Research on Physician's In-Role and Extra-Role System Usage Behaviors in Hospitals

醫療機構醫生的角色內和角色外系統使用行為研究

Student thesis: Doctoral Thesis

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Author(s)

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Detail(s)

Awarding Institution
Supervisors/Advisors
  • Choon Ling SIA (Supervisor)
  • Kwok Kee WEI (Co-supervisor)
  • Xiping Zhao (External person) (Supervisor)
Award date24 Feb 2021

Abstract

In recent years, the healthcare industry has invested substantial resources in the construction of Electronic Health Records Systems (EHRs) to improve the care quality of medical services. To achieve the expected benefits after implementing EHRs, the management of hospitals gradually realized that they should not only deploy new technologies to replace the paper chart but also have to pay the extra attention to the actual use of systems. Most previous studies investigated systems usage by using simple conceptualization and adopting variables such as duration, frequency and the number of functions used, without giving much attention to the rich conceptualization by considering the three aspects of the user, task, and systems collectively. Based on the differences between using systems is coercive to accomplish their basic and primary work or the use of systems is a voluntary activity on how to smart use for achieving higher performance beyond the compulsory use does, we differentiated systems usage as in-role systems use (IRSUB) and extra-role systems use (ERSUB). In addition, systems usage at the group level is not merely the aggregation of each member’s usage behavior. Thus, this thesis further considers two levels of analysis by investigating the antecedents that influence two types of system usage at the individual and team level respectively.

To address these limitations, we conducted two studies to explore the antecedents of IRSUB and ERSUB at each level. Drawing upon the framework of stimulus-motivation-behavior and achievement goal theory, study one investigates how job fluidity affects one’s IRSUB and ERSUB through the mediation process of three types of goal orientation at the individual level. By drawing upon the social categorization theory, study two examines how team diversity affects team IRSUB and ERSUB at the team level and further analyzes the moderating effect of transformational leadership on the relationships between team diversity and team IRSUB and ERSUB. To test the proposed relationships, we conducted a survey-based field study at one of the top-tier and largest hospitals in the northwestern of China. We obtained 238 questionnaires from 76 medical teams and used the collected data to verify the research model. The results support 13 of 17 hypotheses. The main innovative work in our study is presented in the following:

Firstly, this thesis explores the positive influence of job fluidity on learning goal orientation (LGO) toward IS use and the negative impact of job fluidity on performance approach and avoidance goal orientation toward IS use. Based on the framework of stimulus-motivation-behavior and achievement goal theory, study one divides goal orientation toward IS use into LGO, performance approach goal orientation (PAPGO), and performance avoidance goal orientation (PAVGO). The results show that a high level of job fluidity stimulates LGO toward systems usage. On the contrary, the low level of job fluidity stimulates the performance approach and avoidance goal orientation toward IS use. Previous studies on systems use are predominantly based on the premise that employees’ work status is stable. These studies have not focused on and explored how an individual’s job fluidity influences systems usage. and there is no corresponding construct to measure the individual’s job fluidity. The study served as the foundation for the following exploration on how individual physician’s different levels of job fluidity affect the different types of goal orientation and also provide theoretical support and guidance for future studies on job fluidity.

Secondly, this thesis explores the positive effect of LGO toward IS use on physicians’ IRSUB and ERSUB and the positive impact of PAPGO toward IS use on physicians’ IRSUB and the negative effects on ERSUB. Through a review of related literature, study one differentiates systems usage into IRSUB and ERSUB at the individual level and demonstrated that physicians with a LGO toward IS use are possibly to perform IRSUB and ERSUB. However, physicians with PAPGO toward IS use will increase their IRSUB and decrease their ERSUB. The PAVGO toward IS use has no significant influence on IRSUB and ERSUB. Most of the prior studies on systems usage mainly focused on the use of systems functions and the compliance of system security, but neglected to examine the role of IRSUB and ERSUB that users perform to meet their job requirements. The study lays the foundation for research on systems use and provides guidance for how to realize the expected value of the information systems.

Thirdly, this thesis explores the negative influence of educational background diversity on team IRSUB and the positive influence of expertise diversity and experience diversity on team IRSUB and ERSUB. Based on the social categorization theory, study two discusses the different effects of relational-related diversity and task-related diversity on team IRSUB and ERSUB. Results show that educational background diversity has a negative impact on team IRSUB, expertise diversity and experience diversity have a positive effect on team IRSUB and ERSUB. Previous studies examining systems usage at the team level assumes that team members do not change but keep stable all the time and have not considered the influence of team diversity on team systems usage due to the influence of team members’ job fluidity. This study takes the medical team as the analysis unit and based on the perspective of team diversity, found that different types of team diversity had different effects on team IRSUB and ERSUB, which made up for the deficiency of empirical research on systems use at the team level in previous literature.

Finally, this thesis explores the moderating effect of transformational leadership on the relationship between educational background diversity and team IRSUB and ERSUB. The results show that transformational leadership positively moderated the negative impact of educational background diversity on team ERSUB. Previous studies show that transformational leadership has significant influences on team members’ psychology and behavior. However, studies on systems usage have not yet explored the moderating mechanism of transformational leadership on the relationship between team diversity and team systems use. This study enriched the understanding of boundary conditions about team systems use and recommended that hospitals should consider the effects of transformational leadership in promoting team ERSUB.

    Research areas

  • systems usage behavior, health information systems, job fluidity, team diversity, goal orientation