Organizational factors affecting successful adoption of innovative eHealth services: a case study employing the FITT framework

Objective

The paper presents an application of the “Fit between Individuals, Task and Technology” (FITT) framework to analyze the socio-organizational-technical factors that influence IT adoption in the healthcare domain.

Method

The FITT framework was employed as the theoretical instrument for a retrospective analysis of a 15-year effort in implementing IT systems and eHealth services in the context of a Regional Health Information Network in Crete. Quantitative and qualitative research methods, interviews and participant observations were employed to gather data from a case study that involved the entire region of Crete.

Results

The detailed analysis of the case study based on the FITT framework, showed common features, but also differences of IT adoption within the various health organizations. The emerging picture is a complex nexus of factors contributing to IT adoption, and multi-level interventional strategies to promote IT use.

Conclusion

The work presented in this paper shows the applicability of the FITT framework in explaining the complexity of aspects observed in the implementation of healthcare information systems. The reported experiences reveal that fit management can be viewed as a system with a feedback loop that is never really stable, but ever changing based on external factors or deliberate interventions. Management of fit, therefore, becomes a constant and complex task for the whole life cycle of IT systems.     

Electrophysiological characterization of neural stem/progenitor cells during in vitro differentiation: study with an immortalized neuroectodermal cell line

Despite the accumulating data on the molecular and cell biological characteristics of neural stem/progenitor cells, their electrophysiological properties are not well understood. In the present work, changes in the membrane properties and current profiles were investigated in the course of in vitro-induced neuron formation in NE-4C cells. Induction by retinoic acid resulted in neuronal differentiation of about 50% of cells. Voltage-dependent Na+ currents appeared early in neuronal commitment, often preceding any morphological changes. A-type K+ currents were detected only at the stage of network formation by neuronal processes. Flat, epithelial- like, nestin-expressing progenitors persisted beside differentiated neurons and astrocytes. Stem/progenitor cells were gap junction coupled and displayed large, symmetrical, voltage-independent currents. By the blocking of gap junction communication, voltage-independent conductance was significantly reduced, and delayed-rectifying K+ currents became detectable. Our data indicate that voltage-independent symmetrical currents and gap junction coupling are characteristic physiological features of neural stem and progenitor cells regardless of the developmental state of their cellular environment.     

Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists

BACKGROUND: Organizational changes and relative growth of the ageing population together with related health problems seem to have increased stressfulness in the work of anaesthesiologists. However, little is known about their work-related well-being and the factors through which their situation could be improved. METHODS: A cross-sectional questionnaire study of the level and the determinants of job satisfaction, work ability and life satisfaction among female and male anaesthesiologists involved 258 Finnish anaesthesiologists working full time (53% men). RESULTS: The respondents had fairly high job satisfaction, work ability and life satisfaction. No gender differences appeared in these well-being indicators, but their determinants differed by gender. Job satisfaction was only associated with work-related factors in both genders: with job control in women and with job control and organizational justice in men. Work ability correlated with job control and health in both genders and with family life in women. Life satisfaction correlated with individual- and family related factors such as social support and family problems in both genders. Life satisfaction correlated with physical workload in men and health in women. Women had less job control, fewer permanent job contracts and more domestic workload than men. CONCLUSIONS: Job control and organizational justice were the most important determinants in work-related well-being. Work-related factors were slightly more important correlates of well-being in males, and family life seems to play a larger role in the well-being of female anaesthesiologists. Organizational and gender issues need to be addressed in order to maintain a high level of well-being among anaesthesiologists.     

A partnership model of early intervention in psychosis programme--a Canadian experience

Aim: To describe how a new partnership model of early intervention in psychosis, early intervention in psychosis (EIP) programme delivery in Canada attracted the interest of the community and acquired government funding. Methods: The process by which a few individuals used a conceptual framework of integrated, collaborative, flexible and recovery focused principles to engage community partners and attract government funding is described. Results: The establishment of a small EIP programme and its expansion to a regional programme serving an area of 20 000 square kilometers and a population of approximately 500 000 people were achieved. A programme specific logic prototype was developed. A synergy of public, private and academic services emerged with an infrastructure for ongoing cohesiveness and productivity. Annual clinic visits increased from 641 in 2002 to 1904 in 2007 and annual new patients enrollments grew from 46 to 128 within the same period. Staffing grew from an interdisciplinary staff of 1.5 full‐time equivalent (FTE) to the current 10.0 FTE. Conclusions: A carefully orchestrated programme organization that is inclusive rather than exclusive can produce a balance of evidence‐based best practices in client focused service, community mental health integration and academic productivity.     

An analysis of the concept of organizational commitment

TOPIC.   Building organizational commitment.
PURPOSE.   This paper aims to analyze the concept of organizational commitment, including its attributes, antecedents, outcomes, and measurements.
SOURCES OF INFORMATION.   CINAHL, MEDLINE, Psychology and Behavioral Sciences Collection, Sociological Collection, and PubMed.
CONCLUSION.   By understanding the concept of organizational commitment, administrators and nurses can become more aware of their levels of commitment, bridge gaps in communication, and eventually provide higher-quality care to clients.     

Combat stress casualties in Iraq. Part 1: behavioral health consultation at an expeditionary medical group

PURPOSE: We review the role of military mental health professionals in consulting with inpatient medical patients and staff at a combat hospital and aeromedical evacuation staging facility in Iraq. CONCLUSIONS: Behavioral health consultation with medical and surgical patients during hospitalization and prior to aeromedical evacuation can help identify patients with combat stress exposure that may require future mental health follow-up. PRACTICE IMPLICATIONS: Extensive use of civilian mental health practitioners including nurse psychotherapists and psychiatric nurse practitioners will be needed to provide psychiatric care for the large number of U.S. veterans who return from deployment with combat stress related disorders.     

Improving the role of nursing in the treatment of depression in primary care in Spain

PURPOSE. We describe a multicomponent program for the systematic evaluation and treatment of depression in primary care. CONCLUSION. Primary‐care nurses trained in clinical and therapeutic aspects of depression play a central role in care management, patient education, treatment adherence, and clinical monitoring. PRACTICE IMPLICATIONS. Diverse interventions, including organizational changes and the enhancement of the role of nurses, have been effective in improving depression outcomes in primary‐care settings.     

Flexible and dynamic organization of bone marrow stromal compartment

The bone marrow mesenchymal compartment contains putative stem/progenitors of skeletal tissue components such as bone, cartilage, haematopoiesis-supporting stroma and adipocytes. Previously appreciated as vital to the support of haematopoiesis, these cells have also been recently recognized as having significant immunomodulatory properties with implications for allogeneic haematopoietic cell transplantation. Despite having been studied for more than three decades and currently being used in different clinical settings, their biology remains elusive. The aim of this review is to critically analyse the field of mesenchymal stem/progenitor cell biology, in respect of their relationship with other mesenchymal cell-types. Several issues concerning lineage commitment and inter-conversion potential between different mesenchymal cell-types are reviewed.