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Impacts of case-based health knowledge system in hospital management: The mediating role of group effectiveness
Accepted Manuscript Title: Impacts of case-based health knowledge system in hospital management: the mediating role of group effectiveness Authors: Dongxiao Gu, Shuyuan Deng, Qian Zheng, Changyong Liang, Jiao Wu PII: DOI: Reference:
S0378-7206(17)30276-8 https://doi.org/10.1016/j.im.2019.04.005 INFMAN 3162
To appear in:
INFMAN
Received date: Revised date: Accepted date:
5 April 2017 8 April 2019 12 April 2019
Please cite this article as: Gu D, Deng S, Zheng Q, Liang C, Wu J, Impacts of case-based health knowledge system in hospital management: the mediating role of group effectiveness, Information and amp; Management (2019), https://doi.org/10.1016/j.im.2019.04.005 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Impacts of case-based health knowledge system in hospital management: the mediating role of group effectiveness Dongxiao Gu1, Shuyuan Deng2, Qian Zheng1, Changyong Liang1, *, Jiao Wu3
2
of Management, Hefei University of Technology, 193 Tunxi Road, Hefei, Anhui 230009, China
Seidman College of Business, Grand Valley State University, 50 Front Avenue SW, Grand
Rapids, Michigan 49504, USA
of Business, Northern Illinois University., 1425 W. Lincoln Hwy., DeKalb, IL 60115, USA
* Corresponding
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3 College
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1 School
author.
E-mail addresses: [email protected] (D. Gu), [email protected] (S. Deng), [email protected] (Q.
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Zheng), [email protected] (C. Liang), [email protected] (J. Wu).
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ABSTRACT:
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With the rise of artificial intelligence, case-based health knowledge management
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systems (CBHKS) have been widely adopted in hospitals. CBHKS are data-driven intelligent platforms that integrate latest technologies, such as artificial intelligence
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and cloud computing. As an integral part of smart hospitals, CBHKS can support
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decision processes at different levels in hospitals. However, researchers have not yet clearly addressed how CBHBKS improves hospital management outcomes. Based on group effectiveness and leadership performance-maintenance theories, we develop a
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conceptual model to explain the role of CBHKS in hospital management. To test the research hypotheses in the conceptual model, we collected survey data from 214 doctors, and performed data analysis using partial least squares (PLS)-based structural equation modeling. The empirical testing results show that the CBHKS 1
implementation significantly and positively influences group performance, group members’ satisfaction, group learning, and external satisfaction; and group members’ satisfaction and external satisfaction significantly and positively affect management performance and maintenance.
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KEYWORDS: case-based systems; group effectiveness; hospital management performance; knowledge management; hospital; intelligent health information
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management.
1．Introduction
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With the rapid development of modern information technology (IT) and the
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application of artificial intelligence, intelligent knowledge-based information systems
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(IS) have been universally implemented throughout the world. The healthcare industry is no exception. In fact, many large hospitals in China have adopted case-
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based health knowledge management systems (CBHKS). For instance, the CBHKS
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developed by Winning Health Technology Group has been used in more than 1500 hospitals in China, supporting more than 200,000 doctors [1]. CBHKS are
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comprehensive, intelligent software platforms that integrate a variety of latest information technologies such as artificial intelligence and cloud computing. It
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utilizes large volumes of historical cases, to support decision processes in hospitals. In particular, the system can provide decision makers with similar historical cases (i.e., issues and their solutions). As a result, CBHKS effectively facilitate the utilization of healthcare information resources, knowledge management, and management decision making in hospitals. Practically, CBHKS are beneficial for many functional areas in a 2
hospital, such as medical diagnoses and prognoses, drug inventory management, nursing management, medical equipment management, patient relationship management, and human resources. Because of their comprehensiveness and efficiency in knowledge reasoning, CBHKS are playing an increasingly important
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role in improving hospital management, becoming an integral part of “smart hospitals.”
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Prior research has explored the positive impact of hospital information systems
(HIS) on organizational performance [2-4]. Furthermore, scholars have discussed the
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influence path of hospital IT application on organizational performance, through
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stay [6], and patient satisfaction [7].
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factors such as the breadth and depth of information sharing [5], patients’ length of
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This study examines the post adoption use of CBHKS, which is closely
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associated with the long-term performance of hospital management. Using expectation confirmation theory, Bhattacherjee [8] was among the first to investigate
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the continued use of IT. His work was followed by an array of studies that focused on
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information systems post adoption behavior (ISPAB) [9-11]. ISPAB explains why individuals and organizations continue to use and expand IS functions and proposed the factors affecting the continuing utilization of IS and IS expansion among
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individuals and organizations. This stream of research forms the theoretical foundation for the continued use of CBHKS in hospitals. The theoretical basis of ISPAB mainly involves diffusion of innovations theory, organizational learning theory, and revolutionary management theory [12-14]. Earlier, ISPAB research has 3
focused on certain cognitive factors, such as perceived service attributes (usefulness and compatibility) and perceived service utilization and network externality (complementary product usage) [15]. When studying the impact of IS on hospitals’ management performance, prior research has mainly focused on constructs such as
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clinical supervision, the hierarchy and complementarity of organizational structure, and hospital governing boards [16-18]. Few studies have comprehensively examined
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the impact of group effectiveness on management performance, which has been
concerned by some scholars in the past [19, 20]. Hence, in the effect evaluation of the
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post-adoption use of CBHKS, the indirect influence of CBHKS on management
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output through the mediating effect of group effectiveness should also be considered.
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Group effectiveness is the degree to which a team has accomplished the goals or
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objectives administered by some authorized personnel or the organization [21].
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Sundstrom and Mclntyre [22] believed that group efficiency has four aspects: group performance, group learning, group satisfaction, and the degree of external
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satisfaction. These four aspects may influence post adoption attitudes and behaviors
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of individuals within a group and organizational performance. Hospitals have various departments, institutes, centers, etc. These group-level units are affected by group cohesiveness and teamwork within the confines of processes and research [23]. Group
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effectiveness is an important manifestation of an organization’s effectiveness as well as a sign of management competency in hospitals. Examining continued use of IS through studying the mediating effect of group effectiveness will fill an important gap in ISPAB research. Additionally, studying the influence path of CBHKS on hospital 4
performance through all four dimensions of group effectiveness may further enrich the literature on the organizational impact of HIS. Therefore, it is of practical significance to understand how CBHKS improve management performance and maintenance in hospitals through group effectiveness.
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When measuring management outcomes, previous IS studies often used management performance as the key indicator [24, 25]. According to Misumi’s [26]
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performance-maintenance (PM) theory of leadership, the performance leadership function (P) is oriented toward goal achievement and problem solving, and the
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maintenance leadership function (M) involves preserving group social stability. In PM
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theory, P and M are considered to be two axes on which the level of each factor can be
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measured [27]. In general, high performance and high maintenance leadership will
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bring about ideal management effect. Although PM theory is widely used to study
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leadership behavior, P and M essentially reflect the main concerns of organizational managers and are important aspects of management objectives. Therefore, it is
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necessary to consider both P and M when studying the management output of an
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organization. Prior research has studied the effects of these two aspects, respectively. Some study has proved the positive relationship between IS application and employee satisfaction [28-30], which is closely related to the group maintenance of the
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organization. At the same time, a similar conclusion has been drawn on the relationship between IS application and organizational performance [31, 32]. Hence, both P and M are vital to the improvement of hospital management. However, when evaluating management outcomes, management maintenance has been seldom taken 5
into consideration. Practically, the loss of talents is an critical issue for managers [33, 34]. Hence, typically considered human capital-intensive, hospitals should regard the maintenance of talents as one of the most important management objectives. It is necessary to include management maintenance in the assessment of management
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results [26]. This will also enrich the research on evaluating the management outcomes resulted from CBHKS implementation.
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Based on the frameworks of the group effectiveness and PM theory of
leadership, this study investigates the impact of CBHKS on hospital management
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outcomes by means of the mediating effect of group effectiveness. Particularly, we
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reveal how group effectiveness mediates the effect of CBHKS implementation on
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management performance and maintenance. To achieve this, we adopt the four-
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dimension measures of group effectiveness proposed by Sundstrom and Mclntyre
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[22], namely group performance, group members’ satisfaction, external satisfaction, and group learning. Our study addresses the following research questions:
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(1) Does the implementation of CBHKS improve hospital management
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performance and maintenance? (2) How does group effectiveness mediate the impact of CBHKS on
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management performance and maintenance in hospitals? Answering these questions is important for developing a holistic view on how
CBHKS impact management outcomes. From a practical perspective, the potential findings will promote the CBHKS implementation and help hospital management use such systems more effectively. 6
The rest of the paper is organized as follows. In Section 2, we review related research on IS post adoption use, group effectiveness, and the PM theory of leadership, which provides the theoretical foundation for our study. Then, in Section 3, we develop the research model and propose the research hypotheses. We discuss in
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Section 4 the research methodology used to test the hypotheses. In Section 5, we present our results and further test the mediating effect of group effectiveness between
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CBHKS and management performance. The last section concludes this paper with a discussion of findings, implications for theory and practice, limitations, and future
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directions.
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2. Theoretical Foundations
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2.1. Group Effectiveness
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Prior research has examined the influence of IS implementation on hospital performance from the perspective of technology, patient experience, and satisfaction
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[4-6]. Little research paid attention to the role of group effectiveness in the
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relationship between HIS and management outcomes. Group, including the formal or informal team, is an important part of organization, and group behavior is an important research aspect in organization. McGrath [35] posited that a group (or team,
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as in management literature) is a social collection of existing mutual understanding and potential interaction between members. If a group can complete a given task and meet its members’ individual needs, it is considered highly effective. Russell et al.[36] believed that group effectiveness is an important result and embodiment of
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organization or group behavior [37]. In the IS research community, scholars also have studied the impact of IS implementation on group efficiency, and provided empirical evidence to support positive effect of IS on group efficiency [38, 39]. Hence, it is reasonable to believe that group effectiveness may play an important role in the
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relationship between CBHKS and hospital management outcomes. Hackman [40] proposed the earliest definition of group effectiveness. In his
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study, group effectiveness has been defined from three perspectives: work output, impact on group members (including satisfaction), and the improvement of group
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problem-solving skills for the future. Later research supplemented and perfected the
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definition of group effectiveness. Sundstrom and Mclntyre [22] used member
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satisfaction, performance, external satisfaction, and team learning to measure group
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effectiveness. Cohen and Baily [41] further noted that the three aspects of group
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effectiveness are: (1) group performance, namely efficiency, productivity, response speed, quality, service customers’ satisfaction, and innovation; (2) members of the
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group, namely satisfaction of the members, commitment, and trust in management;
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and (3) members’ behavior, namely the absence of members, turnover, and safety. Lurey and Raisinghani [42] believed that member satisfaction and performance could
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be used to evaluate group effectiveness. Based on the definitions of group effectiveness in prior research and the four
dimensions of group effectiveness proposed by Sundstrom and Mclntyre [22], we measure group effectiveness using the following: group performance, group member satisfaction, group learning, and external satisfaction. Most studies on group 8
effectiveness have focused mostly on constructing a reasonable group management system that enhances group effectiveness. The influence of group effectiveness is relevant to many levels in a management hierarchy, such as individual, team, business unit, and organization [41, 43, 44]. In this study, we focus on the impact of group
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effectiveness on organizational performance, explaining why the adoption of CBHKS in hospitals affects group work and influences management performance through
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group effectiveness. Measuring these four dimensions of group effectiveness as intermediary variables, we develop our research model to explain the impact of
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CBHKS on hospital performance and maintenance.
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2.2. Performance-Maintenance (PM) Theory of Leadership
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Misumi [45] proposed the PM theory of leadership in the 1970s. This theory divides leadership behavior into two categories, i.e., Performance (P) and
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Maintenance (M). The performance function means that a leader must make detailed
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work plans, require and strictly monitor a staff to carry out the plans to ensure that a group’s specific goals can be achieved. The maintenance function means that a leader
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should be concerned about staff welfare, try to build a harmonious relationship with its members, carefully encourage them, and pay attention to proper authorization to
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ensure ongoing improvement in the organization’s normal operation. In PM theory, leaders have two main management objectives: organizational
goals and organizational relationships. Organizational goals focus on how to improve management performance; organizational relationship focuses on how to establish a stable and harmonious inner environment that maintains the organization. Echoing 9
PM theory, we establish management effectiveness and management maintenance as the dual goals of adopting CBHKS in hospitals to capture the impact of CBHKS on hospital management.
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3. Conceptual Models and Hypothesis Development 3.1. CBHKS implementation and group effectiveness
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3.1.1 CBHKS Implementation and Group Performance
According to the definition by Cohen and Baily [41], group performance is
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mainly reflected in the efficiency, productivity, responsiveness, quality of service,
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customers’ satisfaction, and innovation during healthcare services. A rich literature
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exists on the relationships between IT investment and performance. Most related
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studies consider the investment and implementation of IT as a positive factor in group
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and organizational performance [46, 47]. The use of IT can improve the effectiveness and efficiency [47] and the quality of products and services [48].
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In the healthcare industry, some scholars have researched the influence of IS on
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hospital management performance. For example, Menachemi et al. [49] discussed the positive impact of hospital IT on financial performance. Cui et al. [50] empirically showed that a performance management IS could improve the performance of clinical
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departments — such as in the quality and efficiency of healthcare services in Shanghai’s Ninth People’s Hospital — through a real-time query platform for the staff that could help its members monitor and analyze key performance indexes and solve problems. 10
CBHKS are one type of IT service platform specifically used within the healthcare arena that is also likely to improve group performance. CBHKS provide an information integration platform that supports synchronous sharing of medical information between multiple departments. For example, patients’ test results can be
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quickly shared with medical group members in different departments to accelerate diagnosis and treatment. According to Media Synchronicity Theory, an improved
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capability of media to support information synchronicity could enhance
communication performance and then promote the collaborative behaviors of staff
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members [51]. As an important media in hospital management, CBHKS may
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strengthen two aspects of a medical staff’s information synchronicity: (1) reductions
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in the time needed to query patients’ information and improve the efficiency of
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treatment; and (2) promotion of communication and sharing of knowledge among
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doctors, which will lead to improvement in the quality of healthcare service. Improving the efficiency and quality of healthcare services will enhance the group
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performance of hospital staff by attracting more patients. Hence, we hypothesize:
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H1a: CBHKS Implementation positively influences group performance. 3.1.2 CBHKS Implementation and Group Members’ Satisfaction
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Another dimension of group effectiveness is group members’ satisfaction. This
refers to the satisfaction of internal members and to their commitment and trust in management [41]. In the context of a hospital, it represents the work attitudes of doctors, nurses, and other medical staff. Considerable research has been done on the relationships between the implementation of IS and group member satisfaction. For 11
example, Ammenwerth et al. [52] believe that IT could be used to improve the sense of responsibility in nursing care, thus, improving the efficiency of nurses as well as increasing the satisfaction of patients and other members of the hospital staff. Langfred [53] posited that team performance depends on an individual’s and a team’s
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autonomy, which could both be improved by the implementation of IS. This further encourages users’ initiative and adds to their satisfaction.
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Media Synchronicity Theory posits that communication effectiveness may be
enhanced by faster information conveyance and higher information convergence [51],
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which, in turn, will improve users’ satisfaction with access to information and its use.
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We believe that CBHKS implementation improves doctors’ autonomy. Doctors can
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conveniently query medical records using CBHKS. This makes their work less
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dependent on IT staff. Moreover, the query and report features of CBHKS cost
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doctors less time to check information of patients and prior treatment, shortening the cycle of creating medical records and improving the efficiency of diagnosis and
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treatment. The improvement of efficiency is even more pronounced in medical group
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collaboration. In addition, the data analytics component of CBHKS also provides a powerful tool for doctors to conduct medical research, which is of positive significance for improving doctors' professional knowledge and ability. All of these
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improve the satisfaction of members of the medical staff, facilitating their completion of treatment processes. More efficient treatment processes will improve patients’ satisfaction and, in turn, improve their relationship with the medical staff. Hence, we propose the following hypothesis: 12
H1b: CBHKS Implementation positively influences group members’ satisfaction. 3.1.3 CBHKS Implementation and Group Learning Some scholars who study group learning define it from the perspective of a
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learning process. For instance, Edmondson et al. [54] regarded it as “an ongoing
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process of reflection and action, characterized by asking questions, seeking feedback,
experimenting, reflecting on results, and discussing errors or unexpected outcomes of actions.” Other researchers define it from the perspective of group learning results.
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London et al. [55] consider group learning as “the extent to which members seek
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opportunities to develop new skills and knowledge, welcome challenging
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assignments, were willing to take risks on new ideas, and work on tasks that require considerable skill and knowledge.”
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The relationship between IT implementation and group learning has received a lot
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of attention in the literature [56]. Scholars believe that IT plays an important role in the process of shifting to a “learning organization” by providing technical support for
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effectively storing, organizing, and modifying information and knowledge. Furthermore, some scholars believe that IT could facilitate organizational learning
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[57]. Related studies suggested that the implementation of new technologies often requires employees to update their skills [58, 59]. Sharma [60] proposed that learning should take place in a space that permits convenient cooperation and exchanges with others and not be confined to closed spaces for independent study. In hospitals, the use of CBHKS also promotes group learning among the staff. In 13
particular, the implementation of such a system requires doctors to learn how to use it correctly, which can be regarded as a technical learning process for a group. Moreover, CBHKS can support hospital decision processes by analyzing large volumes of historical cases, identifying similar cases, and generating solutions.
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Hence, CBHKS implementation will promote the information and knowledge sharing among doctors and enhance their treatment skills. Last but not least, the CBHKS
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implementation can encourage doctors to cooperate in the treatment process. Hence, we hypothesize:
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H1c: CBHKS Implementation positively influences group learning.
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3.1.4 CBHKS Implementation and external satisfaction
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External satisfaction is a consequence of group behaviors and a dimension of group effectiveness. According to Sundstrom and Mclntyre [22], higher group
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effectiveness leads to higher consumer satisfaction. Information conveyance and
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information convergence through media could not only affect a staff’s work efficiency but also improve a customer’s perceived information transparency [51], which
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promotes trust among contracting parties and improves external satisfaction. The implementation of IS is likely to improve patient satisfaction and hospital
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management and reduce administrative costs. Amin et al. [61] posited that the utilization of IS can optimize inspection processes, standardize operating procedures, and improve patient and staff satisfaction. Aiken [62] concluded that the application of IS in hospitals optimizes the treatment process by shortening treatment time and improving service quality, thus enhancing patient communication and improving 14
patient satisfaction with his or her medical treatment. CBHKS are the integrated IS not only for medical staff but also for patients. On the one hand, CBHKS improve the efficiency and speed of medical information transmission. On the other hand, CBHKS increase the transparency and sharing of
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information between doctors and patients. Because of the improved efficiency, doctors will have more time to discuss treatment with other doctors and rethink their
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work, making treatment more effective. This is likely to enhance patients’ satisfaction. Moreover, CBHKS implementation will show a hospital’s IT capability and
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commitment. This will create a better image of the hospital, potentially improving
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external satisfaction. Hence, we hypothesize:
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H1d: CBHKS Implementation positively influences external satisfaction. 3.2. Group effectiveness and hospital management
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According to PM theory, the outcome of hospital management can be divided
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into management performance and management maintenance. The CBHKS implementation may improve group effectiveness. As a consequence, higher group
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effectiveness may also lead to the improvement of hospital management (including performance and maintenance).
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3.2.1 Group performance and hospital management Only a few studies have analyzed the relationships between hospital management
and group effectiveness. Besstremyannaya et al. [63] believed that hospital management performance was a kind of output that reflected hospital input as
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represented by cost efficiency. CBHKS implementation, as a kind of IT input, may improve the efficiency, productivity, and responsiveness of a group of doctors [41] and, as a result, improve patients’ satisfaction with hospital services. High patient satisfaction leads to more use of healthcare services from the same hospital,
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increasing its financial income, an important indicator of management performance. Hence, the usage of CBHKS has a significant impact on management performance.
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Hence, we hypothesize:
H2a: Group performance positively influences hospital management
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performance.
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Hospital management maintenance means keeping the relationships in a hospital
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stable and harmonious through appropriate communication while supporting
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employees' autonomy. It preserves a hospital’s social stability. High group
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performance will improve financial performance [64], which could improve the income of individuals and groups under the generally accepted performance appraisal
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system and enhance the stability of the organization. Furthermore, high group
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performance implies harmonious interpersonal relationships and efficient communication in organizations, which would foster group members’ job satisfaction
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and improve management maintenance. Hence, we hypothesize: H2b: Group performance positively influences hospital management
maintenance. 3.2.2 Group members’ satisfaction and hospital management Group members’ satisfaction is related to the recognition, responsibilities, 16
supervision, and opportunities offered during their work [65]. A number of researchers have empirically found that satisfaction is related to performance, such as organizations’ outcomes and management effectiveness [66]. For example, Sweeney [67] described the links between satisfaction and organizational outcomes. Koys [68]
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found that employee satisfaction had positive effects on organizational levels of effectiveness, which actually is a manifestation of management levels. Judge et al.
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[69] performed a comprehensive quantitative review of research on the satisfaction– performance relationship and concluded that these two variables were at least
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moderately correlated. Other scholars suggested that team job satisfaction is related to
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new product performance and commercial success [70]. Hence, we hypothesize:
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H3a: Group members’ satisfaction positively influences hospital management
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performance.
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In the context of hospital management, many scholars have studied the relationships between group members’ satisfaction and hospital performance. Student
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et al. [71] tested the positive effect of nurses’ satisfaction with communication on
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performance. Mascia et al. [72] studied how hospital restructuring influences the job satisfaction of physicians. The use of CBHKS is likely to improve communication efficiency and accelerate the efficiency of searches for knowledge. It is also likely to
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trigger the restructuring of a hospital’s business processes and shorten diagnosis time. Thus, the presence of CBHKS may improve both the staff’s job satisfaction and the hospital’s performance. This is an important indicator of management performance and maintenance. Hence, we hypothesize: 17
H3b: Group members’ satisfaction positively influences hospital management maintenance. 3.2.3 Group learning and hospital management
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Synergy from group learning will foster higher levels of creativity and productivity than any single individual can create [73]. This synergy could eventually
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result in innovative solutions to management problems and to the improvement of
organizational management. Group learning will be helpful for better communication and coordination in teams. It has been shown to have a positive influence on new
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product quality through the improvement of management [74]. Hassan et al. [75]
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suggested that team learning behaviors play a significant role in ensuring the success
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of marketing teams. Argote [76] posited that the occurrence of team learning was mainly manifested in the relatively enduring change in the knowledge and
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performance of team members. He also used organizational and team learning curves
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to measure the performance of team learning. Chen and Zheng [77] found a significant positive relationship between a team’s learning ability and team
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performance. Pagell [78] examined the adaptability between employee skills and work environment and suggested that it directly affects organizational performance.
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In hospitals, leaders, department directors, managers, and medical staff can use
various functions of CBHKS to conduct group learning and acquire information and knowledge for management decision making. All of these could improve the professional skills of a medical group and deliver a high quality of healthcare service to patients. These gains also could lead to more efficiency that would permit treatment 18
of more patients as well as earn their trust, which eventually will improve hospital management performance. Hence, we propose the following hypothesis: H4a: Group learning positively influences hospital management performance. In addition, CBHKS could also help improve the effectiveness of group learning
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and increase the communication behaviors of group members, which, in turn, could increase team cohesion and promote the hospital’s management maintenance. Jahani
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et al. [79] proposed that the learning levels promoted the job satisfaction of hospital employees. Through information sharing and intelligent mining, CBHKS could
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improve the efficiency of communication among medical staff, increase the depth and
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breadth of communication information content, and thus improve the learning level of
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medical staff. Hence, CBHKS could increase the job satisfaction of medical staff and
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further improve hospital management maintenance. We propose the following
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hypothesis:
H4b: Group learning positively influences hospital management maintenance.
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3.2.4 External satisfaction and hospital management
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Previous studies have investigated the relationships between external satisfaction
and management performance and maintenance [80]. External satisfaction is a kind of
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work attitude from external stakeholders, while management maintenance directly embodies organizational effectiveness [81]. Terziovski [82] investigated the relationships among quality management practices, customer satisfaction, and productivity improvement. He suggested that improvement of customers’ satisfaction correlates positively with productivity improvement. 19
External satisfaction in hospitals mainly refers to patients’ satisfaction. The CBHKS implementation improves treatment effectiveness and efficiency, saves patients’ time, and then improves external satisfaction. Patients’ attitudes are vital in determining whether patients will choose a hospital again. Moreover, patients’
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satisfaction influences the service choices of potential customers through word-ofmouth. As one dimension of group effectiveness, external satisfaction is an important
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reflection of whether the work of medical groups is effective. As a result, external
satisfaction can directly influence hospital performance. Therefore, we propose the
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following hypothesis:
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H5a: External satisfaction has a significantly positive effect on hospital
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management performance.
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In addition, CBHKS can promote healthcare service effectiveness, which also
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improves the satisfaction of patients. This improves doctor–patient relationships, which indirectly enhance the stability of medical groups [83]. High external
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satisfaction can reduce the doctor–patient conflict, increase the medical group
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members’ sense of security, and promote the stability of medical working group. Hence, external satisfaction influences the hospital’s continuing development and
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maintenance. Therefore, we propose the following hypothesis: H5b: External satisfaction has a significant positive effect on hospital
management maintenance. Based on the above hypotheses, we present our research model in Figure 1.
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Group Performance
H1b
Group Members’ Satisfaction
H2b H2a
H3b H3a
The Implementation of CBHKS
Management Performance
H1c
Management Maintenance
H4a
Group Learning
H4b
H5a
External Satisfaction
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H1d
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H1a
H5b
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Fig. 1. The research model
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4. Methodology
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To test our research model, a study was conducted at one of the biggest hospitals
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in East China. This hospital has successfully implemented CBHKS. The CBHKS implemented at the hospital are easy to use and useful for doctors, nurses, and
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managers. The hospital started to adopt IS in 1996. The doctors and nurses in this
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hospital were among the first to promote the use of HIS. The implementation of CBHKS in the hospital started in 2012, mainly providing management and decision support for medical staff and hospital managers. The CBHKS include functions such
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as cases organizing and maintenance, collaborative case-based diagnosis and nursing support for doctors and nurses, case-based management and decision support for hospital managers, online members’ communications, and group learning. At present, this system has become a widely used popular support tool for healthcare decision 21
making and hospital management in this hospital. 4.1. Measurements The measurements for most of the variables were adapted from previous studies. Seven constructs are used in this study: CBHKS implementation, Group Performance,
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Group Members’ Satisfaction, Group Learning, External Satisfaction, Management
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Performance, and Management Maintenance. All of the items were measured with a seven-point Likert scale [84, 85], ranging from 1 (strongly disagree) to 7 (strongly agree). CBHKS implementation was measured based on the items from Angst and
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Agarwal [86] and Tippins and Sohi [87]. The measurements for performance and
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satisfaction were adopted from Lurey and Raisinghani [42] in 2001. The
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measurements of group learning are mainly based on the team learning research of
4.2. Data collection
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Huang et al. [88].
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We used a multistage iterative process to collect the data. We conducted a pilot
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study using 85 respondents to test for any ambiguous expressions, awkward wordings, or distortions of the original meanings.
On the basis of data and respondents’
suggestions in the pilot study, we modified the questionnaire, which was then used to
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collect data from the medical staff in the hospital. This study had the full support of the hospital’s management. A small gift with a value of approximately $10 was provided to each respondent who completed and returned the questionnaire. The survey lasted for two and a half months.
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The participants were randomly from the group leaders (such as department heads and office directors). Then, with the assistance of these group leaders, we informed the selected participants and explained the purpose of the study. Based on the questionnaire filling rule, we informed the group leaders in advance, they should
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organize at least two in-group discussions and extensively solicit opinions and suggestions from personnel within the group. Based on full communication and
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consultation with colleagues within groups, the leaders filled in the questionnaires on behalf of their groups. Although the questionnaires were completed by the leaders,
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obviously the scores represent common understanding of groups, not only individual
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opinions of leaders.
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They were also informed that participation was voluntary as well as anonymous.
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We distributed 250 questionnaires and got 225 returned ones. The response rate is
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90%. Among the 225 questionnaires returned, 11 were discarded as incomplete. Hence, we used 214 responses in the analysis. The sample demographics were shown
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in Table 1. In this table, we only counted the people who finally filled in the
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questionnaires. Table 1 shows the demographic data. Table 1
Sample demographics. Category
Number
Percentage
Male
120
56.1%
Female
94
43.9%
18-28 years old
15
7.0%
28-48 years old
140
65.4%
48-60 years old
49
22.9%
>60 years old
10
4.7%
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Gender
Age
Educational background 23
College
53
24.7%
Graduate school
161
75.3%
214
100%
Total
4.3. Data analysis technique PLS-based structural equation modeling (SEM) was used to perform a
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simultaneous evaluation of both measurement quality (measurement model) and construct interrelationship (structural model) [9]. Prior studies have indicated that
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PLS-SEM overcame problematic model identification issues and that it is a powerful method to analyze complex models by using smaller samples [89, 90]. Covariance-
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based SEM cannot provide robust results because our sample size is limited. Thus, in
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this study, we used SmartPLS 2 to evaluate measurement quality and test hypotheses.
5.1. Measurement Model
M
A
5. Results
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Analysis of the measurement model mainly involves the assessment of reliability
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and validity. Among the reliability metrics, Cronbach’s α reliability coefficient has been most commonly used. A factor’s Cronbach’s α evaluates the internal consistency
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of the measurements. The threshold value of Cronbach’s α recommended by Hair et al. [91] is 0.5. Another metric for internal consistency is composite reliability, which
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is not sensitive to the number of items in the scale [91]. Hair et al. [91] considered composite reliability of 0.7 or more to be very credible. Both Cronbach's α and composite reliability were used for a comprehensive analysis of the reliability of the questionnaires. The validity of constructs is commonly measured from two aspects, i.e., 24
convergent validity and discriminant validity. Convergent validity can be assessed by using average variance extracted (AVE). AVE measures the level of variance captured by a construct versus the level because of measurement error. AVE values higher than 0.5 are considered very good. According to Fornell and Larcker [92], to ensure the
AVE value needs to exceed its correlation with other constructs.
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existence of discriminant validity among the factors, the square root of a construct’s
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Table 2 presents the assessment of reliability and validity. All of the Cronbach’s α and composite reliability values exceed 0.8, indicating very good reliability. All of
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the AVE values exceed 0.5, suggesting good convergent validity. The right part of
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Table 2 shows the correlations among the constructs; the square roots of the AVE
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values are on the diagonal. The square root of each construct’s AVE value exceeds its
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correlations with other constructs, indicating strong discriminant validity. Table 3
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shows the mean, standard deviation, and factor loadings of each measurement. All of
validity.
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the factor loadings exceed 0.7, providing additional evidence for good discriminant
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We followed Kock and Lynn [93] and Kock [94] to assess potential common method bias using a full collinearity test. Specifically, we created a dummy construct (with a single indicator containing random values between 0 and 1) and used all
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constructs to predict it through a PLS regression. The variance inflation indicator (VIF) values for each of the construct are reported in Table 4. All of the VIF values are below the recommended threshold, i.e., 3.3. This suggests that our data analysis is not threatened by common method bias or multicollinearity. 25
Table 2 Reliability and discriminant validity.
's Alpha
Composit
AV
e
E
Reliability
CI
ES
GL
GM S
GP
0.895
0.928
0.762
0.873
ES
0.954
0.960
0.666
0.446
0.816
GL
0.905
0.934
0.779
0.337
0.703
0.883
GMS
0.897
0.921
0.662
0.512
0.693
0.740
0.814
GP
0.931
0.948
0.785
0.543
0.693
0.617
0.741
0.886
0.869
0.901
0.605
0.471
0.652
0.652
0.640
0.705
0.885
0.921
0.745
0.569
0.601
0.557
0.600
HM M HMP
HM
M
P
0.775
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CI
HM
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Cronbach
0.637
0.635
0.863
Note：CI represents “CBHKS implementation,” HMP represents “Hospital management performance,” HMM represents “Hospital management maintenance,” ES represents “External satisfaction,” GL represents “Group
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learning,” GMS represents “Group members’ satisfaction,” GP represents “Group performance.”
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Table 3
Measurement Item
Mean
Std. Deviation
Loading
5.35
1.60
0.838
5.51
1.52
0.912
5.40
1.30
0.913
CI104
5.58
1.23
0.826
GP101
5.38
1.26
0.870
GP102
5.50
1.05
0.899
GP103
5.35
1.10
0.881
CBHKS
CI101
implementation
CI102
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Group performance
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CI103
M
Construct
A
Coefficients and significance.
5.76
1.09
0.798
GMS101
5.63
1.13
0.723
satisfaction
GMS102
5.50
1.05
0.779
GMS103
5.19
1.25
0.820
GMS104
5.30
1.11
0.842
GMS105
5.69
1.07
0.730
GMS106
5.37
1.05
0.765
GL101
5.26
1.22
0.850
GL102
5.38
1.14
0.922
GL103
5.48
1.03
0.894
GL104
5.56
1.05
0.893
GL105
5.41
1.05
0.870
ES101
4.95
1.28
0.811
ES102
5.32
1.23
0.846
ES103
5.41
1.18
0.845
ES104
5.23
1.17
0.879
ES105
4.90
1.38
0.768
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GP104
Group members’
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Group learning
External satisfaction
26
4.74
1.40
0.723
Hospital
HMP101
5.46
0.98
0.815
management
HMP102
5.56
0.95
0.868
performance
HMP103
5.50
1.03
0.849
HMP104
5.53
1.03
0.851
HMP105
5.61
1.05
0.853
HMP106
5.91
0.87
0.757
HMP107
5.81
0.91
0.827
HMP108
5.60
0.97
0.795
HMP109
5.71
1.02
0.840
HMP110
5.91
0.93
0.793
HMP111
5.72
0.89
0.784
HMP112
5.98
0.90
0.748
Hospital
HMP101
5.52
1.16
0.861
management
HMP102
5.36
1.33
0.900
maintenance
HMP103
5.18
1.32
HMP104
5.25
1.09
SC R 0.894 0.875
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Note: The loading is reported by SmartPLS 3.0.
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ES106
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Table 4
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The test of common method bias and multicollinearity CBHKS implementation Group performance
Group learning External satisfaction
VIF 1.446 1.614 1.506 2.125
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Group members’ satisfaction
M
Construct
1.803 2.055
Hospital management maintenance
1.121
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Hospital management performance
5.2. Structural Model Figure 2 shows the R2 values for each endogenous latent variable. Group
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effectiveness explains 59.1% of the management performance’s variation and 60.5% of management maintenance’s variation. The CBHKS implementation explains, respectively, 32.4%, 22.2%, 29.5%, and 26.2% of the variations in group performance, group members’ satisfaction, group learning, and external satisfaction. 27
These R2 values suggest the model has acceptable explanatory power.
Group Performance R2=32.35%
0.471** (16.210)
Group Members’ Satisfaction R2=22.21%
0.076 (1.833)
0.140** (3.187)
0.279** (8.987)
0.203** (4.878)
The Implementation of CBHKS
Management Performance R2=59.10% Group Learning R2=29.53%
0.512** (20.466)
External Satisfaction R2=26.16%
0.234** (5.859)
-0.024 (0.519)
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0.543** (19.883)
Management Maintenance R2=60.46%
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0.569** (24.320)
0.307** (9.292)
0.534** (16.791)
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Fig. 2. Model results
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Note: Path coefficients with t value in parentheses. ∗ p < .05.∗∗ p < .01
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As shown in Figure 2 and Table 4, the positive relationship between CBHKS
M
implementation and group performance (H1a) is supported (βH1a=0.569**). The
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positive relationships between CBHKS implementation and group member satisfaction, group learning, and external satisfaction (H1b, H1c, and H1d) are supported
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as well (βH1b=0.471**, βH1c=0.543**, and βH1d=0.512**, respectively). All the
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dimensions of group effectiveness have been shown to significantly and positively influence management performance (βH2a=0.140**, βH3a=0.203**, βH4a=0.234**, and βH5a=0.307**, respectively). Thus, hypotheses H2a, H3a, H4a, and H5a are supported.
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The positive relationship between group members’ satisfaction and management maintenance and the positive relationship between external satisfaction and management maintenance (H3b and H5b) are also supported (βH3b=0.279** and βH5b=0.534**, respectively). However, the positive influences of group performance
28
and group learning on management maintenance are not significant (βH2b=0.076 and βH4b=-0.024). Thus, hypotheses H2b and H4b are not supported. Table 5 contains a summary of these results. Table 5
Hypothesized Path
Standardized Path T-value Coefficients(β)
H1a: CBHKS Implementation→ Group performance
0.569**
24.320
H1b: CBHKS Implementation→ Group members’ satisfaction
0.471**
16.210
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Structural parameter estimates.
H1c: CBHKS Implementation → Group learning
0.543**
19.883
Supported
H1d: CBHKS Implementation→ External satisfaction
0.512**
20.466
Supported
H2a: Group Performance → Hospital management performance
0.140**
3.187
Supported
H2b: Group Performance → Hospital management maintenance
0.076
1.833
Not supported
4.878
Supported
0.279**
8.987
Supported
H4a: Group Learning→ Hospital management performance
0.234**
5.859
Supported
H4b: Group Learning→ Hospital management maintenance
0.203**
H3b: Group Members’ Satisfaction → Hospital management
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maintenance
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performance
Supported Supported
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U
H3a: Group Members' Satisfaction → Hospital management
Results
0.519
Not supported
0.307**
9.292
Supported
H5b: External Satisfaction → Hospital management maintenance
0.534**
16.791
Supported
5.3 Test of Mediation
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M
-0.024
H5a: External Satisfaction→ Hospital management performance
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In our research model, we hypothesized that group performance, group members’
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satisfaction, group learning, and external satisfaction mediate the effect of CBHKS implementation on management performance and maintenance. Thus, we further
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tested the mediation effects. For this purpose, we followed the procedure for testing mediation effects of a PLS model in Rai et al. [95]. First, we added a direct path between CBHKS implementation and management performance. The R-squared for management performance is 0.5930. The R-squared for management performance in the original model (full mediation) is 0.5928. We calculated pseudo F statistics 29
following Rai et al. [95] to test if this difference is significant. The pseudo F statistic is 0.1007 with (1, 206) degrees of freedom. The p value is not significant, suggesting that adding the direct effect does not improve the model fit. Moreover, the path coefficient of the direct effect is not significant, either. This suggests that the four
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dimensions of group effectiveness fully mediate the effect of CBHKS implementation on management performance.
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In the same fashion, we added a direct path between CBHKS implementation and management maintenance. The R-squared for management maintenance is 0.6201.
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The R-squared for this construct in the original model is 0.6046. The pseudo F
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statistic is 8.3640 with (1, 206) degrees of freedom, which is statistically significant.
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The path coefficient of the direct effect is -0.1610, which is also statistically
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significant. Meanwhile, the path coefficients of the four dimensions of group
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effectiveness have increased. This suggests that the direct effect may have a suppression effect on the relationship between CBHKS implementation and the four
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dimensions of group effectiveness. Specifically, CBHKS implementation has a
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positive correlation (0.34) with management maintenance. It is also positively correlated with external satisfaction (0.51), group learning (0.54), group members’ satisfaction (0.47), and group performance (0.57). However, the direct effect of
A
CBHKS implementation on management maintenance has a negative path coefficient when it is included and the “predictive validity” of the four dimension of group effectiveness has increased. By definition [96, 97], CBHKS implementation is likely to be a negative suppressor in our research model. 30
It is considered as an inconsistent mediation when the mediation effect has a different sign than the direct effect and one of the independent variables is a negative suppressor [98]. This is common in situations where the direct effect may be counterproductive [98]. In our research context, implementation of a new system may
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bring changes that immediately lower the stability of relationships in a hospital. It may also reduce employees’ perception of autonomy because they are mandated to
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use the new system. This is a plausible explanation of the negative direct effect of
CBHKS implementation on management maintenance. Nonetheless, in the partial
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mediation model, all coefficients in the four mediation paths are positive and
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statistically significant. The total effect of CBHKS implementation on management
A
maintenance is 0.34. This satisfies the condition of mediation with the presence of a
M
negative suppressor [99]. Thus, our results support the role of group effectiveness in
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maintenance.
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mediating the positive but indirect effect of CBHKS implementation on management
6. Discussion and Conclusions
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In this study, the relationships among CBHKS implementation, group
effectiveness, and the improvement of management performance and management
A
maintenance in hospital management are thoroughly investigated. The results show that CBHKS implementation has a significant, positive effect on group effectiveness. Moreover, all of the four dimensions of group effectiveness have significant, positive effects on hospital management performance. Group members’ satisfaction and external satisfaction also have significant, positive effects on hospital management 31
maintenance. But the effects of group performance and group learning on management maintenance are not significant. We also tested the mediating effect of group effectiveness between CBHKS implementation and hospital management output. According to the result of empirical
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test, group effectiveness fully mediates the effect of CBHKS implementation on hospital management performance and partially mediates the effect on hospital
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management maintenance. In addition, we find that CBHKS implementation has the negative direct effect on hospital management maintenance.
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6.1. Implications
A
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6.1.1 Implications for research
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This study has important implications for IS research. First, we investigated how
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CBHKS implementation affects the two different dimensions of hospital management: management performance and management maintenance. Drawing on the PM theory,
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we introduce two aspects of leadership behavior into our research as two dimensions of management output. P and M have been studied as the management output in some
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prior researches, respectively [28-32]. Our study considers both dimensions in our research context and shows that CBHKS implementation impacts management
A
performance and maintenance differently. This is not only new but also important in the literature on the organizational impact of IS. Prior related studies paid more attention to organizational performance, which is one of the most important aspects in evaluating management outcomes [24, 25, 63]. However, the importance of management maintenance cannot be neglected because it concerns the stability of an 32
organization [26]. Our findings show that CBHKS implementation indeed affects both management performance and maintenance through group effectiveness. Future IS research may consider examining both management performance and maintenance when studying the impact of IS implementation. This will provide us with a holistic
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view on how it impacts management outcomes. Second, we introduced the four dimensions of group effectiveness to our
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research model and demonstrated their mediating roles in the relationship between
CBHKS implementation and management outcomes. Group effectiveness is a meso-
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level construct, while management output is an organizational level construct. In our
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study, we established the influence path of CBHKS on the organizational level
A
construct by virtue of the meso-level construct of group effectiveness, which is
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seldom discussed in previous literature. Our study further enriches the literature on
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the path of IT's impact on organizational output. From the empirical results, the mediating effect of group effectiveness shows internal differences. Among the four
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dimensions, group performance and group learning capture the improvements of
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group-level business processes while group members’ satisfaction and external satisfaction reflect the emotional consequences. Our findings show that group effectiveness fully mediates the effect of CBHKS implementation and management
A
performance. This suggests that both business process improvements and emotional factors contribute to management performance and can fully capture the effect of CBHKS implementation. However, in the relationship between CBHKS implementation and management maintenance, only group members’ satisfaction and 33
external satisfaction are significant mediators. This implies that organizational stability may have a stronger association with emotional factors than economic factors. Merely improving group-level business processes is not effective in enhancing organizational stability. Rather, the emotional consequences brought by IS
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implementation are more significant. These findings have provided a foundation for future research that aims at gaining deep insights when studying the organizational
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impact of IS.
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6.1.2 Implications for practice
A
N
The systems we investigated in this study, CBHKS, are used in the healthcare
M
industry, a high-impact area where intelligent systems are being widely deployed. Our research findings have important implications for doctors and other decision makers
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in hospitals. On the one hand, our data analysis shows that CBHKS implementation
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has positive (but indirect) effects on management performance and maintenance. This provides new empirical evidence for the usefulness of CBHKS. Such evidence is
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crucial in initiating CBHKS projects in hospitals that have not implemented such a system yet. On the other hand, our findings show that group effectiveness fully
A
mediates the positive effects. This calls for decision makers’ attention on the group level outcomes when considering the organizational impact of CBHKS. In particular, when studying the potential benefits of CBHKS implementation in the project planning phase, the four dimensions of group effectiveness can provide important indicators for intangible returns. 34
Based on the results from our data analysis, the roles of CBHKS seem to be complex in influencing the relationship between CBHKS implementation and management maintenance. Although the positive effect of CBHKS implementation on management maintenance is mediated by group effectiveness, the direct effect is
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negative. This implies that CBHKS implementation may immediately decrease organizational stability because of the required change to the habits and culture in a
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hospital. Thus, the positive impact of CBHKS on management maintenance may only be observed in the long horizon. Moreover, only the emotional aspect of group
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effectiveness (i.e., group members’ satisfaction and external satisfaction) is significant
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in mediating the positive effect of CBHKS implementation on management
A
maintenance. As a result, hospital management is advised to focus more on emotional
M
dimensions to mitigate the potential negative impact on organizational stability when
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implementing CBHKS. This is important for both internal and external stakeholders.
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6.2. Limitations and Future Research This study is not without limitations. First, we measured external satisfaction
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based on medical staff’s perception. Although the medical staff is frequently updated with patient’s feedback, our instruments did not directly collect this information from
A
patients. However, external satisfaction intends to capture the change in satisfaction after the CBHKS implementation. Most patients do not use the hospital’s service long enough to experience such a change. Yet, many hospital employees worked for the hospital both before and after the CBHKS implementation. Thus, their perception of external satisfaction can better capture the “change” aspect of the construct. Future 35
research may validate our results by measuring external satisfaction directly by conducting patient surveys. In this study, we focused on the indirect (mediated) effect of CBHKS implementation on management outcomes rather than the direct effect. The results
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from our data analysis suggest that CBHKS implementation may be a negative suppressor. Its direct effect on management maintenance is negative, but its mediated
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effect is positive. Although we provided a plausible explanation for it, this interesting
mechanism needs to be further examined and empirically tested. Further research may
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work in this direction.
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Moreover, CBHKS have been implemented in a large number of hospitals. These
A
hospitals may differ in their processes and management. In this study, we only used
M
data collected from one hospital. Thus, the generalizability of our findings should be
multiple hospitals.
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interpreted with cautions. Future studies may validate our findings using data from
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Additionally, future research can also focus on studying how the CBHKS
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implementation enhances different dimensions of healthcare service quality. Aagja and Garg [100] developed a scale to measure perceived service quality for public hospitals from a user’s perspective. The scale they developed is called public hospital
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service quality (PubHosQual), which measures the five dimensions of hospital service quality: admission, healthcare service, overall service, discharge process, and social responsibility. Based on our current study, future work can address how CBHKS affect improvement in the different dimensions of hospital service quality, and further 36
examine which specific modules or functions of CBHKS work most effectively. This will be helpful in identifying areas where specific modifications are needed so that hospital management can focus on these areas during the implementations of healthcare IT.
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Funding
This research is partially supported in data collection, analysis, and
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interpretation by the National Natural Science Foundation of China
A
CC E
PT
ED
M
A
N
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(NSFC) [grant number 71331002, 71771075, 71771077, 71503033].
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Dongxiao Gu is an associate professor of Management Information Systems(MIS) at the Hefei University of Technology's School of Management. His research interests include health data modelling and mining, the behavioural and emotional aspects of the use of emerging technologies in healthcare. He served as a Young Scientists Committee Member for the 6th Exploratory Round Table Conference of Chinese Academy of Sciences and Max Planck Society (ERTC 2015), the local arrangements co-chair for China Summer Workshop on Information Manaement(CSWIM2015), track(smart health and smart aging care) co-chair for Association of Information Systems-China(CNAIS2019). His research has been appeared in over seventy journals,such as Information & Management, Knowledge-Based Systems, International Journal of Production Research, International Journal of Project Management, Expert Systems with Applications, International Journal of Medical Informatics, Artificial Intelligence in Medicine, IEEE Access, Computers & Industry Engineering, and so on.
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Shuyuan (Lance) Deng is an Assistant Professor of Management Information Systems at the Seidman College of Business, Grand Valley State University. He received his Ph.D. in Information Systems from University of Wisconsin-Milwaukee and his M.B.A from University of Illinois at Chicago. His research interests include artificial intelligence, machine learning, natural language processing, the social and economic impact of IS, and enterprise systems. His research has appeared in leading information systems journals, such as MIS Quarterly, Decision Support Systems, Journal of the Association for Information Systems, ACM Transactions on MIS, and Journal of Business Analytics.
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Qian Zheng is a Ph.D. candidate at the Hefei University of Technology and is an associate professor at the Anhui Science and Technology University. She received a Master’s degree in Industry Economics from the Hefei University of Technology, Hefei, China. Her research mainly focuses on information management, information technology adoption behaviours, cloud computing services and performance, and business model innovations related to cloud computing in various sectors. ChangYong Liang is a professor of MIS and associate dean of the
Academy of Sceince at the Hefei University of Technology. His research focuses on information management, the role of cloud knowledge systems in smart health care and elderly care services. He is the author of more than one hundred publications in IS journals, such as Information & Management, Expert Systems with Applications, Knowledge-Based Systems, Computers & Industrial Engineering, International Journal of Intelligent Systems, etc. He is the co-chair for the 9th China 45
Summer Workshop on Information Management (CSWIM2015), member of China Smart Health 50 People Forum, Executive member of the council for Smart health and aging division at China Association of Gerontology and Geriatrics, Vice Editor-in-Chief for Operation Research&Management.
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Jiao (Aimee) Wu is an assistant professor at the Department of Operations Management and Information Systems, in the College of Business , Northern Illinois University in the United States. Her research focuses on social media behavior, online envy, and crosscultural IT usage. She has published in Americas Conference on Information Systems (AMCIS), Decision Institute (DSI) Annual Meeting.
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Appendix A
CBHKS implementation (CI)
References Liang et al. [83] Song and Zahedi [101]; Chen [102]; Lurey, Raisinghani , [103];Venkate sh. [104]
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Group performance (GP)
Items CI 1: We frequently used the CBHKS in our group. CI 2: Without the CBHKS, our work will be inconvenient CI 3: The CBHKS have been implemented in our group CI 4: The CBHKS have been commonly used by our group members. GP 1: The use of the CBHKS has increased our group productivity GP 2: The use of the CBHKS improves our group performance in our job. GP 3: The use of the CBHKS enhances our group effectiveness in our job. GP 4: The use of the CBHKS makes an important GP contribution to the overall performance of our group work GMS 1: We am satisfied with CBHKS. GMS 2: We am pleased with the use of CBHKS. GMS 3: We think that we made the correct decision to use CBHKS to get supportive information or knowledge. GMS 4: We am satisfied with the service that we have received from CBHKS GMS 5: The CBHKS are pretty good and we like to use it. GMS 6: Overall, we were satisfied with CBHKS. GL1.With the assistance of CBHKS, we tend to agree on how best to serve patients or the customers GL 2. After CBHKS implementation, we have a set standard procedure for handling routine requirements from patients or other departments GL 3. CBHKS provide an important platform for our group to learn how to analyze and utilize various data resources to response to questions raised by patients or other departments GL 4. When faced with new information about our customers, our managers usually agree on how the information will impact our firm. GL 5.We are knowledgeable about our customers’ strengths and weaknesses. ES1: Based on the communication with patients, we feel that with the implementation of CBHKS, they think the service provided by the hospital is more consistent with their expectations. ES2: Based on the extensive communication with patients and other departments, we feel that they are more satisfied with the work of our department after the CBHKS implementation. ES3: Based on the extensive communication with patients, as well as the reduction of actual disputes and complaints, we feel doctor– patient relationship have become better after the CBHKS implementation ES4: Based on the communication with our patients, we feel that they are more satisfied with our work now. HMP 1: After the CBHKS implementation, the work plans of our group became better and problem handling was more flexible. HMP 2: The CBHKS implementation makes it is easier to acquire health knowledge and improved the level of our leadership. HMP 3: CBHKS provide some professional solutions to some difficult issues and challenge, and it improved our leadership efficacy
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Construct
Anderson and Sullivan [105]; Kohli et al. [106]; Kim and Koh, [107]
Tippins and Soh, [87]; Du et al., [108]; Chen et al. [102]
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Group learning (GL)
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Group members satisfaction (GMS)
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External satisfaction (ES)
Hospital management performance (HMP)
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Liang et al. [83]
Xu [109]; Rai et al. [95]; Chen et al. [102]; Alper et al. [110]
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Hospital management maintenance (HMM)
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HMP 4: The efficiency of our information communications with the patients was improved after the CBHKS implementation. HMP 5: The efficiency of our information communications with other departments was improved after the CBHKS implementation. HMP 6: The CBHKS implementation is helpful for our productivity of leadership work in our department HMP 7: After the use of CBHKS, our department reached our target more smoothly HMP 8: After the use of CBHKS, our department have more effectively accomplished our tasks than before HMP 9: After the use of CBHKS, our department have better achievements than before HMP 10: After the use of CBHKS, the service provided by our department exceed external expectation. HMP 11: After the use of CBHKS, the group members in our department are more concerned about the quality of their work. HMP 12: After the use of CBHKS, the group members in our department work very well and the team skills are growing rapidly HMM1: Our responsibility and awareness of the care and maintenance of collective interests were improved after the CBHKS implementation HMM2: The CBHKS implementation provides opportunity for leaders to think better working methods and have more communication with group members which improved the level of trust of leaders to subordinates. HMM3: The CBHKS implementation made much work become easier, improved our working relationship within the group, and enhanced the unity and harmony of our group. HMM4: Our ability of organization and coordination of leadership were improved with the assistance of CBHKS.
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Xu [109]; Feng & Zhang [111]
S0378-7206(17)30276-8 https://doi.org/10.1016/j.im.2019.04.005 INFMAN 3162
To appear in:
INFMAN
Received date: Revised date: Accepted date:
5 April 2017 8 April 2019 12 April 2019
Please cite this article as: Gu D, Deng S, Zheng Q, Liang C, Wu J, Impacts of case-based health knowledge system in hospital management: the mediating role of group effectiveness, Information and amp; Management (2019), https://doi.org/10.1016/j.im.2019.04.005 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Impacts of case-based health knowledge system in hospital management: the mediating role of group effectiveness Dongxiao Gu1, Shuyuan Deng2, Qian Zheng1, Changyong Liang1, *, Jiao Wu3
2
of Management, Hefei University of Technology, 193 Tunxi Road, Hefei, Anhui 230009, China
Seidman College of Business, Grand Valley State University, 50 Front Avenue SW, Grand
Rapids, Michigan 49504, USA
of Business, Northern Illinois University., 1425 W. Lincoln Hwy., DeKalb, IL 60115, USA
* Corresponding
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3 College
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1 School
author.
E-mail addresses: [email protected] (D. Gu), [email protected] (S. Deng), [email protected] (Q.
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Zheng), [email protected] (C. Liang), [email protected] (J. Wu).
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ABSTRACT:
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With the rise of artificial intelligence, case-based health knowledge management
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systems (CBHKS) have been widely adopted in hospitals. CBHKS are data-driven intelligent platforms that integrate latest technologies, such as artificial intelligence
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and cloud computing. As an integral part of smart hospitals, CBHKS can support
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decision processes at different levels in hospitals. However, researchers have not yet clearly addressed how CBHBKS improves hospital management outcomes. Based on group effectiveness and leadership performance-maintenance theories, we develop a
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conceptual model to explain the role of CBHKS in hospital management. To test the research hypotheses in the conceptual model, we collected survey data from 214 doctors, and performed data analysis using partial least squares (PLS)-based structural equation modeling. The empirical testing results show that the CBHKS 1
implementation significantly and positively influences group performance, group members’ satisfaction, group learning, and external satisfaction; and group members’ satisfaction and external satisfaction significantly and positively affect management performance and maintenance.
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KEYWORDS: case-based systems; group effectiveness; hospital management performance; knowledge management; hospital; intelligent health information
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management.
1．Introduction
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With the rapid development of modern information technology (IT) and the
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application of artificial intelligence, intelligent knowledge-based information systems
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(IS) have been universally implemented throughout the world. The healthcare industry is no exception. In fact, many large hospitals in China have adopted case-
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based health knowledge management systems (CBHKS). For instance, the CBHKS
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developed by Winning Health Technology Group has been used in more than 1500 hospitals in China, supporting more than 200,000 doctors [1]. CBHKS are
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comprehensive, intelligent software platforms that integrate a variety of latest information technologies such as artificial intelligence and cloud computing. It
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utilizes large volumes of historical cases, to support decision processes in hospitals. In particular, the system can provide decision makers with similar historical cases (i.e., issues and their solutions). As a result, CBHKS effectively facilitate the utilization of healthcare information resources, knowledge management, and management decision making in hospitals. Practically, CBHKS are beneficial for many functional areas in a 2
hospital, such as medical diagnoses and prognoses, drug inventory management, nursing management, medical equipment management, patient relationship management, and human resources. Because of their comprehensiveness and efficiency in knowledge reasoning, CBHKS are playing an increasingly important
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role in improving hospital management, becoming an integral part of “smart hospitals.”
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Prior research has explored the positive impact of hospital information systems
(HIS) on organizational performance [2-4]. Furthermore, scholars have discussed the
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influence path of hospital IT application on organizational performance, through
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stay [6], and patient satisfaction [7].
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factors such as the breadth and depth of information sharing [5], patients’ length of
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This study examines the post adoption use of CBHKS, which is closely
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associated with the long-term performance of hospital management. Using expectation confirmation theory, Bhattacherjee [8] was among the first to investigate
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the continued use of IT. His work was followed by an array of studies that focused on
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information systems post adoption behavior (ISPAB) [9-11]. ISPAB explains why individuals and organizations continue to use and expand IS functions and proposed the factors affecting the continuing utilization of IS and IS expansion among
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individuals and organizations. This stream of research forms the theoretical foundation for the continued use of CBHKS in hospitals. The theoretical basis of ISPAB mainly involves diffusion of innovations theory, organizational learning theory, and revolutionary management theory [12-14]. Earlier, ISPAB research has 3
focused on certain cognitive factors, such as perceived service attributes (usefulness and compatibility) and perceived service utilization and network externality (complementary product usage) [15]. When studying the impact of IS on hospitals’ management performance, prior research has mainly focused on constructs such as
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clinical supervision, the hierarchy and complementarity of organizational structure, and hospital governing boards [16-18]. Few studies have comprehensively examined
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the impact of group effectiveness on management performance, which has been
concerned by some scholars in the past [19, 20]. Hence, in the effect evaluation of the
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post-adoption use of CBHKS, the indirect influence of CBHKS on management
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output through the mediating effect of group effectiveness should also be considered.
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Group effectiveness is the degree to which a team has accomplished the goals or
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objectives administered by some authorized personnel or the organization [21].
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Sundstrom and Mclntyre [22] believed that group efficiency has four aspects: group performance, group learning, group satisfaction, and the degree of external
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satisfaction. These four aspects may influence post adoption attitudes and behaviors
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of individuals within a group and organizational performance. Hospitals have various departments, institutes, centers, etc. These group-level units are affected by group cohesiveness and teamwork within the confines of processes and research [23]. Group
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effectiveness is an important manifestation of an organization’s effectiveness as well as a sign of management competency in hospitals. Examining continued use of IS through studying the mediating effect of group effectiveness will fill an important gap in ISPAB research. Additionally, studying the influence path of CBHKS on hospital 4
performance through all four dimensions of group effectiveness may further enrich the literature on the organizational impact of HIS. Therefore, it is of practical significance to understand how CBHKS improve management performance and maintenance in hospitals through group effectiveness.
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When measuring management outcomes, previous IS studies often used management performance as the key indicator [24, 25]. According to Misumi’s [26]
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performance-maintenance (PM) theory of leadership, the performance leadership function (P) is oriented toward goal achievement and problem solving, and the
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maintenance leadership function (M) involves preserving group social stability. In PM
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theory, P and M are considered to be two axes on which the level of each factor can be
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measured [27]. In general, high performance and high maintenance leadership will
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bring about ideal management effect. Although PM theory is widely used to study
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leadership behavior, P and M essentially reflect the main concerns of organizational managers and are important aspects of management objectives. Therefore, it is
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necessary to consider both P and M when studying the management output of an
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organization. Prior research has studied the effects of these two aspects, respectively. Some study has proved the positive relationship between IS application and employee satisfaction [28-30], which is closely related to the group maintenance of the
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organization. At the same time, a similar conclusion has been drawn on the relationship between IS application and organizational performance [31, 32]. Hence, both P and M are vital to the improvement of hospital management. However, when evaluating management outcomes, management maintenance has been seldom taken 5
into consideration. Practically, the loss of talents is an critical issue for managers [33, 34]. Hence, typically considered human capital-intensive, hospitals should regard the maintenance of talents as one of the most important management objectives. It is necessary to include management maintenance in the assessment of management
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results [26]. This will also enrich the research on evaluating the management outcomes resulted from CBHKS implementation.
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Based on the frameworks of the group effectiveness and PM theory of
leadership, this study investigates the impact of CBHKS on hospital management
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outcomes by means of the mediating effect of group effectiveness. Particularly, we
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reveal how group effectiveness mediates the effect of CBHKS implementation on
A
management performance and maintenance. To achieve this, we adopt the four-
M
dimension measures of group effectiveness proposed by Sundstrom and Mclntyre
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[22], namely group performance, group members’ satisfaction, external satisfaction, and group learning. Our study addresses the following research questions:
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(1) Does the implementation of CBHKS improve hospital management
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performance and maintenance? (2) How does group effectiveness mediate the impact of CBHKS on
A
management performance and maintenance in hospitals? Answering these questions is important for developing a holistic view on how
CBHKS impact management outcomes. From a practical perspective, the potential findings will promote the CBHKS implementation and help hospital management use such systems more effectively. 6
The rest of the paper is organized as follows. In Section 2, we review related research on IS post adoption use, group effectiveness, and the PM theory of leadership, which provides the theoretical foundation for our study. Then, in Section 3, we develop the research model and propose the research hypotheses. We discuss in
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Section 4 the research methodology used to test the hypotheses. In Section 5, we present our results and further test the mediating effect of group effectiveness between
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CBHKS and management performance. The last section concludes this paper with a discussion of findings, implications for theory and practice, limitations, and future
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directions.
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2. Theoretical Foundations
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2.1. Group Effectiveness
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Prior research has examined the influence of IS implementation on hospital performance from the perspective of technology, patient experience, and satisfaction
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[4-6]. Little research paid attention to the role of group effectiveness in the
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relationship between HIS and management outcomes. Group, including the formal or informal team, is an important part of organization, and group behavior is an important research aspect in organization. McGrath [35] posited that a group (or team,
A
as in management literature) is a social collection of existing mutual understanding and potential interaction between members. If a group can complete a given task and meet its members’ individual needs, it is considered highly effective. Russell et al.[36] believed that group effectiveness is an important result and embodiment of
7
organization or group behavior [37]. In the IS research community, scholars also have studied the impact of IS implementation on group efficiency, and provided empirical evidence to support positive effect of IS on group efficiency [38, 39]. Hence, it is reasonable to believe that group effectiveness may play an important role in the
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relationship between CBHKS and hospital management outcomes. Hackman [40] proposed the earliest definition of group effectiveness. In his
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study, group effectiveness has been defined from three perspectives: work output, impact on group members (including satisfaction), and the improvement of group
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problem-solving skills for the future. Later research supplemented and perfected the
N
definition of group effectiveness. Sundstrom and Mclntyre [22] used member
A
satisfaction, performance, external satisfaction, and team learning to measure group
M
effectiveness. Cohen and Baily [41] further noted that the three aspects of group
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effectiveness are: (1) group performance, namely efficiency, productivity, response speed, quality, service customers’ satisfaction, and innovation; (2) members of the
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group, namely satisfaction of the members, commitment, and trust in management;
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and (3) members’ behavior, namely the absence of members, turnover, and safety. Lurey and Raisinghani [42] believed that member satisfaction and performance could
A
be used to evaluate group effectiveness. Based on the definitions of group effectiveness in prior research and the four
dimensions of group effectiveness proposed by Sundstrom and Mclntyre [22], we measure group effectiveness using the following: group performance, group member satisfaction, group learning, and external satisfaction. Most studies on group 8
effectiveness have focused mostly on constructing a reasonable group management system that enhances group effectiveness. The influence of group effectiveness is relevant to many levels in a management hierarchy, such as individual, team, business unit, and organization [41, 43, 44]. In this study, we focus on the impact of group
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effectiveness on organizational performance, explaining why the adoption of CBHKS in hospitals affects group work and influences management performance through
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group effectiveness. Measuring these four dimensions of group effectiveness as intermediary variables, we develop our research model to explain the impact of
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CBHKS on hospital performance and maintenance.
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2.2. Performance-Maintenance (PM) Theory of Leadership
M
Misumi [45] proposed the PM theory of leadership in the 1970s. This theory divides leadership behavior into two categories, i.e., Performance (P) and
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Maintenance (M). The performance function means that a leader must make detailed
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work plans, require and strictly monitor a staff to carry out the plans to ensure that a group’s specific goals can be achieved. The maintenance function means that a leader
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should be concerned about staff welfare, try to build a harmonious relationship with its members, carefully encourage them, and pay attention to proper authorization to
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ensure ongoing improvement in the organization’s normal operation. In PM theory, leaders have two main management objectives: organizational
goals and organizational relationships. Organizational goals focus on how to improve management performance; organizational relationship focuses on how to establish a stable and harmonious inner environment that maintains the organization. Echoing 9
PM theory, we establish management effectiveness and management maintenance as the dual goals of adopting CBHKS in hospitals to capture the impact of CBHKS on hospital management.
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3. Conceptual Models and Hypothesis Development 3.1. CBHKS implementation and group effectiveness
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3.1.1 CBHKS Implementation and Group Performance
According to the definition by Cohen and Baily [41], group performance is
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mainly reflected in the efficiency, productivity, responsiveness, quality of service,
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customers’ satisfaction, and innovation during healthcare services. A rich literature
A
exists on the relationships between IT investment and performance. Most related
M
studies consider the investment and implementation of IT as a positive factor in group
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and organizational performance [46, 47]. The use of IT can improve the effectiveness and efficiency [47] and the quality of products and services [48].
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In the healthcare industry, some scholars have researched the influence of IS on
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hospital management performance. For example, Menachemi et al. [49] discussed the positive impact of hospital IT on financial performance. Cui et al. [50] empirically showed that a performance management IS could improve the performance of clinical
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departments — such as in the quality and efficiency of healthcare services in Shanghai’s Ninth People’s Hospital — through a real-time query platform for the staff that could help its members monitor and analyze key performance indexes and solve problems. 10
CBHKS are one type of IT service platform specifically used within the healthcare arena that is also likely to improve group performance. CBHKS provide an information integration platform that supports synchronous sharing of medical information between multiple departments. For example, patients’ test results can be
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quickly shared with medical group members in different departments to accelerate diagnosis and treatment. According to Media Synchronicity Theory, an improved
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capability of media to support information synchronicity could enhance
communication performance and then promote the collaborative behaviors of staff
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members [51]. As an important media in hospital management, CBHKS may
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strengthen two aspects of a medical staff’s information synchronicity: (1) reductions
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in the time needed to query patients’ information and improve the efficiency of
M
treatment; and (2) promotion of communication and sharing of knowledge among
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doctors, which will lead to improvement in the quality of healthcare service. Improving the efficiency and quality of healthcare services will enhance the group
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performance of hospital staff by attracting more patients. Hence, we hypothesize:
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H1a: CBHKS Implementation positively influences group performance. 3.1.2 CBHKS Implementation and Group Members’ Satisfaction
A
Another dimension of group effectiveness is group members’ satisfaction. This
refers to the satisfaction of internal members and to their commitment and trust in management [41]. In the context of a hospital, it represents the work attitudes of doctors, nurses, and other medical staff. Considerable research has been done on the relationships between the implementation of IS and group member satisfaction. For 11
example, Ammenwerth et al. [52] believe that IT could be used to improve the sense of responsibility in nursing care, thus, improving the efficiency of nurses as well as increasing the satisfaction of patients and other members of the hospital staff. Langfred [53] posited that team performance depends on an individual’s and a team’s
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autonomy, which could both be improved by the implementation of IS. This further encourages users’ initiative and adds to their satisfaction.
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Media Synchronicity Theory posits that communication effectiveness may be
enhanced by faster information conveyance and higher information convergence [51],
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which, in turn, will improve users’ satisfaction with access to information and its use.
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We believe that CBHKS implementation improves doctors’ autonomy. Doctors can
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conveniently query medical records using CBHKS. This makes their work less
M
dependent on IT staff. Moreover, the query and report features of CBHKS cost
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doctors less time to check information of patients and prior treatment, shortening the cycle of creating medical records and improving the efficiency of diagnosis and
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treatment. The improvement of efficiency is even more pronounced in medical group
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collaboration. In addition, the data analytics component of CBHKS also provides a powerful tool for doctors to conduct medical research, which is of positive significance for improving doctors' professional knowledge and ability. All of these
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improve the satisfaction of members of the medical staff, facilitating their completion of treatment processes. More efficient treatment processes will improve patients’ satisfaction and, in turn, improve their relationship with the medical staff. Hence, we propose the following hypothesis: 12
H1b: CBHKS Implementation positively influences group members’ satisfaction. 3.1.3 CBHKS Implementation and Group Learning Some scholars who study group learning define it from the perspective of a
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learning process. For instance, Edmondson et al. [54] regarded it as “an ongoing
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process of reflection and action, characterized by asking questions, seeking feedback,
experimenting, reflecting on results, and discussing errors or unexpected outcomes of actions.” Other researchers define it from the perspective of group learning results.
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London et al. [55] consider group learning as “the extent to which members seek
A
N
opportunities to develop new skills and knowledge, welcome challenging
M
assignments, were willing to take risks on new ideas, and work on tasks that require considerable skill and knowledge.”
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The relationship between IT implementation and group learning has received a lot
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of attention in the literature [56]. Scholars believe that IT plays an important role in the process of shifting to a “learning organization” by providing technical support for
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effectively storing, organizing, and modifying information and knowledge. Furthermore, some scholars believe that IT could facilitate organizational learning
A
[57]. Related studies suggested that the implementation of new technologies often requires employees to update their skills [58, 59]. Sharma [60] proposed that learning should take place in a space that permits convenient cooperation and exchanges with others and not be confined to closed spaces for independent study. In hospitals, the use of CBHKS also promotes group learning among the staff. In 13
particular, the implementation of such a system requires doctors to learn how to use it correctly, which can be regarded as a technical learning process for a group. Moreover, CBHKS can support hospital decision processes by analyzing large volumes of historical cases, identifying similar cases, and generating solutions.
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Hence, CBHKS implementation will promote the information and knowledge sharing among doctors and enhance their treatment skills. Last but not least, the CBHKS
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implementation can encourage doctors to cooperate in the treatment process. Hence, we hypothesize:
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H1c: CBHKS Implementation positively influences group learning.
A
N
3.1.4 CBHKS Implementation and external satisfaction
M
External satisfaction is a consequence of group behaviors and a dimension of group effectiveness. According to Sundstrom and Mclntyre [22], higher group
ED
effectiveness leads to higher consumer satisfaction. Information conveyance and
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information convergence through media could not only affect a staff’s work efficiency but also improve a customer’s perceived information transparency [51], which
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promotes trust among contracting parties and improves external satisfaction. The implementation of IS is likely to improve patient satisfaction and hospital
A
management and reduce administrative costs. Amin et al. [61] posited that the utilization of IS can optimize inspection processes, standardize operating procedures, and improve patient and staff satisfaction. Aiken [62] concluded that the application of IS in hospitals optimizes the treatment process by shortening treatment time and improving service quality, thus enhancing patient communication and improving 14
patient satisfaction with his or her medical treatment. CBHKS are the integrated IS not only for medical staff but also for patients. On the one hand, CBHKS improve the efficiency and speed of medical information transmission. On the other hand, CBHKS increase the transparency and sharing of
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information between doctors and patients. Because of the improved efficiency, doctors will have more time to discuss treatment with other doctors and rethink their
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work, making treatment more effective. This is likely to enhance patients’ satisfaction. Moreover, CBHKS implementation will show a hospital’s IT capability and
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commitment. This will create a better image of the hospital, potentially improving
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external satisfaction. Hence, we hypothesize:
M
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H1d: CBHKS Implementation positively influences external satisfaction. 3.2. Group effectiveness and hospital management
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According to PM theory, the outcome of hospital management can be divided
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into management performance and management maintenance. The CBHKS implementation may improve group effectiveness. As a consequence, higher group
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effectiveness may also lead to the improvement of hospital management (including performance and maintenance).
A
3.2.1 Group performance and hospital management Only a few studies have analyzed the relationships between hospital management
and group effectiveness. Besstremyannaya et al. [63] believed that hospital management performance was a kind of output that reflected hospital input as
15
represented by cost efficiency. CBHKS implementation, as a kind of IT input, may improve the efficiency, productivity, and responsiveness of a group of doctors [41] and, as a result, improve patients’ satisfaction with hospital services. High patient satisfaction leads to more use of healthcare services from the same hospital,
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increasing its financial income, an important indicator of management performance. Hence, the usage of CBHKS has a significant impact on management performance.
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Hence, we hypothesize:
H2a: Group performance positively influences hospital management
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performance.
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Hospital management maintenance means keeping the relationships in a hospital
A
stable and harmonious through appropriate communication while supporting
M
employees' autonomy. It preserves a hospital’s social stability. High group
ED
performance will improve financial performance [64], which could improve the income of individuals and groups under the generally accepted performance appraisal
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system and enhance the stability of the organization. Furthermore, high group
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performance implies harmonious interpersonal relationships and efficient communication in organizations, which would foster group members’ job satisfaction
A
and improve management maintenance. Hence, we hypothesize: H2b: Group performance positively influences hospital management
maintenance. 3.2.2 Group members’ satisfaction and hospital management Group members’ satisfaction is related to the recognition, responsibilities, 16
supervision, and opportunities offered during their work [65]. A number of researchers have empirically found that satisfaction is related to performance, such as organizations’ outcomes and management effectiveness [66]. For example, Sweeney [67] described the links between satisfaction and organizational outcomes. Koys [68]
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found that employee satisfaction had positive effects on organizational levels of effectiveness, which actually is a manifestation of management levels. Judge et al.
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[69] performed a comprehensive quantitative review of research on the satisfaction– performance relationship and concluded that these two variables were at least
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moderately correlated. Other scholars suggested that team job satisfaction is related to
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new product performance and commercial success [70]. Hence, we hypothesize:
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H3a: Group members’ satisfaction positively influences hospital management
M
performance.
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In the context of hospital management, many scholars have studied the relationships between group members’ satisfaction and hospital performance. Student
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et al. [71] tested the positive effect of nurses’ satisfaction with communication on
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performance. Mascia et al. [72] studied how hospital restructuring influences the job satisfaction of physicians. The use of CBHKS is likely to improve communication efficiency and accelerate the efficiency of searches for knowledge. It is also likely to
A
trigger the restructuring of a hospital’s business processes and shorten diagnosis time. Thus, the presence of CBHKS may improve both the staff’s job satisfaction and the hospital’s performance. This is an important indicator of management performance and maintenance. Hence, we hypothesize: 17
H3b: Group members’ satisfaction positively influences hospital management maintenance. 3.2.3 Group learning and hospital management
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Synergy from group learning will foster higher levels of creativity and productivity than any single individual can create [73]. This synergy could eventually
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result in innovative solutions to management problems and to the improvement of
organizational management. Group learning will be helpful for better communication and coordination in teams. It has been shown to have a positive influence on new
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product quality through the improvement of management [74]. Hassan et al. [75]
A
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suggested that team learning behaviors play a significant role in ensuring the success
M
of marketing teams. Argote [76] posited that the occurrence of team learning was mainly manifested in the relatively enduring change in the knowledge and
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performance of team members. He also used organizational and team learning curves
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to measure the performance of team learning. Chen and Zheng [77] found a significant positive relationship between a team’s learning ability and team
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performance. Pagell [78] examined the adaptability between employee skills and work environment and suggested that it directly affects organizational performance.
A
In hospitals, leaders, department directors, managers, and medical staff can use
various functions of CBHKS to conduct group learning and acquire information and knowledge for management decision making. All of these could improve the professional skills of a medical group and deliver a high quality of healthcare service to patients. These gains also could lead to more efficiency that would permit treatment 18
of more patients as well as earn their trust, which eventually will improve hospital management performance. Hence, we propose the following hypothesis: H4a: Group learning positively influences hospital management performance. In addition, CBHKS could also help improve the effectiveness of group learning
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and increase the communication behaviors of group members, which, in turn, could increase team cohesion and promote the hospital’s management maintenance. Jahani
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et al. [79] proposed that the learning levels promoted the job satisfaction of hospital employees. Through information sharing and intelligent mining, CBHKS could
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improve the efficiency of communication among medical staff, increase the depth and
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breadth of communication information content, and thus improve the learning level of
A
medical staff. Hence, CBHKS could increase the job satisfaction of medical staff and
M
further improve hospital management maintenance. We propose the following
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hypothesis:
H4b: Group learning positively influences hospital management maintenance.
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3.2.4 External satisfaction and hospital management
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Previous studies have investigated the relationships between external satisfaction
and management performance and maintenance [80]. External satisfaction is a kind of
A
work attitude from external stakeholders, while management maintenance directly embodies organizational effectiveness [81]. Terziovski [82] investigated the relationships among quality management practices, customer satisfaction, and productivity improvement. He suggested that improvement of customers’ satisfaction correlates positively with productivity improvement. 19
External satisfaction in hospitals mainly refers to patients’ satisfaction. The CBHKS implementation improves treatment effectiveness and efficiency, saves patients’ time, and then improves external satisfaction. Patients’ attitudes are vital in determining whether patients will choose a hospital again. Moreover, patients’
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satisfaction influences the service choices of potential customers through word-ofmouth. As one dimension of group effectiveness, external satisfaction is an important
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reflection of whether the work of medical groups is effective. As a result, external
satisfaction can directly influence hospital performance. Therefore, we propose the
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following hypothesis:
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H5a: External satisfaction has a significantly positive effect on hospital
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management performance.
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In addition, CBHKS can promote healthcare service effectiveness, which also
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improves the satisfaction of patients. This improves doctor–patient relationships, which indirectly enhance the stability of medical groups [83]. High external
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satisfaction can reduce the doctor–patient conflict, increase the medical group
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members’ sense of security, and promote the stability of medical working group. Hence, external satisfaction influences the hospital’s continuing development and
A
maintenance. Therefore, we propose the following hypothesis: H5b: External satisfaction has a significant positive effect on hospital
management maintenance. Based on the above hypotheses, we present our research model in Figure 1.
20
Group Performance
H1b
Group Members’ Satisfaction
H2b H2a
H3b H3a
The Implementation of CBHKS
Management Performance
H1c
Management Maintenance
H4a
Group Learning
H4b
H5a
External Satisfaction
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H1d
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H1a
H5b
N
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Fig. 1. The research model
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4. Methodology
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To test our research model, a study was conducted at one of the biggest hospitals
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in East China. This hospital has successfully implemented CBHKS. The CBHKS implemented at the hospital are easy to use and useful for doctors, nurses, and
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managers. The hospital started to adopt IS in 1996. The doctors and nurses in this
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hospital were among the first to promote the use of HIS. The implementation of CBHKS in the hospital started in 2012, mainly providing management and decision support for medical staff and hospital managers. The CBHKS include functions such
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as cases organizing and maintenance, collaborative case-based diagnosis and nursing support for doctors and nurses, case-based management and decision support for hospital managers, online members’ communications, and group learning. At present, this system has become a widely used popular support tool for healthcare decision 21
making and hospital management in this hospital. 4.1. Measurements The measurements for most of the variables were adapted from previous studies. Seven constructs are used in this study: CBHKS implementation, Group Performance,
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Group Members’ Satisfaction, Group Learning, External Satisfaction, Management
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Performance, and Management Maintenance. All of the items were measured with a seven-point Likert scale [84, 85], ranging from 1 (strongly disagree) to 7 (strongly agree). CBHKS implementation was measured based on the items from Angst and
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Agarwal [86] and Tippins and Sohi [87]. The measurements for performance and
A
N
satisfaction were adopted from Lurey and Raisinghani [42] in 2001. The
M
measurements of group learning are mainly based on the team learning research of
4.2. Data collection
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Huang et al. [88].
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We used a multistage iterative process to collect the data. We conducted a pilot
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study using 85 respondents to test for any ambiguous expressions, awkward wordings, or distortions of the original meanings.
On the basis of data and respondents’
suggestions in the pilot study, we modified the questionnaire, which was then used to
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collect data from the medical staff in the hospital. This study had the full support of the hospital’s management. A small gift with a value of approximately $10 was provided to each respondent who completed and returned the questionnaire. The survey lasted for two and a half months.
22
The participants were randomly from the group leaders (such as department heads and office directors). Then, with the assistance of these group leaders, we informed the selected participants and explained the purpose of the study. Based on the questionnaire filling rule, we informed the group leaders in advance, they should
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organize at least two in-group discussions and extensively solicit opinions and suggestions from personnel within the group. Based on full communication and
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consultation with colleagues within groups, the leaders filled in the questionnaires on behalf of their groups. Although the questionnaires were completed by the leaders,
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obviously the scores represent common understanding of groups, not only individual
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opinions of leaders.
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They were also informed that participation was voluntary as well as anonymous.
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We distributed 250 questionnaires and got 225 returned ones. The response rate is
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90%. Among the 225 questionnaires returned, 11 were discarded as incomplete. Hence, we used 214 responses in the analysis. The sample demographics were shown
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in Table 1. In this table, we only counted the people who finally filled in the
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questionnaires. Table 1 shows the demographic data. Table 1
Sample demographics. Category
Number
Percentage
Male
120
56.1%
Female
94
43.9%
18-28 years old
15
7.0%
28-48 years old
140
65.4%
48-60 years old
49
22.9%
>60 years old
10
4.7%
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Gender
Age
Educational background 23
College
53
24.7%
Graduate school
161
75.3%
214
100%
Total
4.3. Data analysis technique PLS-based structural equation modeling (SEM) was used to perform a
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simultaneous evaluation of both measurement quality (measurement model) and construct interrelationship (structural model) [9]. Prior studies have indicated that
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PLS-SEM overcame problematic model identification issues and that it is a powerful method to analyze complex models by using smaller samples [89, 90]. Covariance-
U
based SEM cannot provide robust results because our sample size is limited. Thus, in
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this study, we used SmartPLS 2 to evaluate measurement quality and test hypotheses.
5.1. Measurement Model
M
A
5. Results
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Analysis of the measurement model mainly involves the assessment of reliability
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and validity. Among the reliability metrics, Cronbach’s α reliability coefficient has been most commonly used. A factor’s Cronbach’s α evaluates the internal consistency
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of the measurements. The threshold value of Cronbach’s α recommended by Hair et al. [91] is 0.5. Another metric for internal consistency is composite reliability, which
A
is not sensitive to the number of items in the scale [91]. Hair et al. [91] considered composite reliability of 0.7 or more to be very credible. Both Cronbach's α and composite reliability were used for a comprehensive analysis of the reliability of the questionnaires. The validity of constructs is commonly measured from two aspects, i.e., 24
convergent validity and discriminant validity. Convergent validity can be assessed by using average variance extracted (AVE). AVE measures the level of variance captured by a construct versus the level because of measurement error. AVE values higher than 0.5 are considered very good. According to Fornell and Larcker [92], to ensure the
AVE value needs to exceed its correlation with other constructs.
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existence of discriminant validity among the factors, the square root of a construct’s
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Table 2 presents the assessment of reliability and validity. All of the Cronbach’s α and composite reliability values exceed 0.8, indicating very good reliability. All of
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the AVE values exceed 0.5, suggesting good convergent validity. The right part of
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Table 2 shows the correlations among the constructs; the square roots of the AVE
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values are on the diagonal. The square root of each construct’s AVE value exceeds its
M
correlations with other constructs, indicating strong discriminant validity. Table 3
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shows the mean, standard deviation, and factor loadings of each measurement. All of
validity.
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the factor loadings exceed 0.7, providing additional evidence for good discriminant
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We followed Kock and Lynn [93] and Kock [94] to assess potential common method bias using a full collinearity test. Specifically, we created a dummy construct (with a single indicator containing random values between 0 and 1) and used all
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constructs to predict it through a PLS regression. The variance inflation indicator (VIF) values for each of the construct are reported in Table 4. All of the VIF values are below the recommended threshold, i.e., 3.3. This suggests that our data analysis is not threatened by common method bias or multicollinearity. 25
Table 2 Reliability and discriminant validity.
's Alpha
Composit
AV
e
E
Reliability
CI
ES
GL
GM S
GP
0.895
0.928
0.762
0.873
ES
0.954
0.960
0.666
0.446
0.816
GL
0.905
0.934
0.779
0.337
0.703
0.883
GMS
0.897
0.921
0.662
0.512
0.693
0.740
0.814
GP
0.931
0.948
0.785
0.543
0.693
0.617
0.741
0.886
0.869
0.901
0.605
0.471
0.652
0.652
0.640
0.705
0.885
0.921
0.745
0.569
0.601
0.557
0.600
HM M HMP
HM
M
P
0.775
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CI
HM
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Cronbach
0.637
0.635
0.863
Note：CI represents “CBHKS implementation,” HMP represents “Hospital management performance,” HMM represents “Hospital management maintenance,” ES represents “External satisfaction,” GL represents “Group
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learning,” GMS represents “Group members’ satisfaction,” GP represents “Group performance.”
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Table 3
Measurement Item
Mean
Std. Deviation
Loading
5.35
1.60
0.838
5.51
1.52
0.912
5.40
1.30
0.913
CI104
5.58
1.23
0.826
GP101
5.38
1.26
0.870
GP102
5.50
1.05
0.899
GP103
5.35
1.10
0.881
CBHKS
CI101
implementation
CI102
PT
Group performance
ED
CI103
M
Construct
A
Coefficients and significance.
5.76
1.09
0.798
GMS101
5.63
1.13
0.723
satisfaction
GMS102
5.50
1.05
0.779
GMS103
5.19
1.25
0.820
GMS104
5.30
1.11
0.842
GMS105
5.69
1.07
0.730
GMS106
5.37
1.05
0.765
GL101
5.26
1.22
0.850
GL102
5.38
1.14
0.922
GL103
5.48
1.03
0.894
GL104
5.56
1.05
0.893
GL105
5.41
1.05
0.870
ES101
4.95
1.28
0.811
ES102
5.32
1.23
0.846
ES103
5.41
1.18
0.845
ES104
5.23
1.17
0.879
ES105
4.90
1.38
0.768
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GP104
Group members’
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Group learning
External satisfaction
26
4.74
1.40
0.723
Hospital
HMP101
5.46
0.98
0.815
management
HMP102
5.56
0.95
0.868
performance
HMP103
5.50
1.03
0.849
HMP104
5.53
1.03
0.851
HMP105
5.61
1.05
0.853
HMP106
5.91
0.87
0.757
HMP107
5.81
0.91
0.827
HMP108
5.60
0.97
0.795
HMP109
5.71
1.02
0.840
HMP110
5.91
0.93
0.793
HMP111
5.72
0.89
0.784
HMP112
5.98
0.90
0.748
Hospital
HMP101
5.52
1.16
0.861
management
HMP102
5.36
1.33
0.900
maintenance
HMP103
5.18
1.32
HMP104
5.25
1.09
SC R 0.894 0.875
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Note: The loading is reported by SmartPLS 3.0.
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ES106
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Table 4
A
The test of common method bias and multicollinearity CBHKS implementation Group performance
Group learning External satisfaction
VIF 1.446 1.614 1.506 2.125
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Group members’ satisfaction
M
Construct
1.803 2.055
Hospital management maintenance
1.121
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Hospital management performance
5.2. Structural Model Figure 2 shows the R2 values for each endogenous latent variable. Group
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effectiveness explains 59.1% of the management performance’s variation and 60.5% of management maintenance’s variation. The CBHKS implementation explains, respectively, 32.4%, 22.2%, 29.5%, and 26.2% of the variations in group performance, group members’ satisfaction, group learning, and external satisfaction. 27
These R2 values suggest the model has acceptable explanatory power.
Group Performance R2=32.35%
0.471** (16.210)
Group Members’ Satisfaction R2=22.21%
0.076 (1.833)
0.140** (3.187)
0.279** (8.987)
0.203** (4.878)
The Implementation of CBHKS
Management Performance R2=59.10% Group Learning R2=29.53%
0.512** (20.466)
External Satisfaction R2=26.16%
0.234** (5.859)
-0.024 (0.519)
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0.543** (19.883)
Management Maintenance R2=60.46%
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0.569** (24.320)
0.307** (9.292)
0.534** (16.791)
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Fig. 2. Model results
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Note: Path coefficients with t value in parentheses. ∗ p < .05.∗∗ p < .01
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As shown in Figure 2 and Table 4, the positive relationship between CBHKS
M
implementation and group performance (H1a) is supported (βH1a=0.569**). The
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positive relationships between CBHKS implementation and group member satisfaction, group learning, and external satisfaction (H1b, H1c, and H1d) are supported
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as well (βH1b=0.471**, βH1c=0.543**, and βH1d=0.512**, respectively). All the
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dimensions of group effectiveness have been shown to significantly and positively influence management performance (βH2a=0.140**, βH3a=0.203**, βH4a=0.234**, and βH5a=0.307**, respectively). Thus, hypotheses H2a, H3a, H4a, and H5a are supported.
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The positive relationship between group members’ satisfaction and management maintenance and the positive relationship between external satisfaction and management maintenance (H3b and H5b) are also supported (βH3b=0.279** and βH5b=0.534**, respectively). However, the positive influences of group performance
28
and group learning on management maintenance are not significant (βH2b=0.076 and βH4b=-0.024). Thus, hypotheses H2b and H4b are not supported. Table 5 contains a summary of these results. Table 5
Hypothesized Path
Standardized Path T-value Coefficients(β)
H1a: CBHKS Implementation→ Group performance
0.569**
24.320
H1b: CBHKS Implementation→ Group members’ satisfaction
0.471**
16.210
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Structural parameter estimates.
H1c: CBHKS Implementation → Group learning
0.543**
19.883
Supported
H1d: CBHKS Implementation→ External satisfaction
0.512**
20.466
Supported
H2a: Group Performance → Hospital management performance
0.140**
3.187
Supported
H2b: Group Performance → Hospital management maintenance
0.076
1.833
Not supported
4.878
Supported
0.279**
8.987
Supported
H4a: Group Learning→ Hospital management performance
0.234**
5.859
Supported
H4b: Group Learning→ Hospital management maintenance
0.203**
H3b: Group Members’ Satisfaction → Hospital management
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maintenance
N
performance
Supported Supported
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U
H3a: Group Members' Satisfaction → Hospital management
Results
0.519
Not supported
0.307**
9.292
Supported
H5b: External Satisfaction → Hospital management maintenance
0.534**
16.791
Supported
5.3 Test of Mediation
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M
-0.024
H5a: External Satisfaction→ Hospital management performance
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In our research model, we hypothesized that group performance, group members’
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satisfaction, group learning, and external satisfaction mediate the effect of CBHKS implementation on management performance and maintenance. Thus, we further
A
tested the mediation effects. For this purpose, we followed the procedure for testing mediation effects of a PLS model in Rai et al. [95]. First, we added a direct path between CBHKS implementation and management performance. The R-squared for management performance is 0.5930. The R-squared for management performance in the original model (full mediation) is 0.5928. We calculated pseudo F statistics 29
following Rai et al. [95] to test if this difference is significant. The pseudo F statistic is 0.1007 with (1, 206) degrees of freedom. The p value is not significant, suggesting that adding the direct effect does not improve the model fit. Moreover, the path coefficient of the direct effect is not significant, either. This suggests that the four
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dimensions of group effectiveness fully mediate the effect of CBHKS implementation on management performance.
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In the same fashion, we added a direct path between CBHKS implementation and management maintenance. The R-squared for management maintenance is 0.6201.
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The R-squared for this construct in the original model is 0.6046. The pseudo F
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statistic is 8.3640 with (1, 206) degrees of freedom, which is statistically significant.
A
The path coefficient of the direct effect is -0.1610, which is also statistically
M
significant. Meanwhile, the path coefficients of the four dimensions of group
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effectiveness have increased. This suggests that the direct effect may have a suppression effect on the relationship between CBHKS implementation and the four
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dimensions of group effectiveness. Specifically, CBHKS implementation has a
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positive correlation (0.34) with management maintenance. It is also positively correlated with external satisfaction (0.51), group learning (0.54), group members’ satisfaction (0.47), and group performance (0.57). However, the direct effect of
A
CBHKS implementation on management maintenance has a negative path coefficient when it is included and the “predictive validity” of the four dimension of group effectiveness has increased. By definition [96, 97], CBHKS implementation is likely to be a negative suppressor in our research model. 30
It is considered as an inconsistent mediation when the mediation effect has a different sign than the direct effect and one of the independent variables is a negative suppressor [98]. This is common in situations where the direct effect may be counterproductive [98]. In our research context, implementation of a new system may
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bring changes that immediately lower the stability of relationships in a hospital. It may also reduce employees’ perception of autonomy because they are mandated to
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use the new system. This is a plausible explanation of the negative direct effect of
CBHKS implementation on management maintenance. Nonetheless, in the partial
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mediation model, all coefficients in the four mediation paths are positive and
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statistically significant. The total effect of CBHKS implementation on management
A
maintenance is 0.34. This satisfies the condition of mediation with the presence of a
M
negative suppressor [99]. Thus, our results support the role of group effectiveness in
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maintenance.
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mediating the positive but indirect effect of CBHKS implementation on management
6. Discussion and Conclusions
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In this study, the relationships among CBHKS implementation, group
effectiveness, and the improvement of management performance and management
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maintenance in hospital management are thoroughly investigated. The results show that CBHKS implementation has a significant, positive effect on group effectiveness. Moreover, all of the four dimensions of group effectiveness have significant, positive effects on hospital management performance. Group members’ satisfaction and external satisfaction also have significant, positive effects on hospital management 31
maintenance. But the effects of group performance and group learning on management maintenance are not significant. We also tested the mediating effect of group effectiveness between CBHKS implementation and hospital management output. According to the result of empirical
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test, group effectiveness fully mediates the effect of CBHKS implementation on hospital management performance and partially mediates the effect on hospital
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management maintenance. In addition, we find that CBHKS implementation has the negative direct effect on hospital management maintenance.
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6.1. Implications
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6.1.1 Implications for research
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This study has important implications for IS research. First, we investigated how
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CBHKS implementation affects the two different dimensions of hospital management: management performance and management maintenance. Drawing on the PM theory,
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we introduce two aspects of leadership behavior into our research as two dimensions of management output. P and M have been studied as the management output in some
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prior researches, respectively [28-32]. Our study considers both dimensions in our research context and shows that CBHKS implementation impacts management
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performance and maintenance differently. This is not only new but also important in the literature on the organizational impact of IS. Prior related studies paid more attention to organizational performance, which is one of the most important aspects in evaluating management outcomes [24, 25, 63]. However, the importance of management maintenance cannot be neglected because it concerns the stability of an 32
organization [26]. Our findings show that CBHKS implementation indeed affects both management performance and maintenance through group effectiveness. Future IS research may consider examining both management performance and maintenance when studying the impact of IS implementation. This will provide us with a holistic
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view on how it impacts management outcomes. Second, we introduced the four dimensions of group effectiveness to our
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research model and demonstrated their mediating roles in the relationship between
CBHKS implementation and management outcomes. Group effectiveness is a meso-
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level construct, while management output is an organizational level construct. In our
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study, we established the influence path of CBHKS on the organizational level
A
construct by virtue of the meso-level construct of group effectiveness, which is
M
seldom discussed in previous literature. Our study further enriches the literature on
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the path of IT's impact on organizational output. From the empirical results, the mediating effect of group effectiveness shows internal differences. Among the four
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dimensions, group performance and group learning capture the improvements of
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group-level business processes while group members’ satisfaction and external satisfaction reflect the emotional consequences. Our findings show that group effectiveness fully mediates the effect of CBHKS implementation and management
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performance. This suggests that both business process improvements and emotional factors contribute to management performance and can fully capture the effect of CBHKS implementation. However, in the relationship between CBHKS implementation and management maintenance, only group members’ satisfaction and 33
external satisfaction are significant mediators. This implies that organizational stability may have a stronger association with emotional factors than economic factors. Merely improving group-level business processes is not effective in enhancing organizational stability. Rather, the emotional consequences brought by IS
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implementation are more significant. These findings have provided a foundation for future research that aims at gaining deep insights when studying the organizational
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impact of IS.
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6.1.2 Implications for practice
A
N
The systems we investigated in this study, CBHKS, are used in the healthcare
M
industry, a high-impact area where intelligent systems are being widely deployed. Our research findings have important implications for doctors and other decision makers
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in hospitals. On the one hand, our data analysis shows that CBHKS implementation
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has positive (but indirect) effects on management performance and maintenance. This provides new empirical evidence for the usefulness of CBHKS. Such evidence is
CC E
crucial in initiating CBHKS projects in hospitals that have not implemented such a system yet. On the other hand, our findings show that group effectiveness fully
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mediates the positive effects. This calls for decision makers’ attention on the group level outcomes when considering the organizational impact of CBHKS. In particular, when studying the potential benefits of CBHKS implementation in the project planning phase, the four dimensions of group effectiveness can provide important indicators for intangible returns. 34
Based on the results from our data analysis, the roles of CBHKS seem to be complex in influencing the relationship between CBHKS implementation and management maintenance. Although the positive effect of CBHKS implementation on management maintenance is mediated by group effectiveness, the direct effect is
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negative. This implies that CBHKS implementation may immediately decrease organizational stability because of the required change to the habits and culture in a
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hospital. Thus, the positive impact of CBHKS on management maintenance may only be observed in the long horizon. Moreover, only the emotional aspect of group
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effectiveness (i.e., group members’ satisfaction and external satisfaction) is significant
N
in mediating the positive effect of CBHKS implementation on management
A
maintenance. As a result, hospital management is advised to focus more on emotional
M
dimensions to mitigate the potential negative impact on organizational stability when
ED
implementing CBHKS. This is important for both internal and external stakeholders.
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6.2. Limitations and Future Research This study is not without limitations. First, we measured external satisfaction
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based on medical staff’s perception. Although the medical staff is frequently updated with patient’s feedback, our instruments did not directly collect this information from
A
patients. However, external satisfaction intends to capture the change in satisfaction after the CBHKS implementation. Most patients do not use the hospital’s service long enough to experience such a change. Yet, many hospital employees worked for the hospital both before and after the CBHKS implementation. Thus, their perception of external satisfaction can better capture the “change” aspect of the construct. Future 35
research may validate our results by measuring external satisfaction directly by conducting patient surveys. In this study, we focused on the indirect (mediated) effect of CBHKS implementation on management outcomes rather than the direct effect. The results
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from our data analysis suggest that CBHKS implementation may be a negative suppressor. Its direct effect on management maintenance is negative, but its mediated
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effect is positive. Although we provided a plausible explanation for it, this interesting
mechanism needs to be further examined and empirically tested. Further research may
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work in this direction.
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Moreover, CBHKS have been implemented in a large number of hospitals. These
A
hospitals may differ in their processes and management. In this study, we only used
M
data collected from one hospital. Thus, the generalizability of our findings should be
multiple hospitals.
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interpreted with cautions. Future studies may validate our findings using data from
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Additionally, future research can also focus on studying how the CBHKS
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implementation enhances different dimensions of healthcare service quality. Aagja and Garg [100] developed a scale to measure perceived service quality for public hospitals from a user’s perspective. The scale they developed is called public hospital
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service quality (PubHosQual), which measures the five dimensions of hospital service quality: admission, healthcare service, overall service, discharge process, and social responsibility. Based on our current study, future work can address how CBHKS affect improvement in the different dimensions of hospital service quality, and further 36
examine which specific modules or functions of CBHKS work most effectively. This will be helpful in identifying areas where specific modifications are needed so that hospital management can focus on these areas during the implementations of healthcare IT.
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Funding
This research is partially supported in data collection, analysis, and
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interpretation by the National Natural Science Foundation of China
A
CC E
PT
ED
M
A
N
U
(NSFC) [grant number 71331002, 71771075, 71771077, 71503033].
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Dongxiao Gu is an associate professor of Management Information Systems(MIS) at the Hefei University of Technology's School of Management. His research interests include health data modelling and mining, the behavioural and emotional aspects of the use of emerging technologies in healthcare. He served as a Young Scientists Committee Member for the 6th Exploratory Round Table Conference of Chinese Academy of Sciences and Max Planck Society (ERTC 2015), the local arrangements co-chair for China Summer Workshop on Information Manaement(CSWIM2015), track(smart health and smart aging care) co-chair for Association of Information Systems-China(CNAIS2019). His research has been appeared in over seventy journals,such as Information & Management, Knowledge-Based Systems, International Journal of Production Research, International Journal of Project Management, Expert Systems with Applications, International Journal of Medical Informatics, Artificial Intelligence in Medicine, IEEE Access, Computers & Industry Engineering, and so on.
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Shuyuan (Lance) Deng is an Assistant Professor of Management Information Systems at the Seidman College of Business, Grand Valley State University. He received his Ph.D. in Information Systems from University of Wisconsin-Milwaukee and his M.B.A from University of Illinois at Chicago. His research interests include artificial intelligence, machine learning, natural language processing, the social and economic impact of IS, and enterprise systems. His research has appeared in leading information systems journals, such as MIS Quarterly, Decision Support Systems, Journal of the Association for Information Systems, ACM Transactions on MIS, and Journal of Business Analytics.
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Qian Zheng is a Ph.D. candidate at the Hefei University of Technology and is an associate professor at the Anhui Science and Technology University. She received a Master’s degree in Industry Economics from the Hefei University of Technology, Hefei, China. Her research mainly focuses on information management, information technology adoption behaviours, cloud computing services and performance, and business model innovations related to cloud computing in various sectors. ChangYong Liang is a professor of MIS and associate dean of the
Academy of Sceince at the Hefei University of Technology. His research focuses on information management, the role of cloud knowledge systems in smart health care and elderly care services. He is the author of more than one hundred publications in IS journals, such as Information & Management, Expert Systems with Applications, Knowledge-Based Systems, Computers & Industrial Engineering, International Journal of Intelligent Systems, etc. He is the co-chair for the 9th China 45
Summer Workshop on Information Management (CSWIM2015), member of China Smart Health 50 People Forum, Executive member of the council for Smart health and aging division at China Association of Gerontology and Geriatrics, Vice Editor-in-Chief for Operation Research&Management.
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Jiao (Aimee) Wu is an assistant professor at the Department of Operations Management and Information Systems, in the College of Business , Northern Illinois University in the United States. Her research focuses on social media behavior, online envy, and crosscultural IT usage. She has published in Americas Conference on Information Systems (AMCIS), Decision Institute (DSI) Annual Meeting.
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Appendix A
CBHKS implementation (CI)
References Liang et al. [83] Song and Zahedi [101]; Chen [102]; Lurey, Raisinghani , [103];Venkate sh. [104]
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Group performance (GP)
Items CI 1: We frequently used the CBHKS in our group. CI 2: Without the CBHKS, our work will be inconvenient CI 3: The CBHKS have been implemented in our group CI 4: The CBHKS have been commonly used by our group members. GP 1: The use of the CBHKS has increased our group productivity GP 2: The use of the CBHKS improves our group performance in our job. GP 3: The use of the CBHKS enhances our group effectiveness in our job. GP 4: The use of the CBHKS makes an important GP contribution to the overall performance of our group work GMS 1: We am satisfied with CBHKS. GMS 2: We am pleased with the use of CBHKS. GMS 3: We think that we made the correct decision to use CBHKS to get supportive information or knowledge. GMS 4: We am satisfied with the service that we have received from CBHKS GMS 5: The CBHKS are pretty good and we like to use it. GMS 6: Overall, we were satisfied with CBHKS. GL1.With the assistance of CBHKS, we tend to agree on how best to serve patients or the customers GL 2. After CBHKS implementation, we have a set standard procedure for handling routine requirements from patients or other departments GL 3. CBHKS provide an important platform for our group to learn how to analyze and utilize various data resources to response to questions raised by patients or other departments GL 4. When faced with new information about our customers, our managers usually agree on how the information will impact our firm. GL 5.We are knowledgeable about our customers’ strengths and weaknesses. ES1: Based on the communication with patients, we feel that with the implementation of CBHKS, they think the service provided by the hospital is more consistent with their expectations. ES2: Based on the extensive communication with patients and other departments, we feel that they are more satisfied with the work of our department after the CBHKS implementation. ES3: Based on the extensive communication with patients, as well as the reduction of actual disputes and complaints, we feel doctor– patient relationship have become better after the CBHKS implementation ES4: Based on the communication with our patients, we feel that they are more satisfied with our work now. HMP 1: After the CBHKS implementation, the work plans of our group became better and problem handling was more flexible. HMP 2: The CBHKS implementation makes it is easier to acquire health knowledge and improved the level of our leadership. HMP 3: CBHKS provide some professional solutions to some difficult issues and challenge, and it improved our leadership efficacy
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Anderson and Sullivan [105]; Kohli et al. [106]; Kim and Koh, [107]
Tippins and Soh, [87]; Du et al., [108]; Chen et al. [102]
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External satisfaction (ES)
Hospital management performance (HMP)
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HMP 4: The efficiency of our information communications with the patients was improved after the CBHKS implementation. HMP 5: The efficiency of our information communications with other departments was improved after the CBHKS implementation. HMP 6: The CBHKS implementation is helpful for our productivity of leadership work in our department HMP 7: After the use of CBHKS, our department reached our target more smoothly HMP 8: After the use of CBHKS, our department have more effectively accomplished our tasks than before HMP 9: After the use of CBHKS, our department have better achievements than before HMP 10: After the use of CBHKS, the service provided by our department exceed external expectation. HMP 11: After the use of CBHKS, the group members in our department are more concerned about the quality of their work. HMP 12: After the use of CBHKS, the group members in our department work very well and the team skills are growing rapidly HMM1: Our responsibility and awareness of the care and maintenance of collective interests were improved after the CBHKS implementation HMM2: The CBHKS implementation provides opportunity for leaders to think better working methods and have more communication with group members which improved the level of trust of leaders to subordinates. HMM3: The CBHKS implementation made much work become easier, improved our working relationship within the group, and enhanced the unity and harmony of our group. HMM4: Our ability of organization and coordination of leadership were improved with the assistance of CBHKS.
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Xu [109]; Feng & Zhang [111]