The Role of Organizational Culture in the Management of Clinical e-health Systems David Bangert Department of Management and International Relations University of Hawaii 2404 Maile Way Honolulu, HI 96822 bangert@cba.hawaii.edu Robert Doktor Department of Management and International Relations University of Hawaii 2404 Maile Way, #C305 Honolulu, HI 96822 doktor@cba.hawaii.edu Abstract The research here presented focuses upon the informal, social, and cultural side of managerial coordination and control as manifested in clinical e-health systems. Specifically, the research seeks to analyze and determine the role specific dimensions of organizational culture may have upon effective managerial coordination and control in clinical e-health systems. The Problem Modern health care organizations are confronted with the advent of new clinical e- health technologies as never before. Early evidence suggests great difficulty in the implementation of these new technological advances ( Bangert and Doktor, 2000). Telemedicine is a good example of this problem. Originally conceived as a two-way video conference between a primary care provider and patient at one end, and a specialist at the other end, telemedicine has evolved into a clinical information technology sub- system in which multi-media email and web-based applications transfer precise and detailed clinical patient information between health-care providers, and sometime the patients themselves, accurately and rapidly across long distances. The result is enhanced patient access to better health care, reduced total health care costs and, as a consequence of easy access to the most appropriate specialist expertise, higher overall quality of the health care delivered (Davis, et. al 2000). Despite the great promise of clinical e- health solutions such as telemedicine, successful implementations with high utilization have been rare (Pushkin, et al., 1997). There are many reasons for poor implementation performance (Bashshur and Gringsby, 1995, Bashshur, Sanders and Shannon, 1997). Often legal barriers prevent telemedicine from being used across political boundaries. The issue of reimbursement of HCP services is sometimes a barrier to utilization. Sometimes the technology does not perform as advertised. While all the issues listed above are real and relevant, they do not explain what we believe to be the fundamental cause of the problem. It is our hypothesis that a primary cause of implementation problems in clinical e-health solutions such as telemedicine are organizational in their origin. We hope to demonstrate that most modern health care organizations are conceived, designed and structured to promote effectiveness and efficiency of a bygone era; a time when quality was assured by formal authoritarian control, iron-clad rules, and a one best way mentality. It is our intention to demonstrate that in many places around the globe, the most appropriate strategy for a health care organization embarking seriously into e- health solutions will be a strategy that requires a more organic and less mechanistic organization design. We intend to argue that, for many health care organizations, a more organic organizational structure and culture will better match the cultural and knowledge/ learning predispositions of the organization’s members. Further, our intent is to demonstrate that it is this harmony between the predisposition of the organization’s membership and it’s strategic intent and organizational design that will be instrumental in achieving higher utilization of e-health solutions. Proceedings of the 36th Hawaii International Conference on System Sciences - 2003 0-7695-1874-5/03 $17.00 (C) 2003 IEEE 1