Key IT management issues in hospitals: Results of a Delphi study in Canada

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Abstract

Purpose

To develop an authoritative list of IT management issues faced by CIOs and IT directors in public hospitals.

Methods

The ranking-type Delphi method, which elicits the opinion of a panel of experts through iterative controlled feedback, was used in this study. Data collection involved three main steps during which three panels of experts in Ontario (n = 13 in rural hospitals; n = 9 in community hospitals; n = 8 in academic hospitals) provided their input about the key IT management issues in hospitals and their relative importance. Attrition rate was minimal; 28 out of the 30 experts who participated in the study completed all three phases of the survey.

Results

During the brainstorming phase, the responses from the three panels were consolidated resulting in a list of 36 IT management issues; eleven were overlapping between the three panels. In the narrowing down phase, 18 issues were retained in the rural panel; 20 issues in the community panel; and 17 issues in the academic panel. The top issues retained in this phase included: managing demand and expectations for IT services (76% of participants); having sufficient funds (69% of participants); recognizing IT as a key stakeholder in major hospital decisions (65% of participants); and implementation of an EMR (62% of participants). In the ranking phase, a moderate level of consensus was obtained for all three panels: W = 0.41 (rural panel); W = 0.54 (community panel); and W = 0.43 (academic panel). Despite the differences in the preoccupations between the three groups, there were similarities on certain IT management issues. Besides having sufficient funds, three of the top IT management issues relate to the strategic positioning of IT within the hospital: managing demands and expectations for IT services; IT competing with other clinical priorities for scarce resources; and recognizing IT as a key stakeholder in major hospital decisions.

Conclusions

This study is the first to systematically and rigorously identify and prioritize critical IT management issues in hospitals, which may be generalizable to similar environments in other industrialized countries. The prioritized lists of IT management issues may be used as a benchmark and diagnostic tool to support internal strategic decision making related to IT. The broadening of understanding of the challenges faced by IT executives in hospitals would support a more systematic evaluation of these issues over time, and allow management, educational, and research resources to be invested in the appropriate areas.

Highlights

► Top IT management issues were related to the strategic positioning of IT within hospitals. ► Top issues differed across the three panels underscoring differences between the hospitals. ► Findings provided evidence as benchmark and diagnostic tool supporting strategic decision making related to IT. ► Management, educational, and research resources may be invested to address the issues in relevant areas.

Introduction

Health care organizations today are continuously looking for and introducing new information technologies (IT) that are capable of improving staff productivity and process efficiency and enabling better quality of services [1], [2]. Emerging technologies are intensively used to address some of the major challenges faced in health care systems around the world. For example, telehomecare is considered as a promising patient management approach in light of the shortage in registered nurses and health care professionals in many industrialized countries [3], [4], [5], [6]. As another example, clinical decision support systems have also become critical tools for addressing patient safety issues, which may reduce medication errors and support clinical decision making [7], [8]. In addition, there has been an increasing focus on the importance of having an integrated infrastructure that supports the flow and exchange of patients and information within health care systems and the building of an interoperable electronic health records (EHR) system [9], [10]. In light of all these changes and the increasing role of technology in health care organizations in general, and hospitals in specific, IT executives and decision makers are facing various challenges and issues, which unless recognized and addressed, may hinder progress in this area.

In Canada, the health care system has undergone major transformations in recent years [11], [12], which have been paralleled by a significant evolution in the implementation of IT in this sector. A national initiative for investment in IT has been underway since 2001, which is driven by significant efforts for the implementation of standardized EHR systems [9]. The province of Ontario, which has the highest number of health care organizations and networks in the country [13], has been among the leading provinces in the national movement toward the implementation of electronic medical record (EMR) systems and the adoption of the state-of-the-art technologies that support health care delivery. Consequently, and in light of these changes, IT managers in this province are facing new realities and issues that require systematic assessment and evaluation.

IT management issues have been thoroughly examined in the Information Systems (IS) literature. As early as the 1980s, the business literature has recognized the importance of investigating these issues from the perspective of chief information officers (CIOs) in order to gain a better understanding of the challenges and concerns in this domain and make sound judgments in areas requiring management, educational, and research resources [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25]. From a methodological standpoint, the Delphi approach has been consistently used to examine key management issues in this field (e.g., [14], [16], [17], [18] given its merit in surfacing new issues in exploratory studies, and its ability to move a group of experts toward reaching a consensus [26].

Some of the major IT management issues that have been reported in the IS literature in the past include: attracting, developing, and retaining IT professionals; improving IT strategic planning; facilitating and managing business process reengineering; improving the effectiveness of software development; developing and implementing an information architecture; and keeping updated with new trends in IT [16], [20], [23], [24], [25]. These concerns have been thoroughly assessed, and efforts have been invested to address them over the years. Based on a recent survey of IT leaders who are members of the Society for Information Management, the five most important issues reported nowadays in business organizations include: (1) business productivity and cost reduction; (2) IT and business alignment; (3) business agility and speed to market; (4) business process reengineering; and (5) IT cost reduction [25]. Interestingly, a shift in the focus of these issues was noticed compared to previous years, with a higher emphasis on the role of IT in cutting costs and improving productivity in time of economic recession [25].

The medical informatics literature has lagged behind with respect to the evidence-based assessment and analysis of contemporary IT management issues from the perspective of IT executives in health care organizations. A review of the medical informatics literature reveals scattered discussions of challenges in the context of health IT projects and the success of their implementation. Some of the themes that commonly emerge as hindering the realization of benefits from health IT include: lack of sufficient resources [27]; absence of process reengineering [28]; privacy and security concerns [28], [29]; lack of IT knowledge by clinicians [27]; and absence of standards to support system interoperability [30]. Despite the limited evidence in this area, no prior study to date has specifically and thoroughly examined IT management issues, nor assessed their priorities in this sector.

This study addresses this gap and presents the results of a Delphi study conducted with CIOs and IT directors in rural, community, and academic hospitals in Canada. The results support the development of an authoritative list of issues that can be used in future research to build a comprehensive framework of IT management issues in health care, examine their evolution over time, and identify areas requiring management, educational, and research resources.

Section snippets

Methods

The Delphi method has been used since the early 1960s to investigate a broad range of research problems in various academic fields [26], [31]. It is a valuable data-driven approach in exploratory studies where limited evidence exists on specific topics and questions [26]. The ranking-type Delphi, which is the most commonly used Delphi method in the IS field, involves a set of linked questionnaires and aims to elicit the opinion of a panel of experts through iterative controlled feedback [16],

Phase 1: brainstorming

Given the exploratory nature of this study and the limited evidence in this area, the goal of this phase was to develop a comprehensive list of IT management issues that covers the spectrum of issues faced by CIOs/IT directors in different types of hospitals. The number of issues provided by each respondent ranged between three and ten issues. In total, 207 issues were generated by the three panels. Eighty eight issues were identified in the rural hospitals panel; 61 issues in the community

Discussion

Although the three types of hospitals considered in this study differ in terms of their characteristics and environments, a considerable number of IT management issues were consistent across the panels, which highlights their relevance in the context of public hospitals in general. Some of the top common issues that were identified by the three panels were related to the strategic positioning of IT within the hospital (e.g., managing demands and expectations for IT services, IT competing with

Conclusion

This study presented the findings of a Delphi study that was conducted with CIOs and IT directors in rural, community, and academic hospitals in the most populated Canadian province and one of the largest health care jurisdictions in the country. More specifically, we followed a systematic and rigorous approach working toward the development of an authoritative list of IT management issues in public hospitals. Since the three lists of IT issues generated in this study were based on the input of

Authors’ contributions

All authors (Dr. Mirou Jaana, Dr. Haitham Tamim, Dr. Guy Paré, and Ms. Mari Teitelbaum) contributed substantially to the manuscript entitled “Key IT Management Issues in Hospitals: Results of a Delphi Study in Canada”.

Conflict of interest statement

The manuscript entitled “Key IT Management Issues in Hospitals: Results of a Delphi Study in Canada”, which was prepared by Dr. Mirou Jaana, Dr. Haitham Tamim, Dr. Guy Paré, and Ms. Mari Teitelbaum, does not present any conflict of interest.

Acknowledgments

The Telfer School of Management at the University of Ottawa and the Canada Research Chairs Program are gratefully acknowledged for providing financial support for this research project. We also thank the 30 dedicated experts who made this research possible.

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