Debunking the myth of industry 4.0 in health care: insights from a systematic literature review

Development of an Evidence-Based Conceptual Model of the Health Care Sector Under Digital Transformation: Integrative Review

BACKGROUND

Digital transformation is currently one of the most influential developments. It is fundamentally changing consumers' expectations and behaviors, challenging traditional firms, and disrupting numerous markets. Recent discussions in the health care sector tend to assess the influence of technological implications but neglect other factors needed for a holistic view on the digital transformation. This calls for a reevaluation of the current state of digital transformation in health care. Consequently, there is a need for a holistic view on the complex interdependencies of digital transformation in the health care sector.

OBJECTIVE

This study aimed to examine the effects of digital transformation on the health care sector. This is accomplished by providing a conceptual model of the health care sector under digital transformation.

METHODS

First, the most essential stakeholders in the health care sector were identified by a scoping review and grounded theory approach. Second, the effects on these stakeholders were assessed. PubMed, Web of Science, and Dimensions were searched for relevant studies. On the basis of an integrative review and grounded theory methodology, the relevant academic literature was systematized and quantitatively and qualitatively analyzed to evaluate the impact on the value creation of, and the relationships among, the stakeholders. Third, the findings were synthesized into a conceptual model of the health care sector under digital transformation.

RESULTS

A total of 2505 records were identified from the database search; of these, 140 (5.59%) were included and analyzed. The results revealed that providers of medical treatments, patients, governing institutions, and payers are the most essential stakeholders in the health care sector. As for the individual stakeholders, patients are experiencing a technology-enabled growth of influence in the sector. Providers are becoming increasingly dependent on intermediaries for essential parts of the value creation and patient interaction. Payers are expected to try to increase their influence on intermediaries to exploit the enormous amounts of data while seeing their business models be challenged by emerging technologies. Governing institutions regulating the health care sector are increasingly facing challenges from new entrants in the sector. Intermediaries increasingly interconnect all these stakeholders, which in turn drives new ways of value creation. These collaborative efforts have led to the establishment of a virtually integrated health care ecosystem.

CONCLUSIONS

The conceptual model provides a novel and evidence-based perspective on the interrelations among actors in the health care sector, indicating that individual stakeholders need to recognize their role in the system. The model can be the basis of further evaluations of strategic actions of actors and their effects on other actors or the health care ecosystem itself.

Are Health Information Systems Ready for the Digital Transformation in Portugal? Challenges and Future Perspectives

PURPOSE

This study aimed to reflect on the challenges of Health Information Systems in Portugal at a time when technologies enable the creation of new approaches and models for care provision, as well as to identify scenarios that may characterize this practice in the future.

DESIGN/METHODOLOGY/APPROACH

A guiding research model was created based on an empirical study that was conducted using a qualitative method that integrated content analysis of strategic documents and semi-structured interviews with a sample of fourteen key actors in the health sector.

FINDINGS

Results pointed to the existence of emerging technologies that may promote the development of Health Information Systems oriented to "health and well-being" in a preventive model logic and reinforce the social and management implications.

ORIGINALITY/VALUE

The originality of this work resided in the empirical study carried out, which allowed us to analyze how the various actors look at the present and the future of Health Information Systems. There is also a lack of studies addressing this subject.

RESEARCH LIMITATIONS/IMPLICATIONS

The main limitations resulted from a low, although representative, number of interviews and the fact that the interviews took place before the pandemic, so the digital transformation that was promoted was not reflected. Managerial implications and social implications: The study highlighted the need for greater commitment from decision makers, managers, healthcare providers, and citizens toward achieving improved digital literacy and health. Decision makers and managers must also agree on strategies to accelerate existing strategic plans and avoid their implementation at different paces.

Impact of industry 4.0 on healthcare systems of low- and middle- income countries: a systematic review

Purpose

A growing body of empirical research has emerged, focused on leveraging Industry 4.0 technologies to develop and optimise systems within various operational contexts, including healthcare delivery. However, even though a significant number of studies have been published on application of digital technologies in enhancing delivery and health outcomes of health systems, systematic studies that review how extensively these technologies have been applied within a low- and middle-income economies' context remain scarce in the literature. This work attempts to close that gap by investigating the impact of industry 4.0 on healthcare systems in emerging economies.

Methods

The study follows a systematic review approach and uses PRISMA guidelines to conduct the research and synthesise its findings. A final sample of 72 articles is selected for in-depth review following a systematic screening from an initial list of 597 results.

Results

The study successfully synthesises the latest research in the subject area and reveals that, hitherto, approaches to use of digital tools have been fragmented and thus unable to provide holistic optimisation solutions for healthcare systems in low-resource settings. The analysis exposes a heavy skew towards adoption of mobile health and telemedicine technologies, with conspicuous research gaps in the use of augmented reality, additive manufacturing as well as simulation and digital twin technologies.

Conclusions

The study provides researchers, health-care practitioners and systems engineers with knowledge on the state-of-the-art in healthcare systems optimisation and points out research gaps that may be addressed through future empirical studies.

The impact of Industry 4.0 technologies and the soft side of TQM on organisational performance: a multiple case study analysis on manufacturing organisations

Purpose

The purpose of this study is to explore how Industry 4.0 (I40) technologies support workers' engagement in soft total quality management (TQM) practices for organisational performance.

Design/methodology/approach

The authors conducted a multiple case study of six Italian manufacturing organisations that operate with I40 production and implement TQM practices. The authors concentrated on the relationship between I40 technologies and soft TQM aspects.

Findings

I40 technologies provide two forms of engagement with workers. Workers can act as machine supervisors and expert assembly operators. Organisations use five soft TQM practices to involve and develop workers for TQM that vary according to automation levels. The five soft TQM practices are top management design around workers, incremental trials with I40 technologies, worker empowerment, I40 sociotechnical collaboration and individual feedback systems.

Originality/value

In the literature that focusses primarily on how I40 technologies support the hard side of TQM by creating a data-driven and automated quality management system, the authors illustrate how the workforce can be engaged in I40 with five soft TQM practices to improve organisational performance. Thus, the authors complement the theory of hard and soft TQM aspects for I40 production systems.

Reaping the benefits of digital transformation through Public-Private Partnership: A service ecosystem view applied to healthcare

The ongoing digital transformation ushers unprecedented challenges for publicly owned healthcare organizations. Collaborative governance models, such as Public Private Partnerships (PPPs), advance their readiness to address such challenges, paving the way for the establishment of a viable service ecosystem. However, little is known about how PPPs enhance the publicly owned healthcare organizations’ ability to thrive amidst the digital transformation. The article investigates this issue, drawing on the exploratory case of “Lab@AOR”, a PPP established between Loccioni and the University Hospital of Marche (Italy) which focused on the robotization of a critical component of healthcare services’ delivery. Three ingredients have been found to nurture the PPP’s cohesiveness and success: (1) the alignment between the public partner’s needs and the private partner’s competences, (2) knowledge contamination, and (3) the adoption of patient-centeredness as the inspiring principle of the collaboration. The PPP represents an initial step of the transition towards a service ecosystem, entailing a fully-fledged partners’ integration for value co-generation.

Total quality service in digital era

Purpose

Total quality management is a valuable approach to continuously improve the quality of organizations; however, scholars debate its applicability to services, which require specific best practices that are different from those related to manufacturing. Moreover, digitization is pervading all kinds of services, but little has been written about total quality service practices in digital-based companies. For this purpose, the authors provide a holistic model of total quality service that reflects the peculiarities of such companies, guided by the question: how do total quality service practices change in digital-based service organizations?

Design/methodology/approach

The authors conduct an illustrative case study on Healthware Group, a global integrated digital health organization, to evaluate theoretical assumptions about total quality service practices in the digital environment.

Findings

The findings allow to validate the model provided. In addition, the study enables them to observe the changes the authors are witnessing in service provision in the digital era and the consequent transformation of best practices. To be accurate, the authors cannot refer to a full transformation in digital-based companies but rather to the enrichment and extension of TQS practices. The best illustration of these conclusions has been summarized in a set of propositions corresponding to seven of the key levers of a TQS model.

Originality/value

The paper represents the first attempt to discuss the relationship between total quality service and digitalization, offering a set of propositions for academics and insights for practitioners. The model can be used as a tool to visualize the different levers that successful implementation of TQS in digital-based services companies can rely on.

Recognizing the legacy of the TQM Journal: a bibliometric analysis of Scopus indexed publications (2008 - 2021)

Purpose

The purpose of this paper is to examine the trends in research published by the TQM Journal since its indexing in the Scopus database in 2008. The paper intends to offer a bibliometric analysis of the TQM Journal by highlighting the contributions made by the journal through citations, prominent authors, most frequent keywords and publications across geographical regions.

Design/methodology/approach

The study involved the use of descriptive and visual methods to examine the quantitative and qualitative features of the bibliometric data. The authors made use of Biblioshiny using R-Studio and VoS viewer user interfaces to perform various types of bibliometric analysis on the bibliomteric data of the journal extracted from Scopus database (the largest inter-disciplinary database in social sciences).

Findings

With 85% of cited documents having a total 12,079 citations, the TQM Journal is one of the most reputed and impactful journals in the field of performance, integrated management system total quality management and allied concepts. The publications in the TQM Journal have cited many top-rated journals relevant to the domain. Maximum contributions in TQM Journal are submitted by authors from Italy, India and UK. Major submissions made to TQM Journal have focused on the quality concepts relevant to production and manufacturing sector in particular. In this regard, the TQM Journal has a very bright scope in covering the diverse and latest trends across industries especially during pandemic and changes happening thereof. The contributions of the editorial team along with authors and reviewers are unmatchable in making the reputation of the TQM Journal.

Originality/value

To the best of knowledge of the authors, this is going to be first bibliometric study ever conducted on the TQM Journal on documents published in Scopus database. The work carried out is unique, as it is an attempt by authors to comprehend the legacy of the TQM Journal through bibliometric data and showcase the past trends and explore future directions for the TQM Journal.

Toward digital transformation in healthcare: a framework for remote monitoring adoption

Purpose

Digital transformation (DT) is a priority for the healthcare sector. In many countries, it is still considered in the early stages with an underestimation of its benefits and potentiality. Especially in Italy, little is known about the impact of digitalization – particularly of the Internet of Things (IoT) – on the healthcare sector, for example, in terms of clinician's jobs and patient's experience. Drawing from such premises, the paper aims to focus on an overlooked healthcare area related to the chronic heart diseases field and its relationship with DT. The authors aim at exploring and framing the main variables of remote Monitoring (RM) adoption as a specific archetype of healthcare digitalization, both on patients and medical staff level, by shedding some lights on its overall implementation.

Design/methodology/approach

The authors empirically inquiry the RM adoption within the context of the Cardiology Department of the Casilino General Hospital of Rome. To answer our research question, the authors reconstruct the salient information by using induction-type reasoning, direct observation and interviewees with 12 key informants, as well as secondary sources analysis related to the hospital (internal documentation, presentations and technical reports).

Findings

According to a socio-technical framework, the authors build a model composed of five main variables related to medical staff and patients. The authors classify such variables into an input-process-output (I-P-O) model. RM adoption driver represents the input; cultural digital divide, structure flexibility and reaction to change serve the process and finally, RM outcome stands for the output. All these factors, interacting together, contribute to understanding the RM adoption process for chronic disease management.

Research limitations/implications

The authors' research presents two main limitations. The first one is related to using a qualitative method, which is less reliable in terms of replication and the interpretive role of researchers. The second limitation, connected to the first one, is related to the study's scale level, which focuses on a mono-centric consistent level of analysis.

Practical implications

The paper offers a clear understanding of the RM attributes and a comprehensive view for improving the overall quality management of chronic diseases by suggesting that clinicians carefully evaluate both hard and soft variables when undertaking RM adoption decisions.

Social implications

RM technologies could impact on society both in ordinary situations, by preventing patient mobility issues and transport costs, and in extraordinary times (such as a pandemic), where telemedicine contributes to supporting hospitals in swapping in-person visits with remote controls, in order to minimize the risk of coronavirus disease (COVID-19) contagion or the spread of the virus.

Originality/value

The study enriches the knowledge and understanding of RM adoption within the healthcare sector. From a theoretical perspective, the authors contribute to the healthcare DT adoption debate by focusing on the main variables contributing to the DT process by considering both medical staff and patient's role. From a managerial perspective, the authors highlight the main issues for RM of chronic disease management to enable the transition toward its adoption. Such issues range from the need for awareness of the medical staff about RM advantages to the need for adapting the organizational structure and the training and education process of the patients.

Strategic issues of big data analytics applications for managing health-care sector: a systematic literature review and future research agenda

Purpose

The proposed article is aimed at exploring the opportunities, challenges and possible outcomes of incorporating big data analytics (BDA) into health-care sector. The purpose of this study is to find the research gaps in the literature and to investigate the scope of incorporating new strategies in the health-care sector for increasing the efficiency of the system.

Design/methodology/approach

Fora state-of-the-art literature review, a systematic literature review has been carried out to find out research gaps in the field of healthcare using big data (BD) applications. A detailed research methodology including material collection, descriptive analysis and categorization is utilized to carry out the literature review.

Findings

BD analysis is rapidly being adopted in health-care sector for utilizing precious information available in terms of BD. However, it puts forth certain challenges that need to be focused upon. The article identifies and explains the challenges thoroughly.

Research limitations/implications

The proposed study will provide useful guidance to the health-care sector professionals for managing health-care system. It will help academicians and physicians for evaluating, improving and benchmarking the health-care strategies through BDA in the health-care sector. One of the limitations of the study is that it is based on literature review and more in-depth studies may be carried out for the generalization of results.

Originality/value

There are certain effective tools available in the market today that are currently being used by both small and large businesses and corporations. One of them is BD, which may be very useful for health-care sector. A comprehensive literature review is carried out for research papers published between 1974 and 2021.

The Organizational Aspect of Human Resource Management as a Determinant of the Potential of Polish Hospitals to Manage Medical Professionals in Healthcare 4.0

Industry 4.0 solutions have penetrated the healthcare sector, thus creating challenges that healthcare entities should meet. For this, a proper relationship between human resource management (HRM) within healthcare entities and Healthcare 4.0 is needed. In addition, organizations mainly focus on HRM practices, yet organizational issues are overlooked. In this context, the aim of the article was to analyze and evaluate the involvement and roles of key HRM actors, such as line managers and human resource (HR) specialists (HR departments) within strategic healthcare entities, namely hospitals. It was also important to identify the potential of hospitals to meet the requirements of Healthcare 4.0. A study was performed on a group of 285 Polish hospitals. Five respondents were recruited from each hospital. The total population amounted to 1425 interviewees. Due to the complexity of the research, it was outsourced. The results of the analysis identified that hospitals largely engage line managers in medical personnel management. However, a lack of managerial competence may become a major barrier in coping with challenges created by Healthcare 4.0. Organizational solutions do not support the strategic role of HR specialists; their anchoring in the organizational structures limits the possibility to support the changes required for the transformation towards Healthcare 4.0.