(Word limit – 3000 words with +/- 10 % permissible flexibility)(Marks: 90 marks)
1. As technology has been an increasingly important factor in all of our lives for the past 50 years, it
is important to realise that the healthcare sector has been in parts the forerunner and in some cases
it has remained outdated. Referring to a recently published article (Alrahbi, D., Khan, M. and
Hussain, M., 2021. Exploring the motivators of technology adoption in healthcare. International
Journal of Healthcare Management, 14(1), pp.50-63.) the adoption of Health Information
Technology (HIT) is dependent on different healthcare stakeholders. These stakeholders are:
Patients; Members of Society; Foresight experts and Employees. The article goes on to explains
different motivators for the stakeholders to adopt HIT.
a. What is the main motivator for each of the stakeholder groups?
b. Following this article and with the use of other academic sources, please explain what
obstacles and motivators the stakeholders will encounter in the implementation of a
electronic patient/health record.
c. Please look at your own country. Does it have a universal electronic health record? Please
explain what the driving factors were for its implementation or why it has not been
implemented. (Do write the name of your country) -CLO 5,CLO 4
2. In preparation and prevention of another health crisis, the governments of the world need to have
a plan on how to deal with the costs that occur as a result of a pandemic. These plans greatly
differ per country, however it is wise to learn from successes and failings of other countries.
Please read the following article: Thomson, S., García-Ramírez, J.A., Akkazieva, B., Habicht, T.,
Cylus, J. and Evetovits, T., 2022. How resilient is health financing policy in Europe to economic
shocks? Evidence from the first year of the COVID-19 pandemic and the 2008 global financial
crisis. Health Policy, 126(1), pp.7-15.
a. What are the consequences for the health of a population with the implementation of
austerity measures and how did this influence the healthcare outcomes during the Covid19 pandemic? -CLO 3
3. Congratulations, you’re the director of a health care organisation in the UAE. This fictitious
health organization needs to be prepared for the future. Your organization works in the field of
old-age care. Based on the current health trends in the UAE and the world, please answer the
following questions:
©Al Tareeqah Management Studies – 2023
3
a. State the Vision and Mission statement of your organization.
b. Use the OKR’s to decide upon the Strategic Priorities; Strategic Initiatives
/Projects; Daily, weekly, monthly decisions. -CLO 1
4. Besides the cost, management of public health and all the factors relating to the social
determinants of health have been very important in the governmental responses to Covid-19. CLO 2
a. The United Kingdom has had multiple problems in the field of healthcare management
when it comes to Covid-19. This cumulated in many reports, editorials and articles on the
subject. Please conduct a SWOT-analysis based on the academic and governmental
sources available on the UK’s handling of the pandemic. Please provide at least three
points in every window. Propose strategies to overcome the identified threats and
weakness key points.
b. Conduct a SWOT-Analysis on your own governmental response to the Covid-19
pandemic. Please provide at least three points in every window. Propose strategies to
overcome the identified threats and weakness key points.
c. When looking at the SWOT-analysis that you have conducted, please explain if there are
similarities between the two countries. What are lessons that your country can learn from
how the UK approached the pandemic?
©Al Tareeqah Management Studies – 2023
4
International Journal of Healthcare Management
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/yjhm20
Exploring the motivators of technology adoption
in healthcare
Dana Alrahbi, Mehmood Khan & Matloub Hussain
To cite this article: Dana Alrahbi, Mehmood Khan & Matloub Hussain (2021) Exploring
the motivators of technology adoption in healthcare, International Journal of Healthcare
Management, 14:1, 50-63, DOI: 10.1080/20479700.2019.1607451
To link to this article: https://doi.org/10.1080/20479700.2019.1607451
Published online: 06 May 2019.
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INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT
2021, VOL. 14, NO. 1, 50–63
https://doi.org/10.1080/20479700.2019.1607451
Exploring the motivators of technology adoption in healthcare
Dana Alrahbi, Mehmood Khan and Matloub Hussain
College of Business Administration, Abu Dhabi University, Abu Dhabi, United Arab Emirates
ABSTRACT
ARTICLE HISTORY
This paper seeks to determine the motivators that affect the adoption of information
technology (IT), specifically in modern healthcare systems, based on a case study in the
United Arab Emirates (UAE). The aim is to identify, examine, and place in a hierarchical
structure, based on a two-step exploratory methodology, the motivators for IT adoption of
four main categories of healthcare stakeholders (employees, patients, UAE citizens and
residents, and accredited foresight experts) via an analytic hierarchy process (AHP) model.
AHP revealed the relative importance weights of the seven IT adoption motivators and their
41 sub-motivators. Government support was found to be the most important group of
motivators, followed by knowledge sharing, infrastructure, green management, lean
management, internal/external environment, and social sustainability. The paper facilitates
improving technology adoption generally, specifically in the UAE’s healthcare system. A
Pareto chart visually presents the ranking of all sub-factors to help supply-chain practitioners
better allocate resources for IT implementation. Little research has examined the combined
perspectives of various stakeholders and no study has hitherto investigated the significant
motivators of IT adoption in the UAEs’ healthcare industry. Including foresight experts is new
in this domain.
Received 26 July 2018
Accepted 28 March 2019
Introduction
Technology has come to play an important role in
managing healthcare systems in terms of managing
and processing healthcare data and transmitting reports
over large distances in a fraction of the time previously
required [1,2]. Many stakeholders are involved in the
management, use, and maintenance of such systems,
including funding agencies, technology providers,
users, and patients and their families. We use Ahlan
and Ahmad’s [3] definition of health information technology (HIT), i.e. the use of computers for digital assistance by physicians, e.g. electronic storage of health
records and patient histories, and computerized entries
of physicians’ orders by healthcare professionals such
as other doctors, nurses, care-givers, hospitals, test centers and laboratories, and patients. HIT has been found
to have many benefits for all stakeholders, e.g. improving the quality, timeliness, and efficiency of information
transfer in healthcare, minimizing errors, and reducing
the cost of maintaining physical records [4–9]. Murthy
[10], for instance, proposed ‘personalized medicine’,
an interesting HIT form that offers access to patients’
health information, encourages participation, and
invites technology to enable better outcomes. It also
increases productivity and improves the quality of life,
while decreasing costs.
Traditionally, the healthcare arena has been slow to
adopt the various technological advancements that are
CONTACT Mehmood Khan
United Arab Emirates
mehmood.khan@adu.ac.ae
© 2019 Informa UK Limited, trading as Taylor & Francis Group
KEYWORDS
Technology adoption;
healthcare; United Arab
Emirates; healthcare
information technology (HIT);
motivators; stakeholders;
future foresight
benefiting other industries worldwide [11]. However,
nowadays, driven by social and demographic changes,
the use of HIT is showing an upward trend, particularly
in Western nations. Consumer demand is becoming
more sophisticated and HIT is one way to deliver
efficient and safer care services [12]. HIT is gradually
becoming a vital component of care delivery and
promises significant efficacy and quality gains [13].
Thus, understanding the factors behind user acceptance of different IT specifications is of the utmost
importance for the entire health eco-system [14].
Extant literature indicates many information-technology motivators, including the desire for integration,
access to real-time information, modernization and
dissatisfaction with older systems, image considerations, decision-making and complexity, process performance and productivity, response time, reduced
operating costs, strategic decision-making, management reporting, business flexibility, transactional
efficiency, performance expectancy, effort expectancy,
and facilitating conditions [15–20]. However, there is
a dearth of research in the United Arab Emirates
(UAE) examining the combined perspectives of
employees, patients, citizens and residents, and foresight experts. Eliciting views from these four stakeholder groups, which is the focus of this research, is
critical because of their individual and combined salience. Furthermore, the inclusion of the latter group,
College of Business Administration, Abu Dhabi University, P.O. Box 59911, Abu Dhabi,
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT
foresight experts, in our analysis is entirely new in this
domain of research. Foresight experts help companies
to navigate likely changes by presenting an early assessment of forthcoming opportunities (and obstacles).
However, these specialists do more than forecasting:
they examine various current phenomena and processes, such as networks, because optimizing planning
and decision-making necessarily requires understanding the extent to which current and historical practices
have been adequate.
Given the roles played by different stakeholders
involved in HIT, it is imperative to explore the underlying rationale for their participation [21–23]. This
analysis seeks to determine the motivators that affect
the adoption of information technology in modern
healthcare systems based on a case study of the UAE.
The main objectives of this research can be summarized as follows:
.
.
.
.
.
use stakeholder theory as a framework for understanding the adoption of HIT in the healthcare
industry;
explore motivators for the adoption of HIT;
categorize motivators of HIT adoption across various stakeholders;
develop a hierarchical structure for these categories
of motivators; and
calculate the significance of each category using the
analytical hierarchy process.
Literature review
HIT overview
HIT includes all computer-enabled applications that are
applied to healthcare systems worldwide [22]. Cloudbased information systems and electronic health records
(EHRs) have mostly found universal acceptance and
contributed to the exponential growth of the HIT market [24]. Research estimates that the HIT sector will be
worth USD 44.8 billion by 2024, with three main players
(Cerner Corporation: North Kansas City, MO, USA,
McKesson: San Francisco, California, United States,
and All Scripts: Chicago, Illinois, United States) holding
a 26% global market share [8]. This growth rate is
already visible in the developed Western world, but
specialists expect further expansion in developing
nations, which will need a mass-scale electronic and
digital transformation of their health data, which presents opportunities for investors [25–28].
Most growth will likely be seen in hospitals as they
convert health records to the electronic medium to
bridge the connection between practitioners and customers [8]. The US is the global leader in terms of HIT
conversion, backed by an early legislative framework.
The Health Information Technology for Economic
and Clinical Health (HITECH) Act was passed in the
51
US in 2009 to encourage doctors and hospitals to start
the transition to EHRs. In addition, the US Patient Protection and Affordable Care Act (PPACA) of 2010 provided substantial financial incentives for investment in
electronic medical records [29]. The PPACA strongly
encourages the use of EHRs and personalized patient
technology to enable and sustain self-management [30].
There are numerous environmental pressures on the
healthcare industry to embrace EHRs, ranging from
federal government incentives to local competitive
forces [31]. US federal policies were major drivers of
EHR adoption, sometimes imposing penalties on professionals that did not implement this technological
innovation.
Modern healthcare systems are increasingly
migrating to software-as-a-service (SaaS) apps for documenting patient interactions and information management [32]. The cloud-based storage of data also
occurs via SaaS applications, which can make data
more accessible, more durable, and safer [33].
Huang et al. [34] explored the patterns of e-health
tools adoption by Chinese hospitals in connecting
with their patients to offer a clear picture of the HITdevelopment status quo and formulate strategies for
further progress towards the delivery of high-quality
care. The authors pointed out that hospital best performers, in the top-tier and private hospitals, shared common dynamics in using interactive tools, although,
overall the trend was much stronger among private
organizations. For general hospitals and public facilities, particularly those in the second tier, the pace of
HIT adoption was slower and the number of interactive tools was lower, as they focused more on providing
static information and advertising rather than on offering interactive, tailored patient services.
The UAE manages the funding of its healthcare sector based on domestic resources alone within a mixed
public–private system. Emirati citizens have access to
the public system, which is centrally managed and
funded. In 1971, the UAE had seven hospitals and 12
healthcare centers, growing to over 70 public and private hospitals and 150 medical centers by 2016 [35].
Healthcare spending in the UAE is forecast to reach
AED 73.52 billion (USD 20.03 billion) by 2020 and
nearly AED 202 billion (USD 28 billion) by 2025,
mainly driven by population growth, demographic
shifts, problematic lifestyle habits, medical tourism,
and efforts to introduce the universal health insurance
and rising wealth, which increase demand for higherquality medical services [36].
To meet the growing demand for healthcare within
the UAE and increase its attractiveness as a medical
tourism hub, the government launched UAE Vision
2021 [37]. This agenda seeks to make the UAE a
world-class healthcare destination and includes the
setup of integrated IT systems and electronic data.
These objectives can be achieved only if HIT is
52
D. ALRAHBI ET AL.
implemented throughout the healthcare system, allowing for a seamless integration of all stakeholders. The
federal UAE government is already planning to
implement initiatives such as mobile applications for
patient engagement, data analytics, and digitization of
electronic medical records.
Trends in the healthcare industry among Arab
countries have revealed dramatic changes, particularly
in the Middle East. However, Alsadan et al.’s [4] study
highlighted that, despite rich financial resources, most
Arab nations still lag behind in terms of HIT adoption
because of a lack of professional competency and dedicated funding. Further, government-assisted public
facilities display a low level of IT usage, whereas private
establishments are financially unable to adopt HIT
under its various forms (EHRs, telemedicine, eHealth).
These states thus need to come up with viable strategies
to remove financial and cultural de-motivators and
barriers to enjoy competitive advantages.
Motivators for HIT adoption
McClellan’s [38] cross-sectional study of physicians to
identify the motivators behind HIT adoption found
34.1% of HIT functionalities were adopted within
physician practices. One in seven professionals failed
to successfully adopt HIT and one in five did not
even heed reminders. Primary care practices and relatively larger practices adopted HIT more readily. Physicians in specialties focused on patient-centered care
were more likely to embrace HIT. Therefore, this
study underlines that the adoption of HIT does not
necessarily mean physicians and other healthcare
staff will actually use it. Patient-centered institutions’
physicians finding it easier to adopt HIT suggests
that management philosophy does have a bearing on
the implementation process.
In 2009, the US Congress committed to financial
incentives to motivate physicians to adopt EHRs; however, adoption rates were still inconsistent. HeiseyGrove and Patel’s [39] analysis of the factors behind
the successful adaptation of EHRs revealed that large
and multi-specialty practices had the lowest numbers
of physicians hesitant or reluctant to use EHRs, while
these numbers were highest for solo practitioners.
Financial incentives were a significant determinant,
with 62% of physicians quoting them as a major
reason. Other factors included the need to fulfill a
board-certification requirement (39%), good feedback
from other colleagues (37%), possibility of electronic
exchange (36%), technical assistance (35%), assistance
with EHR selection (17%), and availability of certified
EHRs (13%). Interestingly, these incentives made a larger number of physicians adopt EHRs during 2010–
2013 compared to those who had adopted it before
2009. This suggests that EHR implementation could
also be achieved via good word-of-mouth publicity.
The prospective Medicare payments system is also a
major motivator HIT adoption in the US [40,41].
Heisey-Grove and Patel [39] also identified the factors appealing to physicians who did not wish to adopt
EHRs: financial incentives (51%); technical assistance
in implementation (46%); board certification (44%);
possibility of electronic exchange (39%); feedback
from colleagues (36%); assistance in EHR selection
(29%); and EHR availability (19%).
Another important factor is to create small wins for
adopters throughout the implementation period,
requiring developers to clearly distinguish between
implementation and adoption [42]. Change-management practices should be utilized, e.g. change agents
and leaders to motivate others [38]. The recognition
of national, organizational, and personal barriers and
motivators can help in adjusting HIT implementation
and making it more likely to be adopted. Other motivators include incentives, patient safety, administrative
simplification, competitive advantage, patient-centered
and accountable organizational systems, revenue
enhancements, and cost savings [43,44].
A recent exploratory analysis using structural
equation modeling (SEM) by Samhan [45] of 237
healthcare providers highlighted that hospitals with a
cyber-risk insurance policy were more likely to adopt
and use EMR systems. The phenomenon of cyberattacks was perceived as a major contributor to technology resistance.
Despite many studies emphasizing the benefits of
HIT implementation, the drivers of technology adoption
and the HIT – financial-excellence nexus have received
far less attention. Some scholars have examined the role
of HIT in improving organizational performance, profitability indicators, competitive advantages, and in reducing back office expenses, transportation costs, medical
liability costs and errors, and inventories [46–48]. Li
and Collier’s [49] theoretical framework pointed out
that HIT can increase clinical and process quality and
intermediate business activities, which in turn leads to
superior financial results.
According to a recent study [50], personal and
organization-level factors are the most important motivators, followed by equipment, workflow, and thematic
interconnectivity, meaning that healthcare professionals would need to be comfortable using the technologies if they are to be implemented effectively.
Using the technology acceptance model (TAM),
Chen et al. [51] explored nurses’ attitudes towards
the use of HIT, finding that perceived usefulness (i.e.
perceived ease of use) was the major, direct driver of
the intention to use HIT. Furthermore, perceived usefulness was indirectly impacted by other enablers, such
as the perceived usability, individual abilities, and
internet access.
Cancela et al. [52] used the analytic hierarchy process (AHP) model to identify the most important
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT
motivators for adopting a telehealth system for Parkinson’s disease for two different categories of healthcare
stakeholders: experts with a clinical background (clinicians); and experts with a technical background
(engineers). Their findings revealed that ‘on/off fluctuations detection’, ‘increased wearability acceptance’,
‘increased self-management support’, and ‘increased
self-management support’ were the most relevant
HIT acceptance motivators for the two groups.
Based also on the AHP framework, Lambooij and
Hummel [53] explored the perspectives of six key
healthcare stakeholders, namely physicians, nurses,
patients, managers, insurers, and policy makers, concerning the acceptance of IT innovation. Politics and
the power balance among these groups may be particularly relevant for modern technologies with wide
impact within the healthcare eco-system, where various
stakeholders are mutually dependent in their adoption
and use. The application of the stakeholder theory in
the context of HIT implementation enables a better
understanding of why the diffusion of valuable innovation occurs more slowly than many stakeholders
desire it to. The results revealed different preference
structures for selected HIT forms. For instance, policy
makers indicated efficiency as the most important HIT
motivator, while patients, nurses, and physicians indicated that efficiency was the least important motivator.
Health gains were most important for health insurance,
nurses, and patients, while satisfaction was the most
important criterion in embracing HIT for managers
and physicians but was only moderately significant
for physicians, managers, and nurses.
Wang et al. [54] explored the interplay between
HIT-related spending, business processes, and financial
indicators of performance and productivity in the US,
asserting that HIT investments were connected to positive financial performance, return on assets, and productivity. Given the significant spending required by
HIT formats, e.g. EHRs, there are extensive debates
on the associated financial and productivity
payoffs, particularly for smaller healthcare facilities
[49,55,56].
53
However, comprehensive studies on the motivators for
institutions, physicians, nurses, front office, and other stakeholders within a healthcare facility are still scarce.
Theoretical perspectives
This research is grounded in stakeholder theory [57–
59]. The present work aims to combine four stakeholders groups, namely employees, patients, UAE citizens and residents, and foresight experts to present a
unique perspective on what motivates them to adopt
HIT in the context of the UAE (see Figure 1). A
detailed description of each stakeholder category participating in our survey is presented in Table 1, while
Table 2 details the demographics of the stakeholders
participating in this research with regards to age, gender, level of education, and years of experience.
Since the decision to adopt a technological advancement in the field of healthcare is heavily influenced by
peer recommendations [60], stakeholder theory is a
suitable framework for identifying the motivators and
barriers to HIT adoption and can also highlight the
differences or similarities among the views of the stakeholders, if any. This can help those who plan and make
decisions for the healthcare sector to better understand
the environment. Stakeholder theory also improves the
understanding of the interplay between all participants
in the system [57].
Most researchers have focused on the measurement
of technology adoption mainly by physicians and on
what motivates them to implement a new technology
in their practice [61,62]. However, none of these studies
have explored the perspective of foresight experts.
Research framework
Phase 1: Exploration of the motivators
Questionnaire development
Based on a two-step exploratory methodology, our
analysis aims to identify, examine, and place in a hierarchical structure the motivators that influence the
decision to adopt HIT of four main categories of
Figure 1. Stakeholder view of technology-adoption motivators in the healthcare sector.
54
D. ALRAHBI ET AL.
Table 1. Description of each stakeholder category participating in the survey.
Stakeholder group
Employee
Patient
UAE citizen or
resident
Foresight expert
Description
Any individual working in the healthcare sector, regardless of the nature of their job (physician, nurse, technician, administrative,
pharmacists, medical equipment developer, policy makers, software developers, etc.).
Any individual that has a history of long experience with the treatment of their chronic illnesses, such as genetic disorders in blood
cells, multiple neurological sclerosis, and diabetes. The treatment of all these diseases would require a heavy involvement of
modern technology for scans, investigations, and procedures. The service provider can belong to any medical facility (type of clinic
or hospital) or any sector (private or public). If the patient was under the age of 18, the interview was conducted in the presence of
a parents or guardian.
Any UAE citizen or resident, male or female, aged 18–65 years.
Any trainee, male or female, that has undertaken foresight training or is foresight-accredited. Foresight is focused on potential
changes in the external surroundings and how these could impact the organization. Experts in this field assist companies in
navigating such likely changes by presenting an early assessment of the opportunities ahead (or obstacles). Foresight specialists do
more than forecasting; they examine aspects of networking and prepare decisions about the future. In addition, they provide
information about the future, which is a part in the planning and decision processes.
Table 2. Demographics of the stakeholders participating in this research.
Age (years)
18–24
25–34
35–44
45–54
55–64
56–74
Gender
Male
Female
Level of education
Below high school
High school
Bachelor’s degree
Master’s degree
Doctoral degree
Years of experience
26
Employees (n = 15)
Society members (n = 40)
Patients (n = 40)
Future foresight experts (n = 15)
1
4
5
4
1
0
3
4
10
9
12
3
5
8
12
11
3
1
0
5
6
2
2
0
9
6
13
27
11
29
8
7
0
2
8
2
3
2
5
17
14
2
1
6
18
12
3
0
0
8
6
1
1
3
4
3
1
3
1
4
13
11
8
3
4
7
9
12
6
2
0
1
4
6
3
1
healthcare stakeholders via a model that indicates the
practical implementation and management steps to
deal with such factors. We chose an exploratory methodology to gain knowledge of the four groups’ opinions
on HIT motivators, which the respondents would offer
by virtue of their experience. Exploratory research
refers to the collection of data in an informal and
unstructured manner and is best suited to guide the
survey design and question building [63].
The sample size was based on the availability and
accessibility of the different stakeholders groups. Over
time, AHP has been successfully applied in studies
with small sample sizes. Several scholars have reported
viable AHP-driven findings with a limited number of
experts, inter alia, five respondents [64,65], seven
participants [66], 18 participants [67], and 25 respondents [68].
In phase 1, we designed an exploratory survey as the
sole data collection instrument for the four groups of
respondents. To this end, 15 interviews were initially
conducted with the employees’ category, 40 interviews
with the patients’ category, 20 interviews with the
future foresight experts’ category, and 40 candidates
from the society members’ category. The survey
included group-customized demographics questions
(see Table 2). The survey was structured following
the framework in Figure 1. The 115 responses were collected over a period of one month.
Sample
For the employees’ category, local and foreign physicians in public and private hospitals, with more than
five years’ experience with a technology, were selected
for this research. This category also included administrators with an experience of selecting and implementing technologies in healthcare. Eight administrators
and seven physicians represented the total of 15 candidates that were selected and interviewed.
For the patients’ category, candidates were selected
based on their long experience with the treatment of
their chronic illnesses such as genetic disorders in
blood cells, multiple neurological sclerosis and diabetes. The treatment of all these diseases would require
a heavy involvement of modern technology for scans,
investigations and procedures. A total of 40 patients
were selected and interviewed.
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT
The future foresight category is relatively modern
and only a few organizations are involved in training
and certifying their employees in this area. A total of
20 trained experts were approached and 15 were interviewed for this research. The analysis of future foresight experts’ opinions is a novel approach in
academic research but provides a new way of directly
involving the industry’s planning capacity in studying
HIT adoption motivators. Nowadays, the term foresight expert engenders far more expectations than previously, although professional foresight services are still
note clearly defined from the perspective of the market
[69]. However, several authors have adopted the
definition of foresight professionals as individuals
engaged in
a systematic, future-oriented, analytical and interactive process that partly contributes to shared visions
concerning long-term developments within science,
technology, business and society and partly facilitates
the alignment of relevant stakeholder groupings
around desirable developments through relevant strategies, decisions and actions. [70]
Foresight is an activity focused on the cognitive part of
anticipation [71]. This process enables individuals to
‘see far and wide’ to improve how they think through
their decisions [72]. Hence, foresight experts modify
individual representations by creating new frames for
analysis [73].
Foresight experts serve both private and public sectors, at the global, national, and regional levels [74].
From the standpoint of commercial entities that practice foresight, the number is limited and only complements, rather than substitutes for, graduate
education. This is already a reality, as companies are
now training their own foresight experts [75].
The category of society members was broad. A total
of 40 candidates were hand-picked based on their education, age, and job experience to match the other categories as closely as possible. Four focus group sessions
were conducted with 10 candidates. Within each focus
group, candidates with similar criteria and background
were grouped in order to attain the highest level of
positive influence and discuss the research topic openly
and freely.
Data collection and analysis
The researchers sent invitation letters electronically to
all selected 15 representatives of the four stakeholder
groups to take part in a 60–90-min interview to investigate the motivators for HIT adoption in the context of
the UAE. They were informed that, if choosing to
voluntarily participate, the completion of the survey
would demonstrate their consent, and that they may
decide to withdraw at any time. There was no compensation for responding nor was there any known risk. To
ensure that all information remained confidential, no
55
names were included. Hence, the principles of
informed consent and confidentiality that protect the
dignity and rights of all participants, minimizing the
risk of harm, were met.
The interview included demographics-related questions and one main question regarding their view of
motivators that impact the adoption of the latest technologies in the healthcare sector. Based on the interview findings, we created separate tables for each
interviewee and listed his/her thoughts and ideas discussed; subsequently, we analyzed the answers and
started coding the repeated elements to obtain the list
of factors to be included in our study.
All identified factors during the interview were listed
by the researchers to gain insights and explore possible
gaps that may exist. Motivators refer to the internal and
external factors that encourage the adoption of new
technologies in the healthcare sector.
Candidates’ responses were collected and filtered
to remove repetitive answers. They were additionally
condensed, based on similarity, to create a list of a
more manageable length, from which discrete thematic items were produced. Thus, after the removal
of repetitive entries via filtering techniques, the outcome of phase 1 was the identification of 66 motivators of technology adoption in the sector for the four
main stakeholders of the healthcare industry (see
Table 3). The next step was to group them into similar themes. The final list included 16 factors identified by the society members, 19 by employees
working in the healthcare sector, 10 by patients
using healthcare services, and 21 by the foresight
experts.
Phase 2: Development of the AHP model
Ranking of identified factors
In phase 2, we developed the AHP model. The AHP
framework, pioneered by Thomas Saaty in 1980, is a
highly efficient instrument to address complex
decision-making that helps the individual/team behind
it establish priorities and choose the best option(s). By
decreasing the complexity of decisions to a range of
pairwise comparisons, followed by a synthetization of
the outcomes, AHP calibrates both the subjective and
objective facets of a decision. AHP involves five steps
[76]: development of the hierarchical structure; pairwise comparison; calculation of criteria weights; computation of option scores matrix; and ranking of the
options. The AHP model is a powerful and flexible
instrument because the score and, thus, the final prioritization, are achieved via the pair-wise assessment of
both the factors and the alternatives provided by the
user. The computations enabled by AHP are guided
by the decision-makers’ experience; from this perspective, AHP can reshape qualitative and quantitative
evaluations of the latter into a multi-criteria ranking.
56
D. ALRAHBI ET AL.
Table 3. Stakeholders’ view of motivators of technology adoption in the healthcare sector.
UAE citizens and residents
Employees
1
2
3
4
5
6
7
Online access
Smart technologies
Demand for speedy procedures
Financial status of society
Social awareness
Current infrastructure(information)
Support from insurance companies.
Leadership support
Culture
Support from teaching hospitals
Support for career development
2030 Vision
Current infrastructure(buildings)
High standards in hospitals
8
9
10
Organizational culture in hospitals
Demand for speedy procedures
Demand for quality services
11
Demand for error-free diagnosis
Current infrastructure(buildings)
Centralized/integrated access with
Emirates ID
Cost (to the individual/patient)
12
13
14
Media
Government support
Centralized medical logs
15
16
17
18
19
20
21
Trust
International trade
Social awareness
Geographical location of the UAE
Demand for speedy and error-free
diagnosis
Support from insurance companies
Demand for fewer medical errors
Life saving
Time saving
Nature of tasks
Government support
Furthermore, it is a simple technique because it does
not require a sophisticated system embedding the
decision-makers’ knowledge on the topic. Hence,
AHP facilitates the derivation of ratio scales from
paired comparisons, widely used by practitioners and
researchers due to its power and simplicity [77]. AHP
does not use or involve independent and dependent
variables; thus, there is no need for a moderator [52].
Phase 2 also corresponds to the second objective of
our study, namely the arrangement of identified factors
(in phase 1) into a hierarchical structure. The hierarchal structure of the resulting AHP model includes
the main criteria and sub-criteria of HIT motivators
mentioned by our respondents. As shown in Figure 2,
level 1, the highest level in the hierarchy, mirrors the
overall goal of the study, which is to discover the top
enablers of HIT adoption in UAE. Level 2 represents
the main criteria and level 3 reflects the group of
sub-factors relevant to the primary determinants in
level 2.
To build the research framework, we reduced the
initial set of identified technology adoption motivators
to 41 unique factors by removing commonalities. Based
on relevance, these 41 factors were grouped into seven
main motivator categories: government support; infrastructure; knowledge sharing; internal/external
environment; social sustainability; green management;
and lean management. We took the outcome of phase 1
and shared it with seven experts to obtain feedback and
ensure content validity; thus, interviews were conducted with five senior managers in the Health Authorities of both Abu Dhabi and Dubai, representing
the departments of Innovation and Information Technology and two academicians with many publications
in the same field.
Patients
Foresight experts
Social media
Government support
Competition
Current infrastructure
Medical legislations
2030 Vision
Demand for speedy
recovery
Trust
New happiness indicators
Social awareness
2030 Vision
Demand for fast diagnoses
Strategy for big-data adoption
Demand for less legal cases
Demand for global access
Demand for smart indicators
Demand for control over contagious
illness
New happiness indicators
Demand for error-free diagnoses
Being cost effective
Background in science and
technology
Easy transfer of knowledge
Demand for new technologies
Trust in new technologies
Demand for less medical errors
Existence of local medical schools
Government support
Demand for smart technologies
Current infrastructure
Cost (to the individual/patient)
Foresight
Prioritizing motivators of technology adoption in
the healthcare industry
Questionnaire development. Phase 2 was also intended
to calculate the weights of each identified HIT motivator (objective 4). In this sub-stage, we designed a survey
that used a pairwise matrix with a 1–9 scale as the datacollection instrument, consisting of 30 initial interviews with representatives of the same four groups of
healthcare stakeholders. The instrument included the
same group-customized demographics questions as in
phase 1.
Sample. Our sample included candidates from each
stakeholder category, who were invited to provide their
input on the subject (i.e. pairwise comparisons) for the
AHP analysis. The criteria for membership of each
group were the same as in phase 1.
The respondents were again selected through purposive sampling to ensure adequate discipline and
experience. Based on the years of expertise, experience
with healthcare sector services, and knowledge level of
each, they were considered experts in their field. The
sample size, reduced from 30 to 25 respondents,
although small, is acceptable from the AHP methodology perspective [78].
Data collection. The opinions and input on the subject matter of our respondents were collected through
in-depth interviews and their judgments were used to
establish the pairwise-comparison matrices in AHP.
As previously explained, to ensure the best outcome
and successfully address the subject, the priority for
selected motivators is crucial. The AHP method was
used to set relative importance weights to the seven
identified technology adoption motivators, as well as
their 41 sub-factors. The model provides a complete
and rational framework for structuring the motivators
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT
57
Figure 2. AHP model for prioritizing technology-adoption motivators.
of technology adoption, representing and quantifying
their sub-factors, relating those elements to the overall
goal, and assessing the different solutions.
All 25 experts were asked to evaluate the various
motivators of the AHP model by comparing them,
two motivators at a time, a technique called pairwise
comparison. This gave us the impact of the main criteria on the overall hierarchy.
The experts’ judgment was then used to identify the
factors’ relative meaning and importance. AHP converts these evaluations to numerical values (Saaty’s
1–9 scale) that can be processed and compared over
the entire range of criteria and sub-criteria. Therefore,
the questionnaire was developed using Saaty’s 1–9
scale, as shown in Table 4, and pairwise comparisons
of technology adoption motivators’ criteria and subcriteria were made by each of the 25 experts. For
example, if a respondent identified government support as moderately more important than infrastructure,
the former would be rated 3 and the latter 1/3. The
other criteria and sub-criteria were rated following a
similar approach. The numerical weights or priorities
were derived for each element of the hierarchy, allowing for diverse and often incommensurable elements to
be compared in a rational and consistent way.
Data analysis and AHP results. In line with Saaty
[76], the geometric-mean approach was preferred
over the arithmetic mean to combine the individual
pairwise-comparison judgments of the 25 experts
into the pairwise-comparison matrix. To verify the
consistency of the comparisons, a consistency index
(CI) was applied to each pairwise comparison matrix
(Saaty [75]). Then, the consistency ratio (CR) was
used to assess whether or not a matrix was sufficiently
consistent. Random pairwise comparisons were simulated to produce average random indices for different
sized matrices (see Table 5).
Based on the judgments made by the 25 stakeholder experts, a pairwise-comparison matrix of
the seven main categories of technology adoption
Table 4. Scale for AHP pairwise comparison.
Intensity of importance
1
3
5
7
9
2, 4, 6, 8
Definition
Explanation
Equal importance
Moderate importance
Strong importance
Very strong importance
Absolute importance
Intermediate values
Two criteria contribute equally to the objective
Judgment slightly favors one over another
Judgment strongly favors one over another
A criterion is strongly favored and its dominance is demonstrated in practice
Importance of one over another affirmed on the highest possible order
Used to represent compromise between the priorities listed above
58
D. ALRAHBI ET AL.
Table 5. Random index.
n
1
2
3
4
5
6
7
8
9
10
RI
0.00
0.00
0.58
0.90
1.12
1.24
1.32
1.41
1.45
1.48
Note: n is the number of factors.
Table 6. Geometric means of pair-wise comparison of main criteria.
Criteria
A
B
C
D
E
F
G
Priority vector
1. Government support
1.00
2. Infrastructure
0.31
3. Knowledge sharing
0.69
4. Internal/external environment
0.16
5. Social sustainability
0.32
6. Green management
0.71
7. Lean management
Note: CR value = 0.07 (
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