26th International Association for Management of Technology Conference - IAMOT 2017

The economic and social importance of technology used in industrial operations and services requires the process of choice of technology to be done carefully. In the health area - as it is indicated by frequent OECD reports, the US government and private companies that provide health services - the concern of public and private managers with the quality and costs of services provided to patients is increasingly evident. The literature in the area of industrial operations suggests that technological choice has to meet criteria that go beyond the simple maximization of economic returns. Such choice is influenced by environmental, organizational and individual factors. Many variables can impact the various stages of this process, as for example, acquisition and maintenance costs, efficiency of the production process and brand improvement. In the service area, however, and particularly in the medical and hospital sector, technology choice has been little studied. In previous work we proposed a theoretical model of choice of technology in healthcare organizations. The model includes the analysis of the various stages of the selection process, as well as the different factors that seem to influence decisions at each stage. The next step would be to evaluate if such model could represent well the Brazilian reality. As such, the objective of the present study is to evaluate the adequacy of this theoretical model in Brazilian hospitals. Given the large variety of technologies used in hospitals, we decided to focus on only one type of digital innovation: the Electronic Health Record (EHR). The EHR provides several improvements in the routine of a hospital, not only from the point of view of management but also in the exercise of medical activity. It's possible to have a better grasp of costs, profits and losses as well as to provide a better monitoring of material and human resources used. It can also increase the quality of the doctor-patient relationship, focusing on the humanization of care, increased attention paid to patient safety and the information gathered. To this end, in depth interviews were conducted with hospital administrators, doctors, nurses and technicians in 6 Brazilian hospitals. Previous conversations with specialists indicated that our case studies should be conducted with three pairs of hospitals according to the degree of implementation of EHR: two hospitals at an advanced stage, two at an intermediate stage and two with incipient implementation. Results indicate that although our model seems to represent well the process of choice of technology in the health area, (i) there are some stages that receive little formal attention from hospitals (needs analysis, alternative analysis); and (ii) there are some factors (notably, medical culture and culture of other health professionals) that have such a strong impact on this process that can lead to inappropriate choices or prevent the achievement of the full potential of the innovation. We suggest that there is a need for significant cultural change as well as for the implementation of a more structured process of choice (as initially proposed by us). Our next steps will include (i) a survey study to evaluate propositions obtained in the analysis of the present cases; and (ii) comparative studies with hospitals in different stages of adoption of EHR, trying to relate the degree of adoption with results associated with quality of care and hospital costs.