Developing effective hospital management information systems: A technology ecosystem perspective

Abstract

This thesis presents the results of the program of research performed in the completion of a Doctor of Philosophy (Business) entitled: Developing Effective Hospital Management Information Systems: A Technology Ecosystem Perspective. The central contention of this thesis is that the current ecosystem models in the information technology (IT) and information systems (IS) literature can be extended and improved. In turn they can be better applied to the field of IS and the development and implementation of information systems. This research seeks to highlight an example of how these models can be extended, through an analysis of the specific context of the hospital management information system environment, using the technology ecosystems model (TEM) of Adomavicius et al (Adomavicius et al., 2005). The environment in which hospital managers operate is characterised by high demand pressures, strong public service expectations, and an ever diminishing income stream (in relative terms) with which to provide services. Even in private hospital care, many of these pressures still apply, as well as a pressure to maintain profit margins. The agenda context here is a complex one, particularly when one considers the role of hospitals in this context. Hospitals have multiple competing priorities when viewed from a management perspective. This is despite the fact that the core mission of the hospital is to provide timely, safe care within available human and financial resources, to patients who present for care. This care can be across multiple care settings inside the hospital including the inpatient space, the operating theatres, the intensive care unit, and the emergency department; and in outreach settings. Hospitals however, have been described as a series of cottage industries each loosely coupled with a common objective of supplying care to patients. All of these factors combine to mean that managing a hospital with the above-mentioned aim in mind, is a very difficult task. Nakagawa et al (Nakagawa et al., 2011) talk specifically to this difficulty. In this research I undertake this examination through 2 core exercises. Firstly I examine the literature – both the information related and health care literature, for insights into the questions at hand. Secondly I examine the lessons learned from five Case Studies (CSs). The first four of these are based in physical hospital facilities across three Australian states. The final one is a “virtual CS” in which the views of multiple parties, not centred on any given physical institution, are sought and examined in relation to these questions. Based on the data collected in both the literature review and the CS’, and through a process of triangulation and research model validation, I conclude that a hospital management technology ecosystem (a HOME) can be described. Its existence thus validates the core TEM, and in fact the findings support some meaningful extensions to the TEM. The HOME is predominantly characterised by the presence of strong drivers of change that arise from outside the immediate hospital environment. Examples include changes in the labour market, and the skill sets of workers; changes in the broader development and availability of technology (for example – think of the effects of the rise of smart phones), and changes in government policies and funding arrangements. In the majority of cases these broader influencing forces (Environment Shaping Forces – ESF’s) can be seen to act on the local management environment and the role of technology in that environment, through describable intermediaries. A very obvious example of this is the effect of a global financial downturn - eventually this wide reaching force could be expected to affect hospitals (be they private or public) through struggling performance of a parent company, or state government funding cutbacks. In turn this could easily lead to reduced spending on IT in a given hospital. These findings, along with those around services provided by the ecosystem, and the measurement of ecosystem success or failure, add substantially to the IS knowledge base in this area. This research thus acts as a sound basis for further research in this new direction, but also provides a usable conceptual and practical framework within which stakeholders – managers, clinicians, beauracrats and the software development community - can view the management of hospitals and the technologies in support of that management