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DOI: https://doi.org/10.34069/AI/2022.57.09.3
How to Cite:
Alhamad, I.A., & Singh, H.P. (2022). Digital technologies and information translucence in healthcare management: An institutional
theory perspective for adopting electronic incidence reporting systems. Amazonia Investiga, 11(57), 30-38.
https://doi.org/10.34069/AI/2022.57.09.3
Digital technologies and information translucence in healthcare
management: An institutional theory perspective for adopting
electronic incidence reporting systems
Received: September 1, 2022 Accepted: October 12, 2022
Written by:
Ibrahim Abdullah Alhamad4
https://orcid.org/0000-0001-7099-0335
Harman Preet Singh5
https://orcid.org/0000-0003-4297-0016
Abstract
The purpose of this study was to provide an
institutional theory perspective on the adoption
of electronic IRS technology for healthcare
management. This research employs institutional
theory to investigate the adoption of electronic
IRS for healthcare management. The study’s
conceptual analysis demonstrates that coercive,
normative, and imitative forces influence the
adoption of electronic IRS for healthcare
management. International healthcare
regulations and standards reflect the presence of
coercive forces. International healthcare
societies and professional networks mirror
normative forces. Imitative forces exert pressure
on smaller enterprises and developing nations to
adopt electronic IRS. This research contributes to
the literature and theory by extending the
application of institutional theory to the adoption
of digital technologies such as the electronic IRS.
In addition, the study has practical implications
because it demonstrates the importance of digital
technologies such as electronic IRS for
information translucence and healthcare
management. Small businesses in developing
nations can learn from large businesses in
developed nations to adopt electronic IRS for
efficient and effective healthcare management.
Keywords: Digital technologies, Institutional
theory, information translucence, healthcare
management, electronic incidence reporting
systems.
IRS
IRS
IRS
IRS
IRS
IRS
IRS
.
4
Department of Management and Information Systems, College of Business Administration, University of Ha'il, Kingdom of Saudi
Arabia.
5
Department of Management and Information Systems, College of Business Administration, University of Ha'il, Kingdom of Saudi
Arabia.
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1
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Introduction
Digital technologies have considerably altered
the way modern institutions operate and have
added significant value to business processes
(Gregori & Holzmann, 2020). Digital
technologies have transformed data collection,
information and knowledge creation, and
decision-making processes (Singh &
Alshammari, 2021). Digital technologies enable
dynamic decision-making in the information age
(Klonoff, 2013; Gopal et al., 2018) and enable
sustainable development (Singh et al., 2022a).
Information translucence is one of the most
significant benefits of digital technologies.
Information translucence results in information
availability, information clarity, decreases errors
and eliminates impediments (Albu & Flyverbom,
2016). Information translucence eliminates
superfluous secrecy and provides the necessary
lucidity, awareness, and effectiveness (Danker,
2013). Information translucence is about
accessibility, communication, coopetition,
liaison, and concerted decision-making (Barth &
Schipper, 2008). Thus, information translucence
significantly aids professionals in the decision-
making process (Winkler, 2000). As a result,
digital technologies are increasingly being used
in banks, educational institutions, and hospitals,
among other places.
Digital technologies are transforming medical
practices in the field of healthcare. Using new
tools and the creation of new types of
information, digital technologies enable the
collection of rich and real-time medical data.
They contribute to the creation of novel and
distinct knowledge for healthcare management.
The use of digital technologies enables the
remote storage, analysis, and prediction of
healthcare data. Thus, the application of digital
technologies to healthcare has established itself
as a critical enabler of the digital health
revolution (Klonoff, 2013). Healthcare
institutions can get up-to-date and streamlined
information using digital technologies (Gagnon
et al., 2016). Digital technologies are plating a
vital role in healthcare transformation during and
post COVID-19 (Wang et al., 2021; Mbunge et
al., 2022; Singh et al., 2022b). Thus, digital
technologies can enable effective healthcare
management.
The incidence reporting system (IRS) has
emerged as a crucial healthcare technology. IRS
is widely acknowledged as a crucial system to
facilitate healthcare learning and improve patient
safety (Kumari & Singh, 2022). An effective IRS
catalyzes health safety practices (Pfeiffer, 2010).
IRS gathers information regarding the safety of
patients, which forms a backbone for creating
learning capabilities in organizations for patient
safety (Stavropoulou et al., 2015). IRS help to
create new healthcare policies and practices to
stop the repetition of earlier incidents
(Braithwaite, 2008). Prior research suggests that
IRS is utilized less due to a variety of reasons,
like high workload, fear of liability, inability to
judge reporting usefulness, etc. (Pfeiffer, 2010;
Hwang et al., 2012). Electronic IRS overcomes
many of these challenges (Uyob, 2020). The
increase in adoption of the internet (Alshammari
& Singh, 2018; Alhamad & Singh, 2021a) and
web-based technologies (Alhamad & Singh,
2021b; Singh & Alhamad, 2021) have propelled
the adoption of digital technologies in healthcare,
resulting in the adoption of electronic IRS.
Electronic IRS eliminates the paper-based
recording of hospital incidents and avoids
manual data entry delays and errors (Walsh et al.,
2010). Electronic IRS can be web-based or
incorporated alongwith an electronic health
records technology (Walsh et al., 2010).
Literature suggests that electronic IRS adoption
improves incident reporting (Elliott et al., 2014),
however, the majority of the studies have
employed technology adoption theories such as
user experience and social influence (Shin &
Biocca, 2018), Unified Theory of Acceptance
and Use of Technology (UTAUT) (Venkatesh et
al., 2003; Venkatesh et al., 2016), Technology
Acceptance Model (TAM) (Davis, 1989).
Institutional theory can provide a novel
perspective and decipher forces that lead to the
adoption of digital technology like electronic IRS
for effective healthcare management. However,
prior research has not made enough efforts in this
regard. This study endeavors to bridge these
research gaps. In this research, we explore the
influence of coercive, normative, and imitative
forces of institutional theory on the adoption of
digital technologies such as electronic IRS for
information translucence and healthcare
management.
Review of Literature
IRS provides critical insights into patient safety
at a healthcare organization. The use of IRS in
healthcare organizations is relatively recent, but
they have long been utilized in other industries
(such as railways, aviation, and nuclear power)
(Pham et al., 2013; Allen, 2021). The IRS
provides a mechanism for identifying hazards so
that hospitals can take steps to mitigate them
(Ramírez et al., 2018). IRS provides useful
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information for identifying risks and learning
opportunities for healthcare professionals (Wu et
al., 2007; Laurenza et al., 2018; Tortorella et al.,
2021). The traditional IRS, on the other hand, has
some drawbacks, such as difficulty monitoring
error rates, inability to track changes over time,
development of overlapping and contradicting
reports, lack of in-depth patient safety
evaluations, excessive time, and cost, and so on
(Padilla et al., 2019). There is evidence to suggest
that traditional IRS has been less effective in
reporting and reducing preventable harm
(Shearer et al., 2012; Pham et al., 2013; Al-Rayes
et al., 2020). Because of these limitations,
healthcare providers are debating whether the
traditional IRS has supported the goal of patient
safety.
Traditional IRS constraints are being bypassed
with the use of electronic IRS. Electronic IRS
improves tracking, comprehension, and privacy
of incident reporting (Elliott et al., 2014). The
use of electronic IRS minimizes the number of
missing incident events (Elliott et al., 2014).
Electronic IRS enables decision-makers to view
the status of incidents in real-time and analyze
incident reports to discern incident patterns
(Levtzion-Korach et al., 2009). Electronic IRS
provides healthcare providers with larger access
to the required information, enabling them to
take remedial action (Herchline et al., 2022).
Effective IRS is user-friendly and provides the
necessary privacy for safeguarding sensitive
patient information. Electronic IRS provides
these features and results in increased patient
satisfaction and improves system usability and
security (Alrub et al., 2021). Electronic IRS can
automate clinical processes and play a pivotal
role in clinical governance (Ubogagu-Israel et
al., 2022). Electronic IRS improves hospital
quality management, which leads to improved
patient outcomes (Hewitt et al., 2016). Electronic
IRS can play a pivotal role to improve patient
safety in high-risk situations and improve error
resilience (Stavropoulou et al., 2015; Howell et
al., 2016). Electronic IRS supports the voluntary
reporting of incidents by physicians and other
support staff, which can lead to significant
improvement in patient safety and provide
valuable insights to prevent the recurrence of
incidents (Lurvey et al., 2021). Electronic IRS
provides a lucid and structured framework for
incident reporting and evaluation to promote
patient safety (Dhamanti et al., 2020; Awad et al.,
2021).
Various theories have been employed in prior
research to explain the user adoption of
technologies. Some popular theories include user
experience and social influence (Shin & Biocca,
2018), Unified Theory of Acceptance and Use of
Technology (UTAUT) (Venkatesh et al., 2003;
Venkatesh et al., 2016), Technology Acceptance
Model (TAM) (Davis, 1989). However, we are
interested in the adoption of technology
(electronic IRS) by healthcare institutions in this
study. Institutional theory can serve this research
goal. So, we propose to employ institutional
theory in this study.
Theoretical Framework
In the current research, we would employ the
institutional theory model of DiMaggio & Powell
(1983). According to this model, businesses
gradually adopt similar practices and behaviors.
DiMaggio and Powell (1983) identified three
forces that contribute to this convergence:
coercive, normative, and imitative forces. The
origin of coercive forces is political power and
legitimacy by businesses. They can be conveyed
via legislations, rules, procedures,
standardization, supervision, or complaisance
requirements of an external agency (Kim et al.,
2016). The normative forces are associated with
professional values. They can result from gaining
knowledge from others through professional
networks (Appari et al., 2009). Imitative forces
involve emulating or copying the other's
behavior. These actions result from a business’s
response to uncertainty (Safa et al., 2016).
According to DiMaggio and Powell (1983),
coercive, normative, and imitative forces shape
businesses' convergence toward standardized
practices and recognized behaviors. Therefore,
the institutionalization of businesses is guided by
coercive, normative, and imitative forces.
Teo et al. (2003) have applied the institutional
model to the firm-level espousal of financial
electronic data interchange (FEDI). Shi et al.
(2008) have taken the institutional model and
applied it to the adoption of Internet banking by
individuals. Ugrin (2009) has applied the
institutional model to the process of adopting
enterprise resource planning (ERP) at the firm
level. Sherer (2010) used the institutional model
to analyze how doctors adopted electronic health
records (EHRs). The institutional model was
utilized by Burnett et al. (2015) to investigate
how hospitals in five different European nations
responded to external financial and quality
demands. Singh & Alshammari (2020) applied
institutional theory model of DiMaggio & Powell
(1983) for developing a cyber-security legal
framework.
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The preceding discussion demonstrates that
institutional theory has been applied to digital
technologies and the healthcare industry.
Therefore, we would use institutional theory in
this study.
Conceptual Analysis
The previous discussion elucidates that the
institutionalization of firms is guided by
coercive, normative, and imitative forces. We
endeavor to decipher these forces in the
international healthcare industry context.
Therefore, we employ conceptual analysis to
investigate the role of coercive, normative, and
imitative forces in the adoption of electronic IRS
(Table 1).
Table 1.
Institutional Theory for Adopting Electronic Incidence Reporting Systems
Force
Electronic IRS Adoption Framework for Healthcare Industry (Conceptual
Analysis)
Coercive
In the healthcare industry, coercive forces are reflected in international
standards. International Health Regulations (IHR), health regulations and
2005 have been ratified by 196 countries across the globe and oblige
countries to detect and report public health incidents (WHO, 2019).
International Organization for Standardization (ISO) has developed
everal standards to monitor the vital signs of patients and prevent the s
occurrence of incidents (ISO, 2019). Healthcare professionals across the
globe rely on these standards to contain incidents and provide quality
ompliance with international healthcare. Electronic IRS facilitates c
healthcare regulations and standards by healthcare institutions.
Normative
In the healthcare industry, normative forces are reflected in healthcare
societies and professional networks. The most prominent international
in healthcare is the International Society for Quality in Health society
Care (ISQua) (ISQua, 2022). ISQua seeks to enhance the quality and
security of healthcare by fostering international collaborations and
ISQua has an soliciting the cooperation of healthcare stakeholders.
institutional and professional network of members worldwide. ISQua
promotes healthcare innovations, information translucence, digital
technology adoption, and knowledge sharing. Electronic IRS satisfies
oviders get encouragement to these ISQua objectives, so healthcare pr
adopt this digital technology. There are other noticeable professional
networks like the global health network (GHN, 2022) and the global
network for simulation in healthcare (GNSH, 2022), which encourage the
l technologies like electronic IRS.adoption of digita
Imitative
Developed nations have taken the lead in adopting electronic IRS while
developing nations lag behind (Kumari & Singh, 2022). In developing
countries, large hospitals are more likely to adopt electronic IRS than
f a larger healthcare smaller hospitals. Since hospitals are part o
ecosystem (Aubin & King, 2018; Viswanadham, 2021), the adoption of
electronic IRS by larger enterprises creates imitative pressure on smaller
enterprises to do the same. Healthcare in both developed and developing
nt of the global healthcare ecosystem (Asakura et nations is a compone
al., 2015), so the adoption of electronic IRS by developed countries
encourages developing nations to do the same.
Results and Discussion
The electronic IRS is a crucial digital technology
for healthcare management, as it facilitates
information translucence, information
accessibility, information clarity, and error
reduction (Danker, 2013; Albu & Flyverbom,
2016). Understanding the forces that lead to the
adoption of digital technologies such as
electronic IRS for healthcare management can be
greatly aided by institutional theory. According
to institutional theory, coercive, normative, and
imitative forces (DiMaggio and Powell, 1983)
influence the adoption of digital technologies,
such as the electronic IRS. Therefore, the role of
coercive, normative, and imitative forces in the
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adoption of electronic IRS is conceptually
analyzed in the present study.
The institutional theory perspective demonstrates
that coercive forces are reflected in laws, rules,
procedures, standardization, supervision, and
compliance requirements (Kim et al., 2016). The
present study’s conceptual analysis shows that
coercive forces are manifested in international
health regulations (e.g., international health
regulations (IHR), 2005) (WHO, 2019) and
standards (e.g., International Organization for
Standardization (ISO) (ISO, 2019). Such
coercive forces lead healthcare organizations to
adopt digital technologies like electronic IRS for
healthcare management.
Institutional theory suggests that normative
forces are mirrored in professional networks
(Appari et al., 2009). The current research
conceptual analysis shows that normative forces
are manifested in international healthcare
societies (e.g., International Society for Quality
in Health Care (ISQua) (ISQua, 2022) and
professional networks (e.g., global health
network (GHN, 2022) and global network for
simulation in healthcare (GNSH, 2022). Such
normative forces encourage healthcare
organizations to adopt digital technologies like
electronic IRS for healthcare management.
The institutional theory posits that imitative
forces manifest themselves in emulating or
copying the behavior of others (Safa et al., 2016).
The present study’s conceptual analysis shows
that imitative forces create imitative pressure on
smaller enterprises (Aubin & King, 2018;
Viswanadham, 2021) and developing nations
(Asakura et al., 2015) to adopt electronic IRS.
Conclusions
The emergence of digital technology like
electronic IRS serves the critical need for
information translucence in the healthcare
industry. Electronic IRS technology facilitates
healthcare management, improves patient safety,
and promotes health safety practices. Electronic
IRS technology overcomes the limitations of
traditional IRS and improves tracking,
comprehension, and privacy of incident
reporting. The current research employs the
institutional theory model of DiMaggio & Powell
(1983) to study the adoption of electronic IRS for
healthcare management. The present research
uses institutional theory as it has been applied to
digital technologies and the healthcare industry.
The present study examines the role of
institutional theory’s coercive, normative, and
imitative forces in the adoption of electronic IRS.
The current research conceptual analysis shows
that coercive, normative, and imitative forces
guide the adoption of electronic IRS for
healthcare management. Coercive forces are
reflected in international health regulations (e.g.,
international health regulations (IHR), 2005)
(WHO, 2019) and standards (e.g., International
Organization for Standardization (ISO) (ISO,
2019). Normative forces are manifested in
international healthcare societies (e.g.,
International Society for Quality in Health Care
(ISQua) and professional networks (e.g., global
health network). Imitative forces exert pressure
on smaller businesses and developing nations to
adopt electronic IRS.
Implications and Limitations
The current research has important implications
for theory and practice. One, it deciphers the role
of institutional theory for adopting digital
technologies like electronic IRS. Prior research
proposes the use of technology adoption theories
like user experience and social influence, Unified
Theory of Acceptance and Use of Technology
(UTAUT), Technology Acceptance Model
(TAM), etc. in adopting digital technologies. The
conceptual analysis of the current research
demonstrates that organizational theory, such as
institutional theory, can provide an appropriate
theoretical lens to decipher coercive, normative,
and imitative forces in the adoption of digital
technologies such as electronic IRS. Second, the
current research demonstrates the role of digital
technology like electronic IRS for information
translucence and healthcare management. The
small enterprises in developing nations can take
learnings from large enterprises in developed
nations to adopt electronic IRS for efficient and
effective healthcare management.
Though this study has important implications,
however, there are some limitations. The study
employs conceptual analysis to depict the role of
institutional theory’s coercive, normative, and
imitative forces in guiding the adoption of digital
technology like electronic IRS for healthcare
management. Empirical analysis can validate the
research findings. The current research employs
an international perspective to build its case.
However, every country can have its own set of
institutional forces that guide the adoption of
digital technology like electronic IRS. Therefore,
future research can be conducted on a country-
by-country basis and can provide a thorough
knowledge of the role of digital technologies
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such as electronic IRS in effective healthcare
management in accordance with local conditions.
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