The primary purpose of this study is to empirically investigate the motivators for improving physicians’ performance of HIS usage via the lens of adaptive structuration theory and job demand-control model. Based on the results of 305 valid responses, our study found that technology adaptation is significantly associated with task adaptation in a positive direction. In other words, physicians may first undergo a period of time to adapt to a new HIS. After physicians are familiar with and have adapted to an HIS, they may start to adapt their caring tasks by means of HIS usage. This finding was reported by prior evidence [14, 30, 31]. This finding may further suggest that hospitals should provide sufficient training regarding the use of an HIS in order to diminish the physicians’ learning curve. By doing so, physicians may become acquainted with an HIS more easily and shortly, physicians can similarly adapt their caring jobs as well with an HIS.
Another finding of our study is that technology adaptation is significantly and positively related to job control. After physicians have adapted to an HIS, and even mastered the intricate use of an HIS, physicians would therefore become better able to control their patient care. In words, physicians should have a certain discretion related to their patient care and treatment work with the help of an experienced use of an HIS. This finding is also in accord with prior literature [28, 38]. An implication of this is that hospitals could acquaint physicians with every possible aspect of an HIS usage, thus allowing physicians to have greater control over their work pacing and work quantity.
In addition, technology adaptation is found to be significantly linked with job demands in a positive direction. Once physicians have adapted to the use of an HIS, they will be able to handle their caring jobs not only more efficiently but also more effectively. For physicians, treating a greater number of patients may indicate more income. Physicians are therefore required to work more expeditiously to treat as many patients as possible in a limited amount of time. This finding broadly supports the work of other studies [28, 38]. This finding draws our attention to the importance that hospitals place in providing physicians with sufficient support to quickly learn and familiarize themselves with the use of an HIS.
Our study confirmed that task adaptation has a significant and positive association with job control and job demand, respectively. The results corroborate the findings of prior evidence [29, 38], whereby efforts to adapt technologically can improve overall work performance. This study found that job control and job demand are significantly associated with physicians’ attitude towards the use of an HIS, respectively. It is reasonable to assume that when physicians possess a certain degree of control over their work and have higher requirements for their own work, physicians may hold a positive attitude toward using an HIS. The finding of the relationship between job control and attitude is in accord with prior evidence [34].
A positive relationship between attitude and performance with using an HIS was also confirmed in current study. When physicians hold positive attitudes towards the use of an HIS, physicians should be more proactive in using an HIS which they believe facilitates their patient care. This result is in agreement with prior literature [36]. Generally speaking, the primary responsibility of a resident physician is to provide professional medical care for patients within their clinical privileges correspondent to the level of training they have received. Therefore, clinical tasks such as diagnosis, prescribing attending physician’s orders, delivering test results, assisting in surgery, or writing medical records are all responsibilities residents must bear [39, 40]. Residents must spend more time than attending physician do in using an HIS to accomplish clinical tasks effectively. Further, residents are generally younger than attending physicians, the adaptability to technology or tasks of residents should be stronger than those of attending physicians as a result of exposure. It is therefore reasonable that technology adaptation has a strong effect on task adaptation for residents than that of attending physicians. Further, we also found that task adaptation has a stronger effect on job demand for residents than that of attending physicians.
Attending physicians, on the other hand, primarily supervise the patient care of residents, and they have used an HIS less frequently than residents [39, 40]. Therefore, attending physicians are less familiar with an HIS than that of residents, but attending physicians possess a deeper medical knowledge than residents. When attending physicians become familiar with an HIS, they can still improve upon meeting their job demands through using an HIS. Finally, the effect of job demand on residents’ attitudes is stronger than that of attending physicians. Once residents understand that an HIS can be of great help to their patient case load, they might foster a more positive attitude toward the use an HIS.
This study adopts Adaptive structuration theory and the Job demand-control model to empirically analyze the influence of the use of an HIS on physicians' task performance, which provides a new perspective when studying user-system performance. China possesses a wide-range of differences in the use of an HIS due to both the scale and scope of medical care demands in a population of 1.4 billion people. Most importantly, the potential influence of an HIS usage on user performance among physicians and residents has been largely under-explored. Our study diminishes this research gap in part. Further, understanding the effect of using an HIS on the physicians' job performance can be of help for health care administrators to foster corresponding strategies and take suitable measures to improve user-system performance.
Finally, the sample hospitals are all large-scale hospitals in cities, and there is a lack of small-scale hospitals represented in this data. In other words, the generalizability of our findings is limited to large-scale hospitals located in urban areas. Future research can focus on this issue and collect a wider range of hospitals to advance the topic.