Adam Seth Litwin

Technological Change at Work: The Impact of Employee Involvement on the Effectiveness of Health Information Technology

The link between employee involvement (EI) and organizational performance is not clear-cut, and the diffusion of information technology (IT) in the workplace complicates this relationship. The author argues that new technologies offer an important avenue by which EI can improve firm performance. He also contends that those studies that do consider EI in the context of technological change may be focusing exclusively on workplace-level features of the employment relationship, ignoring variation in functional- and strategic-level aspects of employment relations. To test this hypothesis, he uses Kaiser Permanente Northwest Regions patient scheduling module as an exemplar to investigate the extent to which this particular technology interacts with EI to affect clinic-level improvements in patient satisfaction. He studies the impact of the technology over the period October 2004 to August 2007 across 16 clinics to identify variation across sites. Measuring outcomes from a dataset that includes employee and patient surveys, interviews, archival data, and clinic observations, he finds that the use of IT is associated with performance increases and that these effects are greater in those clinics achieving higher mean levels of EI. This study presents the first empirical evidence of the potential of EI to enhance the effectiveness of health IT.

Drivers and Barriers in Health IT Adoption: A Proposed Framework

Despite near (and rare) consensus that the adoption and diffusion of health information technology (health IT) will bolster outcomes for organizations, individuals, and the healthcare system as a whole, there has been surprisingly little consideration of the structures and processes within organizations that might drive the adoption and effective use of the technology. Management research provides a useful lens through which to analyze both the determinants of investment and the benefits that can ultimately be derived from these investments. This paper provides a conceptual framework for understanding health IT adoption. In doing so, this paper highlights specific organizational barriers or enablers at different stages of the adoption process - investment, implementation, and use - and at different levels of organizational decision-making - strategic, operational, and frontline. This framework will aid both policymakers and organizational actors as they make sense of the transition from paper-based to electronic systems.

Measurement Error in Performance Studies of Health Information Technology: Lessons from the Management Literature

Just as researchers and clinicians struggle to pin down the benefits attendant to health information technology (IT), management scholars have long labored to identify the performance effects arising from new technologies and from other organizational innovations, namely the reorganization of work and the devolution of decision-making authority. This paper applies lessons from that literature to theorize the likely sources of measurement error that yield the weak statistical relationship between measures of health IT and various performance outcomes. In so doing, it complements the evaluation literatures more conceptual examination of health ITs limited performance impact. The paper focuses on seven issues, in particular, that likely bias downward the estimated performance effects of health IT. They are 1.) negative self-selection, 2.) omitted or unobserved variables, 3.) mis-measured contextual variables, 4.) mismeasured health IT variables, 5.) lack of attention to the specific stage of the adoption-to-use continuum being examined, 6.) too short of a time horizon, and 7.) inappropriate units-of-analysis. The authors offer ways to counter these challenges. Looking forward more broadly, they suggest that researchers take an organizationally-grounded approach that privileges internal validity over generalizability. This focus on statistical and empirical issues in health IT-performance studies should be complemented by a focus on theoretical issues, in particular, the ways that health IT creates value and apportions it to various stakeholders.

Justice or Just between Us? Empirical Evidence of the Trade-Off between Procedural and Interactional Justice in Workplace Dispute Resolution

In this article, the authors examine the relationship between an employers implementation of a typical dispute resolution system (DRS) and organizational justice, perceived compliance with the law, and organizational commitment. They draw on unique data from a single, geographically expansive, U.S. firm with more than 100,000 employees in more than 1,000 locations. Holding all time-constant, location-level variables in place, they find that the introduction of a DRS is associated with elevated perceptions of interactional justice but diminished perceptions of procedural justice. They also find no discernible effect on organizational commitment, but a significant boost to perceived legal compliance by the company. The authors draw on these findings to offer a “differential-effects†model for conceptualizing the relationship among organizational justice, perceived legal compliance, and the implementation of dispute resolution mechanisms.

Not Featherbedding, but Feathering the Nest: Human Resource Management and Investments in Information Technology

This study draws on employment relations and management theory, claiming that certain innovative employment practices and work structures pave the way for organizational innovation, namely investments in information technology (IT). It then finds support for the theory in a cross-section of UK workplaces. The findings suggest that firms slow to adopt IT realize that their conventional employment model hinders their ability to make optimal use of new technologies. Therefore, the paper advances the literature beyond studies of unionization’s impact on business investment to a broader set of issues on the employment relations features that make organizations ripe for innovation.

Why Don't Docs Digitize? The Adoption of Health Information Technology in Primary Care Medicine

Reformers in the US have earmarked substantial resources towards encouraging the adoption of electronic health records (EHRs). However, studies have yet to explain why physicians resist adoption and why the investments resulting from a policy push may prove ineffective for improving the efficiency of healthcare delivery. I theorize that health information technology (IT) facilitates certain outcomes that bolster industry-level efficiency, but that the conventional, “fee-for-service” financing of primary care prevents many physicians from appropriating these benefits. Those physicians financing care delivery from a prepaid premium, on the other hand, are positioned to internalize what are otherwise external economies attendant to health IT investment. I find strong statistical support for this theory in a unique panel of US-practicing primary care physicians that allows us to examine health IT adoption as far back as 2001 - long before it garnered policymakers’ attention. The results imply that reformers should focus not on encouraging health IT adoption per se, but on reforms that enable physicians to internalize what are presently socialized benefits.

Complementary or Conflictual? Formal Participation, Informal Participation, and Organizational Performance

Most studies of worker participation examine either formal participatory structures or informal participation. Yet, increasingly, works councils and other formal participatory bodies are operating in parallel with collective bargaining or are filling the void left by its decline. Moreover, these bodies are sprouting in workplaces in which workers have long held a modicum of influence, authority, and production- or service-related information. This study leverages a case from the healthcare sector to examine the interaction between formal and informal worker participation. Seeking to determine whether or not these two forces — each independently shown to benefit production or service delivery — complement or undermine one another, we find evidence for the latter. In the case of the 27 primary care departments that we study, formal structures appeared to help less participatory departments improve their performance. However, these same structures also appeared to impede those departments with previously high levels of informal participation. While we remain cautious with respect to generalizability, the case serves as a warning to those seeking to institute participation in an environment in which some workers have long felt they had the requisite authority, influence, and information necessary to perform their jobs effectively.

Superbugs versus Outsourced Cleaners Employment Arrangements and the Spread of Health Care–Associated Infections

On any given day, about one in 25 hospital patients in the United States has a health care–associated infection (HAI) that the patient contracts as a direct result of his or her treatment. Fortunately, the spread of most HAIs can be halted through proper disinfection of surfaces and equipment. Consequently, cleaners—“environmental services” (EVS) in hospital parlance—must take on the important task of defending hospital patients (as well as staff and the broader community) from the spread of HAIs. Despite the importance of this task, hospitals frequently outsource this function, increasing the likelihood that these workers are under-rewarded, undertrained, and detached from the organization and the rest of the care team. As a result, the outsourcing of EVS workers could have the unintended consequence of increasing the incidence of HAIs. The authors demonstrate this relationship empirically, finding support for their theory by using a self-constructed data set that marries infection data to structural, organizational, and workforce features of California’s general acute care hospitals. The study thus advances the literature on nonstandard work arrangements—outsourcing in particular—while sounding a cautionary note to hospital administrators and health care policymakers.

Editorial Essay Introduction to a Special Issue on Work and Employment Relations in Health Care

Few if any sectors are as critical to society and as dynamic in the arena of work and employment as health care. From a purely economic perspective, the united states spends more than

Collective Bargaining and Technological Investment: The Case of Nurses’ Unions and the Transition from Paper‐Based to Electronic Health Records

9,500 per person per year on insurance premiums, out-of-pocket costs, hospital and physician care, and prescription drugs—