Understanding Adaptation Behaviors of Information Systems in Hospitals: An Integrated View


Student thesis: Doctoral Thesis

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Award date2 Oct 2018


With strong government support, hospitals around the world have been substantially investing in health IT to benefit care service. Despite the increasing adoption of this technology by hospitals, promoting user acceptance can be a considerable challenge. Prior research has reported a significant discrepancy between the expected and actual applications of health IT by designated users, including physicians. Many physicians regard system–related tasks as administrative work and do not consider the system use as core in patient care delivery. It is often observed that physicians engage in usage variation and adaptation when interacting with health IT. To the extent that the value of an information system (IS) hinges on how the system is actually used by users, such adaptation behaviors must have important effects on realizing the benefits of health IT. On the one hand, deviating from pre-designed usage modes considerably undermines the benefits of health IT at the point of care and major touch points with patients. On the other hand, certain studies in the general and healthcare contexts have shown that users’ proactive adaptation of the system, its related tasks, and/or themselves can serve as sources of user innovation, thereby improving performance. Given the various types and potentially mixed effects of physicians’ adaptation behaviors to health IT, this thesis aims to identify and comprehensively understand prominent types of adaptation behaviors of physicians. To address this objective, three notable studies, which make contributions for both research and practitioners, were conducted.

Drawing on the exploitation and exploration literature, IS use and post–adoption literature, together with the healthcare context, Study 1 identifies four types of adaptation behaviors by physicians in the stable post–adoption stage, i.e., direct system use (exploitation), indirect system use (exploitation–to–avoidance), task–technology adaptation (exploration–to–innovation), and individual adaptation (exploration–to–innovation). Considering the tension between exploitation and exploration, Study 1 also investigates the interplay between these adaptation types. A field survey involving 201 physicians is conducted to test the proposed research model. The results show different effects of adaptation behaviors on physicians’ work performance. Specifically, direct and indirect system use do not significantly affect physicians’ work performance. Task–technology adaptation behaviors enhance performance, whereas individual adaptation behaviors decrease it Interestingly, this study also shows that direct system use can compensate the relationship between individual adaptation and performance, and indirect system use can compensate the relationship between task–technology adaptation and performance.

As shown in Study 1, indirect system use is a special adaptation behavior that widely occurs among physicians yet receives scattered attention in prior IS literature. The understanding of its nature, consequences, and antecedents is limited despite its prevalence and importance. Thus, Study 2 and Study 3 attempt to gain a systematical understanding of indirect system use by examining the effects and motivators of indirect system use respectively.

Study 2 centers on the clinical effects of the indirect system use. This study first proposes different effects of indirect system use on clinical care quality and physician–patient interaction care quality. Then, it draws on agency theory and organization control literature and identifies the moderating effects of three control mechanisms (i.e., input, process, and outcome control) on quality of care. A total of 242 physicians from a general public hospital are surveyed to verify the proposed model and hypotheses. The results show that indirect system use can increase clinical care quality but reduce physician–patient interaction care quality. In addition, the three control mechanisms moderate the effects of indirect system use differently, and outcome control is most suitable control mechanism for physicians to induce better performance from indirect system use.

Study 3 explores why junior physicians also frequently engage in indirect system use. As digital natives, junior employees are technologically well-versed and directly apply enterprise systems in daily work. However, prior literature has revealed a considerable level of indirect system use by junior physicians. This study aims to understand this seemingly paradoxical phenomenon. Drawing on IS use and organizational delegation literature, indirect system use is theorized as a technology interaction behavior with delegation in this study. Results of a survey administered to 164 junior physicians show that quantitative overload, positional legitimacy power, and social legitimacy power are significant antecedents of the indirect system use of these junior physicians. Moreover, social legitimacy power exerts a stronger influence than positional legitimacy power.