医疗信息系统使用行为管理:事前、事中还是事后控制?  

Managing healthcare information system use:Input,process or output control?

作　　者：徐瑀婧 童昱 廖少毅[3] 周广全[4] XU Yujing;TONG Yu;LIAO Stephen Shaoyi;ZHOU Guangquan(School of Management,Zhejiang University of Technology,Hangzhou 310023,China;School of Management,Zhejiang University,Hangzhou 310058,China;Department of Information Systems,City University of Hong Kong,Hong Kong,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]浙江工业大学管理学院,浙江杭州310023 [2]浙江大学管理学院,浙江杭州310058 [3]香港城市大学资讯系统系,中国香港特别行政区 [4]广州中医药大学第一附属医院,广东广州510405

出　　处：《管理工程学报》2021年第3期89-98,共10页Journal of Industrial Engineering and Engineering Management

基　　金：浙江省自然科学基金探索项目Q(LQ20G010011);浙江省“钱江人才计划”C类(QJC1902009);浙江工业大学2019年度校人文社科研究基金(GZ19491320005);浙江省属基本科研业务费专项;浙江大学文科教师教学科研发展专项资金资助

摘　　要：由于医院工作流程的复杂性及突发性,医生在完成病区的工作时可能会不完全按照系统预设的方式直接操作医疗信息系统(Health IS),而是采用间接使用的方式完成系统相关工作。间接使用行为指系统既定的用户(例如医生)不亲自使用系统,而是通过中间用户(例如实习生或者其他医生)代为操作系统来完成系统相关工作。尽管间接使用行为在医院场景中普遍存在,现有研究对于这种行为如何影响医生工作绩效的解释还十分有限。为了解决这个问题,本研究首先提出了直接和间接使用行为对于临床治疗服务质量和医患沟通服务质量的不同影响作用;接着,基于代理理论和组织控制相关文献,探索了三种控制机制(即事前控制,事中控制和事后控制)对于医生直接和间接使用行为影响的调节作用。本研究通过对某三级甲等医院242位医生的实地调研验证了所提出的研究假设。结果显示,医生直接系统使用行为能够提升医疗服务质量,而间接系统使用行为对于医疗服务质量有双向的影响,所提出的三种控制机制对于系统使用行为影响的调节作用各不相同。其中,事后控制不仅提高了直接和间接使用行为对临床治疗服务质量的正向影响,还抑制了间接使用行为对医患者沟通服务质量的负向影响。因此,本文提出事后控制是医生实施间接使用时最合适的控制机制。With the promise of improving quality of care,hospitals worldwide have made substantial investments to embrace Health IS.Despite the wide adoption of Health IS,prior literature has reported a significant discrepancy between how the system is expected to be used and how it is actually used by the designated users.In hospitals,not all designated system users(i.e.,principal physicians)employ the system by themselves.Many of them are found to delegate system-related tasks to other people(i.e.,agent physicians)when employing the Health IS to accomplish hospital tasks.We term this behavior indirect system use.Despite the prevalence of indirect system use,extant literature typically focuses on direct system use(i.e.,system users personally employ a system to accomplish work).The understanding of indirect system use impacts is limited.Without direct interaction,indirect system use can free users from their heavy workload,and that may improve both the efficiency and the quality of care.However,the literature on agency theory alerts that the agent physicians who actually perform system-related tasks may depart from the expectation of principal physicians because of the information asymmetry and goal conflict between these two parties.With the seemingly contradictory results,theoretically understanding and comparing the impacts of direct and indirect system use are crucial.This study hence aims to address the research questions:What are the performance impacts of the physicians′direct use and indirect use?What mechanisms can be employed by hospital managers to induce the desirable performance outcomes for the two types of system use?Based on control theory,IS-use literature,and healthcare practice,this study proposes a theoretical research model to address the identified research questions.With the trend of delivering patient-centered services,hospitals have greatly emphasized the clinical care quality that physicians provide to patients and the relationship between physicians and their patients.Thus,we examine two forms

关 键 词：医疗信息系统 直接使用行为 间接使用行为 医生工作绩效 控制机制 

分 类 号：C931.6[经济管理—管理学]