Digitally-mediated coordination in healthcare: the effects of teleconsultation on doctor-to-doctor relational coordination.

BACKGROUND: Digitalization transforms the way in which interdependent work is coordinated, especially in healthcare settings. This work deepens the effect of teleconsultation use on health professionals' coordination. For this aim, we rely on Relational Coordination Theory (RCT), which explores coordination as an interactive process among group participants within the context of task interdependency. METHODS: We collected data through an online survey administered to Italian specialist doctors between March and April 2023. 489 complete answers were gathered. Hypotheses have been tested through Structural Equation Modelling. RESULTS: We found that teleconsultation frequency of use has a positive and significant effect on both components of relational coordination, confirming our hypotheses. CONCLUSIONS: Theoretically, this research contributes to our understanding of the effect of digitally mediated coordination mechanisms on relational coordination. In practice, we shed light on the organizational implications of telemedicine under a novel perspective, focusing on the role of professional interactions in digitally mediated work and providing useful elements for the organizational design of telemedicine.

Use of a maturity model for facilitating the introduction of CAR T-cell therapy-Results of the START CAR-T project.

Introduction: Chimeric antigen receptor (CAR) T-cell therapies are novel immunotherapies for the treatment of hematologic malignancies. They are administered in specialized centers by a multidisciplinary team and require the careful coordination of all steps involved in manufacturing and using cellular therapies. The Maturity Model (MM) is a tool developed and used for assessing the effectiveness of a variety of activities. In healthcare, it may assist clinicians in the gradual improvement of patient management with CAR T-cell therapy and other complex treatments. Methods: The START CAR-T project was initiated to investigate the potential of a MM in the setting of CAR T-cell therapy. Four Italian clinics participated in the creation of a dedicated MM. Following the development and test of this MM, its validity and generalizability were further tested with a questionnaire submitted to 18 Italian centers. Results: The START CAR-T MM assessed the maturity level of clinical sites, with a focus on organization, process, and digital support. For each area, the model defined four maturity steps, and indicated the actions required to evolve from a basic to an advanced status. The application of the MM to 18 clinical sites provided a description of the maturity level of Italian centers with regard to the introduction of CAR T-cell therapy. Conclusion: The START CAR-T MM appears to be a useful and widely applicable tool. It may help centers optimize many aspects of CAR T-cell therapy and improve patient access to this novel treatment option.

Electronic Medical Records implementation in hospital: An empirical investigation of individual and organizational determinants.

The implementation of hospital-wide Electronic Medical Records (EMRs) is still an unsolved quest for many hospital managers. EMRs have long been considered a key factor for improving healthcare quality and safety, reducing adverse events for patients, decreasing costs, optimizing processes, improving clinical research and obtaining best clinical performances. However, hospitals continue to experience resistance from professionals to accepting EMRs. This study combines institutional and individual factors to explain which determinants can trigger or inhibit the EMRs implementation in hospitals, and which variables managers can exploit to guide professionals' behaviours. Data have been collected through a survey administered to physicians and nurses in an Italian University Hospital in Rome. A total of 114 high-quality responses had been received. Results show that both, physicians and nurses, expect many benefits from the use of EMRs. In particular, it is believed that the EMRs will have a positive impact on quality, efficiency and effectiveness of care; handover communication between healthcare workers; teaching, tutoring and research activities; greater control of your own business. Moreover, data show an interplay between individual and institutional determinants: normative factors directly affect perceived usefulness (C = 0.30 **), perceived ease of use (C = 0.26 **) and intention to use EMRs (C = 0.33 **), regulative factors affect the intention to use EMRs (C = -0.21 **), and perceived usefulness directly affect the intention to use EMRs (C = 0.33 **). The analysis carried out shows that the key determinants of the intention to use EMRs are the normative ones (peer influence) and the individual ones (perceived usefulness), and that perceived usefulness works also as a mediator between normative factors and intention to use EMRs. Therefore, Management can leverage on power users to motivate, generate and manage change.

What drives hospital wards' ambidexterity: Insights on the determinants of exploration and exploitation.

OBJECTIVES: Hospital wards are required to exploit current knowledge and explore for new knowledge. Ambidexterity (i.e., the capability to combine both exploitation and exploration) is a major issue in healthcare as result of the growing expectations that hospitals wards have the capability to manage the trade-off between high-quality delivery of care and cost-containment. This study sheds novel light on the determinants of ambidextrous behaviours in hospital wards. METHODS: A theoretical framework has been built on the extant literature. The main determinants of ambidexterity are opening/closing leadership, organisational support, organisational creativity and environmental dynamism. The model has been tested empirically through data collected via survey administered to head physicians in charge of hospital wards. After the quality check, 80 questionnaires were available for the statistical analysis based on a hierarchical sequential linear regression model (with enter methodology). RESULTS: Results showed that opening (ß = 0.389;p < 0.001) and closing (ß = 0.288;p < 0.01) leadership, as well as organisational creativity (ß = 0.499 p < 0.001) are necessary to materialize ambidextrous behaviours (Adj.R²â€¯= 0.529). Environmental dynamism does not moderate these relationships. While opening leadership (ß = 0.375;p < 0.01), organisational creativity (ß = 0.270;p < 0.05) and environmental dynamism (ß = 0.224;p < 0.1) are determinants of exploration, closing leadership (ß = 0.506;p < 0.001) and organisational creativity (ß = 0.529;p < 0.001) are determinants of exploitation. CONCLUSIONS: Head physicians' leadership style as well as organizational creativity play a pivotal role in materializing ambidextrous behaviours in wards.

WhatsApp in hospital? An empirical investigation of individual and organizational determinants to use.

The increasing use of messaging applications such as WhatsApp for both social and personal purposes has determined an increase in the widespread use of these technologies, even in healthcare. A growing number of healthcare professionals have adopted WhatsApp in their daily work in order to share information with peers and patients. Past research has highlighted the advantages and disadvantages of WhatsApp usage in healthcare settings; in particular two positions appear to coexist in the scientific debate: those that expose and underline all of the positive aspects of the phenomenon, and those which also highlight the negative aspects, linked in particular to the clinical risks for patients, data security and privacy protection. The main objective of this study was to assess if and how individual and organizational determinants can trigger or inhibit the use of WhatsApp in a hospital setting, and which variables managers can exploit to guide professionals' behaviors. Data were collected through a survey administered to physicians and nurses in an Italian University Hospital in Rome; a total of 191 high-quality responses were received. The results show that WhatsApp is widely used in the Hospital, and that its use is mainly due to the perception of numerous advantages and benefits reported in clinical practice. Moreover, an interplay exists between organizational and individual factors in determining the use of WhatsApp between healthcare professionals and with patients. In particular, individual factors play a key role as determinants of the use of WhatsApp; healthcare professionals use this technology mainly based on its perceived usefulness. Instead, organizational factors play a secondary role; they do not have a direct influence on the use of WhatsApp, but always act through individual factors. This study is the first to analyses the influence of individual and organizational determinants of WhatsApp usage in the hospital setting, and provides hospital managers with important information in order to manage this phenomenon and implement adequate strategies to exploit its potential increase.

The role of radiation therapy in vulvar cancer: review of the current literature.

The purpose of this article is to discuss the current role of radiation therapy in vulvar cancer and especially to review the recent literature relative to the use of intensity-modulated radiotherapy (IMRT) in disease management. Owing to the low incidence of vulvar cancer, at present there are no available results of cooperative prospective trials. As evidenced in dosimetric and preliminary retrospective clinical studies, the use of IMRT has resulted in superior normal tissue sparing and lower rates of acute and chronic toxicities compared to previous studies that used conventional approaches. Data on long-term outcomes in these patients remain limited.

Mapping ICT access and disability in the workplace: An empirical study in Italy.

BACKGROUND: It is well known that the Information and Communication Technologies (ICT) are important to assist people with disability in the workplace. OBJECTIVE: In this context, this paper sheds light on the state of ICT accessibility for Italian employees with disabilities in private sector companies by mapping and critically analyzing the assistive role of ICT. METHODS: To do this, empirical evidence was drawn from a multi-methods research with middle and top managers from 97 medium and large Italian companies. Quantitative data was collected using a survey was directed at personnel identified as Human Resource (HR) and Information System (IS) managers, followed by a qualitative study with selected firms whose aim was to understand the inner workings of assistive technology and the decision making process related to assistive technology acquisition and use. RESULTS: The main results show the role and the integration level of people with disabilities, and the presence and effectiveness of specific assistive technologies. DISCUSSION: Ways to improve the inclusion of people with disability in the workplace, as well as the use of assistive technologies are discussed. CONCLUSION: ICT could be more disseminated within companies and best used with modifications to improve usability.

The evolution of hospital information systems and the role of electronic patient records: from the Italian scenario to a real case.

Health care organizations can gain great value from Information and Communication Technologies (ICT), yet, although there is growing awareness of the potential benefits associated with their use, results often fall far short of expectations. Each year, the "ICT in Health Care" Observatory--part of the Politecnico di Milano School of Management--outlines a profile of the role of ICT in the Italian health care industry, investigating current projects in terms of their impact on processes and organizations, implementation state of the art, governance models, and prospective pathways. The 2009 collaborative research process outlines the need for a change in the way health care CIOs approach technological and organizational evolutions. ICT departments lack vision, governance mechanisms, skilled resources, and top management commitment. This has led to a series of distortions in the innovation of Hospital Information Systems (HISs) and ICT departments themselves. Currently they are too concerned with day-to-day operations and delay comprehensive initiatives capable of leading to effective ICT-driven innovations. The paper points out the problems that health care organizations are tackling and how they are trying to solve them. The case of the Italian National Cancer Institute in Milan provides a valuable example of how a health care organization is developing its HIS.