CHAPTER 3: DEVELOPMENT OF RESEARCH FRAMEWORK 3.1 Research Framework
According to the service blueprinting of service innovation (Kingman, 1989; W.P.
Carey, 2008) and the four communication types within intra-organizations (Stephen and Arnold, 1997), we have identified the research framework shown in Figure 3-1.
Derived from the service blueprinting model, our research framework aims to examine the relationship between support processes and employee service quality. We argue that various communication types will impact the relationship between support processes and employee service quality. The details about this framework and
According to service blueprint (Kingman, 1989; W.P. Carey, 2008), support processes refer to processes that help a service to achieve goals. In our research, we have separated support processes into two categories, IT support and training support.
3.2.1 IT Support Process
IT can be widely applied to support e-Health service delivery. It can allow patients to measure their own body health index, assist doctors in diagnosing patient conditions, and help healthcare staff to store patient records more conveniently. Though there are currently nine types of IT support for service industries (Thomas 1992), Celler et al.
(2003) have found that IT is increasingly being used to manage chronic illnesses and help nurses in telemedicine videophone consultations that use home telecare systems.
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Bates (2000) has found that using IT in hospitals has helped to prevent many common medical errors; applications such as using robots to fill prescriptions, bar coding, and computerization of the medical administration records have already helped to reduce error rates.
Unquestionably, IT systems play a vital role in our research. Healthcare staff use them to store and analyze patient records, to track patient conditions, and more—functions which, as a result of IT, have increased service quality. Therefore, we propose that healthcare staff with good IT support processes will have high service quality. Thus, we develop the hypothesis H1:
H1: The healthcare staff with good IT support processes will have high service quality of patient care. Summers et al. (1997) have pointed out that employees should receive KSA-oriented training programs. Because e-Health is still relatively new in hospitals, it is important for hospital management to provide specialized training programs in e-Health related knowledge, disease diagnosis, healthcare consulting skills, and so on. Additionally, Puntis et al. (1991) found that an intensive staff training program implemented at a hospital led to a significant reduction of the catheter sepsis rate.
In our research study,, healthcare staff would enhance their knowledge, abilities, and skills relating to e-Health via different training programs. Hence, with adequate training support, healthcare staff would provide more professional service and improved non-IT related service quality. Thus, we propose hypothesis H2:
H2: The healthcare staff with adequate training support will provide improved non-IT related service quality.
3.3 Communication
Herbert (1947) has stated that clear communication is absolutely essential to the success of an organization. Stephen et al. (1997) has also pointed out that via communication, we can eliminate misunderstandings and improve organizational performance. Organizational communication research has therefore often been construed in terms of an information exchange cluster, one that involves information, networks, uncertainty, messages, load, and (more recently) technology (Conrad and Haynes, 2001). Therefore in our research framework, we have integrated communication into e-Health service delivery in order to highlight the importance of communication on the quality of employee service. In the following section, we will
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discuss the four communication flows in intra-organization, as researched by Stephen and Arnold (1997).
3.3.1 Diagonal Communication
Previously, we defined diagonal communication as the sharing of information between people who are in different departments or units (Eleanor and Philip, 2007).
In terms of e-Health, this refers to the communication between the healthcare and IT staffs. Although IT can help improve the efficiency and convenience of service processes, it can also be a hindrance when healthcare staffs don‘t know how to use the systems. In this situation, communication between the healthcare and IT staff is especially important, so that service quality will not be diminished. Healthcare staff should consult with IT personnel what problem they may have and how to fix them;
in this manner, issues relating to the inadequacy of the equipment may be avoided.
Since the healthcare IT staffs are not in the same department, diagonal communication is necessary to solve work-related problems (Wilson, 1992). IT staff could help healthcare staff understand how to use certain measuring tools or other e-Health related devices; any problem the healthcare staff may have, they could consult with the IT department In summary, healthcare staffs that have good communication with their IT support staff will be better off than without their help.
Furthermore, this communication would contribute to higher levels of employee service quality. Thus, we develop the hypothesis H3a:
H3a: When there is good communication between the healthcare and IT staffs, IT support may lead to higher levels of employee service quality.
3.3.2 Upward Communication
Stephen and Arnold (1997) have defined upward communication as information flowing from the lower levels of an organizational hierarchy to the upper levels. In our research, it refers to the communication flow from healthcare staff to the doctors.
Conrad and Haynes (2001) have found that upward communication can help staff with good decision making.
In our research, healthcare staffs are required to provide patient information to doctors and to consult doctors for advice whenever they have problems. With training support, healthcare staff can provide professional service to patients, but sometimes they may not know how to answer a patient‘s question or have some other non-IT problem they don‘t know, in which case, they would consult doctors for advice.
Therefore, we argue that the communication between healthcare staffs and doctors is important, and that enhanced training support would contribute to higher levels of employees‘ non-IT related service quality.
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Downward communication refers to information flowing from the upper levels of an organizational hierarchy to the lower levels (Stephen and Arnold 1997). Downward communication occurs when managers give orders, recognition, or performance appraisals to employees, which makes service tasks more effective (Grunig, 1992).
In our research, downward communication occurs when doctors communicate with the healthcare staff. Doctors inform healthcare staff about what is important, what is valued, and how to perform a task in the best possible way. Using this procedure, healthcare staff would be more adept in handling difficult situations and would provide higher quality service to patients. Thus, the communication between doctors and healthcare staffs is an important factor in enhancing employee service quality and improving training support
3.3.4 Horizontal Communication
Horizontal Communication refers to the communication between people at the same level of an organization or community (Stephen and Arnold, 1997). Horizontal communication provides unity and a sense of direction among employees, accurate feedback, and the ability to implement change effectively. Horizontal communication helps a leader gain control and maintains a level of common purpose between co-workers (Massie, 1960; Parkinson, 1997).
In our research, horizontal communication occurs when healthcare staffs communicate with each other. Though healthcare staffs should normally carry out their own cases, sometimes problems may arise where they require additional assistance; hence, having a strong support and information distribution network between healthcare staffs would be extremely beneficial. Relaying information about e-Health to other healthcare staffs would also help each individual staff enhance their own knowledge. Via horizontal communication, healthcare staff can share information, experience, and support with each other, so they may provide higher quality services to patients.
In sum, we believe that communication between healthcare staffs would enhance training support and contribute higher levels of employee service quality; thus, we propose hypothesis H3b:
H3b: When there is good communication between healthcare staffs, and healthcare staff and doctors, training support can lead to higher levels of employee service quality.
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