Roel W. Schuring

Operational autonomy explains the value of group work in both lean and reflective production

Describes and compares two designs of work group: those which are based on the use of standard operating procedures, as found in lean production, and those based on decentralized in‐group solving of problems, as found in reflective production. Uses a Euro‐Japanese example of the former and a Swedish example of the latter. Concludes that both approaches result in an operational process that runs autonomously. The approaches should be used in different situations.

Electronic prescription system: do the professionals use it?

User-adoption of new IT-applications is the proof-of-the-pudding when it comes to IT-success in healthcare. As a consequence, many studies are made of the role of the users in the introduction of new IT in both theory and practice. User satisfaction is widely accepted as a criterion for IS success. However, to understand IS success or failure, it is necessary to recognise its social and technical causes. The USE IT model has four determinants that have to be balanced in assessing the diffusion and use of information systems. Resistance is defined as the degree to which the surroundings and locality negatively influences the users of IT and the degree to which IT-users themselves are opposing or postponing the IT change. Relevance is the degree to which the user expects that the IT-system will solve his problems or help to realise his actually relevant goals. Micro-relevance is the degree to which IT-use helps to solve the here-and-now problem of the user in his working process. Requirements are defined as the degree to which the user needs are satisfied with the product quality of the innovation. Resources are defined as the degree to which material and immaterial goods are available to design, operate and maintain the information system. The USE IT model clearly makes the transition in the onion model of the book from change management (USE) to technological innovation (IT). The empirical results of this qualitative study with 56 cases show that time and communication are the most important factors for General Practitioners for the diffusion and use of an Electronic Prescription System (EPS). The social aspects and technical aspects have to be balanced to get to real use of the information system. The (job) relevance of the EPS to the working process of the professional was, in all 56 cases, the most important determinant. The resistance of the professional that is often used as the main reason for plateaued diffusion was shown to be the cumulative effects of the other determinants. For instance a GP with limited resources (like a slow PC) will get annoyed by the waiting time and will resist the new system using a lot of processing time. At first the technical determinants, requirements and resources, seemed to be a prerequisite for the social determinants. Analysis of this presumption showed that a thorough check on resources is necessary and that a user–provider contract on requirements would help bridge the information gap.

Explaining plateaued diffusion by combining the user-IT-success factors (USIT) and adopter categories: the case of electronic prescription systems for general practitioners

Although the diffusion of new IT in healthcare does not seem to have levelled off, successes are reported frequently. Many of these successful cases show enthusiastic use of an innovation by a limited group of physicians or other users. This paper explains plateaued diffusion by differentiating the match between user and IT to adopter categories (the User-IT-match or USIT model). This match is described by the (sub)-dimensions of affection/resistance, relevance, requirements and resources. Once the sub-dimensions are determined for all adopter groups, it should become clear that different sub-dimensions play a role for every adopter group, and thus in every successive stage of the diffusion process. The diffusion process plateaus if there is no match with the sub-dimensions that play a role in the adopter category which was to adopt the innovation at that stage. A total of 56 case studies on the diffusion of an Electronic Prescription System (EPS) for general practitioners in the Netherlands was used to test the explanatory power of these factors. We conclude that USIT is of high value in determining adopter category specific diffusion problems, and thus in understanding plateauing diffusion. The relevance-factor has the biggest impact within USIT. The paper includes discussion of the limits of the model and suggestions for elaboration. It also discusses diffusion problems that are specific to this EPS.

Reasons for the Renewed Popularity of Autonomous Work Groups

Until recently, only relatively few Northern European companies had organized their operations by use of autonomous work groups, although the first literature on this subject stems from the 1950s. Yet this seems to be changing. From recent publications and the author′s experience it appears that the diffusion of autonomous work groups is increasing relatively suddenly. A survey among eight cases in six companies (two Dutch, four Swedish) shows that recent changes in the marketplace and in available technology are the main reasons why this increase has taken place and why, according to the companies, this is the very moment to start using autonomous work groups. On the one hand these changes enable the companies to introduce autonomous work groups, while on the other these changes force companies to do so.

USE IT to Create Patient-Relation Management for Multiple Sclerosis Patients

Patients with multiple sclerosis (MS) visit various healthcare providers during the course of their disease. It was suggested that information and communication technology might help to orchestrate their care provision. We have applied the USE IT tool to get insight in the relevant problems, solutions, and constraints of MS care both in the organizational and the information-technological area. There is hardly a chain of healthcare, but rather, a network in which informal communication plays an important role. This informal network worked reasonably effective, but it was inefficient and slow. The MS patient count is small for most care providers. Patients thought that a lack of experience caused their major problems: insufficient and inadequate care. To improve care, we proposed a solution that combines an MS protocol, the introduction of a central coordinator of care and a patient-relation management (PRM) system. This is a simple Web-based application based on an agreement by the caregivers that supports routing, tracking, and tracing for an MS patient and supplies the caregivers with professional guidelines. It is likely that we would have suggested a far more complicated ICT solution if we had only analyzed the MS care process as such without specific consideration of the dimensions in the USE IT tool.

The Competitive Advantage of Autonomous Work Groups in a Changed Environment

Until recently, only relatively few Northern European companies had organized their operations by the use of Autonomous Work Groups, although the first literature on this subject stems from the fifties. Yet this seems to be changing as appears from recent publications and the authors experience, the diffusion of autonomous work groups is speeding up relatively suddenly. A survey among 8 cases in 6 companies (2 Dutch, 4 Swedish) shows that recent changes in the market place and in available technology are the main reasons why this speed up takes place and why, according to the companies, this is the very moment to start with the use of Autonomous Work Groups. On the one hand these changes enable the companies to introduce Autonomous Work Groups, on the other, these changes force companies to do so.

Mini track: 'evaluation of implementation, adoption and diffusion of IS in healthcare (HCADI)

Developing, implementing and using information technology in organisations is a complex social activity. It is often characterised by ill-defined problems or vague goals, conflicts and disruptions that result from organisational change. Successfully implementing information systems in healthcare organisations appears to be a difficult task. Information Technology is seen as an enabler of change in healthcare organisations but (information) technology adoption decisions in healthcare are complex because of the uncertainty of benefits and the rate of change of technology. Relevance and micro-relevance are seen as important determinants for IS success. The (lack of) adoption of IT traditionally found it’s reasons in resistance of the professionals in healthcare organisations but this is clearly changing in healthcare today. When implementing an information system in healthcare it is wise to focus on the success determinants relevance, resistance, requirements and resources. This new minitrack attracted papers on experiences with implementation of information systems in healthcare. Also more theoretical contributions on evaluation and IS success and adoption are encouragedns arising.

E-Health Strategies, Architecture and Workflow Management

The design and development of e-health systems is studied on an organizational, national and international level. On an organizational level, a method is described for modeling the patient care process. On a national level the experiences with respect to the implementation of a national electronic prescription system are reported and analysed. At the international level the influence of national culture on the design of e-health systems is studied in five different countries.

IS Implementation, Adoption and Diffusion in Healthcare

The adoption of different types of technologies is studied and explained. Integration technology adoption describes the link between characteristics of integration technology and their fit with the reasons for adoption. A critical review is provided of telemedicine, where a case is made for an extension of system usage to include the quality of use as well. A more traditional approach is taken toward the study of the adoption of mobile technology. Finally, a new dimension for technology adoption is discussed based on personality traits and the way in which they influence computer anxiety. This, of course, is an inhibiting factor in the adoption of, in this case, telemedicine applications.

Mini track: 'healthcare chain workflow management by use of IT (HCHCW)

Patient visits various organizations or units within organizations to get proper diagnosis and treatment. The role of healthcare workflowmanagement by use of IT is to adjust the contributions of those organizations or units in terms of timing, quality and functionality. Some of these difficulties can be traced back to the heterogeneous nature of healthcare organizations. Professionals require a certain degree of autonomy, whilst workflow management requires a certain degree of standardization. Organizations or units need goals that fit to their specific practice, workflow management requires cooperative goals, or at least, goals that do not conflict. Also, standardization is needed to make full mutual adjustment of organizations possible, even though such standardization may unnecessarily complicate the way of working. As a result, a dedicated business transformation may be necessary. Healthcare organizations have to rethink their boundaries and have to make strategic alliances to be able to cope with the changes in the environment.Patient visits various organizations or units within organizations to get proper diagnosis and treatment. The role of healthcare workflowmanagement by use of IT is to adjust the contributions of those organizations or units in terms of timing, quality and functionality. Some of these difficulties can be traced back to the heterogeneous nature of healthcare organizations. Professionals require a certain degree of autonomy, whilst workflow management requires a certain degree of standardization. Organizations or units need goals that fit to their specific practice, workflow management requires cooperative goals, or at least, goals that do not conflict. Also, standardization is needed to make full mutual adjustment of organizations possible, even though such standardization may unnecessarily complicate the way of working. As a result, a dedicated business transformation may be necessary. Healthcare organizations have to rethink their boundaries and have to make strategic alliances to be able to cope with the changes in the environment.