Abstract
Objective
Few studies examine physicians’ use of different features of health information technology (HIT) in relation to their psychological empowerment and stress, especially in China, where many hospitals are being pushed to share digitized medical information. Further, there are mixed findings about the impact of HIT on stress, with some studies suggesting that HIT increases stress and others suggesting no effect. Hence, there is a need for a nuanced view of HITs to incorporate different features, regions, and outcomes. This work seeks to extend the existing body of knowledge on HIT by assessing the effects of basic (data-related) and advanced (clinical) HIT features on physician empowerment, stress, and ultimately, job satisfaction in Chinese hospitals.
Materials and Methods
We surveyed 367 physicians at 5 class 3 hospitals (ie, regional hospitals that provide specialist medical and healthcare services and carry out high levels of teaching and scientific research tasks) in 5 provinces in China. We specified and estimated a structural equation model using partial least squares.
Results
Physicians who used advanced features experienced improvement in all dimensions of physician empowerment and significant reduction in stress. Physicians who used basic technology, however, experienced improvement in fewer dimensions of physician empowerment and no significant change in stress. Except for efficacy, all dimensions of physician empowerment and stress predicted job satisfaction.
Conclusions
Healthcare professionals should assess the purpose of HIT features and expect different effects on intermediate and ultimate outcomes. The nuanced view of HIT features and processes leading to outcomes sheds light on their differential effects and resolves inconsistencies in prior findings on HIT effects.
Keywords: empowerment, stress, health information technology use, basic (data-related) technology, advanced (clinical) technology
INTRODUCTION
Healthcare information technology (HIT) continues to be a major asset for delivering healthcare services and assessing and rewarding healthcare providers (eg, recent meaningful use initiatives by the Center of Medicare and Medicaid Services). HITs represent digital transformation of healthcare processes, such as medication management, appointment scheduling, and decision support.1 Empirical research has thus been concerned with evaluating the effects of different HITs, such as electronic health records (EHRs) and mobile health applications, from the provider and patient perspectives.2 Examples of the studied effects of HITs include patient satisfaction,2,3 physician satisfaction,2 physician stress,4 and patient engagement.5 However, the mixed effects of HITs2 call for more attention to nuanced views of HITs that incorporate differences in HIT features, cultures or places, and processes leading to outcomes.
Implementation of HITs is generally seen to have great promise for improving healthcare quality. For example, Zai et al6 claimed that a non–visit-based IT-enabled population management system can be implemented in a large, diverse, academic primary care network to perform preventive cancer screening. Meeks et al7 suggested that investments in HIT can enhance the safety and efficiency of patient care and enable knowledge discovery. Despite the increasing use of HIT in the healthcare systems of developed countries, studies addressing how HIT is leveraged by physicians in developing countries, like China, to provide patient care remain scarce.
China has recently been strengthening its healthcare system through far-reaching healthcare reforms with policies focusing on insurance coverage,8 hospital capacity,9 and the healthcare workforce,10 and has made much progress in applying HIT11 to support the implementation of these reforms. Specifically, the Chinese government has recently issued a series of policy documents to promote and guide the development of smart hospitals in order to improve healthcare efficiency and patient satisfaction. For example, in October 2016, “Health China 2030” was published to highlight the construction of a population health information service system and the application of big data in health care.12 The General Office of the State Council issued the Opinions on Promoting the Development of “Internet + Medical and Health” in the year 2018. As delineated in that white paper, class 2 and class 3 hospitals (explained in greater detail in the Materials and Methods section) were required to provide online services (eg, smart medical guidance and mobile payment) by 2020. Specifically, class 3 hospitals were to achieve medical service information sharing by 2020.13 Taken together, this suggests that we are seeing and going to see unprecedented deployment of HIT in China.
Recent years have seen increasing scholarly interest in empowerment in organizational research in general and healthcare research from the patient and physician perspectives.14 Empowerment is a motivational construct manifested in 4 cognitions that reflect an active orientation to a work role: meaning (ie, the importance one places on their work role), autonomy (ie, sense of control over how one does their own work), efficacy (ie, belief in one’s capabilities to successfully undertake their work), and impact (ie, perception that one has made a difference in their work environment).15,16 Although empowerment has been studied extensively in the healthcare context, most of the research conducted focuses on the empowerment of patients and nurses (who strive to gain power in a system where physicians hold more power), with limited studies on physician empowerment.14,17 Nevertheless, physician empowerment is highly relevant in the Chinese context because physicians, mostly full-time salaried employees of different hospitals,18 face constant challenges,19 including long working hours (with unpaid overtime) that continue to escalate amid major pandemics like COVID-19 (coronavirus disease 2019), low pay, and physical abuse from patients.20
Drawing on the empowerment perspective, we aim to investigate whether physicians’ use of HIT will empower them along the dimensions of meaning, autonomy, efficacy, and impact in China. In addition, prior research suggests that the use of HITs may result in physician stress and burnout.4 Many physicians in Chinese hospitals regularly see over 100 patients a day,20 working an average of 50 h/wk. Therefore, we also examine whether the use of HIT will further burden the physicians, increase their stress, and influence their job satisfaction.
Research model
Building on views of effective use of technology21 and intermediate processes leading to outcomes of HITs,22 we developed a model that presents a nuanced view of HIT features and tested the model in China. We posit that physicians’ use of HITs will have positive effects on empowerment, stress, and ultimately, job satisfaction. Figure 1 shows our research model.
Figure 1.
Research model. H: hypothesis; HIT: health information technology.
As illustrated in Figure 1, we categorize use of HIT features based on their purpose21,23 in a healthcare setting. The first category of features, termed basic features, facilitates the documenting (ie, data entry) and viewing (ie, data access) of patient information. Documenting features enable physicians to record notes, patient demographics, medication lists, and discharge summaries. Viewing features enable physicians to display laboratory reports, radiology reports or images, diagnostic test results or images, and consultant reports. The second category of features, termed advanced features, is directly related to the diagnosis and treatment of patients and supports physician decision making and lab or drug ordering. Decision making features support physicians’ decisions about clinical guidelines (eg, beta-blockers), clinical reminders (eg, pneumovax), drug allergy alerts, drug interaction alerts, drug-lab interaction alerts, and drug dosing support (eg, renal dose guidance). Ordering features enable physicians to initiate and track orders for laboratory tests, radiology tests, medications, consultation requests, and nursing orders. Hence, our categorization is based on relevancy to or intensity of core clinical processes (ie, advanced features involve more core processes relative to basic features), rather than expected learning curve as examined in prior research.24
The Institute of Medicine has identified 6 care improvement goals, namely safety, effectiveness, patient-centered care, timely delivery, efficiency, and equity in healthcare access.25 The benefits of HITs in improving these care goals have been well documented and widely recognized by physicians in various areas of medicine.26–28 When adopted by physicians, HITs help streamline healthcare service delivery and management processes that in turn enhance the efficiency and productivity of patient care.29 By exploiting the capabilities of basic and advanced HITs, physicians can electronically document and view patient information, order tests and medications, and obtain needed decision support prior to, during, and after patient treatment. Accordingly, we expect that physicians’ use of both types of HITs will enhance their sense of competency in treating patients, autonomy in managing patient care, confidence in positive impact of the treatment on patient condition, and finally, meaning and purpose in treating patients’ diseases. In other words, due to their streamlining capabilities and encapsulated management processes, basic and advanced HITs will empower physicians along the 4 dimensions of meaning, autonomy, efficacy, and impact. Thus, we hypothesize the following:
H1: Physicians’ use of basic technology will be positively associated with the 4 dimensions of empowerment, namely meaning (H1a), autonomy (H1b), efficacy (H1c), and impact (H1d).
H2: Physicians’ use of advanced technology will be positively associated with the 4 dimensions of empowerment, namely meaning (H2a), autonomy (H2b), efficacy (H2c), and impact (H2d).
Research also suggests a dark side of HITs from a physician perspective. Physicians may experience higher cognitive load from using HITs and, ultimately, stress and burnout.4 Information and learning theories partially explain stress and burnout. The information chaos perspective, for instance, suggests that technologies introduce information overload due to the clinician need for organizing, synthesizing, and drawing conclusions from different data sources, such as verbal, nonverbal, and physician notes.30,31 Less is known, however, about whether both of the identified categories of HIT features (ie, basic and advanced) will influence stress. Re-examining such relationships in different contexts and with different specifications of technology helps in strengthening our existing body of knowledge on the impacts of technology in general32 and healthcare in particular. Based on the role of HIT use in inducing cognitive load,4,31 we suggest that physicians’ use of either type of technology will increase their stress. New basic and advanced responsibilities that physicians are expected to fulfill in Chinese hospitals will involve processing information from different sources that will take additional time, overload physicians, and induce stress.4,31
H3: Physicians’ use of basic technology will be positively associated with stress.
H4: Physicians’ use of advanced technology will be positively associated with stress.
Job satisfaction, defined as an employee’s affective reactions to a job,33 represents a key predictor of employee retention in healthcare settings.34,35 Prior research on employee empowerment in different contexts suggests a positive relationship between dimensions of empowerment and job satisfaction.36 An important precondition of job satisfaction is the extent to which an employee finds their job personally meaningful,37 as high (low) level of meaning predicts high (low) level of job satisfaction.38 In addition, as a basic psychological need, autonomy is a key component of intrinsic motivation that in turn determines job satisfaction.39 Moreover, employees who feel more competent in their jobs are more likely to feel satisfied with their jobs.39 Finally, a lack of opportunity to exert impact on the organization (or universal learned helplessness) negatively influences job satisfaction.39 Findings of previous studies have largely validated the relationships between the 4 dimensions of empowerment (except for efficacy) and job satisfaction.39–41 Hence, we expect that the dimensions of meaning, autonomy, efficacy, and impact will be related to physicians’ satisfaction with their job.
H5: (a) Meaning, (b) autonomy, (c) efficacy, and (d) impact will be positively associated with job satisfaction.
Research on physician stress suggests that stressed physicians generally experience lower satisfaction.42 Physician satisfaction and stress continue to be important issues due to their serious implications to patient care.42 According to the general work-stress health model,43,44 stress feeds job-related strains, such as dissatisfaction and boredom, and individual-related strains, such as anxiety and depression. Stressed physicians may also experience a reduced sense of accomplishment and control due to the increased load on their time.45 Thus, we expect that stress will be negatively associated with physician’s job satisfaction.
H6: Stress will be negatively associated with job satisfaction.
MATERIALS AND METHODS
Design and participants
Hospitals in China are organized in a 3-tier system that recognizes their abilities to offer medical care, provide medical education, and conduct medical research.46 Class 1 hospitals (or primary hospitals) are the hospitals and health centers that provide preventive care and basic health care and rehabilitation services to local communities.46 Class 2 hospitals (or secondary hospitals) are regional hospitals that offer comprehensive medical and healthcare services to multiple communities, provide medical education, and conduct medical research.46 Class 3 hospitals (or tertiary hospitals) are regional hospitals that provide specialist medical and healthcare services and carry out high levels of teaching and scientific research tasks to several regions.46 As class 3 hospitals are pushed to achieve medical service information sharing by 2020,13 these hospitals have been implementing a multitude of HITs including electronic medical record, mobile medical service system, radiology information system, picture archiving and communication system, cardiology information system, etc. Chinese physicians are salaried employees of hospitals,46 and thus they typically cannot opt out of using these systems. While HITs may improve the efficiency and productivity of patient care, their use may also result in increased stress and burnout.4,42 Accordingly, our focus on class 3 hospitals is appropriate.
We administered a questionnaire (September and October 2016) to examine the relationships among basic and advanced technologies, physician empowerment, stress, and job satisfaction. We recruited outpatient physicians working in 5 class 3 hospitals in 5 provinces of China: Jilin, Shandong, Inner Mongolia, Chongqing, and Qinghai. These provinces and hospitals were selected for their diverse patient base and wide usage of HIT applications. All 5 hospitals were using HIT applications with similar functions (eg, electronic medical record system, medical image storage and transmission system, hospital management information system). Physicians’ HIT adoption rate in these 5 class 3 hospitals was also similar. We asked the human resources personnel of each hospital to recruit physicians who were willing to participate in our study. Eligible physicians included chronic disease physicians and internists who use HITs on a daily basis to deliver care to patients. A total of 450 physicians consented to participate and 81.6% (n = 367) completed the survey. Table 1 presents the demographic of all the respondents.
Table 1.
Sample characteristics (N = 367)
| n | % | |
|---|---|---|
| Sex | ||
| Male | 190 | 51.8 |
| Female | 177 | 48.2 |
| Age | ||
| <20 y | 4 | 1.1 |
| 20-29 y | 107 | 29.2 |
| 30-39 y | 171 | 46.6 |
| 40-49 y | 56 | 15.3 |
| 50-59 y | 28 | 7.6 |
| 60 y or older | 1 | 0.3 |
| Education level | ||
| Bachelor | 161 | 43.9 |
| Master | 178 | 48.5 |
| PhD | 22 | 6.0 |
| Others | 6 | 1.6 |
| Tenure | ||
| <5 y | 106 | 28.9 |
| 5-10 y | 154 | 42.0 |
| 11-15 y | 40 | 10.9 |
| 16 or more | 67 | 18.3 |
| Specialty | ||
| Pediatrics | 23 | 6.3 |
| Obstetrics and gynecology | 16 | 4.4 |
| Hepatobiliary surgery | 1 | 0.3 |
| Orthopedics | 46 | 12.5 |
| Nuclear medicine | 5 | 1.4 |
| Emergency medicine | 7 | 1.9 |
| Rehabilitation medicine | 2 | 0.5 |
| Scientific research office | 3 | 0.8 |
| Stomatology | 1 | 0.3 |
| Gerontology | 3 | 0.8 |
| Clinical doctor | 9 | 2.5 |
| Urology surgery | 7 | 1.9 |
| Dermatology | 1 | 0.3 |
| General internal medicine | 124 | 33.8 |
| General surgery | 33 | 9.0 |
| Neurosurgery | 10 | 2.7 |
| ENT | 27 | 7.4 |
| Psychological disease | 1 | 0.3 |
| Cardiothoracic surgery | 4 | 1.1 |
| Infirmary | 2 | 0.5 |
| Hospital infection control | 2 | 0.5 |
| Traditional Chinese medicine | 24 | 6.5 |
| Oncology | 15 | 4.1 |
| Missing | 1 | 0.3 |
ENT: ear, nose, and throat.
Main measures
We adapted established scales to measure basic and advanced technologies,23 physician empowerment,22 stress, and job satisfaction (see Supplementary Appendix A).4 HIT measures were adapted based on the American Hospital Association annual survey. The survey captured hospitals’ use of information technology in general and particular features of EHR systems. The complete American Hospital Association survey was administrated to either the CEO of the hospital or the person most knowledgeable about the hospitals’ HIT,23 which increases the relevance and accuracy of our data. We used the back-translation technique to achieve a linguistic equivalence between the English and Chinese versions.47 We modified the wording to fit our current study context. Supplementary Appendix A lists the measures. All items used a 7-point Likert scale, ranging from 1 (strongly disagree or much smaller extent) to 7 (strongly agree or much larger extent).
RESULTS
We used partial least squares, a component-based structural equation modeling technique, to assess the measurement and structural models because it accommodates nonnormality with small to medium sample size. Table 2 shows key measurement criteria: internal consistency reliabilities, average variance extracted, descriptive statistics, and interconstruct correlations. Supplementary Appendix B shows weights and complete item loadings. The internal consistency reliabilities, all of which were >0.80, exceeded the recommended threshold of 0.70,48 demonstrating scale reliability. We then examined item loadings within each construct and cross-loadings. High loadings within each construct, all of which were >0.69, and low cross-loadings among constructs, supported convergent and discriminant validity.48,49Table 2 shows that no interconstruct correlations were greater than the square root of the average variance extracted, further supporting discriminant validity.48,49 Basic and advanced technology, which were modeled formatively,50 all had significant weights, as indicated by the t values in Supplementary Appendix B.
Table 2.
Reliabilities, AVEs, descriptive statistics, and correlations
| Mean | SD | ICR | Items | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 Document | 5.58 | 1.57 | NA | 7 | NA | |||||||||
| 2 View | 5.22 | 1.30 | NA | 6 | 0.42∗∗ | NA | ||||||||
| 3 Decision support | 4.85 | 1.50 | NA | 6 | 0.41∗∗ | 0.55∗∗ | NA | |||||||
| 4 Order | 6.06 | 1.04 | NA | 5 | 0.48∗∗ | 0.42∗∗ | 0.35∗∗ | NA | ||||||
| 5 Job satisfaction | 4.61 | 1.33 | 0.93 | 3 | 0.32∗∗ | 0.35∗∗ | 0.31∗∗ | 0.28∗∗ | 0.90a | |||||
| 6 Stress | 4.86 | 1.15 | 0.84 | 4 | −0.08 | −0.11 | −0.20∗∗ | −0.02 | −0.39∗∗ | 0.75a | ||||
| 7 Meaning | 5.90 | 0.94 | 0.93 | 5 | 0.38∗∗ | 0.28∗∗ | 0.27∗∗ | 0.49∗∗ | 0.37∗∗ | 0.03 | 0.90a | |||
| 8 Autonomy | 5.13 | 1.14 | 0.90 | 3 | 0.21∗∗ | 0.21∗∗ | 0.29∗∗ | 0.27∗∗ | 0.44∗∗ | −0.22∗∗ | 0.44∗∗ | 0.75a | ||
| 9 Efficacy | 5.51 | 0.90 | 0.94 | 7 | 0.36∗∗ | 0.36∗∗ | 0.34∗∗ | 0.43∗∗ | 0.43∗∗ | −0.10 | 0.65∗∗ | 0.58∗∗ | 0.82a | |
| 10 Impact | 5.75 | 0.82 | 0.95 | 7 | 0.34∗∗ | 0.34∗∗ | 0.24∗∗ | 0.46∗∗ | 0.42∗∗ | −0.01 | 0.71∗∗ | 0.45∗∗ | 0.75∗∗ | 0.85a |
AVE: average variance extracted; ICR: internal consistency reliabilities; NA: Not applicable.
Square root of the average variance extracted.
P < .01.
Figure 2 shows the structural model results, including the estimated path coefficients and the variance explained (R2). The model explained 39% of the variance in job satisfaction. H1 (H2) predicts that basic (advanced) HITs will empower physicians along the 4 dimensions of empowerment (meaning, autonomy, efficacy, and impact). The results showed that the effect of basic HITs was significant on meaning (H1a: β=0.25; P < .01), efficacy (H1c: β= 0.22; P < .01), and impact (H1d: β = 0.25; P < .01) but was not significant on autonomy (H1b: β= 0.05; P > .05). Thus, H1 was partially supported. In addition, our results showed that the effect of advanced HITs was significant on meaning (H2a: β= 0.29; P < .01), autonomy (H2b: β= 0.32; P < .01), efficacy (H2c: β= 0.33; P < .01), and impact (H2d: β= 0.27; P < .01). Thus, H2 was fully supported. H3 (H4) suggests that basic (advanced) technology will increase stress. Our results showed that the effect of basic technology was not significant (β = 0.00; P > .05), and thus H3 was not supported. Contrary to our expectation, the effect of advanced technology was significant, but in the opposite direction (β=- 0.14; P < .05). Hence, although H4 was not supported, an interesting finding emerged. H5 predicted that all dimensions of empowerment will have a positive effect on job satisfaction. Our results showed that the effects of meaning (H5a: β= 0.14; P < .05), autonomy (H5b: β= 0.15; P < .05), and impact (H5d: β= 0.19; P < .05) were significant, whereas the effect of efficacy was not significant (H5c: β= 0.10; P > .05). Thus, H5 was partially supported. Finally, H6 suggests that stress will have a negative effect on job satisfaction. The results showed that the effect of stress on job satisfaction was significant (β=-0.35; P < .01), supporting H6.
Figure 2.
Results of hypotheses testing.
Overall, the results suggest that basic technology improved meaning, efficacy, and impact, but not autonomy. Further, basic technology was not associated with stress. In contrast, advanced technology improved all dimensions of empowerment and reduced stress. Finally, 3 dimensions of empowerment (ie, meaning, autonomy, and impact) improved job satisfaction, and stress decreased job satisfaction. Table 3 presents the hypotheses testing results.
Table 3.
Paths coefficients from PLS analysis
| Paths | Coefficients | Result | |
|---|---|---|---|
| H1a | Basic technology → Meaning | 0.25∗∗ | Supported |
| H1b | Basic technology → Autonomy | 0.05 | Not supported |
| H1c | Basic technology → Efficacy | 0.22∗∗ | Supported |
| H1d | Basic technology → Impact | 0.25∗∗ | Supported |
| H2a | Advanced technology → Meaning | 0.29∗∗ | Supported |
| H2b | Advanced technology → Autonomy | 0.32∗∗ | Supported |
| H2c | Advanced technology → Efficacy | 0.33∗∗ | Supported |
| H2d | Advanced technology → Impact | 0.27∗∗ | Supported |
| H3 | Basic technology → Stress | −0.00 | Not supported |
| H4 | Advanced technology → Stress | −0.14∗ | Not supported |
| H5a | Meaning → Job satisfaction | 0.14∗ | Supported |
| H5b | Autonomy → Job satisfaction | 0.15∗ | Supported |
| H5c | Efficacy → Job satisfaction | 0.10 | Not supported |
| H5d | Impact → Job satisfaction | 0.19∗ | Supported |
| H6 | Stress → Job satisfaction | −0.35∗∗ | Supported |
H: hypothesis; PLS: partial least squares.
P < .01.
P < .05.
DISCUSSION
Our findings provide a rich view of HIT value that incorporates differences in HIT features and processes. The classification of HIT features based on the purpose of the technology21 explained different dimensions of physician empowerment, stress, and ultimately, job satisfaction. Relative to basic technology, advanced technology is positively associated with more dimensions of physician empowerment. Contrary to findings of prior research,4 advanced technology was found to be negatively associated with stress in our study. A possible explanation is that physicians in our sample may perceive these features (which are directly related to clinical workflows for diagnosis and treatment of patients) as helpful in fulfilling their responsibilities, thus experiencing increased empowerment and reduced stress. The majority of the identified dimensions of physician empowerment and stress were associated with job satisfaction.
We contribute to research on physician empowerment and HIT in at least 3 ways. First, given the high social status and power of physicians,51 few existing studies focused on understanding physician empowerment in relation to HIT implementation and use. For instance, early case studies suggest that physicians or surgeons may use their power to resist technology implementations.51 However, with recent industry and government pressure to use healthcare technology worldwide19,52 and evidence on the negative consequences of HIT use from a physician perspective,4 it becomes important to enrich our understanding of the relationship between HIT use and physician empowerment. Hence, our study contributes to this line of inquiry by shedding light on the relationship between HIT use and 4 dimensions of physician empowerment. Second, research on physician stress suggests that HITs introduce the burden to organize and synthesize diverse sources of information.30,31 In Chinese hospitals, for instance, new basic and advanced responsibilities consume additional time, overload physicians, and induce stress. Our findings suggest that, by assisting decision making and prescription or test ordering, advanced technology actually reduced stress. We observed the same favorable impact of advanced technology on the 4 dimensions of physician empowerment. Third, research on job satisfaction emphasizes the value of the 4 empowerment dimensions (except for efficacy) for job satisfaction.39–41 We observed a similar pattern in Chinese hospitals, but efficacy was unimportant for inducing feelings of satisfaction. Future research may examine other forms of advanced technologies, such as artificial intelligence or patient engagement technologies, in relation to the 4 dimensions of physician empowerment and ultimately, physician job satisfaction.
Our findings also offer important courses of action to the healthcare industry in China. First, healthcare professionals and policymakers should rethink their assessment of HIT value from a physician perspective. For instance, contrary to research in developed countries,4 our findings suggest that advanced technology specified in terms of ordering and decision making features reduced stress and improved all dimensions of physician empowerment. Hence, healthcare professionals and policymakers in China should focus on promoting the use of advanced instead of basic features to reduce burden on physicians. Further, hospitals need to design and maintain work environments that foster meaningful duties, autonomy, and impact.37 Increased investments in advanced technologies could be one approach to empower physicians and ultimately, increase their job satisfaction.
The results of our study should also be considered in light of its limitations. We collected data from 5 class 3 hospitals located in 5 provinces of China, which may limit the generalizability of our findings. These hospitals were chosen based on ties with one of the authors (YC) to facilitate data collection. However, we believe that such nonrandom selection may not significantly bias the results, as the characteristics of hospitals and physicians in the Chinese system are consistent. In addition, the sample size of 367 physicians is modest, and future research is necessary to strengthen power and generalizability. Finally, physician stress and burnout may be related to usability of information systems used in the hospitals. Future research should include relevant variables (eg, ease of use) in the data collection and analysis.
CONCLUSION
Our work contributes to the existing body of knowledge on assessing the effects of HITs from a physician perspective. With a rich view of HITs, we show that advanced (in contrast to basic) technology reduced physicians’ stress and improved all dimensions of physician empowerment in China. Further, physician empowerment improved job satisfaction and stress reduced job satisfaction. Our holistic model that incorporates (1) a nuanced view of HIT features and (2) processes leading to outcomes of using HITs enriches our understanding of the effects of HITs on physicians in Chinese hospitals.
FUNDING
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
AUTHOR CONTRIBUTIONS
Lead author collected the data and conducted the data analysis with help from the second author. The third and fourth authors provided guidance to the first author in the data collection phase. The fourth author set up the structure and story of the article, and iterated several times, editing and providing feedback, on the manuscript. All authors contributed to the writing, with the second author taking the lead role.
DATA AVAILABILITY STATEMENT
Data are not available for distribution due to privacy and confidentiality requirements of the agreement with the participating hospitals. Reasonable requests will be considered by the lead author and data will be shared subject to approval from hospitals where the data were collected.
CONFLICT OF INTEREST STATEMENT
The authors have no competing interests to declare.
Supplementary Material
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
Data are not available for distribution due to privacy and confidentiality requirements of the agreement with the participating hospitals. Reasonable requests will be considered by the lead author and data will be shared subject to approval from hospitals where the data were collected.