David Bangert

The role of organizational culture in the management of clinical e-health systems

The research here presented focuses upon the informal, social, and cultural side of managerial coordination and control as manifested in clinical e-health systems. Specifically, the research seeks to analyze and determine the role specific dimensions of organizational culture may have upon effective managerial coordination and control in clinical e-health systems.

Organizational Learning and Culture in the Managerial Implementation of Clinical e-Health Systems: An International Perspective

When introducing a new technology that changes the core processes of an organization, such as an e-health initiative, it is important that the structural design and culture of the organization is aligned with the predominant national culture in which the organization is embedded. When a harmonious alignment is achieved, speedy and effective organizational learning can occur. This, in turn, promotes effective utilization of the new technology. The cultural dimension of uncertainty avoidance provides guidance on the type of organizational culture and structure to establish. Our research in five countries supports the believe that in national cultures in which high uncertainty avoidance is predominant, such as France, a highly mechanistic organization is favored; in cultures in which a low uncertainty avoidance dominates, such as the USA, a more organic organizational form should increase the probability of success in promoting effective organizational learning and thereby successfully implementing an e-health strategic intent.

Implementing Store-and-Forward Telemedicine: Organizational Issues

This article documents a study of an organizations cultural readiness for successful implementation of a store-and-forward telemedicine system in a military health care environment. The study focused on the organizations cultural attributes that reflect its learning propensity and thereby its capability to adapt effectively and utilize the new technology. Results suggest that the organization did not possess the most favorable attributes for the utilization of a new technology, and the utilization of the new system was significantly lower than expected during the first 6 months of implementation.

Designing web-based telemedicine training for military health care providers

Background: The purpose of the study was to ascertain those learning objectives that will initiate increased use of telemedicine by military health care providers. Telemedicine is increasingly moving to the center of the health care industrys service offerings. As this migration occurs, health professionals will require training for proper and effective change management. The United States Department of Defense (DoD) is embracing the use of telemedicine and wishes to use Web‐based training as a tool for effective change management to increase use. This article summarizes the findings of an educational needs assessment of military health care providers for the creation of the DoD Web‐based telemedicine training curriculum. Methods: Forty‐eight health care professionals were interviewed and surveyed to capture their opinions on what learning objectives a telemedicine training curriculum should include. Results: Twenty learning objectives were found to be needed in a telemedicine training program. These 20 learning objectives were grouped into four learning clusters that formed the structure for the training program. In order of importance, the learning clusters were clinical, technical, organizational, and introduction to telemedicine. Findings: From these clusters, five Web‐based modules were created, with two addressing clinical learning needs and one for each of the other learning objective clusters.

Telemedicine as an IS implementation problem: comparison of dynamics in the USA and India

The research reported here involved a longitudinal study, lasting three years, of the utilisation of an IS system designed to enhance the quality and accessibility of healthcare for the US military and their dependents. This study employed elements of a positivist methodology and an intensive research method. A discussion of the difficulties and conflicts inherent in multimethodological studies is presented. Findings indicate that low utilisation rates arose from a cultural mind set mismatch. This is compared to findings in India concerning the implementation of GIS systems. The mismatch was between the cultural variables conducive to organisational learning found in the implementing organisation. The Primary Care Clinic yielded low organisational learning cultural variables that were non-conducive to rapid adoption of the new and intrusive IS technology.

Introducing telemedicine as a strategic intent

In many settings, the introduction of new technologies has failed. In the healthcare industry, the implementation of telemedicine-which uses technology in ways that revolutionize the delivery process of healthcare-has failed more often than not. Reasons abound, but one of the most critical features when introducing a technology or process that will profoundly alter an organization is that the technology or process be implemented as a strategic intent; deliberate, championed and strongly led from the top, not from within a single department or functional area. The paper discusses the introduction of telemedicine as strategic intent.

Evaluating the organizational impact of telemedicine for Project Akamai

As an innovative form of healthcare delivery, telemedicine involves technology and process changes that will profoundly affect the organizations into which it is introduced. However, few comprehensive studies have been conducted to determine the impact on organizations that implement such a healthcare delivery process. This paper examines some of the issues that will be studied during Project Akamai when telemedicine is introduced into a natural, yet limited, military setting/spl square/Tripler Army Medical Center and Hickam Primary Care Clinic.

A comparative study of organisational and individual resistance to implementation of e-health technology in France, South Korea, Italy, Great Britain, and the USA

Management is the act of co-ordinating and controlling disparate entities so as to achieve common goals. Co-ordination and control have both a formal bureaucratic, structural side and an informal, social, and cultural side. In studies of e-health systems, well-designed formal bureaucratic structures were not sufficient to ensure acceptable utilisation rates of e-health technologies. Qualitative research has yielded organisational, structural and cultural dimensions related to uncertainty avoidance which may explain some of the variance in utilisation rates. Cross-national studies of e-health utilisation and cultural levels of uncertainty avoidance supply evidence of the role this dimension of culture may play in effective e-health implementations. High uncertainty avoidance nations, such as South Korea and France appear to have higher utilisation success in e-health implementations than in low uncertainty avoidance nations such as Great Britain and the United States.

Preparing Healthcare Professionals for Telemedicine: Results from Educational Needs Research

As part of an overall research program to create a set of web-based interactive distance learning modules, an educational needs assessment was conducted. The educational needs assessment is undertaken to collect information via observation and interview as to which knowledge areas are most desirable for incorporation into the interactive distance learning modules. This research is best undertaken with a neutral stance and without any preconceptions or hypotheses as to which knowledge areas are likely to be most useful. The interactive modules were designed to enhance the utilization of telemedicine by health care providers. This paper is a report on the methodology used and the findings of the needs assessment. The educational needs assessment acts as a compass to guide the creation of curricula. In the design of interactive learning, the needs assessment may be an important tool that informs not only the selection of the content, but also the selection of technology and courseware processes. The methodology described herein may be useful as a template for other authors of interactive learning courseware. The results of this study identified four clusters of content to be offered and confirmed the selection of interactive, web-based distance learning as the most appropriate delivery approach.

Enhancing medical decision-making through telemedicine

Healthcare is changing in certain predictable directions, and telemedicine can effectively deploy informatics and decision theory to positively impact the quality, cost and access to healthcare. As diagnostic and treatment protocols gain acceptance and use by healthcare providers, feedback loops will lead to individual and organisational learning. Through the data capture of informatics and the analytical ability of decision theory, the most important learning will occur at the organisational level as protocols are refined, updated, and expanded based on carefully tracked outcome evaluations.