ESN USER ADOPTION IN
HEALTHCARE ORGANISATIONS
The barriersUniversity: University of Amsterdam Study: MSc. in Business Administration – Digital Business
Thesis coach: dhr. dr. D. (Nick) van der Meulen
Second supervisor: dhr. prof. dr. P.J. (Peter) van Baalen
Author: Kim van der Stappen Student number: 10899723 Date: June, 23th (final version)
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Statement of originality
This document is written by Student Kim van der Stappen who declares to take full responsibility for the contents of this document.
I declare that the text and the work presented in this document is original and that no sources other than those mentioned in the text and its references have been used in creating it. The Faculty of Economics and Business is responsible solely for the supervision of completion of the work, not for the contents
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Abstract
This study investigates the barriers for user adoption of enterprise social media networks (ESNs) in healthcare organisations. Based on previous technology adoption research, such as UTAUT, this study created a model which includes numerous constructs that could have an influence on user adoption of ESNs in healthcare organisations. The aim of this study was to reduce and adjust this model, based on 11 semi-structured interviews spread over three cases, to finally conclude with an accessible model that can be quantitively tested in further research. The main barriers identified for user adoption in healthcare organisations are lack of cultural fit, lack of job-fit, lack of ESN self-efficacy, lack of ESN quality and lack of critical mass. In the final model gender, experience, age, time and voluntariness are included as moderating factors, as these factors may influence the barriers for user adoption. Lastly, interviewees indicated factors that might stimulate user adoption, such as result demonstrability, availability of a community manager and mandatory use. One of the main conclusions of this study is that the management team/board of healthcare organisations wants to use the ESN to facilitate a cultural change, but the discrepancy between the way healthcare organisations are currently organised and what the ESN proposes is clearly too big.
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Table of content
1. Introduction ... 5 1.1 Relevance ... 7 1.1.1 Theoretical relevance ... 7 1.1.2 Practical relevance ... 7 2. Literature review ... 92.1 Enterprise Social Networks (ESN) ... 9
2.2 ESN adoption factors ... 11
2.2 Remaining technology adoption factors ... 18
2.3 ESN adoption model ... 18
2.3 Health 2.0 ... 20 3. Methodology ... 23 3.1 Research context ... 24 3.2 Case selection ... 25 3.2.1 Diagnostica ... 25 3.2.2 House of guidance ... 26 3.2.3 Local health ... 26 3.3 Data quality ... 27
3.3.1 Reliability and bias ... 27
3.3.2 Generalisability ... 28 3.3.3 Validity ... 29 4. Data analysis ... 30 5. Results ... 32 5.1 ESN implementation ... 32 5.2 Withholding factors ... 34 5.3 Stimulating factors ... 37 6. Discussion ... 38 6.1 Discussion ... 38 6.2 Voluntary or mandatory? ... 43
6.3 Cultural change or cultural fit? ... 44
7. Conclusion ... 45
7.1. Conclusion ... 45
7.2 Contributions ... 45
7.3 Limitations ... 46
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8. References ... 49
8.1 Websites ... 60
Appendix ... 61
Appendix A: Motivation for ENS implementation ... 61
Appendix B: Withholding factors ... 63
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1. Introduction
Many organisations have witnessed their employees moving toward more self-determination and flexibility, especially in terms of time and spatial-independent work (Zhang, Cody & Wu, 2010; Majumdar, Krishna & Bjorn, 2013). Systems that support flexibility and networked collaboration, such as enterprise social networks (ESNs), have been playing an increasingly important role in changing the way organisations arrange their communication and working habits (Aral, Dellarocas & Godes, 2013; Von Krogh, 2012). The healthcare sector also feels the need to change toward this new way of working and since the impact of the internet and other technological developments on healthcare is expected to increase (Chou, Hunt, Beckjord, Moser & Hesse, 2009; Hawn, 2009; Thompson, Younes & Miller, 2012; Greysen, Kind & Chretien, 2010), healthcare organisations simply do not have a choice. A publication of the national guideline on social media use by the Dutch Medical Association (KNMG) also mentioned the importance of social media use in healthcare organisations (KNMG, November, 2011). The report points out that participation by healthcare professionals on social media can foster communication and collaboration. New networks with colleagues may arise, which could for example cause new insights in other disciplines. KNMG wants the use of eHealth, including social media, to be a self-evident part of healthcare, because it can positively contribute to the improvement of the quality of healthcare in the Netherlands (KNMG, November, 2011). Concerning the use of social media such as Facebook and Twitter, healthcare professionals indicate that they experience barriers such as privacy concerns, legal grounds, no need for use, inefficiency and lack of skills. The main reason for not using social media is that they think it is not efficient, followed by a lack of skills (Antheunis, Tates & Nieboer, 2013). Despite the fact that the object of this study are ESNs for internal usage, the factors mentioned above already give an image of the barriers healthcare professionals face concerning the use of social media. While there is some empirical research investigating user’s motives to adopt ESN in an enterprise setting (Chin, Evans & Choo, 2015; ; Kügler, Smolnik & Raeth, 2012) there does not
6 seem to be any research on ESN adoption in healthcare organisations. Van der Wal, De Graaf & Lasthuizen (2008) investigated the similarities and differences between the organisational values of the private and the public sector. They conducted an comparative empirical survey of 382 managers from a variety of private and public sector organisations in the Netherlands. The results of their study show that honesty, innovativeness and profitability are predicted by and strongly related to the private sector and impartiality, incorruptibility and lawfulness are predicted by and strongly related to the public sector (Van der Wal et al., 2008). Bate (2000) specifically investigates the healthcare sector and concluded from a large-scale change programme within a hospital that they struggled to transform from a divided and rigid ‘hierarchy’ into a more collaborative and flexible ‘networked community, because of organisational culture, relationships and skills. As ESNs support flexibility and networked collaboration, ESNs seems to better match the values of the private sector instead of the public sector, therefore different barriers to user adoption in healthcare organisations are expected.
Because there seems to be a literature gap and a clear practical need, this study investigates the barriers of adopting ESNs in healthcare organisations. This study thereby aims at creating a conceptual model that can be quantitively tested in further research. To address this research gap, the main question of this study is: What are the barriers for user adoption of enterprise social media networks in healthcare organisations? This question will be investigated based on qualitative data collected in three healthcare organisations in the Netherlands.
After discussing the theoretical and practical relevance of this study, the literature review will be provided. Within the literature review first the definition of ESNs used in this study will be explained where after an overview of research on ESN adoption factors based on general technology adoption literature and specific research on ESN adoption will be provided. This chapter ends with an overview of literature on social media use in healthcare organisations,
7 as the features of an ESN are comparable with the features of a social media platform. The third chapter discusses the methods used for this study, gives an overview of the selected cases and demonstrates the trustworthiness and rigor of this study. Chapter four elaborates on the data analysis, where after chapter five will present the results. This study will conclude with a discussion and conclusion of the results where the final model will be presented and an answer on the research question will be provided.
1.1 Relevance
1.1.1 Theoretical relevance
The theoretical relevance of this study is to fill a research gap in the literature concerning a specific context of ESNs. As the literature review will show, there is some research on ESN adoption, but there seems to be no research in the healthcare context. The literature review concludes with a model that gives an overview of the constructs defined in previous ESN adoption research combined with technology adoption constructs defined in the most known technology adoption literature. This model gives a clear overview of the constructs that already are defined and is used as a basis for the semi-structured interviews. The aim of this study is to reduce and adjust this model as the research progresses to finally conclude with an accessible model that can be quantitively tested in further research. The final model will, based on the interviews, show the barriers of ESN adoption in the healthcare context.
1.1.2 Practical relevance
The practical relevance of this study can be divided in two parts; relevance for ESN platform owners and for healthcare organisation who want to implement, or are implementing an ESN. The final model resulting from this study will provide organisations insights in the barriers for user adoption of ESNs. When implementing an ESN, healthcare organisations can take the constructs presented in the model into account to overcome, or, when that is not possible, recognize and acknowledge the barriers. For healthcare organisations that consider the implementation of an ESN, the final model can be used as grounding for the deliberation. For
8 ESN platform owners, the final framework resulting from this study will help with the implementation of their platform in healthcare organisations. Based on the defined barriers the standard implementation process or even the features of the platform might need specific adjustments for the healthcare sector.
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2. Literature review
In this chapter substantiation of the research question will be provided. First, the definition of ESN used in this study will be explained to give a clear image of the object this study investigates. The second paragraph gives an overview of research on ESN adoption factors based on general technology adoption literature and specific research on ESN adoption. The chapter will be concluded with a model of all the factors that could play a role in adopting a new technology. This overview is given to provide a broad image of adoption factors that may play a role in the implementation of ESNs in the contexts of healthcare organisations. To find out which factors are critical for a successful ESN implementation in healthcare organisations, the factors presented in this model are used as a basis for the semi-structured interviews. The last paragraph gives an overview of social media use in healthcare organisations, as shortly explained in the introduction. Despite the fact that social media is not the same as an ESN, most of the features are comparable, therefore this paragraph gives an image of how healthcare professionals use social media for their work.
2.1 Enterprise Social Networks (ESN)
Research in the area of ESNs has only started recently and is still evolving. Therefore many definitions and terms have been developed and are used interchangeably, such as enterprise 2.0 (McAfee, 2009), Enterprise Social Networking Sites (Malsbender, Recker, Kohlborn, Beverungen, & Tanwer, 2013; Ellison, Gibbs & Weber, 2015), Corporate Social Network (Vaezi, 2011), Corporate Social Software (Steinhuser, Smolnik & Hoppe, 2011), Enterprise Social Media Platform (Leonardi, Huysman, Steinfield, 2013) and Enterprise Social Software platform (Herzog, Richter & Steinhüser, 2015; Kügler, et al., 2012). Wehner, Ritter & Leist (2017) conducted a literature review of 106 articles and identified the term ESN to be the one used most often. ESN can be defined as “a web-based technology that supports users’ contributions of persistent objects to a shared pool and that enables company-wide responses to these objects” (Herzog et al., 2015, p.3). ESNs can be used in two different ways. The most
10 commonly studied way, is a platform that is used to communicate with external stakeholders, such as the public in large, vendors and customers (Leonardi, et al., 2013). However, this study focusses on the less commonly studied way in which organisations use a platform for internal communication, collaboration and social interaction within the organisation. In the context of this study ESN is defined as a web-based platform that allows employees to (1) implicitly reveal or explicitly indicate particular colleagues as communication partners; (2) broadcast messages to the whole organisation, the whole department or communicate messages with specific colleagues; (3) post, sort and edit files, texts and messages; (4) view the files, texts, connections and messages communicated, posted, sorted and edited by anyone else in the organisation at any time (Leonardi et al., 2013).
Within organisations there are many communication technologies implemented that cover one of the aspects mentioned above. For example Q&A forums allow people to broadcast messages to the whole organisation, while e-mail allows people to communicate messages to specific colleagues. What makes ESNs unique and even potentially transformational is that it allows users to do these three activities all in one place. These activities are, as mentioned in point four of the definition, stored, recorded, and available for anyone in the organisation at any time (Treem & Leonardi, 2012). Consequently there are at least two affordances that ESNs provide that make them distinct from other communication technologies used in organisations. ESNs expand the range of texts, networks and people from whom people can learn across the organisation. Thereby they provide people visibility into the communicative actions of others in the organisation and the visible traces of those communicative actions last over time. Increased opportunities for social learning is one of, if not the most important, benefit of these affordances for organisations (Leonardi et al., 2013).
The emergence of ESNs has typically followed one of the following paths: (1) use of publicly available websites, such as Twitter, Google+ and Facebook; (2) private
11 implementations of proprietary of open source software, either installed as a hosted (cloud-based) software service (SaaS) or installed on an organisation’s own server; (3) in-house proprietary solutions. This study focusses on the second path.
2.2 ESN adoption factors
Within Information Technology (IT) and Information Systems (IS) literature, a rich diversity of theoretical constructs, models and theories exist. However, researchers have exorbitantly made use of just one theory, the Technology Acceptance Model (TAM) (Dwivedi, Williams and Lal, 2008; Hirschheim, 2007; Williams, Dwivedi, Lal and Schwarz, 2009). Within this model most researchers focused on the associated constructs ‘perceived usefulness and ‘perceived ease of use’ (Dwivedi et al., 2008; Hirschheim, 2007; Williams et al., 2009), which may have created homogeneity in this field of study (Dwivedi et al. 2008; Williams et al. 2009). Benbasat & Barki (2007) even argued that the overwhelmingly use of TAM has hindered the progress of research in the area of acceptance and adoption of IS/IT. By taking into account the debate on TAM, Venkatesh, Morris, Davis and Davis (2003) developed the ‘Unified Theory of Acceptance and Use of Technology’ (UTAUT) based on user acceptance literature and the following eight prominent models: Theory of Reasoned Action (TRA), TAM, TAM2, Motivational Model (MM), Theory of Planned Behaviour (TPB), combined TAM and TPB (C-TAM-TPB), Model of PC Utilization (MPCU), Innovation Diffusion Theory (IDT) and Social Cognitive Theory (SCT). The UTAUT model is presented in figure one on the next page.
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Figure one: UTAUT (Venkatesh et al., 2003)
Performance Expectancy entails the degree to which people think a certain technology or
system will enhance their performance within their job, effort expectancy entails the degree of ease associated with the use of the system, social influence entails the degree to which a person observes that important others believe he or she should use the new system. In TRA, Ajzen & Fishbein (1980) define this concept as ‘subjective norm’. Finally, facilitating conditions are defined as the degree to which a person believes that a technical and organisational infrastructure exists to support the use of the particular system (Venkatesh et al., 2003).
Experience, voluntariness, gender, and age were confirmed as moderating factors of UTAUT,
such that the effect will be stronger for older women in early stages of experience, particularly in mandatory settings (Venkatesh et al., 2003).
13 technology adoption models might be too parsimonious (Venkatesh & Davis, 2000). Technology specifications such as social interactions (e.g., critical mass of users, reputation, and community aspects) between users play a vital role in the context of social software adoption (Lai & Turban 2008). Therefore, in creating a model explaining ESN adoption these factors of social interaction should be incorporated (Soliman and Beaudry 2010). Kügler et al. (2012) proposed an adoption model for enterprise social software platforms (ESSP) combining the theoretical perspectives of Innovation Diffusion Theory (IDT) and Social Capital Theory (SCT). IDT (Rogers, 1995), which is grounded in sociology has been used since the 1960s to study a broad range of innovations, ranging from organisational innovation to agricultural tools (Tornatzky and Klein, 1982). Moore & Benbasat (1991) suplemented the model with a refined set of constructs, so it could fit the IS context and found support in the predictive validity of it (Agarwal and Prasad, 1997; Karahanna, Straub & Chervany, 1999; Plouffe, Hulland & Vandenbosch, 2001). These constructs are; Relative advantage, ease of use, image, visibility, compatibility, results demonstrability and voluntariness of use. Relative advantage is the degree in which a system is perceived as being better than the system used before (Moore & Benbasat, 1991). Visibility entails the degree to which a user can see others using the system
(Moore & Benbasat, 1991). A system is compatible when it is being consistent with the existing needs, values and past experiences of users (Moore & Benbasat, 1991). Results
demonstrability entails whether the results of the system are tangible (Moore & Benbasat,
1991) and finally, voluntariness of use (in UTAUT discussed as a moderating factor) is the degree to which the use of a system is out of free will or mandatory (Moore & Benbasat, 1991).
Ease of use can be compared with perceived ease of use, as mentioned in TAM (Davis, 1989) and effort expectancy as discussed in UTAUT (Venkatesch et al., 2003) and image can be compared with image in TAM2 (Blau, 1964; Pfeffer, 1982), where it refers to the belief of people - that are important to the individual in question - , that the decision to use a certain
14 technology contributes to the quality of the job (Blau, 1964; Pfeffer, 1982).
SCT represents the values embedded in a network of an individual, such as norms, trust and further values that facilitate a person’s actions (Tsai & Ghoshal 1998). SCT plays a crucial role in promoting information diffusion (Coleman, 1988) and in establishing behavioural norms among the members of a social unit, such as an organisation (Walker, Kogut & Shan, 1997). Therefore Kügler et al. (2012) use SCT next to IDT to account for the organisational climate factors. Based on these theories and semi-structured interviews in two organisations Kügler et al. (2012) proposed a model on the basis of technological factors, social factors, and organizational climate. Looking at the technological factors relative advantage, ease of use and result demonstrability, as already explained, play a big role. Compatibility, reputation (image) and perceived critical mass (visibility) define the social factors. In all systems, the usage behaviour depends on the number of people who already use the system (Higgins, Compeau & Meister, 2007). However, this relationship is of extra importance for social software, since the software becomes more valuable when more people create content (Wattal, Racherla & Mandviwalla, 2010).
Within the organisational climate, trust, collaboration norms, community ties and private social software experience play an important role. Trust can be measures based on the degree of integrity of employees, competence, behaviours and good intentions (Kieser, Kramer & Tyler, 1996). Concerning organisational social software use, trust is a key determinant (Paroutis and Al Seleh, 2009). Collaboration norms refer to the degree of agreement in the organisation concerning teamwork, collaboration and cooperation (Coleman & Coleman 1994; Kankanhalli, Tan & Wei, 2005). Norms of teamwork and collaboration have shown to improve information exchange in other contexts (Orlikowski, 1992), so may also apply to the adoption of ESNs. The stronger the community ties in an organisation are the bigger the motivation is to cooperate and to share knowledge (Lewicki & Bunker, 1996). Contradicting, contradictory
15 and distinct identities of group members might cause barriers to collaborative activities, such as knowledge creation and information sharing (Nahapiet & Ghoshal, 1998). Finally, Thompson, Higgins & Howell (1994), just as Venkatesh et al. (2003) showed that experience with technology has a moderating effect on usage-determining factors.
Chin et al. (2015) studied the factors that enable or inhibit ESN usage among employees within professional service firms. Seven social, six individual, four organisational and two technological factors have been identified. The social factors are: social ties, social climate, sense of connectedness, task characteristics, information quality, reciprocity and critical mass. Magni, Angst, and Agarwal (2012) found that Social ties influence a person’s usage behaviour on IT implementation. The study of Chin et al., (2015) confirmed that employees are more likely to receive and/or contribute knowledge from employees where they already have a close relationship with. The social climate within an organisation is determined by employees’ behaviour, thoughts and feelings (Bock, Zmud, Kim & Lee, 2005). Boh & Wong (2013), Chen and Huang (2007), Kügler et al. (2012) and the study of Chin et al. (2015) found that a positive social climate, in this context a collaborative and innovative climate, has a positive influence on ESN adoption. As an ESN facilitates the online interaction between employees and gives every employee a voice irrespectively of rank or job title, it is not surprising that a sense of
connectedness increases ESN adoption and use as well (Grieve, Witteveen, Tolan & Marrington, 2013). Task characteristics also play a role in communications technology use (Koo, Wati, and Jung, 2011). Chin et al. (2015) found that ESNs can be useful to complete tasks that lack adequate instructions or information. Finally, the quality of information on ESNs depend on the employees’ contribution and response and the perception of quality, which depends on its suitability for a certain task and context (Emamjome, Rabaa'i, Gable & Bandara, 2013). A variety of studies identified information quality as a key success factor for enterprise resource planning, knowledge management systems, IS and corporate social software in
16 organisations (DeLone & McLean 1992; Kulkarni, Ravindran & Freez, 2007; Lin, 2010; Steinhuser et al. 2011; Chin et al., 2015). Reciprocity corresponds to long-term consequences as mentioned in Triandis’ (1977) model of PC Utilization (MPCU), where long-term consequences give an indication of the outcomes of the system that will have a pay-off in the future (Thompson et al., 1994) and critical mass corresponds to perceived visibility, as discussed in IDT.
The six individual factors are: knowledge self-efficacy, ESN self-efficacy, time, personality, enjoyment of helping others and reputation. In knowledge contribution behaviour
knowledge self-efficacy has been reported as an influential factor (Hsu, Ju, Yen, & Chang,
2007; Kankanhalli et al., 2005). When employees believe that their knowledge is useful and valuable to others in the organisation they are more likely to contribute (Kankanhalli et al. 2005). ESN self-efficacy is in line with self-efficacy as will be later discussed in social cognitive theory (Compeau & Higgins, 1995), where it entails the judgement of one’s ability to use a certain technology to accomplish a job or task. Chin et al. (2015) reported that the time
to contribute to the ESN seems to be a crucial factor as it influences other factors such as perceived critical mass and information quality, such that when people do not spend much time on the ESN, the information quality and the perceived visibility will be lower . The effect of
personality traits on social media use has got increased academic interest (Amichai-Hamburger
and Vinitzky 2010; Correa, Hinsley, and De Zúñiga 2010; Orchard, Fullwood, Galbraith & Morris, N, 2014). Individuals have unique personality traits that inhibit or enable ESN use. The Big-Five model of McCrae and John (1992) gives an overview of five broad personality traits. Lastly, the perception of intrinsic benefits, such as enjoyment of helping others and external benefits, such as reputation (image, as discussed in IDT) have a positive effect on online knowledge contribution (Bock et al. 2005; Kankanhalli, et al. 2005; Stewart and Osei-Bryson, 2013; Chin et al., 2015).
17 The organisational factors include organisational size and structure, facilitating conditions, ESN strategy and top management support. Gremillion (1984) suggested a positive relationship between IS use and organizational size and structure, though in the more recent study of Chin et al. (2015) this was not the case. This is perhaps due to the presence of temporal and geographical distances (different time zones) and country culture, as in authoritarian cultures social networking in the workplace may be banned. In the study of Venkatesh et al. (2003) facilitating conditions have been identified as key in predicting the use of IS. The study of Chin et al. (2015) found that such facilitating conditions include awareness, required training, guidance, ESN policy, alignment with performance and reward system for participation. ESN strategy entails a strategy that underlines the importance of the ESN for the individual and the whole organisation (Aral et al., 2013). The study of Chin et al. (2015) showed that the lack of ESN strategy works as an inhibitor to use it. Lastly, the study of Chin et al. (2015) shows that the interviewee’s perceived value of the ESN is influenced by top management support. Some interviewees even mentioned that it is a critical factor for success.
Chin et al. (2015) identified two factors in the technological dimension; ESN platform quality and perceived security. ESN platform quality relates to platform features, accessibility,
integration and ease of use. DeLone & McLean (1992) identified system quality, which is closely related to platform quality as an important factor in the adoption of IS. Steinhüser et al. (2011) also identified this as an influencer in the adoption of corporate social software. As ESNs can be a third-party software system, which means that the system is not build inhouse, employees are naturally concerned about the privacy and security of organisational information. These concerns may influence their perceived value of the ESN. Prior research on enterprise 2.0 applications (Wang, Jung, Kang & Chung, 2013) and social networking use (Shin, 2010) also identified security and privacy as an influencing factor on the use of these systems.
18 2.2 Remaining technology adoption factors
When looking at research done on ESN adoption factors, most of the adoption factors of the eight models used by Venkatesh et al. (2003) are included. Though, to create a clear overview of the factors that might play a role in de adoption of ESNs in healthcare organisations, the factors that did not come up, are discussed in this paragraph. Social Cognitive Theory is one of the most powerful theories in human behaviour (Bandura 1986). In the context of IS, Compeau & Higgins (1995) applied and extended SCT. Compeau & Higgins (1995) specifically studied computer use, but the underlying theory and de basics of the model allow it to be extended to use and acceptance of IS and IT in general. The core constructs in this model are: performance outcome expectations, personal outcome expectations, self-efficacy, affect and anxiety.
Performance outcome expectations deal with the performance-related consequences of the
behaviour. Specifically, performance outcome expectations deal with job-related outcomes (Compeau & Higgins, 1995). Personal outcome expectations deal with the personal consequences of the behaviour. Specifically, personal outcome expectations deal with sense of accomplishment and the individual esteem (Compeau & Higgins, 1995). Self- efficacy is the judgement of one’s ability to use a certain technology to accomplish a job or task and affect is defined as a person’s liking for a particular behaviour. Finally, anxiety is defined as emotional or anxious reactions towards certain behaviour, for example using a computer. Job-fit is also a frequently used factor to determine the intention to use a new technology. Among others TAM2 and MPCU use job relevance in the sense that it depicts whether a certain technology matches the job (Wu, Chou, Weng & Huang, 2011).
2.3 ESN adoption model
As shown in this chapter there are numerous factors that play a role in determining the intention to use a (ESN) system. These factors that play a role in determining the intention to use a system are grouped together in a model in figure two. This model is used to create topics for the semi-structured interviews. As discussed in the literature review, Venkatesh et al. (2003) mentioned
19 voluntariness, gender, experience (just as Thompson, Higgins & Howell (1994) and age as moderating factors of UTAUT. Therefore, though not mentioned in the model, experience, voluntariness, gender and age are also considered during the interviews. Within ESN platform conditions, the construct ‘ESN platform quality’ is a combination of effort expectancy, as discussed in UTAUT (Venkatesh et al., 2003), ease of use as discussed in the article of Kügler et al. (2012), perceived ease of use as mentioned in TAM (Davis, 1989) and ESN platform quality as discussed by Chin et al. (2015). When looking at the ESN job-fit, de construct ‘long- term consequences’ is a combination of reciprocity, as mentioned by Chin et al., (2015) and long-term consequences as mentioned in MPCU (Triandis, 1977) and ESN self-efficacy can be compared with self-efficacy as discussed by Compeau & Higgins (1995). Looking at the social factors, critical mass is a combination of visibility as discussed by Moore & Benbasat, (1991) and critical mass as discussed by Chin et al. (2015) and Kügler at al. (2012). Image is a combination of image as discussed in TAM2 (Blau, 1964; Pfeffer, 1982) and reputation in
Kügler et al. (2012). Subjective norm is a combination of social influence as mentioned in UTAUT (Venkatesh et al., 2003) and subjective norm as mentioned in TRA (Ajzen & Fishbein, 1980). Looking at the organisational factors, facilitating conditions is mentioned in UTAUT (Venkatesh et al., 2003) and further elaborated in the study of Chin et al. (2015)
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Figure two: summary adoption constructs
2.3 Health 2.0
As the features of an ESN, as discussed in the first paragraph, are comparable with the features of a social media platform, such as Twitter and Facebook, it is interesting to look at the use of social media in the healthcare sector, as this could create a basis of what to expect of ENS use.
Eysenbach (2008) indicated that it might be too early to create an absolute definition of Health 2.0 or Medicine 2.0, though figure three shows their suggested framework. According to the this model, five major themes emerge from web 2.0 in health, health care, medicine, and science, which will outlive the specific services and tools offered. These emerging and recurring themes are: participation, openness, collaboration, apomediation and social networking. Most
21 of the concepts speak for themselves, however, apomediation is a new socio-technological term. This term is invented to avoid the term ‘web 2.0’ in the scholarly debate (Eysenbach, 2007). Apomediation characterizes the “third way” for users to identify credible and trustworthy
services and information. The most common approach is to use intermediaries (ie, “gatekeepers” or middle man), for example health professionals providing “relevant” information to a patient (Eysenbach, 2008). The difference between an apomediary and an intermediary is that an intermediary stands “in between” the consumer and information, which means he is necessary to receive the information in the first place. In contrast, apomediation means that there are agents (people, tools) which “stand by” to guide a consumer to high quality services and information without being a prerequisite to receive that service or information in the first place.
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Figure three: Health 2.0 framework (Eysenbach, 2008)
Figure three also depicts three main user groups of health 2.0 applications: biomedical researchers, health professionals and patients/consumers (Eysenbach, 2008). For this study, the focus is on the health professionals.
The fact that there are advantages involved in applying communication and information technologies in the healthcare sector have been well established (Street, 2003). The literature
22 has also shown that social media hold considerable potential value in the healthcare context, as they emphasize participation and collaboration of the stakeholders involved (Antheunis et al., 2013), enable new ways of sharing of and access to information (Kaplan & Haenlein, 2010; Vance, Howe & Dellavalle, 2009) and enable users’ direct participation and increase
individuals’ connectivity (Chou et al., 2009). Antheunis et al. (2013) investigated patients’ and
health professionals’ motives and use of social media and the expectations and barriers for health-related social media use. For this study only the results related to the healthcare professionals are relevant. For healthcare professionals the barriers to use social media were divided in five subcategories: Lack of skills, inefficiency, legal grounds, no need for use and privacy concerns. For healthcare professionals the main reason for not using social media is that they think it is inefficient, followed by a lack of skills. The motives for using health-related social media for health professionals were divided in communication with colleagues, marketing, doctor-patient communication, efficiency and increasing knowledge (Antheunis et al., 2013). Healthcare professionals mainly used Twitter and LinkedIn for a marketing purpose and to contact fellow professionals. To the knowledge of Antheunis et al. (2013), the fact that healthcare professionals contact each other on social media, is a remarkable finding since it has not been previously reported. Looking at this study it can be said that healthcare professionals feel the need to contact other professionals via social media. As an ESN facilitates a platform where employees can communicate and work together, this might be a good fit.
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3. Methodology
This study investigates the barriers for user adoption of ESNs in healthcare organisations and thereby aims at creating a conceptual model that can be quantitively tested in the future. The main question is therefore: What are the barriers for user adoption of enterprise social media networks in healthcare organisations? In the field of technology adoption much research has been conducted and as the literature review shows, there is also some research done on the adoption factors of ESNs. In the context of healthcare organisations some research has been conducted on the use of social media, however these studies do not focus on something similar as ESNs. As there is no research done on the adoption of ESNs in the context of healthcare organisations, this study investigates an unexplored context of ESNs. To enter this new field of study, the model in figure two is created to summarizes all the constructs used in previous research. The aim of this study is to reduce and adjust this model as the research progresses to finally conclude with an accessible model. To gain a rich understanding of the process being enacted and the context of the study, a case study will be most suitable (Eisenhardt & Graebner, 2007). Yin (2009) distinguishes different case studies based upon two discrete dimensions; holistic case versus embedded case and single case versus multiple case. This study investigates three different healthcare organisations that more than one year ago started with the implementation of an ESN. Therefore, this study uses a multiple holistic case study, as discussed by Yin (2009). To gain insights in the adoption of ESNs, semi-structures interviews are conducted. Semi-structured interviews are used, because in this way the interviews can be structured based on the core constructs identified in the model in figure two, but there will be much room left for input from the respondents (Saunders, Lewis & Thornhill 2012). Half of the interviews were conducted by phone and the other half were conducted face-to-face. All interviews were held in Dutch.
24 paragraph explains the reasons for the case selection and the last paragraph shows the steps taken to ensure that the results are rigorous and reliable.
3.1 Research context
The Enterprise Social Network used for this study is Part- up. Part-up is an online collaboration platform that provides an online workspace where teams inside organisations and communities can work together. The unique feature of Part-up is that it supports people to create teams and find the right talents needed. The company was founded in December 2014 and launched its platform in September 2015. Today more than 7500 people registered at the platform. Besides individuals who can make free use of the platform, over 60 companies pay a yearly amount to make use of the platform. Among them large organisations as PGGM, Achmea, the municipality of Amsterdam and the ministry of public health, welfare and sport.
The basics of the platform, when used by an organisations are as follows; employees, in the context of Part-up called uppers, can create a part-up which is a (project) team of which the members work together to realize a pre-arranged goal. Within the part-up employees can share knowledge in the form of documents, images or messages. A tribe is a public or private environment consisting of uppers and part-ups. Tribes keep groups of uppers and part-ups together. So for example there could be a tribe for Achmea and within this tribe there could be different part-ups concerning Achmea. A partner is an upper who performs activities within a part-up and a supporter is an upper who contributes to the part-up by giving tips and suggestions via the timeline. The organisations have the option to share their tribe with every upper on the platform, including uppers from other organisations, or they can decide to only share it with their own organisation. For this study organisations that only share their page internally are selected. The platform also has a chat function. When an organisation purchases the platform, workshops are included. First a core team, a group of around five people who will lead the implementation, will be assembled. After the core team is in place, three workshops are
25 organised concerning the reason for implementation (why), the ‘game rules’ (how) and community building (what).
What distinguishes Part-up form other ESNs such as Trello, Yammer and Slack is that Part-up helps employees to form a team consisting of colleagues from all departments, while platforms such as Trello, Yammer and Slack assume you already have a team.
3.2 Case selection
Around 20 healthcare organisations have implemented Part-up in the last two years. For this study it is important that the healthcare workers have enough experience with the platform, therefore one of the requirements for the case selection was that the organisations must have started at least one year ago with the introduction of the platform. Another requirement for the case selection was that the cases needed to be large organisations with multiple departments, as the ESN is then of greater value. It is important that all the cases are about equal in that perspective, because otherwise the benefits they gain from the platform may vary, which for example could cause a different motivation to use the platform. Looking at the 20 healthcare organisations that are using the platform, eight meet the requirements. As this research was written on the office of Part-up, is was relatively ease to contact those eight organisations. From those eight organisations, three were open for interviews, these organisations are used for this study. A description of the organisations used for this study is listed below. The names are fictive to guarantee anonymity.
3.2.1 Diagnostica
Diagnostica has been the specialist in education, care and diagnostics for people with a hearing- and communicating disability in the Netherlands for 225 years. Diagnostica helps people who are hearing impaired or deaf or people who have language development disabilities or deaf blindness. Diagnostica has about 4.700 employees spread over 20 schools, 80 care and diagnostics locations and six audiological centres. About one year ago Diagnostica started with the implementation of Part-up from the need to organise in a more flexible way and to connect
26 the different centres. The researcher has interviewed an internal communication manager, who is also head of the core team (female), an ICT project manager (female) and a project manager assistant (female). All interviewees, except the project manager assistant, are members of the core team. The project manager assistant started a part-up a couple of months ago.
3.2.2 House of guidance
In more than 500 small-scale locations in the Netherlands, over 6,300 employees attend more than 7,500 clients with mental disabilities. They provide assisted living and help people with a mental disability with their daily work. For all those who cannot work, House of guidance provides day-care. The employees work from a Christian perspective since the establishment of the organisation in the sixties. House of guidance started the implementation of Part-up around a year ago with the intention to better anticipate on the wishes of the clients. The researcher has interviewed a marketing manager, who was the former head of the core team (male), a communication manager, who is the current head of the core team (male) and two location managers who are also both responsible for stimulating entrepreneurship throughout the organisation (female). All interviewees, except the marketing manager, are members of the core team.
3.2.3 Local health
Local health has 2.300 employees and supports more than 2.200 clients and their relatives in one of the provinces of the Netherlands. Local health provides services from a local perspective based on everyone's own strength, ranging from temporary guidance to long-term care and treatment. Local health connects their services at every stage of life: children, young adolescents, adults and elderly. Because there is not much communication between the different regions of the province, information gets lost, which is exactly the reason why Local health introduced Part-up about two years ago. The researcher has interviewed a human research development advisor, who also is the head of the core team (female), an innovation manager
27 (male) and one of the communication managers (female). All interviewees are members of the core team.
3.3 Data quality 3.3.1 Reliability and bias
In relation to qualitative research, reliability is concerned with whether other researchers would reveal similar results (Easterby-Smith, Thorpe & Jackson, 2008; Silverman, 2007). One response to the issue of reliability in qualitative research is that this type of research is complex and dynamic and because the results of interviews reflect reality at the time they were collected, interviews are not necessarily intended to be repeatable (Marshall & Rossman, 2006). However, concerns about reliability within semi-structured interviews are also partly related to issues of bias, which can be minimized. There are three types of bias to consider that may occur relating to interviews. The first of these is interviewer bias. This is where non-verbal behaviour, tone or comments of the interviewer can create a bias, as the behaviour of the interviewer might influence the interviewees response to the questions being asked (Saunders et al., 2012). It is not possible to totally overcome the interviewer bias, as the interviewer is always physically presented, which already could create a bias. However, in this research the interviewer tried to minimize the bias by entering the interviews with barely any knowledge about the theme, which provides an open mind. Besides that, all interviews were recorded and transcribed in word and phrases that were not that self-evident were checked with colleagues to minimize misinterpretations. The second bias that may occur is the interviewee or response bias (Saunders et al., 2012). Taking part in a research, especially in an interview, is an intrusive process. In principle, an interviewee may be willing to participate, but may nevertheless be sensitive to the exploration of certain subjects (Saunders et al., 2012). Therefore, interviewees may choose not to discuss and reveal a topic or an aspect of a topic that is important for the study. This may cause that the interviewee casts the organisation or himself in a ‘socially desirable’ role. The interviewer tried to minimize this bias by interviewing three employees
28 from different functions in each case to gain a broad perspective and thereby find out from different perspective what is going on in the organisation. Next to that the interviewer also tried to summarise the responses of the interviewees during the interviews and presented those small summaries to the interviewees during the interview, to test her understanding. The last bias can be labelled as participation bias. Because interviews are time-consuming, some of those whom the interviewer would like to talk to could be not willing to take part, which may bias the sample. The interviewer in this research did not face any problems concerning this bias, as the individuals that were selected all participated. This might be due to the fact that the interviewer worked two times per week at the office of Part-up, which made it easier to connect with users of Part-up.
3.3.2 Generalisability
Generalisability relates to whether the results of a study are applicable to other settings (Saunders et al., 2012). Based on the use of a small and unrepresentative number of cases, it is likely that there are concerns concerning the generalisability of findings from qualitative research. Bryman (1988) points out that a rigorous and well-completed case study is more likely to be useful to applicate in other setting, than one that lacks such rigour. Therefore this study tried to create rigour related to the selection of the cases. All three cases are healthcare organisations in the Netherlands with 2000 to 7000 employees. To demonstrate that the findings have a broader theoretical significance than the cases that are investigated, it is of great importance to relate the study to existing theory (Marshall & Rossman, 2006). This study is conducted based on many constructs concerned technology adoption and specific ESN adoption established in previous research (see figure two). These constructs are questioned in three cases in the healthcare sector with the ultimate goal to reduce the amount of concepts to create an accessible mode. Thereby this study builds on previous research on ESN adoption and contributes to the literature on ESN adoption in the healthcare context.
29 3.3.3 Validity
In interviews validity may be achieved where these are conducted carefully due to explore themes and responses from a variety of angles, to probe meanings and to clarify questions. (Saunders et al. 2012). Questioning in such interviews is very important. Questioning does not only influence the validity, but also the reliability and (potential) bias (Saunders et al., 2012). The interviewer payed attention to the process of interviewing. Since the appearance of the interviewer affects the perception of the interviewees, the interviewer dressed very neutral, as healthcare workers do too. As the first few minutes of an interview have a significant impact on the outcome of the interview, the interviewer first explained the reason for the interview and further introduced herself. After that the interviewees where asked to tell something about themselves. Concerning the approach to questioning the questions were phrased clearly to overcome misunderstandings and the interviewer tried to ask them in a neutral tone of voice. The researcher also tried to combine open questions, which allows interviewees to describe and define a situation or an event, and probing questions, which are used to explore responses that are significant for a certain theme relevant for the research topic (Saunders et al., 2012). Other actions taken, such as recording and transcribing the interviews also contribute to the validity of this study.
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4. Data analysis
Within Diagnostica and Local health three interviews were conducted and within House of guidance four interviews were conducted. Within each organisation one of the interviewees was accountable for leading the implementation of the ESN. Half of the interviews were conducted by phone and the other half were held face to face. All interviews were recorded and written down in transcripts and coded via word comments. As there does not seem to be any research on ESN adoption in healthcare organisations, this study enters an unexplored field, therefore an inductive approach is used to analyse the data. The study did not commence with a clearly defined theoretical framework, however, figure two was created as a base for the interviews. As the data collection progressed a theoretical framework was developed empirically based on the experiences in the field (Hutjes & Buuren, 1992). This data structure can be found in figure four on the next page. As Saunders et al. (2012) mentioned, while you might start with either a deductive or inductive approach, in practice, research is likely to combine both. For the analysis of the semi-structured interviews the ‘’Gioia methodology’’ (Gioia, Corley & Hamilton, 2013) is used to make sense of the data. Early in the research a myriad of informant categories, terms and codes emerged, a process similar to Strauss & Corbin’s (1998) process of open coding. During this 1st-order analysis the researcher tried to stay as closely as possible to the terms used by the interviewees. This 1st-order analysis resulted in more than 50 categories. As the research progressed the researcher started seeking similarities and differences in the data, a process similar to Strauss & Corbin’s (1998) process of axial coding. After this process the categories were reduced to about 25 categories. In the next step these 25 categories were labelled. In the 2nd-order analysis deeper structures among the categories were found, which made the data even more structured. Once a workable set of categories (1st-order analysis) and themes (2nd-order analysis) were in hand (what Glaser & Strauss (1967) termed ‘‘theoretical saturation’’), the 2nd-order themes were distilled even further into ‘‘aggregate dimensions’’ (Gioia et al., 2012).
31 The results of this full set of 1st-order categories, 2nd-order themes and aggregate dimensions are displayed in a data structure (see figure four).
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5. Results
Based on the data structure presented in figure four, this chapter further explains the results. The first paragraph emphasizes on the motivation for ESN implementation, the second paragraph emphasizes on the withholding factors for using the ESN and the last paragraph elaborates on the stimulating factors for using the ESN. The results are presented based on quotes from the semi-structured interviews that can be found in the appendix.
5.1 ESN implementation
The first element of the research question focuses on the implementation of the ESN. The main themes, as discussed in figure four, are motivation for implementation, the initiator, the implementation approach and the initial reactions of the employees. For the first theme interviewees were asked to reflect upon the reasons why the ESN was implemented in the first place, about which a set of open-ended question were asked. Several reasons for the implementation were described or mentioned throughout the interviews, such as stimulating entrepreneurship, facilitating contact with other departments and facilitating cultural change.
‘’…we want everybody, from every department to step up if they have an idea, Part-up can facilitate this’’ (House of guidance, communication manager)
‘…we sought ways to shape entrepreneurship within our organisation.’’ (House of guidance, marketing manager)
The interviewees were also asked who initiated the implementation of the ESN. It was clear that in all three organizations, the board or the management team initiated the implementation. Sometimes, other departments in the organisation were not even aware of the fact that the organisation was going to implement the ESN. For a lot of employees the implementation of Part-up came unexpectedly, which gave them no time to ask questions about the reason for the implementation.
33
‘’The idea came from the board, as a communication department we were not even aware of the fact that we were implementing Part-up, I just read it on a blog’’ (Diagnostica, internal
communication manager)
The implementation approach is also very similar in all three cases. However, based on the interviews there seems to be a difference in how the employees have experienced the implementation and how the initiators have experienced the implementation. The quote below shows a reaction of two of the employees.
‘’The application has been introduced with a number of open space meetings, two or three I think. They explained what the application entails and after that they actually did not pay any more attention to it. Like, if you want to use it, then use is, and if you don’t, then don’t. That is
not the most successful way to implement something new ’’ (Diagnostica, ICT project manager).
‘’There actually wasn’t a real implementation strategy. For us it is just a loose platform, apart from all other systems we already have’’ (House of guidance, communication
manager).
As the quotes show, the employees were not satisfied about how the ESN was implemented. In all three cases the implementation approach was somewhat similar, as employees of Part-up are very involved in the implementation process. As discussed before, Part-up first assembles a core team and organises a couple of inspiration work-shops to explain the platform for people who are interested. After that, the core-team is responsible for inviting every employee to participate on the platform and they need to be reachable for practical questions about the platform. The response of one of the participants of the core team on the question how the ESN was implemented, was actually very positive. As the quote below shows, he indicated that he did find that there was a clear strategy outlined for the implementation.
‘’Step by step, we do not require employees to create an account. We try to link it continuously to activities and meetings and we try to focus on departments where it can be
used as an added value. (…) Last theme month we have also used it’’ (House of guidance, marketing manager).
34 However, when asking the members of the core team about how much time they spend on Part-up, they do not seem to spend much time on leading the implementation of the platform.
‘’…if I need to be honest, it is actually very low profile. I for example need to welcome all new uppers who sign up, but I really do not have time for that’’ (Diagnostica, internal
communication manager)
‘’…Kees (fictional name) was responsible for leading the core team, but he actually didn’t spend much time on it. So now he turned to me (…) and asked if I want to take over (…) So I
really need to spend time on it now, so far it has been done a bit halfway…’’ (House of guidance, communication manager)
The final theme of the ESN implementation is the initial reaction of the employees. Most employees were a bit cynical toward the ESN, since the organisations have all tried multiple other similar platforms in the past. Thereby, since the use of the system is not mandatory, employees had the option to wait and see what would happen.
‘’The reactions are a bit diverse, one group is very curious, the other group is more awaiting if this is something they will use. People don’t immediately embrace it as the eighth world wonder as this is not the only platform available and people have of course also tried a lot of
other platforms in the past’’(House of guidance, marketing manager).
5.2 Withholding factors
The second element of the research question focuses on the withholding factors of using the ESN. Interviewees were therefore asked to reflect upon why they (and their colleagues) do not use the ESN. The main themes, as discussed in figure four are organizational culture, job-fit, time, ESN quality, ESN self-efficacy and lack of critical mass. Almost all interviewees mentioned the organizational culture as one of the most important reasons for not using the ESN. The hierarchy and characteristics of the so called ‘traditional organization’ were frequently mentioned as factors that withhold employees from using the ESN. Healthcare workers feel they have a very demarcated job, which withholds them from engaging in new projects and developments. They are afraid that if they spend time on activities, that do not immediately relate to their function, the management team will not support it.
35 ‘’We are used to work based on fixed functions, this does not allow you to do anything else if
it does not belong to your function…’’ (Local health, innovation manager)
Since healthcare workers work with highly confidential information, Privacy and security issues also seem to play an important role in the context of healthcare organisations.
‘’…because the platform is not developed by House of guidance, they (healthcare workers) are afraid that cybercriminals might steal their information. Therefore it would be nice if we
could offer the platform of Part-up on our own intranet.’’ (House of guidance, communication manager)
As mentioned in the first paragraph, members of the core team do not spend much time on welcoming new uppers. Besides the core team, healthcare workers in general also experience a lack of time. They are busy enough with their regular work and do not have time left for other projects. Next to that, employees also feel that the time they can spend on the ESN is undefined, which results in employees not knowing, if and how much time they can spend on the platform.
‘’People are busy enough with their regular work…’’( Local health, innovation manager)
…but the problem with me is that I do not know how far I can go, can I work with Part-up during my working hours and how far can I go with this?’’ (Diagnostica, Project Manager
assistant)
Another core theme that came up was the lack of job-fit. Part-up provides a platform were you can work together with your colleagues on a project, or you can start a project from your own initiative. However, you do not necessarily have to use the platform to perform your core activities. Since healthcare workers do not have to use their computer for their core activities, they feel like they are wasting time while working on a computer, as time behind the computer means time away from the client. The quote below gives a good example.
‘’…every time I'm behind the computer, I'm not with the client, so Part-up feels like a secondary activity…’’ (House of guidance, communication manager)
36 When looking at the quality of the ESN, the interviewees are not positive about the ease of use of the system and are inclined to compare Part-up with similar systems they do find useful. Most frequently used systems were Yammer, Slack, SharePoint, Trello and the organisational intranet.
‘’I find Yammer more user friendly than Part-up.’’ (Diagnostica, project manager assistant)
Many interviewees also indicated that they feel that they do not know how to work with the ESN. In every case at least one interviewee mentioned that the average employee is a woman above her forties who does not use any kind of social media in her private life. Next to that, most interviewees also indicate that they are afraid of posting something ‘stupid’. The quotes below give two good examples of the reactions that were given.
‘’People in care are generally of good will, but they are not techies when it comes to the use of modern media, sometimes they even have trouble starting up a laptop’’ (House of
guidance, marketing manager)
‘’…everything you post will be public and you do not want to look stupid’’ (Local health, communication manager)’’
Finally, a lack of critical mass withholds people from using the ESN. When you are starting a project on Part-up you want to find the right people to work with, however, as not everyone has an account, people fall back on using e-mail to invite colleagues for a project, as they cannot find them on the ESN. The management team also does not stimulate usage of the ESN, as they barely use Part-up themselves.
‘’Too few people are visible on the platform, so it is hard to find the people you need’’ (House of guidance, location manager)
‘’…if the executives do not give the example themselves, the employees are not going to use it either’’ (Diagnostica, internal communication manager)
37 5.3 Stimulating factors
The last element of the research question focusses on the stimulating factors of using the ESN. Interviewees were therefore asked what would make them (and their colleagues) use the system. The main themes, as discussed in figure four, are result demonstrability, community management and mandatory use. Most interviewees mentioned that they still have not seen any proof of the success of ESNs in the healthcare sector, which makes them sceptical. Proof, from inside, or outside the organization, that Part-up works, will give the interviewees a reason to use the system.
‘’It would be perfect if we could show a few projects that are a success because of the platform. This inspires people and it shows that it can really add value.’’ (Local health,
innovation manager)
As mentioned before, in all organizations a couple of kick-off events were organized to explain how the system works and how you can use it. The interviewees all indicated that these sessions were very helpful, however, these sessions were only organized in the very first stage of the implementation. The interviewees all indicated that it would be helpful to have more of these sessions and to have a number of people in the organisation available for questions about how to use the ESN properly.
‘’When people are using it when you help them a little bit, it's going pretty smooth, but if they have to do it themselves, they experience a reasonable threshold. So personal accompaniment
is good, only than obstacles can be removed.’’ (Local health, innovation manager)
Finally, in every case someone mentioned that it would be good if the use of the ESN would become mandatory.
‘’…what I think is most important is that it needs to be mandatory to create a profile. As long as it is voluntary, nobody will use it.’’ (Diagnostica, Project Manager assistant)
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6. Discussion
In this chapter this study will be concluded. First, an answer on the research question of this study will be given based on the analysis performed in chapter four and the results presented in chapter five, where after the final model will be presented. The results will be compared with previous research and two discussion points will discussed.
6.1 Discussion
The aim of this study was to create an accessible model concerning the barriers of ESN adoption in healthcare organisations that could be quantitively tested in further research. The basis of this model can be found in the analysis chapter and is shortly discussed based on the quotes from the interviews in the results chapter. In this paragraph the results will be thoroughly discussed and compared with previous research and the final model will be presented.
Figure four can be divided in three main parts; the ESN implementation, the withholding factors and the stimulating factors. Together these main themes provide an answer to the research question. All interviewees were asked about how and why they implemented the ESN in their organisation. The main reason for implementation were stimulating entrepreneurship and contact with other departments and in all cases the management team or the board initiated the implementation on a voluntary basis. In most of the cases employees responded with cynicism, because they were experiencing ‘platform fatigue’. This is not surprising, since systems that support flexibility and networked collaboration, such as ESNs, have been playing an increasingly important role in changing the way organisations arrange their communication and working habits (Aral et al., 2013; Von Krogh, 2012), therefore, organisations have tried to implement similar systems multiple times. The second main theme consists of withholding factors, which are divided in organisational culture, time, job-fit, ESN self-efficacy, ESN quality and lack of critical mass. The last main theme consists of stimulating factors, which are divided in result demonstrability, availability of a community manager and mandatory use. Based on these three main themes the final model in figure five is created which could be
