The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal's development--and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs

Information Flow to Front-line Employees

This research is a case study within a large bureaucracy; the physical plant operations of a Tier-one university in the United States. The organization of study received low scores for internal communication in their all-employee surveys in 2012 and 2014 and was cited for “lack of information flow to front-line employees” in a peer audit conducted in 2011. Root causes for these deficiencies are investigated through (1) Activity Theory analysis, (2) Leader-Member Exchange Theory and (3) linear regression analysis of all-employee survey data. No formal initiatives addressing internal communications had been initiated when this study was launched so the research was used to identify areas for improvement within the organization.Human Dimensions of Organization

Cultural diversity and information and communication technology impacts on global virtual teams: An exploratory study.

Modern organizations face many significant challenges because of turbulent environments and a competitive global economy. Among these challenges are the use of information and communication technology (ICT), a multicultural workforce, and organizational designs that involve global virtual teams. Ad hoc teams create both opportunities and challenges for organizations and many organizations are trying to understand how the virtual environment affects team effectiveness. Our exploratory study focused on the effects of cultural diversity and ICT on team effectiveness. Interviews with 41 team members from nine countries employed by a Fortune 500 corporation were analyzed. Results suggested that cultural diversity had a positive influence on decision‐making and a negative influence on communication. ICT mitigated the negative impact on intercultural communication and supported the positive impact on decision making. Effective technologies for intercultural communication included e‐mail, teleconferencing combined with e‐Meetings, and team rooms. Cultural diversity influenced selection of the communication media

Lessons From a Health Information Technology Demonstration in New York Nursing Homes

Outlines the New York State Nursing Home Health Information Technology Demonstration Project; variations in organizational aims in adopting HIT, perceived or real effects, and resulting quality improvement efforts; and considerations for replication

The internet: strategy and boundaries of the firm

Many advantages have been ascribed to the Internet. Although it lacks the necessary elements to be regarded as a strategic resource, the Internet seems to be a useful tool to provide support for business strategies.In this work we discuss how the Internet can be used to support the development of capabilities and define firm boundaries. Using a sample of Spanish firms, empirically analysed, we find positive relationships between the use of the Internet and product differentiation, as well as the introduction of organizational changes. In addition, we present evidence that the Internet reduces both internal coordination costs and transaction costs as a result of the positive relationships found between the use of the Internet, the degree of vertical integration and the establishment of technological agreements with suppliers and customers

Whoʼs Watching Us at Work? Toward a Structural-Perceptual Model of Electronic Monitoring and Surveillance in Organizations

Nearly 80% of organizations now employ some form of employee surveillance. This significant level of use infers a salient need for additional theory and research into the effects of monitoring and surveillance. Accordingly, this essay examines the panoptic effects of electronic monitoring and surveillance (EM/S) of social communication in the workplace and the underlying structural and perceptual elements that lead to these effects. It also provides future scholarly perspectives for studying EM/S and privacy in the organization from the vantage point of contemporary communication technologies, such as the telephone, voice mail, e-mail, and instant messaging, utilized for organizational communication. Finally, four propositions are presented in conjunction with a new communication-based model of EM/S, providing a framework incorporating three key components of the panoptic effect: (a) communication technology use, (b) organizational factors, and (c) organizational policies for EM/S

Building Networks of Practice

{Excerpt} Extensive media coverage of applications such as FaceBook, MySpace, and LinkedIn suggests that networks are a new phenomenon. They are not: the first network was born the day people decided to create organizational structures to serve common interests—that is, at the dawn of mankind. However, the last 10–20 years have witnessed rapid intensification and evolution of networking activities, driven of course by information and communication technologies as well as globalization. These make it possible for individuals to exchange data, information, and knowledge; work collaboratively; and share their views much more quickly and widely than ever before. Thus, less and less of an organization’s knowledge resides within its formal boundaries or communities of practice. Knowledge cannot be separated from the networks that create, use, and transform it. In parallel, networks now play significant roles in how individuals, groups, organizations, and related systems operate. They will be even more important tomorrow. Since we can no longer assume that closely knit groups are the building blocks of human activity—or treat these as discrete units of analysis—we need to recognize and interface with less-bounded organizations, from non-local communities to links among websites. We should make certain that knowledge harvested in the external environment is integrated with what exists within, especially in dynamic fields where innovation stems from inter-organizational knowledge sharing and learning. Therefore, the structure and composition of nodes and ties, and how these affect norms and determine usefulness, must become key concerns. This makes the study of networks of practice a prime interest for both researchers and practitioners

Organizing for Service Innovation: Best-Practice or Configurations?

In this paper we contrast the notions of best-practice and configurations contingent on environmental conditions. The analysis draws upon our study of 38 UK and 70 US service firms which includes an assessment of the organization, processes, tools and systems used, and how these factors influence variation in the development and delivery of new services. The best-practice framework is found to be predictive of performance improvement in samples in both the UK and USA, but the model better fits the USA than UK data. We analyze the UK data to identify alternative configurations. Four system configurations are identified: project-based; mass customization; cellular; and organic-technical. Each has a different combination of organization, processes, tools and systems which offer different performance advantages. The results provide an opportunity for updating the typologies of operations and adapting them to include services, and begin to challenge the notion of any universal 'best practice' management or organization of new product or service development.service industry, performance improvement, best-practice, alternative system configurations