| Abstract |
Introduction: The benefits of the introduction and implementation of Information and Communication Technologies, and particularly of Hospital Information System (HIS) in the healthcare are undisputed, both in terms of economy and quality of services rendered. These benefits are not restricted to the final users of the HIS, but are also carried down to the citizens, who enjoy better health services. However, the use of these systems has only recently been introduced in Greece, and the 7th Health District of Crete was a pioneer in adopting such tools (Integrated Hospital Information System was completely installed by the year of 2007).
Despite the advantages of the Hospital Information Systems (HIS), resistance to their use by the healthcare employees (the final users of the HIS) worldwide is common, creating the imperative need of determining the behavior and the opinions of the personnel, in order to plan all necessary interventions so that the acceptance –and therefore the usage- of the system is bigger.
Objective: The initial objective of this study is to create the appropriate research tool in order to estimate the degree of acceptance and the opinion of the final users of the HIS, with whatever designing such tool from the beginning means (measurement of its reliability and validity). Following this first step, the study intends to examine the attitude of the employees in the public hospitals of the 7th Health District towards the IHIS as well as towards
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the previous system, and also evaluate the employees’ personal perception of the IHIS as a work tool. All employees (Administrative, Medical, Nursing and Technical Departments) at the University General Hospital of Heraklion and the Venizelion General Hospital of Heraklion, Crete, are considered the final users of the system.
Methodology: The cross-sectional research method was chosen for this study. The questionnaire used consisted of closed-end questions and a five-grade scale of equal intervals. It included 32 variables, distributed in three sections, as follows: acceptance of the IHIS, comparative acceptance of the previous system, evaluation of the IHIS features. In order to ensure the questionnaire’s reliability, the Cronbach’s Alpha index was used. In addition, the value of the test-retest reliability coefficient was estimated during both the pilot and the final implementation of the questionnaire. To ensure the validity of the questionnaire, it was checked by five independent researchers with proven knowledge on the topic and then an exploratory factor analysis was implemented, using the method of Principal Components Analysis. In order to detect possible common method error, the Harman Single Factor test was applied. The descriptive measures used were the mean value and the standard deviation. The Pearson coefficient was calculated for estimating the correlations. The analysis of variation of the subgroups created by the demographic characteristics, the t-test and the anova analysis were applied, whereas the post-hoc test was made with the LSD method.
Results: During the pilot implementation, the questionnaire was given to 20 individuals. After collecting the initial results, it was distributed to a sample of 240 people; 140 questionnaires were returned, of which 135 were finally used. The reliability values produced by the test-retest method were found between 0.5 and 1.0. The Cronbach’s Alpha coefficient of internal consistency during the pilot implementation was estimated between 0.743 and 0.946, whereas at the final implementation, between 0.759 and 0.936. The results of the exploratory factor analysis, after varimax rotation, suggested seven factors which account for 68.12% of the total variance. The structure of these factors was not different to that of the questionnaire, thus not questioning its structure. The bias due to the common method of data
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gathering was estimated at 31.096% during the Harman Single Factor test. From the final sample (n=135), 44 of the participants were working at the Administrative department (32.6%), 37 were working at the Medical department (27.4%), 45 at the Nursing department (33.3%) and 9 at the Technical department (6.7%).
- The answers concerning the acceptance of the CIHS were estimated between 2.80 (1.33) and 4.50 (0.86), which is translated from “barely” to “very much”. In the majority, however, they were found to be average.
- The answers regarding the comparative acceptance of the previous system were estimated between 1.58 (0.98) and 2.00 (1.31).
- The answers regarding the characteristics of the CIHS were estimated between 2.70 (1.27) and 3.60 (1.01).
As far as the correlations are concerned, they were found statistically significant, for example the correlation of the questions “the IHIS is necessary for performing my duties” and “I regularly use the IHIS during an ordinary work day” (r=0.67). Other statistically significant correlations are those concerning “Good knowledge of the IHIS” and “Adequate training in the use of the IHIS” (r=0.41). The same applies for the variable “better patients’ service”, with r>0.40, and for other features of the IHIS, such as time-saving, programming, work direction and satisfying operation of the system.
During the analysis of variation, no statistically significant differentiations were recorded depending on the hospital where the participants were working or the variables that are related to the acceptance of the previous system and the demographic features. The variation analysis of the department where the participants belong showed that the Medical department is grading lower and statistically significantly all the variables concerning the characteristics of the IHIS and appear at the anova test.
Conclusions: The attitude of the staff towards the IHIS can be described as average, leaving wide margins for interventions, mainly as far as the training on the use of the system is concerned. As far as the previous system is concerned, the employees did not seem willing to return to it. The
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characteristics of the IHIS were given medium grades, which indicates either insufficient training or incomplete development of the IHIS applications.
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Στάση και απόψεις του προσωπικού των δημόσιων νοσοκομείων της 7ης ΥΠε ως προς τη χρήση και υιοθέτηση του ολοκληρωμένου πληροφοριακού συστήματος υγείας
