Effective implementation of health information technologies in U.S. hospitals.

OBJECTIVES: Two issues pertaining to the effective implementation of health information technologies (HITs) in U.S. hospitals are examined. First, which information technology (IT) system is better--a homegrown or an outsourced one? In the second issue, the critical role of in-house IT expertise/capabilities in the effective implementation of HITs is investigated. STUDY DESIGN/DATA COLLECTION: The data on type of HIT system and IT expertise/capabilities were collected from a national sample of senior executives of U.S. hospitals. The data on quality of patient care were gathered from the Hospital Compare Web site. FINDINGS: The quality of patient care was significantly higher in hospitals deploying a homegrown HIT system than hospitals deploying an outsourced HIT system. Furthermore, the professional competence and compelling vision of the chief information officer was found to be a major driver of another key IT capability of hospitals-professionalism of IT staff. The positive relationship of professionalism of IT staff with quality of patient care was mediated by proactive employee behavior. CONCLUSION: A homegrown HIT system achieves better quality of patient care than an outsourced one. The chief information officer's IT vision and the professional expertise and professionalism of IT staff are important IT capabilities in U.S. hospitals.

From a blame culture to a just culture in health care.

BACKGROUND: A prevailing blame culture in health care has been suggested as a major source of an unacceptably high number of medical errors. A just culture has emerged as an imperative for improving the quality and safety of patient care. However, health care organizations are finding it hard to move from a culture of blame to a just culture. PURPOSE: We argue that moving from a blame culture to a just culture requires a comprehensive understanding of organizational attributes or antecedents that cause blame or just cultures. Health care organizations need to build organizational capacity in the form of human resource (HR) management capabilities to achieve a just culture. METHODOLOGY: This is a conceptual article. Health care management literature was reviewed with twin objectives: (a) to ascertain if a consistent pattern existed in organizational attributes that lead to either blame or just cultures and (2) to find out ways to reform a blame culture. CONCLUSIONS: On the basis of the review of related literature, we conclude that (a) a blame culture is more likely to occur in health care organizations that rely predominantly on hierarchical, compliance-based functional management systems; (b) a just or learning culture is more likely to occur in health organizations that elicit greater employee involvement in decision making; and (c) human resource management capabilities play an important role in moving from a blame culture to a just culture. PRACTICE IMPLICATIONS: Organizational culture or human resource management practices play a critical role in the health care delivery process. Health care organizations need to develop a culture that harnesses the ideas and ingenuity of health care professional by employing a commitment-based management philosophy rather than strangling them by overregulating their behaviors using a control-based philosophy. They cannot simply wish away the deeply entrenched culture of blame nor can they outsource their way out of it. Health care organizations need to build internal human resource management capabilities to bring about the necessary changes in their culture and management systems and to become learning organizations.

Building HR capability in health care organizations.

The current human resource (HR) management practices in health care are consistent with the industrial model of management. However, health care organizations are not factories. They are highly knowledge-intensive and service-oriented entities and thus require a different set of HR practices and systems to support them. Drawing from the resource-based theory, I argue that HRs are a potent weapon of competitive advantage for health care organizations and propose a five-dimensional conception of HR capability for harnessing HRs in health care organizations. The significant complementarities that exist between HRs and information technologies for delivering safer and better quality of patient care are also discussed.

Assessing home care agencies' readiness for telehealth.

Home healthcare is facing a set of challenging new realities in the 21st century such as funding limitations and increased life expectancy. Many believe that the use of telehealth enabling patients at home to interact with nurses at the clinical site using videoconferencing technology, will be a cost-effective solution to providing quality care services. Many agencies have adopted or are planning on implementing a telehealth solution. Level of agencies' readiness can lead to a lower level of risk, and a more successful innovation outcome. We developed a framework for assessing home care agencies' readiness for telehealth consisting of 35 items. This instrument can be used as a decision support tool for agencies that are about to implement a telehealth system as well as a formative or summative evaluation tool for agencies already utilizing telehealth.