CHAPTER 4: RESEARCH ANALYSIS
4.2 Research Analysis
4.2.2 Framework Application
For each of the four segments, we ask, ―Which department has the best performance and influencing factor?‖ ―Can good communication between the different support processes positively affect employee service quality?‖ To answer these questions, we will next interpret these cases using the research framework proposed in the earlier chapter.
Support process
In the context of our research framework, support processes can be divided into two variables, training and IT support (see row I in Table 4-2).
1. Training support. In terms of e-Health service, hospitals should provide relevant training for the healthcare staffs to do their job.
From the group interview and the prospectus, we discovered that each department needs different training for its health staffs. Since these staffs inherently do not have relevant experience, hospitals should provide training to enhance SOP processing abilities, specialized service, health education, and knowledge of appropriate phone-calling procedures to all departments. More specifically, the A3 department needs to provide training for nutritional-based knowledge, and A4 needs to provide the training for psychological and religion counseling, according to their specific service needs.
From our interview with healthcare staffs and doctors, we found that the A1 department did not provide any out of the four required trainings; the A2 department provided three out of the four required trainings; The A3 department provided four out of the five required trainings; and, A4 provided all required trainings for their healthcare staffs. We assessed the degree of training support based on the percentage of trainings required and the numbers provided by the department. Therefore, we ranked A1 with a low level, A2 and A3 department with a medium to high level, and A4 department with the highest level of support.
Below are excerpts of our interviews:
There is no health education training; we just depend on our experience (A1 healthcare staff).
I think our priority should be to promote how to take care of the patient; usually, they just provide us with the general lesson (A2 healthcare staff).
We think they should provide nutrition and diet related lessons (A3 healthcare staff).
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Knowledge (A4 healthcare staff).2. IT support. In terms of e-Health, IT systems and measuring devices also helps healthcare staffs provide crucial services. Healthcare staffs in the A1 department, with the help of IT systems, record and measure patients‘ data, generate reports, analyze physiology data, and provide consultations by phone. In our interview, we found out that the A1 department thinks that the integration of IT systems and the provision of health reports are the most deficient of the four IT supports. Healthcare staff in the A2 department, use IT systems to record patients‘ data, generate reports, analyze physiology data, make phone calls, and help patients to solve problems with their measure devices (issues about their stability, ease of use, compatibility, and design).
In our interview, the A2 department believed that the reliability, ease of use, and compatibility of the measuring devices and new functions of IT system need further improvement. The A3 department healthcare staff, with the help of IT systems, receives measuring data via 3G, record patients‘ measuring data, analyze physiology data, and make phone calls to patients. In our interview, we found that the A3 department thinks the reliability and ease of use of the measuring device, the integration, and data transmission compatibility of the IT systems have the most deficiencies. The A4 department healthcare staff, with the help of IT systems, makes video conferencing via 3G, arrange patients‘ data, and make phone calls. In our interview, we found that the A4 department thinks that 3G signal causes the most issues. We assess the degree of IT supports based on the percentage of deficiencies reported on all IT supports in the department. In sum, we‘ve assessed that departments A1, A2 and A3 provide a medium level of support, and that A4 provides medium to high level of support.
Below are excerpts from our interviews:
If there were better integration of the IT systems and support staff who could direct me to the system that what I need, things would be a lot easier (A1 healthcare staff).
Measuring device problems are a big deal, since we measure data every day and need to make decisions by it (A2 healthcare staff).
Losing signal is our biggest problem; sometimes data which was sent two days ago isn’t received until two days later (A3 healthcare staff).
Besides using 3G, there are others are good signal supports. (A4 healthcare staff)
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Communication includes four major subcategories: diagonal communication, upward communication, downward communication, and horizontal communication (see Table 4-2, row II).
1. Diagonal communication. In e-Health, healthcare staffs have to help patients to solve problems with devices and measure data using IT systems; consequently, it is essential that they have good communication with the IT staff. We define this level of communication by the examining the coordination between healthcare staffs and IT staffs with regards to different devices and systems.
Healthcare staffs have to coordinate with IT staffs frequently, especially in the A2 department, since there are so many devices involved. The A3 department has two main measuring devices involved, and the A4 and A1 departments have one and no devices involved, respectively. Using the number of devices as a basis, we can determine the department‘s frequency of communication with IT staffs. Our results show that the A1 department has the lowest level of communication, A3 and A4 have a medium level, and A2 has the highest.
Below are excerpts from our interviews:
When a member from the IT staff comes to set up the measuring machine for patients, they’ll let us know ahead of time, so we can start making a schedule (A2 healthcare staff).
We have asked the IT staff to adjust measuring machines before (A3 healthcare staff).
We’ve had the problem of delayed e-mails, but the IT department couldn’t repair immediately, as it was during a holiday (A3 healthcare staff).
2. Upward communication. Healthcare staffs have to consult with doctors when they have problems, or other demanding situations. From the interviews, we found out that upward communication most often occurs when healthcare staffs have a question relating to medication, a follow-up, or patients‘ consultation question in order to truly address the patients‘ condition. Healthcare staffs usually met with physicians once or twice a week.
The A3 department met the most often, and asked about all the topics except medication, in general; A1 didn‘t communicate with doctors about the medication or follow-up questions; A2 didn‘t communicate with doctors about patients‘ consultation;
and, A4 didn‘t make communication with doctors in regards to follow-ups and patient consultations. Thus, we assessed the level of communication based on the frequency
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that the healthcare staffs consulted the doctor, and found that the A1 department had the lowest level, A3 and A4 had a medium level, and A2 had the highest level.
Below are excerpts from our interviews:
We communicate with doctors face to face to tell them which patient has a problem.
Also, we have meetings once a week, so we can consult to doctors (A1 healthcare staff).
Often, we’d ask doctors if a patients’ medication needed to be adjusted, or whether the patient needed a follow-up (A2 healthcare staff).
If a patient has problem, we would refer to a doctor for advice (A3 healthcare staff).
We have meeting every Tuesday to report to doctors and discuss the cases we’ve had (A4 healthcare staff).
3. Downward communication. Doctors have to instruct healthcare staffs on what they think would help healthcare staffs. We define this level of communication by the number of times doctors instruct healthcare staffs of their own accord. From the interviews, we found out that downward communication occurs when doctors want to give feedback, or share a message, either in person, or in the regular meetings that occur once or twice a week. A1 department doctors had the most occurrences of downward communication for both purposes; A2 and A4 doctors mostly shared messages, and A3 doctors only gave feedback. We determined that the A1 department had the highest level of downward communication, A2 and A4 department had a medium-to-high level, and A3 department had a medium level.
Below are excerpts from our interviews:
We have meetings once a week, where the doctor tells us what to trace (A1 healthcare staff).
We give them feedback on problem solving and encourage them to consult us, whenever they have an issue (A1 doctor).
We transmit important messages to healthcare staffs (A2 doctor).
We have meetings twice a week and give them feedback on the spot; but I think they [the healthcare staff] should personally contact me, because otherwise, I would think they did not have problem (A3 doctor).
4. Horizontal communication. From our interviews, we found that healthcare staffs
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―job-handing over‖, and support and experience sharing between the healthcare staffs.
A1 has the best of all the above items; A2 has a little problem with handing over and experience sharing; and both A3 and A4 have lack in support and have a problem in experience and message sharing. We assessed that the A1 department has the highest level of horizontal communication, A2 has a medium-to-high level, and A3 and A4 both have medium levels.
Below are excerpts from our interviews:
We have to support with each other and share messages through meetings once a week (A1 healthcare staff).
Some people are effective in handing over, but some are not (A2 healthcare staff).
We would upload data of patients’ problem and hand it over to the system (A4 healthcare staff).
Employee service quality
Employee service quality can be classified into two subcategories: IT related service quality and non-IT related service quality (shown in Table 4-2, row III).
1. IT related service quality. Healthcare staffs have to a responsibility to provide adequate IT-related service quality to patients. Examples of this service include:
helping patients to solve problems with measuring devices, generating healthy reports, and analyzing the patient‘s body index with IT systems. It follow that patients are directly affected by the IT-related service quality. Thus, we define the IT related service quality of a department by the service completeness, given by IT systems.
Through our interviews and data analysis, we discovered that the IT systems in the A2 department demonstrate all of above service qualities. In contrast, the A1 IT department doesn‘t help patients solve device problems, and the A3 and A4 departments don‘t provide healthy reports to patients. Thus, we‘ve designated the A1 and A4 department with medium level of service quality, the A2 department with high level, and the A3 department with medium-to-high level.
Below are excerpts from our interviews:
We would use the IT system for tracing patients’ health index, but we can also generate the health report ourselves (A1 healthcare staff).
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unusual data measurements would cause them to worry (A2 healthcare staff).We analyze patients’ body indexes and to solve their problems using a measuring worried patients. In this study, we define non-IT related service quality by the degree of service completeness. From our interviews and research, we found out that only the A3 department has did not provide adequate relief and concerns to patients; the other three departments performed well enough in all the above mentioned service items.
Therefore, we‘ve assessed the A1, A2 and A4 department to have a high level non-IT related service quality, and theA3 department to have a medium-to-high level.
Below are excerpts from our interviews:
We would check-in on the patient by phone and provide call in service for consultation in order to allow the patient to feel more close to us (A1 healthcare staff).
When patient called in for consultations, we would give them advice on medicines and diets, thereby providing relief (A2 healthcare staff).
We would call out to patients three times a week out of concern for them (A3 healthcare staff).
Besides medicinal care, we provided extra services such as psychological and religious counseling (A4 healthcare staff).
So far, we have seen the factors that impact the performance of delivery system from case to case. Table 4-2 summarizes these factors according to the above analysis (for original Chinese content of interviews, see Appendix B). In the table, we can compare the concept of each variable in our model, and the level of each department corresponding to each concept. From this table, we can conclude that communication factors do influence support processes to positively affect employee service quality.
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Training Support The extent to support the required
trainings. Low Medium
to High
Medium
to High High
IT Support The completeness of IT systems
and devices. Medium Medium Medium Medium
to High II.
Communication
Diagonal Communication The coordination between healthcare staffs and IT staffs across different devices.
The frequency of healthcare staffs to consult doctors.
The frequency of doctors to guide
healthcare staffs initiatively. High Medium
to High Medium Medium to High Horizontal
Communication
The intensity of coordination and support between healthcare staffs and each other.
High Medium
to High Medium Medium Overall
Assessment High Medium
to High Medium Medium to High III. Employee
Service Quality
IT related service quality The completeness of service related to IT systems. Non-IT related service quality The completeness of service.
High High Medium
to High High
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cross-case analysis and then discuss the results in comparison to our research model.5.1 Cross-Case Analysis Results
Figure 5-1 shows the summary of case analysis presented in the last chapter. As the charts (a) and (b) indicate, we can see the impact of diagonal communication on IT support of each department, as well as the impact of other communications on the non-IT support of each department.
(a)
The impact of diagonal communication on IT support
The impact of other communications on training support
Figure 5-1. Summary of case analysis: (a) the impact of diagonal communication on IT support and (b) impact of other communications on non-IT support.