Understanding information exchange in healthcare operations: Evidence from hospitals and patients

• Published date: 01 May 2015
• Date: 01 May 2015
• DOI: http://doi.org/10.1016/j.jom.2014.12.003

Journal of Operations Management 36 (2015) 201–214

Contents lists available at ScienceDirect

Journal of Operations Management

journal homepage: www.elsevier.com/locate/jom

Understanding information exchange in healthcare operations:

Evidence from hospitals and patients

David D. Dobrzykowskia,∗, Monideepa Tarafdar b

aDepartment of Supply Chain Management and Marketing Sciences, Rutgers Business School – Newark and New Brunswick, Rutgers University, 1

Washington Park, Room 958, Newark, NJ 07102-3122, United States

bManagement Science Department, Lancaster University (Management School), Room A42, Lancaster LA1 4YX, UK

article info

Article history:

Received 15 July 2014

Received in revised form

23 December 2014

Accepted 30 December 2014

Available online 13 January 2015

Accepted by Daniel R Guide

Keywords:

Hospital operations

Health IT

Electronic Health Records

PACS

Physician employment

Coordination

Vertical integration

IT use

Social ties

abstract

Coordination – or the information exchange among physicians and hospital staff – is necessary for

desirable patient outcomes in healthcare delivery. However, coordination is difficult because health-

care delivery processes are information intensive, complex and require interactions of hospitals with

autonomous physicians working in multiple operational systems (i.e. multiple hospitals). We examine

how three important variables distinctive of the healthcare operations context – use of IT for dissem-

ination of test results (ITDR) (i.e. electronic health records systems) by physicians and hospital staff,

social interaction ties among them, and physician employment – influence information exchange and

patient perceptions of their care. Drawing from the literature on process inter-dependencies and coordi-

nation, vertical integration and social exchange, we develop and test research hypotheses linking ITDR,

social interaction ties and physician employment to information exchange relationship, and informa-

tion exchange relationship to provider–patient communication. Using a paired sample of primary survey

data and secondary archival data from CMS HCAHPS for 173 hospitals in the USA, we find that increased

information exchange relationship drives provider–patient communication, and increased social interac-

tion ties drives information exchange relationship. Social interaction ties fully mediates the relationship

between ITDR and information exchange relationship. Physician employment amplifies the link between

ITDR and social interaction ties, but does not have an effect on the link between ITDR and information

exchange. We do not find a direct relationship between ITDR, and information exchange relationship or

provider–patient communication.

Published by Elsevier B.V.

1. Introduction

Healthcare is delivered to hospitalized patients by providers

such as physicians, nurses, and other clinicians. Coordination, or

the information exchange relationship among providers in health-

care delivery, is necessary to achieve desirable patient outcomes

(Boyer and Pronovost, 2010). Drawing on the operations and infor-

mation systems (IS) literature, information exchange relationship

is defined as accurate, timely, adequate, and credible information

interchange among those involved in a particular process (Lee,

1997; Metters, 1997; Li et al., 2005). Unfortunately, however, coor-

dination is challenging given inherent difficulties in synchronizing

operationalactivities and information in hospitals (Nembhard et al.,

∗Corresponding author. Tel.: 1 973 353 5186.

E-mail addresses: ddobrzykowski@business.rutgers.edu (D.D. Dobrzykowski),

m.tarafdar@lancaster.ac.uk (M. Tarafdar).

2009). Anecdotal patient accounts tellingly support and capture

this challenge.

“The caregivers didn’t appear to be talking to one another.” This

is how retired internist Marsha Wallace described her recent

inpatient hospital stay in Kaiser Health News. “Although hos-

pitals, the federal government, nonprofit groups and insurers

want to improve the system, efforts to boost coordination and

teamwork still have a long way to go” (Rabin, 2013).

“Without coordination, a patient can languish for weeks from

one step to the next while her tumor grows and the illness pro-

gresses. Without integrated care, critical information is easily

lost and treatment delayed or misdirected. Or, as happened to

D’Agostino [a breast cancer patient], specialists offer complex

and sometimes contradictory information to the patient who

sorts it out alone” (Toussaint, 2012).

Physicians have substantial influence on hospital operations and

the services delivered to patients (Ilie et al., 2009). Therefore it

http://dx.doi.org/10.1016/j.jom.2014.12.003

0272-6963/Published by Elsevier B.V.