayena E. Benefits, challenges, and contributors to success for national eHealth systems implementation: a scoping review. J Am Med Inform Assoc 2021; 28:2039-2049. [PMID: 34151990 DOI: 10.1093/jamia/ocab096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Our scoping review aims to assess what legal, ethical, and socio-technical factors contribute to or inhibit the success of national eHealth system implementations. In addition, our review seeks to describe the characteristics and benefits of eHealth systems. MATERIALS AND METHODS We conducted a scoping review of literature published in English between January 2000 and 2020 using a keyword search on 5 databases: PubMed, Scopus, Web of Science, IEEEXplore, and ProQuest. After removal of duplicates, abstract screening, and full-text filtering, 86 articles were included from 8276 search results. RESULTS We identified 17 stakeholder groups, 6 eHealth Systems areas, and 15 types of legal regimes and standards. In-depth textual analysis revealed challenges mainly in implementation, followed by ethico-legal and data-related aspects. Key factors influencing success include promoting trust of the system, ensuring wider acceptance among users, reconciling the system with legal requirements, and ensuring an adaptable technical platform. DISCUSSION Results revealed support for decentralized implementations because they carry less implementation and engagement challenges than centralized ones. Simultaneously, due to decentralized systems' interoperability issues, federated implementations (with a set of national standards) might be preferable. CONCLUSION This study identifies the primary socio-technical, legal, and ethical factors that challenge and contribute to the success of eHealth system implementations. This study also describes the complexities and characteristics of existing eHealth implementation programs, and suggests guidance for resolving the identified challenges.
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Affiliation(s)
- James Scheibner
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland.,College of Business, Government and Law, Flinders University, Adelaide, Australia
| | - Joanna Sleigh
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
| | - Marcello Ienca
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
| | - Effy Vayena
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
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Evidence-making interventions in health: A conceptual framing. Soc Sci Med 2019; 238:112488. [DOI: 10.1016/j.socscimed.2019.112488] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 01/31/2023]
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Bergey MR, Goldsack JC, Robinson EJ. Invisible work and changing roles: Health information technology implementation and reorganization of work practices for the inpatient nursing team. Soc Sci Med 2019; 235:112387. [DOI: 10.1016/j.socscimed.2019.112387] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 01/30/2023]
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Klecun E, Zhou Y, Kankanhalli A, Wee YH, Hibberd R. The dynamics of institutional pressures and stakeholder behavior in national electronic health record implementations: A tale of two countries. JOURNAL OF INFORMATION TECHNOLOGY 2019. [DOI: 10.1177/0268396218822478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Through electronic health record implementation, national healthcare systems are aiming for care integration and enhancement. However, the path to large-scale electronic health record implementation is seldom smooth, involving multiple stakeholders with diverse interests and influences. This study proposes a framework that draws on both stakeholder and institutional theories to understand the complex dynamics of stakeholder interactions and institutional pressures over time during electronic health record systems implementation. This framework is utilized to analyze the national electronic health record programs of Singapore and England, which provide contrasting perspectives on how two top-down system implementations took place with different outcomes. Our results suggest that in the Singapore case, the presence of boundary spanners, supporting implementation agency that included IT staff from healthcare organizations, and greater engagement with medical professionals were associated with more positive dynamics of stakeholder interactions (e.g. limited pushback from professionals or the press) during electronic health record implementation than in England. Differences in the healthcare structures and systems, electronic health record project organization, and the combined influences of institutional pressures shed light on the varying implementation paths and outcomes in the two cases. This study adds to the health information technology literature through a comparative examination of the organizational and social processes during complex national healthcare integration projects. It also contributes to the institutional and stakeholder literatures in several ways, in particular by depicting the processes and outcomes of the dynamics of isomorphic pressures played out under different institutional conditions. Finally, our proposed framework provides a useful conceptual tool for analyzing such complex IT implementations across multiple stakeholders.
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Affiliation(s)
- Ela Klecun
- London School of Economics and Political Science, UK
| | - Ya Zhou
- The University of Nottingham Ningbo China, China
| | | | | | - Ralph Hibberd
- London School of Economics and Political Science, UK
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Stakeholders’ enactment of competing logics in IT governance: polarization, compromise or synthesis? EUR J INFORM SYST 2017. [DOI: 10.1057/s41303-017-0055-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Boonstra A, van Offenbeek MAG, Vos JFJ. Tension Awareness of Stakeholders in Large Technology Projects: A Duality Perspective. PROJECT MANAGEMENT JOURNAL 2017. [DOI: 10.1177/875697281704800102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article analyzes the tensions evolving from project management dilemmas and how they relate to stakeholders in large technology projects. The study addresses an organization-wide electronic health record implementation in a large hospital. It adopts a duality lens in exploring whether and how these tensions materialize through stakeholder voices. In contrast to traditional linear and unitarist thinking in project management, duality thinking may lead to project management practices that acknowledge, appreciate, and accommodate the tensions originating from dilemmas inherent in complex projects. We propose three stakeholder roles that can contribute to project managers’ tension awareness and inform duality management.
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Affiliation(s)
- Albert Boonstra
- Faculty of Economics and Business, University of Groningen, The Netherlands
| | | | - Janita F. J. Vos
- Faculty of Economics and Business, University of Groningen, The Netherlands
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Thune T, Mina A. Hospitals as innovators in the health-care system: A literature review and research agenda. RESEARCH POLICY 2016. [DOI: 10.1016/j.respol.2016.03.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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