INFORMATION SYSTEMS, ERROR CULTURE, AND HEALTHCARE PERFORMANCE OUTCOMES

Abstract

Motivated by significant expenditures on healthcare information systems and growing attention to the reduction of medical errors, this paper examines the effectiveness of information systems and analysis on improving patient outcomes and hospital quality performance. Consistent with technology acceptance models, the benefits from healthcare information technology (HIT) and related analyses are found to progress from adoption, to integration, to use. However, we find that the integration of hospital information technology systems may not directly impact quality performance or patient outcomes. Instead, the results indicate that the analysis of information for organizational decision making mediates the impact of systems adoption and integration on quality and patient satisfaction. Additionally, we concurrently consider the relationship of the analysis of medical error data and the analysis of organizational data and their impacts on hospital performance outcomes. The findings show a significant association between organizational-level data analysis and floor-level error data analysis but suggest that cultures that emphasize error data analysis may not directly impact care quality and patient satisfaction outcomes contrary to popular thinking. The results are supported by analyses of a novel combination of three main sources of primary and secondary data: information systems adoption data from the HIMMS database, survey data on information systems and error data analysis from 250 hospitals throughout the United States, and publicly reported hospital quality and satisfaction data. Structural equation modeling and hierarchical regression are employed to analyze the relationships of systems and cultural factors and the effects of an integrated approach. This paper contributes to healthcare practice and future research by providing additional clarity to the questions surrounding the relationships between information systems, error cultures, and hospital performance. We find that the use of organizational data in decision making may have the most significant impact on performance outcomes of patient satisfaction and quality process of care.