Understanding the dynamics of information technology implementation: The case of clinical information systems

The ultimate intent of this dissertation was to broaden and strengthen our understanding of IT implementation by emphasizing research efforts on the dynamic nature of the implementation process. More specifically, efforts were directed toward opening the "black box" and providing the story that explains how and why contextual conditions and implementation tactics interact to produce project outcomes. In pursuit of this objective, the dissertation was aimed at theory building and adopted a case study methodology combining qualitative and quantitative evidence. Precisely, it examined the implementation process, use and consequences of three clinical information systems at Jackson Memorial Hospital, a large tertiary care teaching hospital.^ As a preliminary step toward the development of a more realistic model of system implementation, the study proposes a new set of research propositions reflecting the dynamic nature of the implementation process.^ Findings clearly reveal that successful implementation projects are likely to be those where key actors envision end goals, anticipate challenges ahead, and recognize the presence of and seize opportunities. It was also found that IT implementation is characterized by the systems theory of equifinality, that is, there are likely several equally effective ways to achieve a given end goal. The selection of a particular implementation strategy appears to be a rational process where actions and decisions are largely influenced by the degree to which key actors recognize the mediating role of each tactic and are motivated to action. The nature of the implementation process is also characterized by the concept of "duality of structure," that is, context and actions mutually influence each other. Another key finding suggests that there is no underlying program that regulates the process of change and moves it form one given point toward a subsequent and already prefigured end. For this reason, the implementation process cannot be thought of as a series of activities performed in a sequential manner such as conceived in stage models. Finally, it was found that IT implementation is punctuated by a certain indeterminacy. Results suggest that only when substantial efforts are focused on what to look for and think about, it is less likely that unfavorable and undesirable consequences will occur. ^

Mindmapping as an adult learning notetaking strategy to increase the encoding of information in a corporate training course

A study was conducted to investigate the effectiveness, as measured by performance on course posttests, of mindmapping versus traditional notetaking in a corporate training class. The purpose of this study was to increase knowledge concerning the effectiveness of mindmapping as an information encoding tool to enhance the effectiveness of learning. Corporations invest billions of dollars, annually, in training programs. Given this increased demand for effective and efficient workplace learning, continual reliance on traditional notetaking is questionable for the high-speed and continual learning required on workers.^ An experimental, posttest-only control group design was used to test the following hypotheses: (1) there is no significant difference in posttest scores on an achievement test, administered immediately after the course, between adult learners using mindmapping versus traditional notetaking methods in a training lecture, and (2) there is no significant difference in posttest scores on an achievement test, administered 30 days after the course, between adult learners using mindmapping versus traditional notetaking methods in a training lecture. After a 1.5 hour instruction on mindmapping, the treatment group used mindmapping throughout the course. The control group used traditional notetaking. T-tests were used to determine if there were significant differences between mean posttest scores between the two groups. In addition, an attitudinal survey, brain hemisphere dominance survey, course dynamics observations, and course evaluations were used to investigate preference for mindmapping, its perceived effect on test performance, and the effectiveness of mindmapping instruction.^ This study's principal finding was that although the mindmapping group did not perform significantly higher on posttests administered immediately and 30 days after the course, than the traditional notetaking group, the mindmapping group did score higher on both posttests and reported higher ratings of the course on every evaluation criteria. Lower educated, right brain dominant learners reported a significantly positive learning experience. These results suggest that mindmapping enhances and reinforces the preconditions of learning. Recommendations for future study are provided. ^

Group participative budgeting: The effect of information asymmetry on group work standards

The complexity of many organizational tasks requires perspectives, expertise, and talents that are often not found in a single individual. Organizations have therefore been placing employees into groups, assigning them to tasks they would formally have undertaken individually. The use of these groups, known as workgroups, has become an important strategy for managing this increased complexity. Empirical research on participative budgeting however has been limited almost exclusively to individuals. This dissertation empirically examines the effect of the information that management and workgroups have about group members' performance capabilities, on the work standards that workgroups select during the participative budgeting process. ^ A laboratory experiment was conducted in which two hundred and forty undergraduate business students were randomly assigned to three-member groups. The study provides empirical evidence which suggests that when management is unaware of group members' performance capabilities, workgroups select higher work standards and have higher performance levels than when management is aware of their performance capabilities. ^

The impact of information technology on organizations: A study of enterprise resource planning system influences on job design and organizational culture

The primary purpose of this research is to study the linkage between perceived job design characteristics and information system environment characteristics before and after the replacement of a legacy information system with a new type of information system (referred to as an Enterprise Resource Planning or ERP system). A public state University implementing an academic version of an ERP system was selected for the study. Three survey instruments were used to examine the perception of the information system, the job characteristics, and the organizational culture before and after the system implementation. The research participants included two large departments resulting in a sample of 130 workers. Research questions were analyzed using multivariate procedures including factor analysis, path analysis, step-wise regression, and matched pair analysis. ^ Results indicated that the ERP system has introduced new elements into the working environment that has changed the perception of how the job design characteristics and organization culture dimensions are viewed by the workers. The understanding of how the perceived system characteristics align with an individual's perceived job design characteristics is supported by each of the system characteristics significantly correlated in the proposed direction. The stronger support of this relationship becomes visible in the causal flow of the effects seen in the path diagram and in the step-wise regression. The perceived job design characteristics aligning with dimensions of organizational culture are not as strong as the literature suggests. Although there are significant correlations between the job and culture variables, only one relationship can be seen in the causal flow. ^ This research has demonstrated that system characteristics of ERP do contribute to the perception of change in an organization and do support organizational culture behaviors and job characteristics. ^

Differential Impacts of Information Technology Services in the Korean Hotel Industry: A Study of Management Perceptions

Successful introduction of information technology applications in various operations of hotel management is vital to most service firms. In recent decades, technologies of information, automation, and communication are increasingly recognized as essential components of a hotel company’s strategic plan. In this study, 62 super-deluxe hotels (5 star), deluxe hotels (4 star), and tourist hotels (3 star) in Korea are examined for differences in the impact of information technology services on guest’ satisfaction, guest convenience, and operational efficiency. The findings generally suggest that the impacts of information technology-enhanced services vary according to the category of hotels in Korea. The results of the study are expected to assist managers in the selections and implementation of information technology systems in their hotel.

Eyewitness memory: Balancing the accuracy, precision, and quantity of information through metacognitive monitoring and control

Historically, memory has been evaluated by examining how much is remembered, however a more recent conception of memory focuses on the accuracy of memories. When using this accuracy-oriented conception of memory, unlike with the quantity-oriented approach, memory does not always deteriorate over time. A possible explanation for this seemingly surprising finding lies in the metacognitive processes of monitoring and control. Use of these processes allows people to withhold responses of which they are unsure, or to adjust the precision of responses to a level that is broad enough to be correct. The ability to accurately report memories has implications for investigators who interview witnesses to crimes, and those who evaluate witness testimony. ^ This research examined the amount of information provided, accuracy, and precision of responses provided during immediate and delayed interviews about a videotaped mock crime. The interview format was manipulated such that a single free narrative response was elicited, or a series of either yes/no or cued questions were asked. Instructions provided by the interviewer indicated to the participants that they should either stress being informative, or being accurate. The interviews were then transcribed and scored. ^ Results indicate that accuracy rates remained stable and high after a one week delay. Compared to those interviewed immediately, after a delay participants provided less information and responses that were less precise. Participants in the free narrative condition were the most accurate. Participants in the cued questions condition provided the most precise responses. Participants in the yes/no questions condition were most likely to say “I don’t know”. The results indicate that people are able to monitor their memories and modify their reports to maintain high accuracy. When control over precision was not possible, such as in the yes/no condition, people said “I don’t know” to maintain accuracy. However when withholding responses and adjusting precision were both possible, people utilized both methods. It seems that concerns that memories reported after a long retention interval might be inaccurate are unfounded. ^

The Influence of Purchase Confidence on Information Source Selection: Implications for Hospitality Industry

Whether the product of choice is a restaurant, vacation resort or hotel, it is important for hospitality marketers to understand how consumers treat purchase decisions and the influence purchase confidence and situation play on that decision. This study investigated the role purchase confidence plays with knowledge in the selection of sources of information during purchase decisions. The results indicate sources of information are perceived differently by consumers and depending on the purchase situation, subjective knowledge is influenced by purchase confidence affecting the source of information considered when making a purchase decision. The results also indicated that those with high purchase confidence and subjective knowledge will rely on themselves as a source when making a purchase rather than a retail clerk or published material.

Eyewitness Memory: Balancing the Accuracy, Precision, and Quantity of Information through Metacognitive Monitoring and Control

Historically, memory has been evaluated by examining how much is remembered, however a more recent conception of memory focuses on the accuracy of memories. When using this accuracy-oriented conception of memory, unlike with the quantity-oriented approach, memory does not always deteriorate over time. A possible explanation for this seemingly surprising finding lies in the metacognitive processes of monitoring and control. Use of these processes allows people to withhold responses of which they are unsure, or to adjust the precision of responses to a level that is broad enough to be correct. The ability to accurately report memories has implications for investigators who interview witnesses to crimes, and those who evaluate witness testimony. This research examined the amount of information provided, accuracy, and precision of responses provided during immediate and delayed interviews about a videotaped mock crime. The interview format was manipulated such that a single free narrative response was elicited, or a series of either yes/no or cued questions were asked. Instructions provided by the interviewer indicated to the participants that they should either stress being informative, or being accurate. The interviews were then transcribed and scored. Results indicate that accuracy rates remained stable and high after a one week delay. Compared to those interviewed immediately, after a delay participants provided less information and responses that were less precise. Participants in the free narrative condition were the most accurate. Participants in the cued questions condition provided the most precise responses. Participants in the yes/no questions condition were most likely to say “I don’t know”. The results indicate that people are able to monitor their memories and modify their reports to maintain high accuracy. When control over precision was not possible, such as in the yes/no condition, people said “I don’t know” to maintain accuracy. However when withholding responses and adjusting precision were both possible, people utilized both methods. It seems that concerns that memories reported after a long retention interval might be inaccurate are unfounded.

Profile of planning: A study of a three-year project on the implementation of collaborative library media programs

The implementation of collaborative planning and teaching models in ten flexibly scheduled elementary and middle school library media centers was studied to determine which factors facilitated the collaborative planning process and to learn what occurs when library media specialists (LMSs) and classroom teachers (CTs) plan together. In this qualitative study, 61 principals, CTs, and LMSs were interviewed on a range of topics including the principal's role, school climate, the value of team planning, the importance of information literacy instruction, and the ideal learning environment. Other data sources were observations, videotapes of planning sessions, and documents. This three-year school reform effort was funded by the Library Power Project to improve library programs, to encourage collaborative planning, and to increase curricular integration of information literacy skills instruction. ^ The findings included a description of typical planning sessions and the identification of several major factors which impacted the success of collaborative planning: the individuals involved, school climate, time for planning, the organization of the school, the facility and collection, and training. Of these factors, the characteristics and actions of the people involved were most critical to the implementation of the innovation. The LMS was the pivotal player and, in the views of CTs, principals, and LMSs themselves, must be knowledgeable about curriculum, the library collection, and instructional design and delivery; must be open and welcoming to CTs and use good interpersonal skills; and must be committed to information literacy instruction and willing to act as a change agent. The support of the principal was vital; in schools with successful programs, the principal served as an advocate for collaborative planning and information literacy instruction, provided financial support for the library program including clerical staff, and arranged for LMSs and CTs to have time during the school day to plan together. ^ CTs involved in positive planning partnerships with LMSs were flexible, were open to change, used a variety of instructional materials, expected students to be actively involved in their own learning, and were willing to team teach with LMSs. Most CTs planning with LMSs made lesson plans in advance and preferred to plan with others. Also, most CTs in this study planned with grade level or departmental groups, which expedited the delivery of information literacy instruction and the effective use of planning time. ^ Implications of the findings of this research project were discussed for individual schools, for school districts, and for colleges and universities training LMSs, CTs, and administrators. Suggestions for additional research were also included. ^

Financial aid and the persistence of associate of arts graduates transferring to a senior university

This study examined the effects of financial aid on the persistence of associate of arts graduates transferring to a senior university in one of four consecutive fall semesters (1998-2001). Situated in an international metropolitan area in the southeastern United States, the institution where the study was conducted is a large public research university identified as a Hispanic Serving Institution. Archival databases served as the source of information on the academic and social background of the 4,669 participants in the study. Data from institutional financial aid records were pooled with the data in the student administrative system.^ For purposes of this study, persistence was defined as ongoing progress until completing the baccalaureate degree. Student social background variables used in the study were gender, ethnicity, age, and income, with GPA and part-time or full-time enrollment status being the academic variables. Amount and type of aid, including grants, loans, scholarships, and work study were incorporated in the models to determine the effect of financial aid on the persistence of these transfer students. Because the dependent variable persistence had three possible outcomes (graduated, still enrolled, dropped out) multinomial logistic regression was the appropriate technique for analyzing the data; four multinomial models were employed in the analysis.^ Findings suggest that grants awarded based on the financial need of students and loans were effective in encouraging the persistence of students, but scholarships and work study were not effective.^

The impact of institutional complexity and top management characteristics on executive compensation and firm performance

While most studies take a dyadic view when examining the environmental difference between the home country of a multinational enterprise (MNE) and a particular foreign country, they ignore that an MNE is managing a network of subsidiaries embedded in diverse environments. Additionally, neither the impacts of global environments on top executives nor the effects of top executives’ capabilities to handle institutional complexity are fully explored. Thus, using a three-essay format, this dissertation tried to fill these gaps by addressing the effects of institutional complexity and top management characteristics on top executive compensation and firm performance. ^ Essay 1 investigated the impact of an MNE’s institutional complexity, or the diversity of national institutions facing an MNE’s network of subsidiaries, on the top management team (TMT) compensation. This essay proposed that greater political and cultural complexity leads to not only greater TMT total compensation but also to a greater portion of TMT compensation linked with long-term performance. The arguments are supported in this essay by using an unbalanced panel dataset including 296 U.S. firms with 1,340 observations. ^ Essay 2 explored TMT social capital and its moderating role on value creation and appropriation by the chief executive officer (CEO). Using a sample with 548 U.S. firms and 2,010 observations, it found that greater TMT social capital does facilitate the effects of CEO intellectual capital and social capital on firm growth. Finally, essay 3 examined the performance implications for the fit between managerial information-processing capabilities and institutional complexity. It proposed that institutional complexity is associated with the needs of information-processing. On the other hand, smaller TMT turnover and larger TMT size reflect larger managerial information-processing capabilities. Consequently, superior performance is achieved by the match among institutional complexity, TMT turnover, and TMT size. All hypotheses in essay 3 are supported in a sample of 301 U.S. firms and 1,404 observations. ^ To conclude, this dissertation advances and extends our knowledge on the roles of institutional environments and top executives on firm performance and top executive compensation.^

Selection and passage of county land preservation voter referendum: The role of government

County jurisdictions in America are increasingly exercising self-government in the provision of public community services through the context of second order federalism. In states exercising this form of contemporary governance, county governments with "reformed" policy-making structures and professional management practices, have begun to rival or surpass municipalities in the delivery of local services with regional implications such as environmental protection (Benton 2002, 2003; Marando and Reeves, 1993). ^ The voter referendum, a form of direct democracy, is an important component of county land preservation and environmental protection governmental policies. The recent growth and success of land preservation voter referendums nationwide reflects an increase in citizen participation in government and their desire to protect vacant land and its natural environment from threats of over-development, urbanization and sprawl, loss of open space and farmland, deterioration of ecosystems, and inadequate park and recreational amenities. ^ The study's design employs a sequential, mixed method. First, a quantitative approach employs the Heckman two-step model. It is fitted with variables for the non-random sample of 227 voter referendum counties and all non-voter referendum counties in the U.S. from 1988 to 2009. Second, the qualitative data collected from the in-depth investigation of three South Florida county case studies with twelve public administrator interviews is transformed for integration with the quantitative findings. The purpose of the qualitative method is to complement, explain and enrich the statistical analysis of county demographic, socio-economic, terrain, regional, governance and government, political preference, environmentalism, and referendum-specific factors. ^ The research finds that government factors are significant in terms of the success of land preservation voter referendums; more specifically, the presence of self-government authority (home rule charter), a reformed structure (county administrator/manager or elected executive), and environmental interest groups. In addition, this study concludes that successful counties are often located coastal, exhibit population and housing growth, and have older and more educated citizens who vote democratic in presidential elections. The analysis of case study documents and public administrator interviews finds that pragmatic considerations of timing, local politics and networking of regional stakeholders are also important features of success. Further research is suggested utilizing additional public participation, local government and public administration factors.^

Life Experiences of Youth Who Were Born with HIV Infection in Puerto Rico: The Voices of Young Survivors

The effectiveness of antiretroviral therapy (ART) transformed the pediatric HIV epidemic. The disease changed significantly over the course of three decades: while early in the epidemic it was almost always fatal, it has become a chronic condition. This study examined how perinatally-infected youth experience the impact of HIV in their lives. A qualitative study using interpretative phenomenological analysis (IPA) was conducted. Twenty in-depth interviews were carried out among 12 women and 8 men aged 18 to 30 years in Puerto Rico. These were conducted in Spanish, audio-recorded, transcribed and translated into English. While narrating their experiences, participants were interpreting what the situation meant to them and how they make sense of it. Three topics emerged: (1) perception and response to treatment and illness, particularly their lived experiences with ART; (2) disclosure experiences; and (3) family matters. Most participants challenged their therapy, in most cases to force their caregivers to disclose their status. Problems with adherence were attributed to busy schedules or forgetfulness. Participants experienced the disfiguring adverse effects of ART, which they endured for years without being informed that ART was the cause of these. Participants’ experiences with disclosure demonstrated the importance of validating them as individuals capable of managing their health. The paternalistic approach of withholding their diagnosis to spare them suffering resulted in increased anxiety. Participants acknowledged the difficulties of revealing their HIV status to their partners. They referred to family and friends as essential in coping with HIV. However, some encountered discrimination and stigma within their families. Participants who had suffered the loss of their parents found other parental figures such as adoptive parents or other family members. Most participants expressed a desire to have children. Perinatally HIV-infected youth will require health services for the rest of their lives. The adult health care into which they transition should consider their needs and journey. Services should consider including family members. This study underscores the need for improved access to mental health services. It is also essential to transcend medical treatment and develop a broader perspective of health care. Health care services should include reproductive decision-making counselling services.

Selection and Passage of County Land Preservation Voter Referendum: The Role of Government

County jurisdictions in America are increasingly exercising self-government in the provision of public community services through the context of second order federalism. In states exercising this form of contemporary governance, county governments with “reformed” policy-making structures and professional management practices, have begun to rival or surpass municipalities in the delivery of local services with regional implications such as environmental protection (Benton 2002, 2003; Marando and Reeves, 1993). The voter referendum, a form of direct democracy, is an important component of county land preservation and environmental protection governmental policies. The recent growth and success of land preservation voter referendums nationwide reflects an increase in citizen participation in government and their desire to protect vacant land and its natural environment from threats of over-development, urbanization and sprawl, loss of open space and farmland, deterioration of ecosystems, and inadequate park and recreational amenities. The study’s design employs a sequential, mixed method. First, a quantitative approach employs the Heckman two-step model. It is fitted with variables for the non-random sample of 227 voter referendum counties and all non-voter referendum counties in the U.S. from 1988 to 2009. Second, the qualitative data collected from the in-depth investigation of three South Florida county case studies with twelve public administrator interviews is transformed for integration with the quantitative findings. The purpose of the qualitative method is to complement, explain and enrich the statistical analysis of county demographic, socio-economic, terrain, regional, governance and government, political preference, environmentalism, and referendum-specific factors. The research finds that government factors are significant in terms of the success of land preservation voter referendums; more specifically, the presence of self-government authority (home rule charter), a reformed structure (county administrator/manager or elected executive), and environmental interest groups. In addition, this study concludes that successful counties are often located coastal, exhibit population and housing growth, and have older and more educated citizens who vote democratic in presidential elections. The analysis of case study documents and public administrator interviews finds that pragmatic considerations of timing, local politics and networking of regional stakeholders are also important features of success. Further research is suggested utilizing additional public participation, local government and public administration factors.

The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

Purpose: Over half the HIV-infected persons in the Caribbean, the second most HIV-impacted region in the world, live in Haiti. Using secondary data from a parent study, this research assessed the effects of psychological and social factors on antiretroviral therapy (ART) adherence among Haitian, HIV-positive, female alcohol users. Theoretical Foundation and Research Questions: Using the Theory of Planned Behavior/Reasoned Action and the Information, Motivation, Behavior skills model as guiding theoretical frameworks, the study examined the effectiveness of an adapted cognitive behavioral stress management (CBSM-A) intervention in improving ART adherence. The effect of psychological factors (depression, anxiety, beliefs about medicine, and social support), social factors (stigma, relationship status, and educational attainment), and alcohol on adherence to ART was assessed. Methods: The sample consisted of 116 female ART patients who were randomly assigned to the CBSM-A intervention or the wait-list control group. Participants completed intervention sessions as well as pre- and post-test assessments. Analyses of variance, t-tests, and point biserial correlations were used to test hypotheses. Results: Surprisingly, ART adherence rates significantly decreased for both groups combined [F (1, 108) = 8.79, p = .004]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post assessment. On average, depression decreased significantly among participants in the CBSM-A group only [(t (62) = 5.54, p < .001)]. For both groups combined, alcohol use significantly decreased between baseline and post-assessment [(F (1, 78) = 34.70, p < .001)]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post-assessment. None of the variables were significantly correlated with ART adherence. Discussion: Adherence to ART did not improve in this sample, nor were any of the variables significantly associated with adherence. The findings suggest that additional supportive and psychological services may be needed in order to promote higher adherence to ART among HIV-positive females. More research may be needed on this sample; a focus on mental health issues, partner conflict, family and sexual history may allow for better targeting and more successful interventions.