INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT

2021, VOL. 14, NO. 1, 50–63

https://doi.org/10.1080/20479700.2019.1607451

Exploring the motivators of technology adoption in healthcare

Dana Alrahbi, Mehmood Khan and Matloub Hussain
College of Business Administration, Abu Dhabi University, Abu Dhabi, United Arab Emirates

ABSTRACT ARTICLE HISTORY

This paper seeks to determine the motivators that affect the adoption of information Received 26 July 2018
technology (IT), specifically in modern healthcare systems, based on a case study in the Accepted 28 March 2019
United Arab Emirates (UAE). The aim is to identify, examine, and place in a hierarchical
KEYWORDS
structure, based on a two-step exploratory methodology, the motivators for IT adoption of Technology adoption;
four main categories of healthcare stakeholders (employees, patients, UAE citizens and healthcare; United Arab
residents, and accredited foresight experts) via an analytic hierarchy process (AHP) model. Emirates; healthcare
AHP revealed the relative importance weights of the seven IT adoption motivators and their information technology (HIT);
41 sub-motivators. Government support was found to be the most important group of motivators; stakeholders;
motivators, followed by knowledge sharing, infrastructure, green management, lean future foresight
management, internal/external environment, and social sustainability. The paper facilitates
improving technology adoption generally, specifically in the UAE’s healthcare system. A
Pareto chart visually presents the ranking of all sub-factors to help supply-chain practitioners
better allocate resources for IT implementation. Little research has examined the combined
perspectives of various stakeholders and no study has hitherto investigated the significant
motivators of IT adoption in the UAEs’ healthcare industry. Including foresight experts is new
in this domain.

Introduction
benefiting other industries worldwide [11]. However,
Technology has come to play an important role in nowadays, driven by social and demographic changes,
managing healthcare systems in terms of managing the use of HIT is showing an upward trend, particularly
and processing healthcare data and transmitting reports in Western nations. Consumer demand is becoming
over large distances in a fraction of the time previously more sophisticated and HIT is one way to deliver
required [1,2]. Many stakeholders are involved in the efficient and safer care services [12]. HIT is gradually
management, use, and maintenance of such systems, becoming a vital component of care delivery and
including funding agencies, technology providers, promises significant efficacy and quality gains [13].
users, and patients and their families. We use Ahlan Thus, understanding the factors behind user accep-
and Ahmad’s [3] definition of health information tech- tance of different IT specifications is of the utmost
nology (HIT), i.e. the use of computers for digital assist- importance for the entire health eco-system [14].
ance by physicians, e.g. electronic storage of health Extant literature indicates many information-tech-
records and patient histories, and computerized entries nology motivators, including the desire for integration,
of physicians’ orders by healthcare professionals such access to real-time information, modernization and
as other doctors, nurses, care-givers, hospitals, test cen- dissatisfaction with older systems, image consider-
ters and laboratories, and patients. HIT has been found ations, decision-making and complexity, process per-
to have many benefits for all stakeholders, e.g. improv- formance and productivity, response time, reduced
ing the quality, timeliness, and efficiency of information operating costs, strategic decision-making, manage-
transfer in healthcare, minimizing errors, and reducing ment reporting, business flexibility, transactional
the cost of maintaining physical records [4–9]. Murthy efficiency, performance expectancy, effort expectancy,
[10], for instance, proposed ‘personalized medicine’, and facilitating conditions [15–20]. However, there is
an interesting HIT form that offers access to patients’ a dearth of research in the United Arab Emirates
health information, encourages participation, and (UAE) examining the combined perspectives of
invites technology to enable better outcomes. It also employees, patients, citizens and residents, and fore-
increases productivity and improves the quality of life, sight experts. Eliciting views from these four stake-
while decreasing costs. holder groups, which is the focus of this research, is
Traditionally, the healthcare arena has been slow to critical because of their individual and combined sal-
adopt the various technological advancements that are ience. Furthermore, the inclusion of the latter group,

CONTACT Mehmood Khan [email protected] College of Business Administration, Abu Dhabi University, P.O. Box 59911, Abu Dhabi,
United Arab Emirates
© 2019 Informa UK Limited, trading as Taylor & Francis Group
 INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 51

foresight experts, in our analysis is entirely new in this US in 2009 to encourage doctors and hospitals to start
domain of research. Foresight experts help companies the transition to EHRs. In addition, the US Patient Pro-
to navigate likely changes by presenting an early assess- tection and Affordable Care Act (PPACA) of 2010 pro-
ment of forthcoming opportunities (and obstacles). vided substantial financial incentives for investment in
However, these specialists do more than forecasting: electronic medical records [29]. The PPACA strongly
they examine various current phenomena and pro- encourages the use of EHRs and personalized patient
cesses, such as networks, because optimizing planning technology to enable and sustain self-management [30].
and decision-making necessarily requires understand- There are numerous environmental pressures on the
ing the extent to which current and historical practices healthcare industry to embrace EHRs, ranging from
have been adequate. federal government incentives to local competitive
Given the roles played by different stakeholders forces [31]. US federal policies were major drivers of
involved in HIT, it is imperative to explore the under- EHR adoption, sometimes imposing penalties on pro-
lying rationale for their participation [21–23]. This fessionals that did not implement this technological
analysis seeks to determine the motivators that affect innovation.
the adoption of information technology in modern Modern healthcare systems are increasingly
healthcare systems based on a case study of the UAE. migrating to software-as-a-service (SaaS) apps for doc-
The main objectives of this research can be summar- umenting patient interactions and information man-
ized as follows: agement [32]. The cloud-based storage of data also
occurs via SaaS applications, which can make data
. use stakeholder theory as a framework for under- more accessible, more durable, and safer [33].
standing the adoption of HIT in the healthcare Huang et al. [34] explored the patterns of e-health
industry; tools adoption by Chinese hospitals in connecting
. explore motivators for the adoption of HIT; with their patients to offer a clear picture of the HIT-
. categorize motivators of HIT adoption across var- development status quo and formulate strategies for
ious stakeholders; further progress towards the delivery of high-quality
. develop a hierarchical structure for these categories care. The authors pointed out that hospital best perfor-
of motivators; and mers, in the top-tier and private hospitals, shared com-
. calculate the significance of each category using the mon dynamics in using interactive tools, although,
analytical hierarchy process. overall the trend was much stronger among private
organizations. For general hospitals and public facili-
ties, particularly those in the second tier, the pace of
Literature review HIT adoption was slower and the number of interac-
tive tools was lower, as they focused more on providing
HIT overview
static information and advertising rather than on offer-
HIT includes all computer-enabled applications that are ing interactive, tailored patient services.
applied to healthcare systems worldwide [22]. Cloud- The UAE manages the funding of its healthcare sec-
based information systems and electronic health records tor based on domestic resources alone within a mixed
(EHRs) have mostly found universal acceptance and public–private system. Emirati citizens have access to
contributed to the exponential growth of the HIT mar- the public system, which is centrally managed and
ket [24]. Research estimates that the HIT sector will be funded. In 1971, the UAE had seven hospitals and 12
worth USD 44.8 billion by 2024, with three main players healthcare centers, growing to over 70 public and pri-
(Cerner Corporation: North Kansas City, MO, USA, vate hospitals and 150 medical centers by 2016 [35].
McKesson: San Francisco, California, United States, Healthcare spending in the UAE is forecast to reach
and All Scripts: Chicago, Illinois, United States) holding AED 73.52 billion (USD 20.03 billion) by 2020 and
a 26% global market share [8]. This growth rate is nearly AED 202 billion (USD 28 billion) by 2025,
already visible in the developed Western world, but mainly driven by population growth, demographic
specialists expect further expansion in developing shifts, problematic lifestyle habits, medical tourism,
nations, which will need a mass-scale electronic and and efforts to introduce the universal health insurance
digital transformation of their health data, which pre- and rising wealth, which increase demand for higher-
sents opportunities for investors [25–28]. quality medical services [36].
Most growth will likely be seen in hospitals as they To meet the growing demand for healthcare within
convert health records to the electronic medium to the UAE and increase its attractiveness as a medical
bridge the connection between practitioners and custo- tourism hub, the government launched UAE Vision
mers [8]. The US is the global leader in terms of HIT 2021 [37]. This agenda seeks to make the UAE a
conversion, backed by an early legislative framework. world-class healthcare destination and includes the
The Health Information Technology for Economic setup of integrated IT systems and electronic data.
and Clinical Health (HITECH) Act was passed in the These objectives can be achieved only if HIT is
52 D. ALRAHBI ET AL.

implemented throughout the healthcare system, allow- The prospective Medicare payments system is also a
ing for a seamless integration of all stakeholders. The major motivator HIT adoption in the US [40,41].
federal UAE government is already planning to Heisey-Grove and Patel [39] also identified the fac-
implement initiatives such as mobile applications for tors appealing to physicians who did not wish to adopt
patient engagement, data analytics, and digitization of EHRs: financial incentives (51%); technical assistance
electronic medical records. in implementation (46%); board certification (44%);
Trends in the healthcare industry among Arab possibility of electronic exchange (39%); feedback
countries have revealed dramatic changes, particularly from colleagues (36%); assistance in EHR selection
in the Middle East. However, Alsadan et al.’s [4] study (29%); and EHR availability (19%).
highlighted that, despite rich financial resources, most Another important factor is to create small wins for
Arab nations still lag behind in terms of HIT adoption adopters throughout the implementation period,
because of a lack of professional competency and dedi- requiring developers to clearly distinguish between
cated funding. Further, government-assisted public implementation and adoption [42]. Change-manage-
facilities display a low level of IT usage, whereas private ment practices should be utilized, e.g. change agents
establishments are financially unable to adopt HIT and leaders to motivate others [38]. The recognition
under its various forms (EHRs, telemedicine, eHealth). of national, organizational, and personal barriers and
These states thus need to come up with viable strategies motivators can help in adjusting HIT implementation
to remove financial and cultural de-motivators and and making it more likely to be adopted. Other motiva-
barriers to enjoy competitive advantages. tors include incentives, patient safety, administrative
simplification, competitive advantage, patient-centered
and accountable organizational systems, revenue
Motivators for HIT adoption
enhancements, and cost savings [43,44].
McClellan’s [38] cross-sectional study of physicians to A recent exploratory analysis using structural
identify the motivators behind HIT adoption found equation modeling (SEM) by Samhan [45] of 237
34.1% of HIT functionalities were adopted within healthcare providers highlighted that hospitals with a
physician practices. One in seven professionals failed cyber-risk insurance policy were more likely to adopt
to successfully adopt HIT and one in five did not and use EMR systems. The phenomenon of cyber-
even heed reminders. Primary care practices and rela- attacks was perceived as a major contributor to tech-
tively larger practices adopted HIT more readily. Phys- nology resistance.
icians in specialties focused on patient-centered care Despite many studies emphasizing the benefits of
were more likely to embrace HIT. Therefore, this HIT implementation, the drivers of technology adoption
study underlines that the adoption of HIT does not and the HIT – financial-excellence nexus have received
necessarily mean physicians and other healthcare far less attention. Some scholars have examined the role
staff will actually use it. Patient-centered institutions’ of HIT in improving organizational performance, profit-
physicians finding it easier to adopt HIT suggests ability indicators, competitive advantages, and in redu-
that management philosophy does have a bearing on cing back office expenses, transportation costs, medical
the implementation process. liability costs and errors, and inventories [46–48]. Li
In 2009, the US Congress committed to financial and Collier’s [49] theoretical framework pointed out
incentives to motivate physicians to adopt EHRs; how- that HIT can increase clinical and process quality and
ever, adoption rates were still inconsistent. Heisey- intermediate business activities, which in turn leads to
Grove and Patel’s [39] analysis of the factors behind superior financial results.
the successful adaptation of EHRs revealed that large According to a recent study [50], personal and
and multi-specialty practices had the lowest numbers organization-level factors are the most important moti-
of physicians hesitant or reluctant to use EHRs, while vators, followed by equipment, workflow, and thematic
these numbers were highest for solo practitioners. interconnectivity, meaning that healthcare pro-
Financial incentives were a significant determinant, fessionals would need to be comfortable using the tech-
with 62% of physicians quoting them as a major nologies if they are to be implemented effectively.
reason. Other factors included the need to fulfill a Using the technology acceptance model (TAM),
board-certification requirement (39%), good feedback Chen et al. [51] explored nurses’ attitudes towards
from other colleagues (37%), possibility of electronic the use of HIT, finding that perceived usefulness (i.e.
exchange (36%), technical assistance (35%), assistance perceived ease of use) was the major, direct driver of
with EHR selection (17%), and availability of certified the intention to use HIT. Furthermore, perceived use-
EHRs (13%). Interestingly, these incentives made a lar- fulness was indirectly impacted by other enablers, such
ger number of physicians adopt EHRs during 2010– as the perceived usability, individual abilities, and
2013 compared to those who had adopted it before internet access.
2009. This suggests that EHR implementation could Cancela et al. [52] used the analytic hierarchy pro-
also be achieved via good word-of-mouth publicity. cess (AHP) model to identify the most important
 INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 53

motivators for adopting a telehealth system for Parkin- However, comprehensive studies on the motivators for
son’s disease for two different categories of healthcare institutions, physicians, nurses, front office, and other sta-
stakeholders: experts with a clinical background (clin- keholders within a healthcare facility are still scarce.
icians); and experts with a technical background
(engineers). Their findings revealed that ‘on/off fluctu- Theoretical perspectives
ations detection’, ‘increased wearability acceptance’,
This research is grounded in stakeholder theory [57–
‘increased self-management support’, and ‘increased
59]. The present work aims to combine four stake-
self-management support’ were the most relevant
holders groups, namely employees, patients, UAE citi-
HIT acceptance motivators for the two groups.
zens and residents, and foresight experts to present a
Based also on the AHP framework, Lambooij and
unique perspective on what motivates them to adopt
Hummel [53] explored the perspectives of six key
HIT in the context of the UAE (see Figure 1). A
healthcare stakeholders, namely physicians, nurses,
detailed description of each stakeholder category parti-
patients, managers, insurers, and policy makers, con-
cipating in our survey is presented in Table 1, while
cerning the acceptance of IT innovation. Politics and
Table 2 details the demographics of the stakeholders
the power balance among these groups may be particu-
participating in this research with regards to age, gen-
larly relevant for modern technologies with wide
der, level of education, and years of experience.
impact within the healthcare eco-system, where various
Since the decision to adopt a technological advance-
stakeholders are mutually dependent in their adoption
ment in the field of healthcare is heavily influenced by
and use. The application of the stakeholder theory in
peer recommendations [60], stakeholder theory is a
the context of HIT implementation enables a better
suitable framework for identifying the motivators and
understanding of why the diffusion of valuable inno-
barriers to HIT adoption and can also highlight the
vation occurs more slowly than many stakeholders
differences or similarities among the views of the stake-
desire it to. The results revealed different preference
holders, if any. This can help those who plan and make
structures for selected HIT forms. For instance, policy
decisions for the healthcare sector to better understand
makers indicated efficiency as the most important HIT
the environment. Stakeholder theory also improves the
motivator, while patients, nurses, and physicians indi-
understanding of the interplay between all participants
cated that efficiency was the least important motivator.
in the system [57].
Health gains were most important for health insurance,
Most researchers have focused on the measurement
nurses, and patients, while satisfaction was the most
of technology adoption mainly by physicians and on
important criterion in embracing HIT for managers
what motivates them to implement a new technology
and physicians but was only moderately significant
in their practice [61,62]. However, none of these studies
for physicians, managers, and nurses.
have explored the perspective of foresight experts.
Wang et al. [54] explored the interplay between
HIT-related spending, business processes, and financial
indicators of performance and productivity in the US, Research framework
asserting that HIT investments were connected to posi-
Phase 1: Exploration of the motivators
tive financial performance, return on assets, and pro-
ductivity. Given the significant spending required by Questionnaire development
HIT formats, e.g. EHRs, there are extensive debates Based on a two-step exploratory methodology, our
on the associated financial and productivity analysis aims to identify, examine, and place in a hier-
payoffs, particularly for smaller healthcare facilities archical structure the motivators that influence the
[49,55,56]. decision to adopt HIT of four main categories of

Figure 1. Stakeholder view of technology-adoption motivators in the healthcare sector.

54 D. ALRAHBI ET AL.

Table 1. Description of each stakeholder category participating in the survey.

Stakeholder group Description
Employee Any individual working in the healthcare sector, regardless of the nature of their job (physician, nurse, technician, administrative,
pharmacists, medical equipment developer, policy makers, software developers, etc.).
Patient Any individual that has a history of long experience with the treatment of their chronic illnesses, such as genetic disorders in blood
cells, multiple neurological sclerosis, and diabetes. The treatment of all these diseases would require a heavy involvement of
modern technology for scans, investigations, and procedures. The service provider can belong to any medical facility (type of clinic
or hospital) or any sector (private or public). If the patient was under the age of 18, the interview was conducted in the presence of
a parents or guardian.
UAE citizen or Any UAE citizen or resident, male or female, aged 18–65 years.
resident
Foresight expert Any trainee, male or female, that has undertaken foresight training or is foresight-accredited. Foresight is focused on potential
changes in the external surroundings and how these could impact the organization. Experts in this field assist companies in
navigating such likely changes by presenting an early assessment of the opportunities ahead (or obstacles). Foresight specialists do
more than forecasting; they examine aspects of networking and prepare decisions about the future. In addition, they provide
information about the future, which is a part in the planning and decision processes.

Table 2. Demographics of the stakeholders participating in this research.

Employees (n = 15) Society members (n = 40) Patients (n = 40) Future foresight experts (n = 15)
Age (years)
18–24 1 3 5 0
25–34 4 4 8 5
35–44 5 10 12 6
45–54 4 9 11 2
55–64 1 12 3 2
56–74 0 3 1 0
Gender
Male 9 13 11 8
Female 6 27 29 7
Level of education
Below high school 0 2 1 0
High school 2 5 6 0
Bachelor’s degree 8 17 18 8
Master’s degree 2 14 12 6
Doctoral degree 3 2 3 1
Years of experience
<5 1 1 4 0
5–10 3 4 7 1
11–15 4 13 9 4
16–20 3 11 12 6
21–25 1 8 6 3
>26 3 3 2 1

healthcare stakeholders via a model that indicates the from the society members’ category. The survey
practical implementation and management steps to included group-customized demographics questions
deal with such factors. We chose an exploratory meth- (see Table 2). The survey was structured following
odology to gain knowledge of the four groups’ opinions the framework in Figure 1. The 115 responses were col-
on HIT motivators, which the respondents would offer lected over a period of one month.
by virtue of their experience. Exploratory research
refers to the collection of data in an informal and Sample
unstructured manner and is best suited to guide the For the employees’ category, local and foreign phys-
survey design and question building [63]. icians in public and private hospitals, with more than
The sample size was based on the availability and five years’ experience with a technology, were selected
accessibility of the different stakeholders groups. Over for this research. This category also included adminis-
time, AHP has been successfully applied in studies trators with an experience of selecting and implement-
with small sample sizes. Several scholars have reported ing technologies in healthcare. Eight administrators
viable AHP-driven findings with a limited number of and seven physicians represented the total of 15 candi-
experts, inter alia, five respondents [64,65], seven dates that were selected and interviewed.
participants [66], 18 participants [67], and 25 respon- For the patients’ category, candidates were selected
dents [68]. based on their long experience with the treatment of
In phase 1, we designed an exploratory survey as the their chronic illnesses such as genetic disorders in
sole data collection instrument for the four groups of blood cells, multiple neurological sclerosis and dia-
respondents. To this end, 15 interviews were initially betes. The treatment of all these diseases would require
conducted with the employees’ category, 40 interviews a heavy involvement of modern technology for scans,
with the patients’ category, 20 interviews with the investigations and procedures. A total of 40 patients
future foresight experts’ category, and 40 candidates were selected and interviewed.
 INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 55

The future foresight category is relatively modern names were included. Hence, the principles of
and only a few organizations are involved in training informed consent and confidentiality that protect the
and certifying their employees in this area. A total of dignity and rights of all participants, minimizing the
20 trained experts were approached and 15 were inter- risk of harm, were met.
viewed for this research. The analysis of future fore- The interview included demographics-related ques-
sight experts’ opinions is a novel approach in tions and one main question regarding their view of
academic research but provides a new way of directly motivators that impact the adoption of the latest tech-
involving the industry’s planning capacity in studying nologies in the healthcare sector. Based on the inter-
HIT adoption motivators. Nowadays, the term fore- view findings, we created separate tables for each
sight expert engenders far more expectations than pre- interviewee and listed his/her thoughts and ideas dis-
viously, although professional foresight services are still cussed; subsequently, we analyzed the answers and
note clearly defined from the perspective of the market started coding the repeated elements to obtain the list
[69]. However, several authors have adopted the of factors to be included in our study.
definition of foresight professionals as individuals All identified factors during the interview were listed
engaged in by the researchers to gain insights and explore possible
gaps that may exist. Motivators refer to the internal and
a systematic, future-oriented, analytical and interac-
tive process that partly contributes to shared visions external factors that encourage the adoption of new
concerning long-term developments within science, technologies in the healthcare sector.
technology, business and society and partly facilitates Candidates’ responses were collected and filtered
the alignment of relevant stakeholder groupings to remove repetitive answers. They were additionally
around desirable developments through relevant strat- condensed, based on similarity, to create a list of a
egies, decisions and actions. [70]
more manageable length, from which discrete the-
Foresight is an activity focused on the cognitive part of matic items were produced. Thus, after the removal
anticipation [71]. This process enables individuals to of repetitive entries via filtering techniques, the out-
‘see far and wide’ to improve how they think through come of phase 1 was the identification of 66 motiva-
their decisions [72]. Hence, foresight experts modify tors of technology adoption in the sector for the four
individual representations by creating new frames for main stakeholders of the healthcare industry (see
analysis [73]. Table 3). The next step was to group them into simi-
Foresight experts serve both private and public sec- lar themes. The final list included 16 factors ident-
tors, at the global, national, and regional levels [74]. ified by the society members, 19 by employees
From the standpoint of commercial entities that prac- working in the healthcare sector, 10 by patients
tice foresight, the number is limited and only comp- using healthcare services, and 21 by the foresight
lements, rather than substitutes for, graduate experts.
education. This is already a reality, as companies are
now training their own foresight experts [75].
Phase 2: Development of the AHP model
The category of society members was broad. A total
of 40 candidates were hand-picked based on their edu- Ranking of identified factors
cation, age, and job experience to match the other cat- In phase 2, we developed the AHP model. The AHP
egories as closely as possible. Four focus group sessions framework, pioneered by Thomas Saaty in 1980, is a
were conducted with 10 candidates. Within each focus highly efficient instrument to address complex
group, candidates with similar criteria and background decision-making that helps the individual/team behind
were grouped in order to attain the highest level of it establish priorities and choose the best option(s). By
positive influence and discuss the research topic openly decreasing the complexity of decisions to a range of
and freely. pairwise comparisons, followed by a synthetization of
the outcomes, AHP calibrates both the subjective and
objective facets of a decision. AHP involves five steps
Data collection and analysis [76]: development of the hierarchical structure; pair-
The researchers sent invitation letters electronically to wise comparison; calculation of criteria weights; com-
all selected 15 representatives of the four stakeholder putation of option scores matrix; and ranking of the
groups to take part in a 60–90-min interview to inves- options. The AHP model is a powerful and flexible
tigate the motivators for HIT adoption in the context of instrument because the score and, thus, the final prior-
the UAE. They were informed that, if choosing to itization, are achieved via the pair-wise assessment of
voluntarily participate, the completion of the survey both the factors and the alternatives provided by the
would demonstrate their consent, and that they may user. The computations enabled by AHP are guided
decide to withdraw at any time. There was no compen- by the decision-makers’ experience; from this perspec-
sation for responding nor was there any known risk. To tive, AHP can reshape qualitative and quantitative
ensure that all information remained confidential, no evaluations of the latter into a multi-criteria ranking.
56 D. ALRAHBI ET AL.

Table 3. Stakeholders’ view of motivators of technology adoption in the healthcare sector.

UAE citizens and residents Employees Patients Foresight experts
1 Online access Leadership support Social media 2030 Vision
2 Smart technologies Culture Government support Demand for fast diagnoses
3 Demand for speedy procedures Support from teaching hospitals Competition Strategy for big-data adoption
4 Financial status of society Support for career development Current infrastructure Demand for less legal cases
5 Social awareness 2030 Vision Medical legislations Demand for global access
6 Current infrastructure(information) Current infrastructure(buildings) 2030 Vision Demand for smart indicators
7 Support from insurance companies. High standards in hospitals Demand for speedy Demand for control over contagious
recovery illness
8 Demand for error-free diagnosis Organizational culture in hospitals Trust New happiness indicators
9 Current infrastructure(buildings) Demand for speedy procedures New happiness indicators Demand for error-free diagnoses
10 Centralized/integrated access with Demand for quality services Social awareness Being cost effective
Emirates ID
11 Cost (to the individual/patient) Government support Background in science and
technology
12 Media Social awareness Easy transfer of knowledge
13 Government support Geographical location of the UAE Demand for new technologies
14 Centralized medical logs Demand for speedy and error-free Trust in new technologies
diagnosis
15 Trust Support from insurance companies Demand for less medical errors
16 International trade Demand for fewer medical errors Existence of local medical schools
17 Life saving Government support
18 Time saving Demand for smart technologies
19 Nature of tasks Current infrastructure
20 Cost (to the individual/patient)
21 Foresight

Furthermore, it is a simple technique because it does Prioritizing motivators of technology adoption in

not require a sophisticated system embedding the the healthcare industry
decision-makers’ knowledge on the topic. Hence, Questionnaire development. Phase 2 was also intended
AHP facilitates the derivation of ratio scales from to calculate the weights of each identified HIT motiva-
paired comparisons, widely used by practitioners and tor (objective 4). In this sub-stage, we designed a survey
researchers due to its power and simplicity [77]. AHP that used a pairwise matrix with a 1–9 scale as the data-
does not use or involve independent and dependent collection instrument, consisting of 30 initial inter-
variables; thus, there is no need for a moderator [52]. views with representatives of the same four groups of
Phase 2 also corresponds to the second objective of healthcare stakeholders. The instrument included the
our study, namely the arrangement of identified factors same group-customized demographics questions as in
(in phase 1) into a hierarchical structure. The hierar- phase 1.
chal structure of the resulting AHP model includes Sample. Our sample included candidates from each
the main criteria and sub-criteria of HIT motivators stakeholder category, who were invited to provide their
mentioned by our respondents. As shown in Figure 2, input on the subject (i.e. pairwise comparisons) for the
level 1, the highest level in the hierarchy, mirrors the AHP analysis. The criteria for membership of each
overall goal of the study, which is to discover the top group were the same as in phase 1.
enablers of HIT adoption in UAE. Level 2 represents The respondents were again selected through pur-
the main criteria and level 3 reflects the group of posive sampling to ensure adequate discipline and
sub-factors relevant to the primary determinants in experience. Based on the years of expertise, experience
level 2. with healthcare sector services, and knowledge level of
To build the research framework, we reduced the each, they were considered experts in their field. The
initial set of identified technology adoption motivators sample size, reduced from 30 to 25 respondents,
to 41 unique factors by removing commonalities. Based although small, is acceptable from the AHP method-
on relevance, these 41 factors were grouped into seven ology perspective [78].
main motivator categories: government support; infra- Data collection. The opinions and input on the sub-
structure; knowledge sharing; internal/external ject matter of our respondents were collected through
environment; social sustainability; green management; in-depth interviews and their judgments were used to
and lean management. We took the outcome of phase 1 establish the pairwise-comparison matrices in AHP.
and shared it with seven experts to obtain feedback and As previously explained, to ensure the best outcome
ensure content validity; thus, interviews were con- and successfully address the subject, the priority for
ducted with five senior managers in the Health Auth- selected motivators is crucial. The AHP method was
orities of both Abu Dhabi and Dubai, representing used to set relative importance weights to the seven
the departments of Innovation and Information Tech- identified technology adoption motivators, as well as
nology and two academicians with many publications their 41 sub-factors. The model provides a complete
in the same field. and rational framework for structuring the motivators
 INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 57

Figure 2. AHP model for prioritizing technology-adoption motivators.

of technology adoption, representing and quantifying other criteria and sub-criteria were rated following a
their sub-factors, relating those elements to the overall similar approach. The numerical weights or priorities
goal, and assessing the different solutions. were derived for each element of the hierarchy, allow-
All 25 experts were asked to evaluate the various ing for diverse and often incommensurable elements to
motivators of the AHP model by comparing them, be compared in a rational and consistent way.
two motivators at a time, a technique called pairwise Data analysis and AHP results. In line with Saaty
comparison. This gave us the impact of the main cri- [76], the geometric-mean approach was preferred
teria on the overall hierarchy. over the arithmetic mean to combine the individual
The experts’ judgment was then used to identify the pairwise-comparison judgments of the 25 experts
factors’ relative meaning and importance. AHP con- into the pairwise-comparison matrix. To verify the
verts these evaluations to numerical values (Saaty’s consistency of the comparisons, a consistency index
1–9 scale) that can be processed and compared over (CI) was applied to each pairwise comparison matrix
the entire range of criteria and sub-criteria. Therefore, (Saaty [75]). Then, the consistency ratio (CR) was
the questionnaire was developed using Saaty’s 1–9 used to assess whether or not a matrix was sufficiently
scale, as shown in Table 4, and pairwise comparisons consistent. Random pairwise comparisons were simu-
of technology adoption motivators’ criteria and sub- lated to produce average random indices for different
criteria were made by each of the 25 experts. For sized matrices (see Table 5).
example, if a respondent identified government sup- Based on the judgments made by the 25 stake-
port as moderately more important than infrastructure, holder experts, a pairwise-comparison matrix of
the former would be rated 3 and the latter 1/3. The the seven main categories of technology adoption

Table 4. Scale for AHP pairwise comparison.

Intensity of importance Definition Explanation
1 Equal importance Two criteria contribute equally to the objective
3 Moderate importance Judgment slightly favors one over another
5 Strong importance Judgment strongly favors one over another
7 Very strong importance A criterion is strongly favored and its dominance is demonstrated in practice
9 Absolute importance Importance of one over another affirmed on the highest possible order
2, 4, 6, 8 Intermediate values Used to represent compromise between the priorities listed above
58 D. ALRAHBI ET AL.

Table 5. Random index.

n 1 2 3 4 5 6 7 8 9 10
RI 0.00 0.00 0.58 0.90 1.12 1.24 1.32 1.41 1.45 1.48
Note: n is the number of factors.

Table 6. Geometric means of pair-wise comparison of main criteria.

Criteria A B C D E F G Priority vector
1. Government support 1.00 3.24 1.45 6.18 3.11 1.42 2.22 0.28
2. Infrastructure 0.31 1.00 1.38 3.03 4.14 1.31 0.95 0.17
3. Knowledge sharing 0.69 0.72 1.00 3.13 5.04 0.92 2.97 0.19
4. Internal/external environment 0.16 0.33 0.32 1.00 1.83 0.65 0.91 0.07
5. Social sustainability 0.32 0.24 0.20 0.55 1.00 0.47 1.03 0.06
6. Green management 0.71 0.76 1.08 1.54 2.14 1.00 2.02 0.15
7. Lean management 1.05 0.34 1.10 0.97 0.49 1.00 0.09
Note: CR value = 0.07 (<0.1 = consistent).

(main criteria) was established (Table 6). After The government-support category was found to be
completing the 7 × 7 pairwise comparisons, we the most relevant group of motivators to technology
applied AHP to determine the weights of relative adoption practices in the healthcare sector in the
importance for each criterion (the priority vector UAE. The overall relative importance (priority) weight
in Table 6). of this category was 28%. This also indicates the set of

Table 7. Geometric means of pair-wise comparison of sub-criteria.

Criteria Priority vector
Government support (CR = 0.08) A1 A2 A3 A4 A5 A6
A1. 2030 Vision 1 1.97 0.64 0.61 0.88 1.13 0.15
A2. Strategic support 0.51 1 0.41 0.97 2.8 0.23 0.12
A3. Financial support 1.56 2.46 1 2.71 3.29 1.48 0.28
A4. Foresight 1.65 1.03 0.37 1 1.53 0.59 0.14
A5. International trade 1.14 0.36 0.3 0.65 1 0.59 0.1
A6. Medical legislation 0.88 4.34 0.68 1.7 1.69 1 0.22
Infrastructure (CR = 0.04 < 0.1) B1 B2 B3 B4
B1. Infrastructure of building 1 0.58 0.59 0.88 0.18
B2. Information infrastructure 1.73 1 3.48 2.07 0.43
B3. Centralized/integrated access with Emirates ID 1.69 0.29 1 0.62 0.18
B4. Existence of local medical school 1.14 0.48 1.6 1 0.22
Knowledge sharing (CR = 0.07) C1 C2 C3 C4 C5 C6
C1. Online access 1 2.09 0.79 0.42 0.32 1.88 0.14
C2. Support from teaching hospitals 0.48 1 0.59 0.94 0.64 3.1 0.14
C3. Support from career development 1.26 1.69 1 2.21 1.91 2.13 0.25
C4. Organizational Culture in hospitals 2.39 1.07 0.45 1 0.9 2.39 0.17
C5. Easy transfer of knowledge 3.09 1.56 0.52 1.11 1 2.88 0.21
C6. Geographical location of the UAE 0.53 0.32 0.47 0.42 0.35 1 0.07
Internal/external environment (CR = 0.05) D1 D2 D3 D4 D5 D6
D1. Centralized medical logs 1 1.07 3.01 2.74 0.83 2.33 0.26
D2. Support from insurance companies 0.93 1 0.71 1.15 0.96 1.22 0.16
D3. Leadership support 0.33 1.41 1 0.73 1.28 0.65 0.14
D4. Nature of tasks 0.36 0.87 1.37 1 0.7 1.07 0.13
D5. Competition 1.21 1.04 0.78 1.42 1 1.21 0.18
D6. Background in science and technology 0.43 0.82 1.53 0.93 0.83 1 0.14
Social sustainability (CR = 0.03) E1 E2 E3 E4 E5 E6
E1. Global access 1 1.36 0.18 0.45 0.28 0.69 0.08
E2. Market trends 0.74 1 0.4 1.15 0.66 0.62 0.11
E3. Patient satisfaction 5.57 2.48 1 2.29 1.79 2.07 0.32
E4. Open communication and feedback system 2.22 0.87 0.44 1 0.37 0.63 0.11
E5. Happiness indicators 3.52 1.52 0.56 2.69 1 1.51 0.22
E6. Equality and opportunity 1.44 1.62 0.48 1.59 0.66 1 0.15
Green management (CR = 0.05) F1 F2 F3 F4 F5 F6
F1. Mortality 1 0.29 0.89 0.67 0.98 0.37 0.09
F2. Control over contagious illnesses 3.5 1 1.95 3.98 2.11 2.2 0.33
F3. Eco-friendly suppliers 1.13 0.51 1 0.54 0.7 0.17 0.09
F4. Smart/new technologies 1.5 0.25 1.86 1 0.53 0.53 0.11
F5. HIMSS accreditation 1.02 0.47 1.43 1.89 1 0.48 0.13
F6. Safety standards 2.69 0.45 5.92 1.88 2.06 1 0.26
Lean management (CR = 0.09) G1 G2 G3 G4 G5 G6 G7
G1. Quick recovery 1 2.6 0.91 3.27 1.51 2.05 0.78 0.22
G2. Quality services 0.38 1 2.27 1.96 3.02 2.64 2.53 0.22
G3. Less medical errors 1.1 0.44 1 1.17 0.7 1.56 0.61 0.11
G4. Less legal medical cases 0.31 0.51 0.86 1 0.74 2.13 2.99 0.13
G5. JCI accreditation 0.66 0.33 1.43 1.34 1 1.41 0.71 0.11
G6. Cost 0.49 0.38 0.64 0.47 0.71 1 1.61 0.09
G7. Quality awards 1.28 0.4 1.63 0.33 1.4 0.62 1 0.12
Note: CR < 0.1 = consistent.
 INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 59

motivators within this category (2030 Vision, strategic Discussion of results

support, financial support, future foresight, inter-
Government support (2030 Vision, strategic support,
national trade, and medical legislation) were the most
financial support, future foresight, international trade,
influential in adopting the latest technologies in the
medical legislation) was found to be the highest impor-
sector.
tance group of motivators to HIT adoption practices in
The next relevant motivator group was knowledge
the UAE, followed by knowledge sharing, infrastruc-
sharing, with a priority weight of 19%. Similarly, the
ture, green management, lean management, internal/
set of motivating practices within this category were
external environment, and social sustainability.
reported as the reasons behind the need among
Regarding the priority weights of the consensus pair-
healthcare employees to share knowledge locally
wise comparison for government support, phase 2
and internationally and access the latest medical
showed that the experts gave the highest priority to
procedures and successful techniques. These two
financial support (28%), followed by medical legis-
groups represented 47% of determinants among the
lation (22%), and a low priority to international trade
surveyed experts. Infrastructure and green manage-
(2%) as a motivator. For the infrastructure factor,
ment had similar priority weights (17 and 15%,
information infrastructure had the highest priority
respectively).
weight (43%), followed by the existence of local medi-
Next were lean management and internal/external
cal schools (22%). For knowledge sharing, the highest
environment (9 and 7%, respectively), considered
priority was given to career development (25%), fol-
low. Finally, social sustainability received the least
lowed by the easy transfer of knowledge (21%), organ-
value of priority weights (6%). The response consensus
izational culture in hospitals (17%), online access and
(7%) fulfilled the acceptable CR requirement of AHP.
support from teaching hospitals with equal priority
To better understand the priorities for the main
rates (14%), and the geographical location of the
motivator categories, a similar approach was followed
UAE (7%). For the internal/external-environment fac-
to establish a pairwise comparison of the sub-criteria
tor, the highest priority was given to centralized medi-
(within each category). We suggest that the prioritiza-
cal logs (26%), followed by competition (18%), support
tion of those motivators within each main category is
from insurance companies (16%), leadership support
essential for a more effective technology adoption: set-
and background in science and technology with equal
ting the right priority would help teams in the hospital,
priorities (14%), and nature of tasks (13%). For social
healthcare leadership, or government bodies to
sustainability, a high priority was attached to patient
efficiently allocate time and financial resources to
satisfaction (32%), followed by happiness (22%), equal-
deal with each of them. The AHP results for the
ity and opportunity (15%), market trends and open
seven pairwise matrices are presented in Table 7.
communication and feedback system with equal

Figure 3. Overall priority of the 41 sub-factors.

60 D. ALRAHBI ET AL.

weights (11%), and global access (8%). For green man- healthcare systems and HIT adoption in the UAE via
agement, the highest priority was given to control over an exploratory two-phase qualitative methodology.
contagious illnesses (33%), followed by safety stan- In-depth interviews with these groups revealed the
dards (26%), HIMSS accreditation (13%), smart/new motivators of HIT adoption and their priority level,
technologies (11%), and mortality and eco-friendly enabling government and healthcare agencies to
suppliers with equal priorities (9%). Finally, for lean adapt their current policies and practices. Although
management, equal priorities were attributed to quick Emiratis have access to the public healthcare system,
recovery and quality services (22%), followed by less centrally managed and funded, this is not perceived
legal medical cases (13%), quality awards (12%), less to be high-quality, as the local expertise is low and
medical errors and JCI accreditation with equal weights the cost of care is high [37]. Hence, the system is
(11%), and cost (9%). All sub-criteria weights assess- under the government’s radar for service quality
ments met the AHP consistency requirements. improvement, with a focus on making it more modern
To better illustrate the impact of the seven main and accessible. Further, the literature lacks comprehen-
motivator categories, an overall relative priority for sive studies that explore the motivators for institutions,
the 41 factors was developed by multiplying the sub- physicians, nurses, front office, and other stakeholders
criteria weights within each social sustainability within a facility, and particularly foresight experts,
group with the overall category weight. For example, showing the need to identify the adoption motivators
the overall relative importance weight for financial sup- for different stakeholders to understand what factors
port was estimated as 0.28 × 0.28 = 7.84%, having the appeal to different sets of employees.
highest priority. In other words, in the healthcare The AHP results and the Pareto chart in Figure 3
industry, financial support is crucial to obtain the latest offer insights for both researchers and policy experts
technologies, which are costly and exclusive. The and a roadmap for practitioners for effective HIT
second priority was attributed to information infra- implementation in the UAE. From an applied perspec-
structure, which is also vital to HIT adoption. Medical tive, the identification of these motivators raises aware-
legislation was third in the ranking because it guaran- ness on how to improve the healthcare system in the
tees that the proper use of the new technologies is UAE by organizing and directing initiatives to deter-
highly relevant for the safety of the public. mine areas of opportunity within the sector. Further-
Figure 3 can be viewed as the implementation plan of more, while AHP sets the priorities for motivators, the
HIT in the UAE, based on the initiatives undertaken to Pareto chart visually presents the ranking of all sub-fac-
deal with the seven motivator categories, as it first tors. Such priority ranking can thus assist supply-chain
focuses on the motivators with higher impact or priority practitioners in better allocating resources (e.g. budget-
distinguished by Pareto’s 80–20 rule. For example, one ing, labor, time) for HIT implementation.
may consider the first 10 motivators and subsequently A limitation of our analysis is that the results, in
apply a gap analysis and a benchmarking study for terms of the identified priorities for specific motivators,
further examination. As these motivators were viewed may vary as a result of experts’ judgments in the AHP
by experts as most relevant to HIT adoption, they are pairwise-comparison matrices. As such, different
expected to provide the most benefits. results may be obtained for the same or similar nations
based on the expert sample used. Therefore, future
research should be directed towards investigating the
Conclusion
effects of these motivators on HIT implementation in
To date, this is the first research to identify, explore, hospitals both in the UAE and globally, and more elab-
and prioritize the motivators that affect the adoption orate conclusions drawn based on these extensive
of HIT by major industry stakeholder groups in the results.
context of the UAE healthcare system (the method-
ology is also applicable to different contexts and
Disclosure statement
could be generalized to similar countries, providing
broad guidelines for the healthcare industry). We No potential conflict of interest was reported by the authors.
aimed to address this gap in the literature by revealing
the incentives for HIT adoption in the daily routines of
Notes on contributors
four main categories of healthcare stakeholders
(employees, patients, UAE citizens and residents, and Dana Alrahbi holds a Master Degree in Business Manage-
ment. She is currently a doctoral candidate at College of
foresight experts) and by creating a model that shows
Business in Abu Dhabi University, United Arab Emirates.
the practical implementation and management steps Her research interests include leadership, technological
to control and enhance such motivators. Therefore, changes, dynamic team motivation, organizational excel-
we make a unique contribution to the field by present- lence and innovation.
ing in an integrated manner the opinions of four differ- Mehmood Khan is an Associate Professor of Operations
ent stakeholder clusters closely associated with the Management at Abu Dhabi University. He has served as
 INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 61

the director of the center of excellence in Sustainable healthcare information technology. Int J Healthc
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