Requests for a coordinated response during the COVID-19 pandemic revealed the limitations of locally-operating public health agencies (PHAs) and have resulted in a growing interest in their digitalization. However, digitalizing PHAs – i.e., transforming them technically and organizationally – toward the needs of both employees and citizens is challenging, especially in federally-managed local government settings. This paper reports on a project that develops and evaluates a continuous (vs. a staged) maturity model, the PHAMM, for digitalizing PHAs as a cornerstone of a digitally resilient public health system in the future. The model supports a coordinated approach to formulating a vision and structuring the steps toward it, engaging employees along the transformation journey necessary for a federally-managed field. Further, it is now being used to allocate substantial national funds to foster digitalization. By developing the model in a coordinated approach and using it for distributing federal resources, this work expands the potential usage cases for maturity models. The authors conclude with lessons learned and discuss how the model can incentivize local digitalization in federal fields.
Die Gesundheitsversorgung in Deutschland ist insgesamt nicht durch Unterversorgung bedroht. Vielmehr ist die Versorgung durch Disparitäten in der regional ungleichen Verteilung der Ressourcen geprägt. Im ambulanten Sektor kommt es daher aufgrund von Fachkräftemangel zu Unterversorgung ländlicher Gebiete bei einer gleichzeitigen Erhöhung des Versorgungsbedarfs der Bevölkerung in ländlich geprägten Regionen. Als eine Option zur Überwindung der Versorgungslücken können Versorgungskonzepte auf Basis von telemedizinischen Anwendungen dienen. Diese Anwendungen müssen, um die Bedürfnisse aller Beteiligten Parteien mit einbeziehen und effizient eingesetzt werden zu können, durch nutzerzentrierte Innovationsansätze gestaltet und umgesetzt werden. Ein vielversprechender Ansatz hierzu ist die aus der Softwareentwicklung stammende Scrum-Methode. Scrum wurde bei der Umsetzung des telemedizinischen Versorgungsansatzes "Gesundheitsversorgung 4.0", welches von Bayerischen Gesundheitsministerium gefördert wurde, eingesetzt. Das Versorgungskonzept "Gesundheitsversorgung 4.0" soll der Berücksichtigung der Bedürfnisse älterer Patienten, auch in stationären Pflegeeinrichtungen, dienen.
The use of digital technology in the healthcare sector, and in hospitals in particular, has an impact on daily routine and on the quality of patient care. In dynamic organizations like hospitals, where urgent needs have to be met, employees develop workarounds for different reasons, which in turn can have a negative impact on the quality of patient care. While the existing literature focuses mainly on the consequences of IT mismatch to work practices in hospitals and classifications thereof, a holistic understanding of the underlying reasons for workers' deviating behavior is missing. This article begins to close this research gap with a systematic literature review on antecedents of workarounds. The structured analysis provides a valuable contribution for both research and practice, as measuring root causes for behavior enables organizations to understand and develop control mechanisms.
As healthcare demands exceed outpatient physicians’ capacities, telemedicine holds far-reaching potential for both physicians and patients. It is crucial to holistically analyze physicians’ acceptance of telemedical applications, such as online consultation. This study seeks to identify supporting and constraining factors that influence outpatient physicians’ acceptance of telemedicine. We develop a model based on the unified theory of acceptance and use of technology (UTAUT). To empirically examine our research model, we conducted a survey among German physicians (n = 127) in 2018–2019. We used the partial least squares (PLS) modeling approach to test our model, including a mediation analysis. The results indicate that performance expectancy (β = .397, P < .001), effort expectancy (β = .134, P = .03), and social influence (β = .337, P < .001) strongly impact on the intention to conduct online consultations and explain 55% of its variance. Structural conditions regarding data security comprise a key antecedent, associating with performance expectancy (β = .193, P < .001) and effort expectancy (β = .295, P < .001). Regarding potential barriers to usage intentions, we find that IT anxiety predicts performance (β=–.342, P < .001) and effort expectancy (β=–.364, P < .001), while performance expectancy fully mediates (βdirect = .022, P = .71; βindirect=-.138, P < .001) the direct relationship between IT anxiety and the intention to use telemedical applications. This research provides explanations for physicians’ behavioral intention to use online consultation, underlining UTAUT’s applicability in healthcare contexts. Performance expectancy, effort expectancy, and social influence are the main drivers of the intention to use online consultations. Further, we identify IT anxiety and the importance of data security as significant antecedents that should be addressed by practitioners (e.g., in telemedical implementation projects) and by further research.
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