DE LAS LICENCIAS, PERMISOS Y AUTORIZACIONES

In this thesis, the term “organisation” refers to all HCFs sites across the KSA that are targeted to join the STN. The Organisational pillar in the JoinSTNassistant framework deals with the internal context of the HCFs sites across the KSA.

As Figure 3.8 shows, in the Organisational pillar, 4 important, predictive and influential organisational-level barriers have been elicited from the 56-selected studies of the extensive literature review, as follows:

 Internal strategy and plans

The studies have shown that, to ensure a successful implementation, the internal strategy and plans (e.g., change management plan, project management plan, strategic plan, etc.) should be in place, and their lack has been repeatedly reported as a major barrier (Bjaalid et al., 2015; Larsen et al., 2016). For instance, in the KSA, this lack has impacted on the implementation of the tele-ICU system by King Faisal Specialist Hospital and Research Centre (AlShubaily, 2014) as well as on the implementation of

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HIT (Khalifa, 2013) and the HER system (Khudair, 2008) within HCFs across the KSA. Similarly, this lack has hindered the adoption of : (i) eGovernment (El-Sofany et al., 2012; Alshehri et al., 2012; Franke & Eckhardt, 2014), (ii) eLearning (Bingimlas, 2009), (iii) eServices (Al-Mudimigh et al., 2011), and (iv) ICT projects (Almajed & Mayhew, 2013) within various organisations across the KSA.

Figure 3.8 The Important, Predictive and Influential Organisational-Level Barriers of the Organisational Pillar

In the studies that were conducted on the context of different countries, the lack of internal strategy and plans within HCFs has also been cited as an influential barrier in the implementation of telemedicine within HCFs in Iran (Keshvari et al., 2014), the rural areas of South Africa (Kachieng’a, 2011), and the USA (LeRouge & Garfield, 2013; Whitten et al., 2010).

 Support and engagement of HCFs’ stakeholders

Many researchers such as Ross et al. (2016) have argued that the implementation of any complex ICT innovation within an organisation often requires major modifications in the existing workflows, business processes, job descriptions, and/or bylaw. In addition, it often requires providing the necessary technical support and training for the staff to gain the required knowledge to use this complex ICT innovation (Ross et al., 2016). Therefore, to ensure a successful implementation, stakeholders support and engagement are required for making any required modifications, as well as for providing the necessary training for the staff to be able to use this complex ICT innovation (Ross et al., 2016). Furthermore, Khalifa (2013) has noted that there are two most important barriers that hindered the implementation processes of Electronic

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Medical Record (EMR) system within the hospitals of the KSA; one relates to the hospital management, which does not accept redesigning (i.e., reengineering) their hospital workflow to match with the EMR system, and the other is the lack of providing the necessary training for the staff to be able to use the EMR system (Khalifa, 2013).

The lack of stakeholders support and engagement has further been a challenging factor for the implementation of telemedicine within many countries such as Kuwait (Buabbas, 2013), Iran (Keshvari et al., 2014), and Malaysia (Zailani et al., 2014). It has also hindered the implementation of ICT projects (Almajed & Mayhew, 2013), eGovernment (Franke & Eckhardt, 2014; Alshehri et al., 2012; El-Sofany et al., 2012), and eServices (Al-Mudimigh et al., 2011) within organisations across the KSA.

The lack of communication, or its complexity and difficulty, among stakeholders has been indicated by many studies as an influential challenge to the implementation decision of ICT innovations within an organisation. For instance, Khudair (2008) has argued that the communication gap between stakeholders (i.e., managers, IT/Records Managers, and physicians) is the real cause of the slow spread of the EHR system within HCFs across the KSA. Almajed and Mayhew (2013) have also cited that the absence of clear communication processes is one of the main factors that negatively influences IT projects success within the KSA. Kodukula and Nazvia (2011) have also indicated that the lack of strong communication among the stakeholders is a challenge surrounding telemedicine implementation within the Maldives. Sadoughi et al. (2013) have argued that the internal communication and clear feedback among all stakeholders is a factor which influences the success of HIT implementation globally.

 Service and organisational impacts

In healthcare, the empirical studies have clarified that the organisational decision to implement any ICT innovations is driven by justifiable motivations (Sadoughi et al., 2013; Kruse et al., 2014). Hence, the HCFs should decide to implement a given ICT innovation only if it would improve the HCFs performance in terms of workflow, structure, function, profits, etc., and/or the quality and efficiency of their healthcare services (Kruse et al., 2014; Venkatraman et al., 2015). Therefore, the decision makers of any organisations (e.g., HCFs) must carefully consider and understand the extent to which their organisation and its services will be impacted by implementing and utilising the new ICT innovation (AL-Hadban et al., 2016; Kaplan & Harris-Salamone,

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2009; Baker, 2012; Zanaboni & Wootton, 2012; Ahmadi et al., 2015). Thus, the decision makers of any HCFs across the KSA are expected to decide joining the STN if this joining would positively impact their HCF performance, in terms of workflow, structure, function, profits, etc. and/or the quality and efficiency of their healthcare services.

 The HCFs constraints

Decision makers of any organisation are considerably affected by the organisational constraints, since they must shape their decisions to meet and comply with the formal regulations (bylaw) and constraints of their organisation (Eisenhardt & Zbaracki, 1992; Elbanna, 2006). One of the frequent reasons that has been cited in the literature review for the unsuccessful implementation of a given ICT innovation is when it does not comply with the organisational constraints, such as the existing organisational business models and strategic partners, business processes, bylaws, core mission, and vision (Kruse et al., 2014; Khalifa, 2013; Shaw et al., 2013; Cresswell & Sheikh, 2013;

Chaudoir et al., 2013; Sadoughi et al., 2013; Ross et al., 2016). Therefore, compatibility with the HCFs constraints is expected to contribute a significant influence on the decision of HCFs across the KSA to join the STN.