From Individual Cognition to Social Ecosystem: A Structuration Model of Enterprise Systems Use

In this paper, we argue that one can understand the adoption and routine use of enterprise systems by examining the fit between the system and the social structures of the organization. We develop a model of the adoption and long- term use of enterprise systems based on sociological concepts (Lord Anthony Giddens’ structuration theory) rather than the usual cognitive psychology concepts. We focus on the adoption and use of three versions of an enterprise KMS to support sales representatives at a multinational pharmaceutical firm. Our first study (a five-year case study of the KMS that went through one failed deployment and two successful ones) shows that the structures of signification, legitimation, and domination all influence loyal use, although domination may be less important. Our second study (a survey of 893 users at the firm) shows that the structures of signification, legitimation, and domination explain about 50 percent of the variance in ongoing loyal use but that their relative importance depends on the job experience of the users: signification and legitimation influence novices more, and signification and domination influence experts more. We believe that this parsimonious three-factor model offers a useful approach for future research and practice

Urban Aboriginal Peoples’ Health Beliefs and Adherence to Treatment for Hypertension

Hypertension in Aboriginal peoples in Canada is on the rise, and the average age of onset is decreasing. Yet, little is presently known about how hypertension --diagnosis and treatment-- is perceived by Aboriginal persons currently diagnosed with the disease. The purpose of this thesis was to investigate urban Aboriginal persons’ attitudes, beliefs, and approaches toward hypertension diagnosis and treatment recommendations. A second purpose was to engage with Aboriginal communities in action research to promote health and awareness of hypertension in a way that meets the communities’ needs. I conducted the research from a critical theoretical perspective and action research methodology. Methods included individual interviews with 11 urban Aboriginal persons residing in Saskatoon who were diagnosed with hypertension by a health care provider, followed by a subsequent focus group with a sample of these interviewees. Being a non-Aboriginal researcher, I conducted this research with guidance from an Aboriginal advisory group who acted as a bridge between me and the community and helped to ensure ethical and cultural appropriateness of the study. I conducted thematic analyses of the interviews and focus group discussions. Findings revealed that overall the respondents adopted the dominant biomedical discourses for health. Specifically, respondents aligned with the individual responsibility framework for health rather than a broader-based view of responsibility. Additionally, respondents demonstrated their knowledge and expertise of biomedical knowledge, despite the persistence of perceived power imbalances and colonial exchanges within health care encounters with Aboriginal patients. Finally, respondents also tended to align with a biomedical approach to the treatment of hypertension, including the use of antihypertensive medications and lifestyle modifications. My analyses also demonstrated that tremendous variability in beliefs and orientations toward health existed in my sample of urban Aboriginal persons. The findings from the present research suggest that such diversity is crucial to consider during health care encounters, as a single approach will not suit the needs of all Aboriginal patients. Although the adoption of biomedical discourses remains prominent, future interventions need to consider the role of macro-level forces on health. Dissemination included a newspaper article, executive summary, and discussions with Aboriginal health policy analysts

Elements Affecting Adoption and Implementation of Health Literacy Initiatives in Healthcare Organizations: A Qualitative Study

Nearly nine in ten U.S. adults struggle to use increasingly complex healthcare organizations and to understand the information these organizations provide. However, healthcare organizations are not yet widely addressing the need to make their services and health information easier to navigate, understand, and use. The purpose of this study was to expand knowledge about the facilitators and barriers to adoption and implementation of health literacy initiatives in healthcare organizations. Sixteen qualitative interviews with individuals who lead health literacy initiatives in 16 organizations across the U.S. were conducted. The study identified multiple facilitators and barriers to health literacy adoption and implementation efforts. Many of the elements had already been identified in the literature but four findings of this study were new. Executive level leadership support emerged as the most crucial element for success. Other important facilitators include (a) senior leadership being aware of the importance of addressing health literacy at the organizational level; (b) the person in charge of the health literacy initiative having authorization to meet with senior leaders, directors, and managers across the organization; (c) the health literacy office being located in an area with organization-wide authority; and (d) the use of a structured, strategic approach to plan and carry out change. Each of these elements is potentially influential in adoption and implementation of other change initiatives in healthcare as well as in health literacy initiatives. Further research to explore these elements could contribute to the literature, and to practical applications, in health literacy and other healthcare initiatives

Patient Safety Law: Regulatory Change in Britain and Canada

Did governments in different countries regulate common concerns about patient safety differently? If so how and why did they do this? This thesis undertakes a historical comparison of the regulation of patient safety in Britain and Canada between 1980 and 2005. These jurisdictions began the period with very similar regulatory frameworks, but by 2005 there were distinct differences in each jurisdiction‘s regulatory response to patient safety. Britain was very actively regulating all aspects of service provision within its health system in the name of patient safety, whereas Canada‘s regulatory direction showed adherence to the 1980s model with only scattered incremental developments. This thesis assesses the broader sociopolitical context and the structure of the health systems in each jurisdiction and concludes there are differences in the logics of these systems that established a foundation for future regulatory divergence. It is argued that between 1980 and 2005 there were two factors that influenced regulatory directionality in each jurisdiction: changing political norms associated with the development of neoliberalism and the New Public Management; and events or scandals associated with the provision of health services. The differing levels of penetration of both the changing political norms into governance cultures and of scandals into the public and political consciousness are critical to explaining regulatory differences between jurisdictions. The thesis concludes that what and how governments chose to regulate is a function of the perceived need for action and the dominant social and political norms within that society. Context is everything in the formulation of regulatory approaches to address pressing social problems

The web 2.0 Internet: Democratized Internet collaborations in the healthcare sector

Les col•laboracions democratitzades a Internet, entenent-les com les eines participatives de la xarxa, o la Web 2.0, afecten en l'actualitat a nombrosos aspectes la nostra vida. Els acadèmics destaquen el potencial de la Web 2.0 per millorar l’aprenentatge o la salut, així com el seu continu impacte en sectors com el de la tecnologia de mitjans de comunicació. També plantegen un gran nombre de qüestions importants als professionals i estudiosos. Per exemple, la consideració crítica de la Web 2.0 com una bombolla o bé com un element més del màrqueting, que necessita d'una determinació del seu abast i naturalesa. Aquest mateix punt és aplicable a l'ús de la Web 2.0 en el sector sanitari, també anomenat com Medicina 2.0 o Sanitat 2.0. Referent a això, considerant el risc que el contingut generat per altres usuaris sigui utilitzat per prendre decisions relatives a la salut, i tenint en compte l'eficàcia no provada de la Web 2.0 com a instrument de la política sanitària, els acadèmics del tema conviden a la definició de millors models que es puguin aplicar a l'ús pràctic d'aquesta eina. Aquesta tesi es centra en l'estudi d'aquestes qüestions fonamentals, en un camp que es mou a gran velocitat, per darrera de la pràctica real, i que requereix la concertació d'una investigació interdisciplinària. Per tant, aquesta tesi incorpora set obres diferents que ofereixen àmplies perspectives sobre l'ús d'eines de col•laboració en la xarxa en el camp de l'atenció sanitària, cadascuna analitzant el tema amb una profunditat suficient com per seguir sent rellevant en un camp en ràpida evolució. Aquestes obres inclouen un examen d'(1) la Web 2.0 i (2) la Medicina 2.0, utilitzant l'anàlisi del contingut de milions de converses de la xarxa per identificar les principals qüestions pràctiques o teòriques i les tensions subjacents a cada concepte. Dos estudis addicionals analitzen (3) com i per què els metges fan servir les eines de la Web 2.0, i (4) com els metges busquen la informació en aquest context en constant moviment com és el d'Internet. Aquests dos estudis es basen en enquestes, diaris i entrevistes amb els metges que treballen en el Servei Nacional de Salut del Regne Unit. Tots dos destaquen resultats importants com ara models per a l'ús de la Medicina 2.0, o contribucions importants a la literatura com la connexió de la recerca cognitiva en la xarxa i la valoració de la informació en xarxa, tots dos camps sense connexió amb anterioritat a aquest treball. Tres estudis addicionals analitzen la web 2.0 des d'una perspectiva organitzacional, incloent (5) un estudi dels models de disseny de l'ús de la Web 2.0 en el sector farmacèutic, el qual detalla els millors models de pràctiques d'ús, i la seva clara relació amb els models de disseny de codi obert, i (6) també les estratègies d'innovació oberta al sector farmacèutic, on les eines de col•laboració en la xarxa permeten aquest tipus d'estratègies. Els dos últims estudis fan servir entrevistes amb 120 executius del sector farmacèutic analitzats a través d'anàlisi temàtic. Tots dos fan contribucions importants a la literatura mitjançant la caracterització de les estratègies d'innovació oberta i les implicacions per generar la capacitat d'absorció en el context d'innovació oberta. L'últim estudi (7) examina la Medicina 2.0 des de la perspectiva dels proveïdors de serveis de salut, per ajudar a la gestió d'ús de la Web 2.0 com un instrument per a millorar l’atenció sanitària. En general, hi ha moltes contribucions importants a la literatura, que en conjunt aconsegueixen ampliar el panorama de la Web 2.0 en l'assistència sanitària, i aporten consideracions especifiques a la literatura que abasta els sistemes d'informació, les ciències de la informació i la informàtica mèdica , així com la innovació oberta i l'estratègia. Las colaboraciones democratizadas en Internet, entendiéndolas como las herramientas participativas de la red o la Web 2.0, afectan en la actualidad a numerosos aspectos nuestra vida. Los académicos destacan el potencial de la Web 2.0 para mejorar el eAprendizaje o la salud, así como su continuo impacto en sectores como el de la tecnología de medios de comunicación. También plantean un gran número de cuestiones importantes a los profesionales y estudiosos. Por ejemplo, la consideración crítica de la Web 2.0 como una burbuja o bien como un elemento más del marketing, que necesita de una determinación de su alcance y naturaleza. Este mismo punto es aplicable al uso de la Web 2.0 en el sector sanitario, también denominado como Medicina 2.0 o Sanitad 2.0. A este respecto y considerando el riesgo de que el contenido generado por otros usuarios sea utilizado para tomar decisiones relativas a la salud, y la eficacia no probada de la Web 2.0 como instrumento de la política sanitaria; los académicos del tema invitan a la definición de mejores modelos que se puedan aplicar al uso práctico de esta herramienta. Esta tesis se centra en el estudio de estas cuestiones fundamentales, en un campo que se mueve a gran velocidad, por detrás de la práctica real, y que requiere la concertación de una investigación interdisciplinaria. Por lo tanto, esta tesis incorpora siete obras distintas que ofrecen amplias perspectivas sobre el uso de herramientas de colaboración en la red en el campo de la atención sanitaria, cada una analizando el tema con una profundidad suficiente como para seguir siendo relevante en un campo en rápida evolución. Estas obras incluyen un examen de (1) la Web 2.0 y (2) la Medicina 2.0, utilizando el análisis del contenido de millones de conversaciones de la red, para identificar las principales cuestiones prácticas o teóricas y las tensiones que subyacen a cada concepto. Dos estudios adicionales analizan (3) cómo y por qué los médicos usan las herramientas de la Web 2.0, y (4) cómo los médicos buscan la información en este contexto en constante movimiento como es el de Internet. Estos dos estudios se basan en encuestas, diarios y entrevistas con los médicos que trabajan en el Servicio Nacional de Salud del Reino Unido. Ambos destacan resultados importantes tales como modelos para el uso de la Medicina 2.0, o contribuciones importantes a la literatura como la conexión de la búsqueda cognitiva en la red y la valoración de la información en red, ambos campos sin conexión con anterioridad al presente trabajo.Tres estudios adicionales analizan la Web 2.0 desde una perspectiva organizacional, incluyendo (5) un estudio de los modelos de diseño del uso de la Web 2.0 en el sector farmacéutico, el cual detalla los mejores modelos de prácticas de uso, y su clara relación con los modelos de diseño de la open source, y (6) y también las estrategias de innovación abierta en el sector farmacéutico donde las herramientas de colaboración en la red permiten este tipo de estrategias. Los dos últimos estudios emplean entrevistas con 120 ejecutivos del sector farmacéutico analizados a través de análisis temático. Ambos hacen contribuciones importantes a la literatura mediante la caracterización de las estrategias de innovación abierta y las implicaciones para generar la capacidad de absorción en el contexto de innovación abierta. El último estudio (7) examina la Medicina 2.0 desde la perspectiva de los proveedores de servicios de salud, para ayudar a la gestión de uso de la Web 2.0 como un instrumento para la gestión de una mejor atención sanitaria. En general, hay muchas contribuciones importantes a la literatura, que en conjunto logran ampliar el panorama de la Web 2.0 en la asistencia sanitaria, y aportan consideraciones específicas a la literatura que abarca los sistemas de información, las ciencias de la información, la informática médica, así como la innovación abierta y la estrategia.Democratized internet collaborations, referring to participatory online tools or Web 2.0, now impact many aspects of people’s lives. Scholars note Web 2.0’s potential to improve eLearning or healthcare, and its ongoing impact in sectors such as tech-media. They also raise a plethora of important questions for practitioners and scholars, such as the criticism of Web 2.0 as hype or marketing term, which necessitates some determination of the scope and nature of Web 2.0. This holds equally for Web 2.0’s use in health care, denoted as Medicine 2.0 or Health 2.0. Moreover, given the risks of people using user-generated content for health decisions, and its unproven effectiveness as a health policy tool, scholars have called for best practice models of use. This thesis addresses these fundamental issues, in a field that is fast moving, behind actual practice, and that requires concerted inter-disciplinary research. Therefore, this thesis incorporates seven distinct works that provide broad perspectives on the use of online collaboration tools in healthcare, each analyzing a specific topic in enough depth to remain relevant in a fast moving field. These works include an examination of (1) Web 2.0 and (2) Medicine 2.0, using content analysis of millions of online conversations to surface the major practical or theoretical issues and tensions that underpin each concept. Two further studies examine (3) how and why doctors use Web 2.0 tools, and (4) how doctors search or forage for information in this evolving internet environment. These two studies rely on surveys, diaries and interviews from doctors working in the UK’s National Health Service (NHS). Both highlight important results, such as models for Medicine 2.0 use, or make important contributions to literature such as connecting the previously separate cognitive online search and internet information judgment literatures. Three further studies examine Web 2.0 from an organizational perspective, including (5) design patterns of Web 2.0’s use in global Pharma, which details best practice models of use and its clear link to Open Source design patterns, and (6) global Pharma’s Open Innovation strategies, where online collaboration tools enable these strategies. The latter two studies employ interviews with 120 pharmaceutical executives analyzed through thematic analysis. They make major contributions to literature by characterizing open innovation strategies and gleaning implications for Absorptive Capacity in the Open Innovation context. The final study (7) examines Medicine 2.0 form the perspective of health service providers, informing management using eHealth as an instrument for improved healthcare management. Overall, there are many major contributions to literature, which together achieve both a broad overview of Web 2.0 in healthcare, but also make specific additions to literature encompassing information systems, information science, medical informatics, and open innovation and strategy

Semantic discovery and reuse of business process patterns

Patterns currently play an important role in modern information systems (IS) development and their use has mainly been restricted to the design and implementation phases of the development lifecycle. Given the increasing significance of business modelling in IS development, patterns have the potential of providing a viable solution for promoting reusability of recurrent generalized models in the very early stages of development. As a statement of research-in-progress this paper focuses on business process patterns and proposes an initial methodological framework for the discovery and reuse of business process patterns within the IS development lifecycle. The framework borrows ideas from the domain engineering literature and proposes the use of semantics to drive both the discovery of patterns as well as their reuse

Factors Affecting the Quality of Practitioner-Patient Communication (and Care): Implications for Medical Education

This study investigated the factors that affect the quality of communication during medical practitioner-patient encounters. To achieve this purpose, the study sought the perceptions of university student-participants using a quantitative-qualitative survey methodology. A significant number of the student- participants were enrolled in healthcare -related programs. Factor Analysis was conducted on the survey items followed by multiple regression analyses and ANOVA. The results of the study suggest that gender and ethnic concordance, doctor quality and medical dynamics are important factors regarding perceptions of case management satisfaction. Additionally, female practitioners were rated higher for case management satisfaction and quality of care. Based on these findings, the study recommends critical and progressive reforms of current medical education policies and curricula which have the potential to improve the quality of communication during medical encounters as well as overall patient care outcomes

The Role of Professional Identity into Explaining Saudi Arabian Healthcare Professional Resistance to Electronic Health Records’ Stratigic Change in Public Hospitals

Electronic Health Record (EHR) is an application that captures patients’ information and promises to improve healthcare services. Hence, many countries, including the developing country, such as Saudi Arabia, invested heavily to implement the system and improve healthcare service delivery. Yet, the system's adoption is slow, and failure is high, which could be related to healthcare professionals’ resistance to change to the EHR applications. Further, despite the importance of the topic of EHR resistance, little research has been conducted in Saudi Arabia regarding healthcare professionals’ resistance to change to EHR. Motivated thus, this research suggested that resistance to EHR in Saudi Arabia results from cultural and professional identity factors, which guide healthcare professionals’ behaviour. Therefore, this research investigated how the professional identity of Saudi healthcare professionals can explain their resistance tousing EHR applications. The study used identity theory as our main theoretical lens along with Hofstede cultural dimension theory and in-depth qualitative interviews to understand the EHR resistance to change phenomenon. Our study has revealed similarities between Saudi and Western healthcare professionals’ factors that could contribute to EHR resistance. However, interestingly, cultural, and religious norms were also found to be one of the leading causes of Saudi healthcare professionals’ resistance to the EHR change. Our theoretical contributions helped us understand the role of identity in EHR use in a place where professionals with a strong professional and cultural identity are the system's main users. In addition, our practical contributions aimed to help the Ministry of Health in Saudi Arabia to understand what healthcare professional needs before adapting an EHR system, or improve the current once. Further, it could help hospital managers address, understand, and solve the challenges facing healthcare professionals as they use the EHR system