Information technology and the employment relationship : an examination of the adoption and use of electronic health records

This dissertation advances theory on the interplay of workplace technological change and features of the employment relationship to inform an active policy debate. In particular, many connect US healthcare's lackluster economic performance -- both historically and relative to other industries -- to its apparent reluctance to adopt electronic health record (EHR) systems. Drawing on management and employment relations theory as well as a multi-method field study of a large-scale healthcare provider, I first demonstrate that performance improvements depend not on the technology per se, but rather on the concomitant adoption of both the information technology (IT) and the rest of its reinforcing work system. In line with prior research, the work system includes workplace-level employment practices like teamwork and training. However, I advance our understanding of these complementarities by showing that their emergence depends on the scope of participatory structures included in the work system. Irrespective of how engaged workers are in the IT initiative, participation only complements the effectiveness of the EHR system where workers could 1.) renegotiate IT-engendered changes in the terms and conditions of employment, and 2.) influence the configuration and deployment of the technology. Based on these findings, IT adoption does not ensure improved performance, implying a shortcoming in policies promoting the diffusion of EHRs rather than the adoption of EHR-inclusive work systems. Drawing once again on both theory and the field study, I propose that only certain medical practices -- most notably, those that finance patient care on a prepaid or "capitated" basis -- internalize the benefits of EHR investment.

Department dc:contributor.department

Sloan School of Management.

Grantor dc:publisher

Massachusetts Institute of Technology

Year dc:date.issued

2008

Author dc:creator

• Litwin, Adam Seth

Advisor dc:contributor.advisor

• Thomas A. Kochan.

• Sloan School of Management.

Statement dc:rights

• M.I.T. theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. See provided URL for inquiries about permission.

Licence dc:rights.uri

• http://dspace.mit.edu/handle/1721.1/7582

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/1721.1/45152

OAI identifier oai:identifier

oai:dspace.mit.edu:1721.1/45152