Accepted for/Published in: JMIR Formative Research
Date Submitted: Jan 29, 2024
Date Accepted: Aug 8, 2024
Critical Success Factors and Acceptance of Casemix System Implementation within the Total Hospital Information System: An Exploratory Factor Analysis of A Pilot Study in Malaysia
ABSTRACT
Background:
The Ministry of Health in Malaysia has implemented the Casemix System and the Health Information System (HIS) to improve healthcare quality, resource allocation, and cost-effectiveness.
Objective:
Hence, this study aims to develop and redefine the instrument for Casemix System implementation within the MOH’s Total Hospital Information System (THIS).
Methods:
A cross-sectional approach was used to collect pilot data from 106 medical practitioners in a hospital equipped with THIS facilities in the Federal Territory hospital. The data was acquired through an online questionnaire based on the Human, Organizational, Technology-Fit (HOT-Fit) evaluation model and Technology Acceptance Model (TAM) frameworks, and it was analyzed using Exploratory Factor Analysis (EFA).
Results:
EFA procedures revealed eight key constructs shaping implementation: system, information, and service quality; organizational factors; perceived ease of use; perceived usefulness; intention to use; and user acceptability. Of the 42 items examined, 41 exhibited strong factor loadings, prompting the excluding of a single item (O1) in preparation for Confirmatory Factor Analysis (CFA) in the field study. No new constructs emerged except for organizational factors (ORG), but the ORG construct was refined into two components: organizational structure and organizational environment, with four items per component. Cumulatively, overall constructs explained 84.07% of the total variance, with the ORG construct demonstrating robust internal reliability, Cronbach Alpha (0.933), and others ranging from 0.914 to 0.969.
Conclusions:
This study illuminates the intricacies of the EFA and underscores the nuanced dimensions of the ORG construct, challenging previous research focusing solely on organizational structure and environment within the ORG. The study concludes that academic consensus on the characteristics and items needed to quantify critical factors for a successful Casemix implementation in THIS still needs to be discovered. The study positions its refined instrument, preparing for fieldwork and CFA, as a crucial advance in understanding the challenges associated with Casemix System implementation complexities within THIS.
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