Managing Information Technology Extreme Events in Healthcare Organizations: An Investigation of Individual Resilience, Performance, and Information Assurance.

다국어 초록 (Multilingual Abstract)

Extreme events can cause devastating effects in hospitals because they threaten the lives of both patients and the hospital staff responsible for providing care. According to the Department of Homeland Security, hospitals are critical infrastructures and are required to remain fully functional during and after an extreme event. Growing evidence shows that an organization's ability to sustain the continuity of critical services is highly driven by the employees' reactions and responses to the disturbance (Lengnick-Hall, Beck, & Lengnick-Hall, 2011; Youssef & Luthans, 2007). Individual resilience, which is an aspect of psychological well-being, and effective performance of healthcare related activities after an extreme event, is of paramount importance to patient safety and to the overall performance of the organization. The objective of this dissertation is twofold: First, to investigate the critical factors that influence an individual's level of resilience after an extreme event. A high capacity for resilience allows healthcare workers to positively and quickly adapt to uncertainties in the workplace. Second, to examine perceived individual performance quality, and compliance behavior as it relates to information security and privacy policies. In healthcare organizations, information security and privacy policies are important because they ensure that healthcare workers protect the security and privacy of patients' health information, thereby limiting the potential risks associated with accidental exposure of sensitive patient data. These two objectives are studied in two essays.
The first essay took a comprehensive approach to empirically investigate the organizational, technical, and psychological factors that influence individual resilience after an extreme event. In essay 1, the Job Demands and Resources theoretical framework was used to create a conceptual model of individual resilience. Survey data was used to empirically test the hypothesized relationships in the model. Specifically, it was hypothesized that Incident Command Leadership (ICL), perceived emotional support by the Information Technology (IT) department, information access, information privacy controls, and perceived job meaningfulness had a positive association with individual resilience. Perceived systems risk was hypothesized to have a negative effect on individual resilience. The impact of systems risk was not supported. All other hypotheses were statistically significant.
The second study investigated the direct influence of individual empowerment on perceived individual performance quality, and compliance with Information Security and Privacy Policies (ISPP). Also, the intervening role of individual resilience was studied. It was hypothesized that an individual's perceived level of empowerment had a direct positive effect on the individual's perceived performance quality, and policy compliance intentions. It was also hypothesized that there were indirect positive relationships through individual resilience. Using survey data, the hypothesized model was quantitatively tested. All hypotheses were supported.
This research has several contributions as follows. It shows that in healthcare organizations, perceptions of systems risk do not seem to affect an individual's psychological ability to adapt during adversity. This suggests that after an extreme event, the priority of healthcare workers is on the patient rather than systems, making concerns about the information systems secondary. This argument is further supported by the fact that the effect of information privacy controls was small (even though it was statistically significant); after an extreme event, healthcare workers may be more focused on the patient's physiological needs rather than on the need to preserve privacy. This study also sheds light on the importance of interpersonal skills of the IT staff. In particular, it was found that emotional support provided by the IT department staff can be essential to increasing hospital staff's resiliency. IT support has been traditionally studied in the context of tangible technical support. While tangible technical support such as the physical repair and maintenance on computers and systems is crucial especially in today's IT-driven workplace, we find in our study that non-technical, soft skills, namely, the ability to provide emotional support and assurance, is also critical in improving an employee's ability for adaptive capacity during unstable working conditions. The contributions of the second essay relate to the role of individual empowerment in improving individual performance and compliance behavior. Individual empowerment was used in this research to refer to perceptions relating to competence, meaning, impact, and self-determination in the workplace (Spreitzer, 1995). This research extends the existing literature on empowerment by showing that even amidst chaotic working environments in service organizations such as hospitals, empowered employees are motivated to perform well. In addition, the results inform managers of the need to address performance behavior from the viewpoint of compliance with ISPP. An extended analysis of the influence of each empowerment factor, namely, competence in task completion, one's level of impact within the organization, self-determination, and meaning, revealed some variations in how performance quality and ISPP compliance intentions were affected. (Abstract shortened by UMI.).