Organizational Learning and Culture in the Managerial Implementation of Clinical e-Health Systems: An International Perspective

Abstract

When introducing a new technology that changes the core processes of an organization, such as an e-health initiative, it is important that the structural design and culture of the organization is aligned with the predominant national culture in which the organization is embedded. When a harmonious alignment is achieved, speedy and effective organizational learning can occur. This, in turn, promotes effective utilization of the new technology. The cultural dimension of uncertainty avoidance provides guidance on the type of organizational culture and structure to establish. Our research in five countries supports the believe that in national cultures in which high uncertainty avoidance is predominant, such as France, a highly mechanistic organization is favored; in cultures in which a low uncertainty avoidance dominates, such as the USA, a more organic organizational form should increase the probability of success in promoting effective organizational learning and thereby successfully implementing an ehealth strategic intent. The ProblemOrganizational culture is recognized as a key component of knowledge management and organizational learning [36]. However, organizational culture is significantly influenced by national culture [49]. Further, for organizational culture to function effectively as a managerial control mechanism, the organizational culture and the formal organizational structure must be harmoniously interrelated [90]. Thus, the structure and culture of an organization must be aligned with the demands and predispositions of the environment in which the organizations operates [57]; noting that a significant aspect of that environment is the national culture in which the organization is embedded [49].Modern health care organizations are confronted with a steady stream of new clinical e-health technologies. Many of these technologies have significantly enhanced the quality of clinical practice, and some of these technologies have also offered the potential of increasing access and/or reducing the overall societal costs of healthcare [22] [2]. Early evidence suggests great difficulty in the implementing some of these new technological advances in the U.S.A. [18]. Telemedicine is a good example of this problem. Bashshur [22] discusses how the second generation of telemedicine has the requisite technology, but faces such uncertainties as lack of long-term sustainability plans, lack of mature programs that can be the basis of definitive cost-benefit analyses, and limited acceptance of telemedicine by health providers and health administrators. Originally conceived as a two-way video conference between a primary care provider and patient at one end, and a specialist at the other end, telemedicine has evolved into a clinical information technology sub-system in which multi-media email and web-based applications as well as real-time consultation transfer of precise and detailed clinical patient information between health-care providers, and sometime between the patients as well. This result holds the potential fo...

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