Post-adoption success of telemedicine system in hospitals

: technological, organizational, environmental influences and technostress

Abstract

Enabled by innovative products and services, technology has penetrated all walks of life today. Telemedicine supported network and communication technologies has allowed online collaborations among virtually separated organizations, bringing new ways of clinical practice. Meanwhile a large amount of literature has emerged on the wide range of benefits technology can bring to healthcare delivery and quality. At the same time there are several anecdotal reports in the media as well as in academic literature exposing problems and challenges associated with technology use in medicine. In order to achieve an all-round success in post-adoption of telemedicine system and service, both inter-organizational business model for long term collaboration and individual end-user's interactions are critical. Accordingly, at organizational level, the thesis proposes an overall framework encompassing technological, organizational, and environmental attributes to systematically assess inter-organizational collaborations on telemedicine service; at individual level, technostress has been suggested as one of major barriers hindering work outcomes, and a specific model is proposed for a depth analysis of the antecedents of prevalent stress problems accompanying telemedicine use. This dissertation employing a mixed method approach involving a qualitative case study and a two-round quantitative study. In the first study, a multi-dimensional framework, extending the Technology-Organization-Environment (TOE) framework with specific theoretical attributes, is proposed. The study adopts a comparative case study methodology design, engages in a deductive analysis, and tests the resulting propositions using data from multiple sources. Results have revealed understandings in three dimensions concerning the antecedents of low utility. First, financial support and consensus among different stakeholders are critical. Second, there is a need for standardized criteria guiding the integration of systems and services. Finally, technology adoption should fit with communication requirements. This thesis elaborates on these and associated findings. It also includes suggestions for practitioners. The second study addresses issues related to the commonly found negative user perceptions regarding technology use in telemedicine service. Several technological features of telemedicine are highlighted along with a theoretical model from the perspective of fit. The model defines the antecedents and outcomes of technostress, i.e., the feeling of anxiety or mental pressure from overexposure or involvement with technology usage, emphasizing on revealing underlying mechanism of stress generation process from the perspective of fit between users and adopted technologies. Survey questionnaires were designed and distributed to healthcare workers with real-time telemedicine consultation experience. Statistical analyses indicated strong correlations between technostressors (work overload and role ambiguity) identified and strain. The relationships between the proposed antecedences and technostressors were supported partially. Individual perceptions of communication and information support were negatively related to perceived work overload, whereas both were not significantly correlated with the perceived role ambiguity. On the other hand, individual perception of social presence was found to significantly impact both technostressors, but the relationship between perceived social support and both technostressors was not supported. Among the major contributions of this dissertation is extending the well-known TOE framework to include the specific theoretical attributes needed to obtain a deep understanding of inter-organizational collaboration on telemedicine service individual practitioners. The extended model also seeks to identify the antecedents and outcomes of technostressors to shed light on the logic underlying the stress production process. Healthcare practitioners, government regulators, and other stakeholders could use the extended framework to improve telemedicine collaboration. The results could also be used by administrators to identify organizational strategies for alleviating stress levels, thus improving work performance and the quality of working life.

Date of Award	3 Oct 2014
Original language	English
Awarding Institution	City University of Hong Kong
Supervisor	Kwok On Matthew LEE (Supervisor) & Douglas VOGEL (Co-supervisor)