Maastricht School of Management FHR Lim A Po Institute

MBA IV

Master of Business Administration Program

2007 – 2009
Maastricht School of Management

“Evaluating the Effectiveness of Information Systems on

organizational performance in hospitals in Suriname”

“A test of an extended version of DeLone and McLean’s IS Success Model 2003”

By
Delano C. Gefferie

Suriname
May 2009

Supervised by: Prof. Dr. Kami Rwegasira PhD

This thesis was submitted in partial fulfillment of the requirements for the degree of Master of
Business Administration (MBA) at Maastricht School of Management (MsM), Maastricht, the
Netherlands
ACKNOWLEDGEMENT
This educational journey has been the most challenging and invigorating experience of my live. I
can only acknowledge a few of many people and organizations on this page who were there along
the way to help me in my growth. Doing research is especially a social process. The support and
advice of other people is crucial in order to carry out an enormous project like this. However, I like
to extend my thanks to several people. I’m grateful for the support of my peers in the MBA course.
They inspired me to work hard to persevere in spite of challenges we faced. My sincere appreciation
goes to the Urmila Monorath, Ria Wong A Fa, and Ismanto Adna who finally got me over the extra
mile.

The Ministry of Health of Suriname and the hospitals in Suriname are acknowledged for the
mandate to conduct this study and their support to the project throughout. The coordinators and other
staff of the Ministry Health and hospitals are recognised for their great effort in preparing the
different information documents and time obtained for distributing en generating the questionnaires
to conduct this study, without which it would not to be possible.

My supervisor Professor Dr. Kami Rwegasira PhD played a key role in maintaining the scientific
rigour for the study and his dedication is appreciated. FHR Lim A Po Institute for Social Studies and
Dr. S. DeBono are credited for the direction and support they provided during the early stages of the
project development, planning and finalization.

I can not forget Mrs. Dr. Ollye Chin A Sen and Mrs. Urmila Monorath who have motivated me to do
the MBA course as well as my friend and fellow Mr. Frits Konigferander who was always there for
me.

Most important is the appreciation directed to all co-ordinators at the Ministry of Health and the
hospitals: Mrs. A. Fitz Jim, Manager Planning and Control of the Diakonessenhuis, Mr. R. Jiwalal,
System Manager of the s’Lands Hospital, Mr. O. Lalay, Financial Manager of Streekziekenhuis
Nickerie and Mrs. Dr. M. Algoe MD, Manager MIS Ministry of Health Suriname and other staff
members of the Department of Health and the hospitals who participated in the study, helping to
make it a success.

MBA Thesis SRFHR0407023 ii

DEDICATION

My family and friends have sustained me through many transitions in my life but my wife, daughters
and brother Karel, deserve the deepest gratitude for being there every step of the way. Karel had
faith in me when I doubted and was my daily cheerleader and drill sergeant when it was hard to
continue. I dedicate this study to my wife, daughters and brother Karel who made this success
possible.

MBA Thesis SRFHR0407023 iii

ABSTRACT

Organizations are very dependent on information systems when evaluating their performance and
there are many indications that these trends will continue in the future. Consequently managements
in organizations in Suriname are fully cognizant of this potential and thereby employ ICT to support
their activities.

The aims of this study are to determine what factors are influencing the effectiveness of Information
Systems and to examine their impact on organizational performance in the hospital environment in
Suriname.

The approach in this study was a multiple case study using surveys and archival data while the
instrument for data collection was a questionnaire. Data were collected from three general hospitals
in Suriname. A set of 75 items, based on the research model, were developed, and aggregated into
four scales for measuring the use of information systems in the hospitals, and six scales for
measuring the effectiveness or success of information systems on organizational performance.
Regression and Structural Modeling Techniques (SEM) were applied to data collected from
questionnaires answered by 99 users of Information Systems and IS support personnel at three
general hospitals in Suriname with more than 100 personnel and an identified automation
organization.

Correlation analysis reveals a statistically significant relationship between both sets of variables,
specified in an IS success model and a behavior model of use. Results show that the strongest or
main factors influencing the effectiveness on organizational performance in the hospitals in
Suriname are User Satisfaction and the Benefits of Use directly and Information Quality indirectly.
In this study those factors seemed to be the strongest predictors of Net Benefits in the hospital
environment of Suriname, and thus performance.

Further results show that the use of information system by the core professions in the three hospitals
is underdeveloped and there is a significant difference in approach and culture between private and
public hospitals.

MBA Thesis SRFHR0407023 iv

TABLE OF CONTENTS
ACKNOWLEDGEMENT ................................................................................................................. ii
DEDICATION ................................................................................................................................... iii
ABSTRACT ....................................................................................................................................... iv
TABLE OF CONTENTS................................................................................................................... v
GLOSSARY ..................................................................................................................................... viii
LIST OF ABBREVIATIONS............................................................................................................ x
LIST OF FIGURES........................................................................................................................... xi
LIST OF TABLES............................................................................................................................ xii
CHAPTER 1 INTRODUCTION .................................................................................................. 1
1.1 Introduction ........................................................................................................................ 1
1.2 Problem definition.............................................................................................................. 2
1.2.1 Research objectives .................................................................................................... 2
1.2.2 Research questions ..................................................................................................... 3
1.3 Research methodology ....................................................................................................... 5
1.3.1 Introduction ................................................................................................................ 5
1.3.2 Research Design.......................................................................................................... 6
1.3.3 Sample and Setting..................................................................................................... 8
1.3.3.1 Questionnaire Design ............................................................................................. 8
1.3.3.2 Sample and Data Collection Procedure.............................................................. 10
1.3.3.3 Data analysis ......................................................................................................... 11
1.4 Research material............................................................................................................. 13
1.5 Scope of research .............................................................................................................. 13
1.6 Chapter Outline................................................................................................................ 14
1.7 Problems and limitations ................................................................................................. 14
1.8 Summary ........................................................................................................................... 15
CHAPTER 2 BACKGROUND INFORMATION .................................................................... 16
2.1 Introduction ...................................................................................................................... 16
2.2 Hospitals in Suriname ...................................................................................................... 16
2.2.1 Information Systems in hospitals in Suriname...................................................... 17
2.2.2 Justification of research design ............................................................................... 17
2.2.3 Attributes which characterize a hospital IS........................................................... 19
CHAPTER 3 LITERATURE REVIEW .................................................................................... 20

MBA Thesis SRFHR0407023 v

 3.1 Introduction ...................................................................................................................... 20
3.2 Information Systems ........................................................................................................ 20
3.3 ERP Systems ..................................................................................................................... 21
3.4 Approaches and methods in use for the evaluation of Information Systems.............. 22
3.4.1 Introduction .............................................................................................................. 22
3.4.2 A conceptual hierarchy of system objectives ......................................................... 23
3.4.3 Relevant approaches to evaluate Information Systems ........................................ 24
3.5 Approaches to the evaluation of Medical Information Systems (MEIS) .................... 32
3.6 Measurement .................................................................................................................... 34
3.7 Organizational issues ....................................................................................................... 35
3.8 Summary ........................................................................................................................... 36
CHAPTER 4 HYPOTHESES DEVELOPMENT AND PROPOSED MODEL .................... 37
4.1 Introduction ...................................................................................................................... 37
4.2 Comparison of Evaluation Approaches ......................................................................... 37
4.3 Applying the IS Success Models in research context .................................................... 38
4.3.1 Operationalization of variables and proposed IS Success Model ........................ 40
4.3.1.1. Variables of IS Success Model................................................................................ 40
4.3.1.2 Variables of Behavior Model of Use ............................................................... 43
4.4 Measures of IS Success Model and proposed Framework ........................................... 45
CHAPTER 5 RESEARCH METHODOLOGY........................................................................ 53
5.1 Procedures and Sample.................................................................................................... 53
5.2 Case Evidence ................................................................................................................... 56
5.2.1 Introduction .............................................................................................................. 56
5.2.2 Case Background‘s Lands Hospital........................................................................ 57
5.2.3 Case Background Diakonessenhuis ........................................................................ 59
5.2.4 Case Background Streekziekenhuis Nickerie ........................................................ 60
5.3 Respondent Characteristics............................................................................................. 61
5.4 Research Instrument and Variable Measurement ........................................................ 61
5.4.1 Research Instrument ................................................................................................ 61
5.4.2 Variable measures .................................................................................................... 62
5.5 Data Analysis and Discussion.......................................................................................... 63
5.5.1 Model testing............................................................................................................. 63
5.5.2 Quality dimensions in Proposed IS Success Model ............................................... 65
5.5.3 Net Benefits of Use in Proposed IS Success Model................................................ 66
MBA Thesis SRFHR0407023 vi
 5.5.4 User Satisfaction in Proposed IS Success Model ................................................... 67
5.5.5 Beliefs in Proposed IS Success Model..................................................................... 67
5.5.6 Net Benefits in Proposed IS Success Model ........................................................... 68
5.5.7 Summary ................................................................................................................... 68
CHAPTER 6 CONCLUSIONS AND RECOMMENDATIONS ............................................. 69
6.1 Conclusions ....................................................................................................................... 69
6.2 Recommendations ............................................................................................................ 70
6.3 Limitations ........................................................................................................................ 73
6.4 Implications for Future Research ................................................................................... 73
BIBLIOGRAPHY ............................................................................................................................ 75
APPENDIX 1: Description of data set.......................................................................................... 78
APPENDIX 2: Questionnaire; English version ........................................................................... 80
APPENDIX 3: Questionnaire; Dutch version.............................................................................. 86
APPENDIX 4: Results pre-test ..................................................................................................... 93
APPENDIX 5: Indication of human resources in health sector in Suriname........................... 94
APPENDIX 6: Hospital sample..................................................................................................... 95
APPENDIX 7: Hypothesized relationships and correlation..................................................... 103
APPENDIX 8: Overview Alternative Hypothesis and testing results ..................................... 106
APPENDIX 9: Descriptive statistics ........................................................................................... 108
APPENDIX 10: Overall results final tests Structural Equation Model .................................... 109
APPENDIX 11: Indication of distribution of spending by payer .............................................. 113
APPENDIX 12: Indication of Health Status and Outcomes Vital Statistics............................. 114
APPENDIX 13: Direct, indirect and total effects of constructs ................................................. 115
APPENDIX 14: Research Model with hypotheses ...................................................................... 116

MBA Thesis SRFHR0407023 vii

GLOSSARY

This is a listing of a definition of some terms used in this thesis.

Definitions:

A system is a set of two or more interrelated components that interact to achieve a goal (Marshall B.
Romney and Paul J. Steinbart, 2006)

An Information System (IS) can be defined technically as a set of interrelated components that
collect (or retrieve), process, store, and distribute information to support decision making and
control in an organization (Kenneth C. Laudon and Jane P. Laudon. 2000).

A Management Information System (MIS) is a formalized computer information system that can
integrate data from various sources to provide the information necessary for management decision
making (J. Hicks, 1990).

Accounting Information System (AIS) is a system that collects, records, stores and processes data
to produce information for decision makers (Marshall B. Romney and Paul J. Steinbart, 2006).

Medical Information Systems (MEIS) is an Information System that provides examples of what
health care providers should do and how medical informatics should be of use in order to gain public
trust (Japan Association of Medical Informatics Commission for the definition of Electronic
Medical Records).

Information is data that have been processed and organized into output that is meaningful to the
person, who receives it. Inventory can be mandatory, essential or discretionary (Marshall B.
Romney and Paul J. Steinbart, 2006).

Data are characters that are accepted as input to an information system for further storing and
processing. After processing the data become information (Marshall B. Romney and Paul J.
Steinbart 2006)

MBA Thesis SRFHR0407023 viii

IS Success is a measure of the degree to which the person evaluating the system believes that the
stakeholder (in whose interest the evaluation is being done) is better off. Logically, if Net Benefits
could be measured with precision, IS Success would be equivalent to Net Benefits. However, IS
Success also has political and emotive overtones of “we won” about it, which are less evident in Net
Benefits (Seddon and Kiew (1997).

A Health Information and Management System (HIMS) is epidemiology a combination from

various sources used to derive information about health status, health care, provision and use of
services and health impact Informatics, McGraw-Hill Concise Dictionary of Modern Medicine, by
The McGraw-Hill Companies, Inc, 2002

A Hospital Information System (HIS) is a system that provides information management features
the hospitals need for daily business; Features: patient tracking, billing and administrative programs;
may include clinical features, McGraw-Hill Concise Dictionary of Modern Medicine, by The
McGraw-Hill Companies, Inc, 2002

MBA Thesis SRFHR0407023 ix

LIST OF ABBREVIATIONS

AIS Accounting Information System

AMOS Analysis of Moment Structures
ANOVA Analysis of Variance
ARKIS Anaesthesia Record-keeping Information System
AZV Algemene Ziektekostenregeling (National Medicare)
CEO Chief Executive Officer
CIS Computerized Information Systems
D&M DeLone and McLean
D&M 1992 Delone and McLean IS Success Model 1992 (original)
D&M 2003 Delone and McLean IS Success Model 2003 (updated)
DKH Diakonessenhuis (private hospital)
ERP Enterprise Resource Planning
GOVT Government
HIS Hospital Information System
ICT Information Communication Technology
IS Information System
ISs Information Systems
LISREL Linear Structural Relationships
LH ‘s Lands Hospital (public hospital)
MRIS Medical Record Information Systems
MIS Management Information System
NHIS National Health Information System
NIS Nursing Record Information System
POP Population
SEM Structural Equation Model
SZN Streekziekenhuis Nickerie (public hospital)
SPSS Statistical Package for Social Science
TAM Technology Acceptance Model

MBA Thesis SRFHR0407023 x

LIST OF FIGURES

Figure 1: Extended DeLone and McLean Success Model 2003 5

Figure 2: The Technology Acceptance Model (TAM) 12
Figure 3: Information System 20
Figure 4: D&M IS Success Model 1992 28
Figure 5: Updated D&M Model 2003 30
Figure 6: Seddon IS Success Model 1997 (a Re-specified version of D&M Model 1992) 31
Figure 7: Levels of clinical efficacy related to use of diagnostic technology 33
Figure 8: Path Analysis Results 65

MBA Thesis SRFHR0407023 xi

LIST OF TABLES
Table 1: Capacity of the three hospitals in the study 8
Table 2: Overview of test group in DKH 9
Table 3: Overall Information Systems hospitals 18
Table 4: Comparison of IS Evaluation Approaches in conceptual hierarchy 39
Table 5: Research hypotheses 52
Table 6: Results of Factor Analyses of construct scales 55
Table 7: Descriptive statistics and Correlation matrix 64

MBA Thesis SRFHR0407023 xii

 This page is intentionally left blank

MBA Thesis SRFHR0407023 xiii

CHAPTER 1 INTRODUCTION

1.1 Introduction
The relationship between the use of Information Technology and organizational performance has widely
been researched in recent years. The results have shown a significant and positive correlation between
IT and organizational performance. This thesis deals with the evaluation of the effectiveness of
information systems (ISs) in hospitals in Suriname. Organizations depend largely on information
systems when evaluating their performance and there are many indications that these trends will
continue in the future. However, there is concern among CEOs and top managers that the investments in
ISs are not yielding the anticipated outcomes. In recent years, Information, and Communication
Technology (ICT) has played a pivotal role in the digital economy. It has become one of the core
elements of managerial reform around the world. Without a doubt, hospital management in Suriname are
fully cognizant of this potential and therefore employ ICT to support hospital activities. Hence, ISs have
emerged. Medical Information Systems (MEIS) were improved the last five years by most of the
hospitals by introducing Microsoft Business Solution Navision, an Enterprise Resource Planning (ERP)
system which should help them to manage their organization efficiently and effectively.

This study aims to understand the fundamental factors that influence the effectiveness of information
systems in hospitals in Suriname, testing an extended version of the Delone and McLean’s IS Success
Model 2003. It reports the results of an empirical study evaluating the contribution of ISs in the
effectiveness on operational performance of hospitals based on literature review and it includes research
of many subject areas related to the evaluation of ISs, such as models and frameworks as well as
literature review on the characteristics of medical informatics and health economics. The thesis
measures the factors, determining information systems’ effectiveness in Surinamese hospitals with more
than 100 employees, having an identified automation organization and using ERP systems by
investigating data collected from users and IS support staff who have experienced ISs. These variables
are presumably system decision performance: System Quality, Information Quality and Service
Quality and the measures for effectiveness: Intention to Use (System Usage), Benefits of Use (Benefits
of use from end-users’ view), User Satisfaction and Net Benefits (Net value from organization’s view)
that are considered the most effective variables to predict organizational performance. In conjunction
with the results of the empirical study conclusions have been drawn and recommendations have been
formulated for hospital management in Suriname.

MBA Thesis SRFHR0407023 1

1.2 Problem definition
Organizations generally implement Information Systems after advise of experienced IS users and
consultants but owing to the complexity of today’s ISs the management is often unsatisfied when
comparing the effectiveness of their IS to those of competitors and/or others. To improve business and
so organizational performance, organizations need an efficient planning and control system that
synchronizes planning of all processes across the organization. The key to competitiveness nowadays is
a solid IS seamlessly (dovetailed) aligned with the core business processes developed to deliver high
quality products and services to customers efficiently and effectively. These demands have prompted
more and more firms and organizations to shift their ICT strategy from developing in-house IS to
purchasing applications, such as ERP to generate synergies and enhance operation efficiency (Hong and
Kim, 2002). ERP systems as an integrated IT solution have been extensively adopted since the late
1900s by organizations to help improve both the efficiency and effectiveness of business processes.
However, it usually takes time to implement ERP systems. Moreover, many ERP solutions are
expensive projects in which a considerable number of diverse experts and different agendas are often
involved.

The problem that organizations face after implementing an ERP system and Information Systems in
general is to determine to what extent they lead to organizational success. Hence the central research
question of this thesis is:

“What are the main factors influencing effectiveness of information systems on the organizational
performance of hospitals in Suriname?”

1.2.1 Research objectives

Under the assumption that effectiveness of Information Systems improves organizational performance,
the following research objectives have been formulated:
1. determination of the factors that influence effectiveness of ISs on organization performance;
2. determination of ISs hospitals in Suriname have in place and the level of their effectiveness;
3. determine the relationship between use of ISs and performance of hospitals in
Suriname.

MBA Thesis SRFHR0407023 2

The Information Systems of the three hospitals involved as a whole is the unit of analysis in this study.
This due to the fact that their ERP system is not in the same stage of development and by doing so facts
can be found to compare findings to help them evaluate how implementation of their ERP system
among other ISs have in the first place benefited them selves, and secondly in comparison with other
hospitals involved in the study. Although it is very important to evaluate the success of ERP
implementation projects since a lot of financial and human resources have been invested, Brandford and
Sandy (2002) reported that 57% of the companies they have interviewed launched no assessment on the
performance of their ERP systems. Lack of empirically effective evaluation models is one of the reasons
for not measuring ERP performance. This is also one of the reasons that motivate the final selection of
the hospitals involved in the study. Hospitals are parent organizations with more than one health care
facility. As a contribution, this study is the first study aimed to understand organizational performance in
hospitals in Suriname by using the Delone and McLean IS Success Model 2003 extended with a partial
behaviour Model of Use derived from the Technology Acceptance Model (Davis et al, 1989) which was
elaborated by Seddon et al.’s in Seddon IS Success Model 1997. As such, it is one of the few studies that
empirically confirm the excellence of an extended version of DeLone and McLean’s IS Success Model
2003 in predicting net benefits from IS use. It also provides a theoretical foundation for researching ISs
effectiveness in the future worldwide.

This study accordingly attempts to test a success model for post-implementation ERP systems among
other ISs and to empirically investigate the multidimensional relationship between the success measures.
In other words, the purpose of this study is to identify the variables for success measurement of post–
implementation of ERP systems particularly and ISs in general. In addition, the relationships between
the success measures are also empirically tested.

To the practitioners (management, users, IS support staff and government), this study provides a useful
guideline for achieving better ISs and increasing benefits from use by identifying specific benefits
factors, which are simple and easy to understand, and can be manipulated through system design and
implementation. It thereby assists hospital management in considering the findings for development and
evaluation of ISs.

1.2.2 Research questions

In this thesis I have, particularly, tested the relationship between the effectiveness of IS and the
organizational performance of hospitals involved. So, the aim of this thesis is to empirically test whether
MBA Thesis SRFHR0407023 3
the use of ISs in organizations leads to productivity improvement or not. The main research questions
derived from the objectives set forth in thesis are:
1. What factors influence effectiveness of Information Systems?
2. Which Information Systems hospitals in Suriname have in place and what is the level of
their effectiveness?
3. What is the relationship between the effectiveness of Information Systems and the
performance of hospitals in Suriname?

A careful scan of the literature shows that researchers in similar studies generally apply statistical and
mathematical models, such as regression analysis, correlation analysis, and data envelopment analysis.
In this study I will apply correlation and path analysis to study the relationship between IS usage and
organizational performance. In order to answer the research questions I found among other models (see
Chapter 2 and 3) DeLone and Mclean’s model a strong theoretically based and empirical tested model to
support my research. I have conducted an empirical study in three hospitals using Computerized
Information Systems (CIS) and implemented an ERP system to analyse the relationship between the
variables with an extended version of DeLone and McClean’s IS Success Model 2003 (see Figure 1).
The aim of the research is not a formal test of the proposed research model. So, my research is an
applied analysis of the model and not a theoretical instrument evaluation exercise.

MBA Thesis SRFHR0407023 4

 3. Partial Behavioral Model of IS Use

Perceived Perceived
Ease of Use Usefulness

1. Measures of Three
Quality Dimensions
Intention
System to Use
Quality

Information
Quality Net Benefits
Benefit
of Use

Service 4. Other Measures of Net

Quality User Benefits of IS Use
Satisfaction

2. General Perceptual Measure

of Net Benefits of IS Systems

Figure 1: Extended DeLone and McLean IS Success Model 2003 (modified)

Source: Shih-Wen Chien, 2004

1.3 Research methodology

1.3.1 Introduction
As the D&M Model is a multidimensional model which need to be analyzed with multivariate
techniques the stage six-step approach to Structural Equation Modeling (SEM) analysis was conducted.
These six stages are: 1

1. Defining individual constructs (see Appendix 1);

1
Hair et al. (2005)
MBA Thesis SRFHR0407023 5
2. Developing overall measuring model (see Figure 1);
3. Designing a study to produce empirical results (see 1.3.2);
4. Assessing the measurement model validity (see 1.3.3.1, 5.1, 5.4.2 and 5.5.1);
5. Specifying model; hypotheses validity (see 1.3.3.1, 5.4.2, 5.5.1 and Appendix 7, 8, 10);
6. Assessing structural model validity (see 1.3.3.1, 1.3.3.3, 5.5.1 and Appendix 7, 8, 10)

1.3.2 Research Design

In order to address the main research questions in this study that may provide valuable insight for
researchers and for hospital management of which factors influence the effectiveness of ISs in general
and the ISs in operation in the hospital environment and therefore its impact on the organizational
performance (net benefits), I have intended to use a quantitative approach. By choosing a quantitative
approach outcomes of net benefits could be predicted the best, then when using a qualitative approach.
Furthermore results are comparable in time while trends could be analyzed and declared.

I specially adopted an extended version of the Updated DeLone and McLean (2003) IS Success Model
to look at the factors that influence organizational performance. According to the proposed model those
factors for the IS Success Model are: System Quality, Information Quality, Service Quality, Benefits of
Use (System Usage), User Satisfaction and Net benefits, while for the behavioral part of this model,
namely System usage/ Benefits of use those factors are Perceived Ease of Use, Perceived Usefulness
and Intention to Use ISs; I have also included behavior and demographic factors that may influence net
benefits based on literature review.

To address the three main research questions of this study mentioned in paragraph 1.2.2 I will discuss
the type of data analyzed in this study and how it will contribute to addressing the research question
involved:

1. What factors influence effectiveness of Information Systems?

Factors that influence the effectiveness of Information Systems have been determined by literature
review and interviews with IT-managers and focus groups. These factors are: System Usage, Benefit of
Use and Users Satisfaction directly. From these factors System Usage has been identified as a behavior
and not a success variable. Both, Benefits of Use and User Satisfaction influence organizational
performance and thus Net Benefits, directly while the quality variables System Quality, Information
Quality and Service Quality influence the effectiveness of IS indirectly (see Appendix 13). Studies have
shown that the more users use a system the more they are satisfied with it, and the more benefits are
MBA Thesis SRFHR0407023 6
resulted from. To elaborate System Usage as a behavior the D&M Model was extended with the
behavior model of use, which consists of the variables Perceived Ease of Use, Perceived Usefulness and
Intention to Use as shown in Figure 1, section 3. All these variables were measured with the
questionnaire instrument shown in Appendix 3, part 1 to 10, while the hypotheses H1a to H9 were
formulated as depicted in Table 5, page 52.

2. Which Information Systems hospitals in Suriname have in place and what is the level of
their effectiveness?
This research question has been addressed by identifying which information systems (see Table 2) the
selected hospitals have installed and in what structure. Furthermore information was gathered to
determine how long these ISs were implemented because the course of implementation is an important
factor which has to be taken in consideration when measuring ISs in a post-implementation stage for a
single hospital or for comparison purposes. Measuring the level of effectiveness of this infrastructure
was achieved by measuring the extent to which System Quality, Information Quality and Service
Quality (part 1 to 3 of the questionnaire contribute to Benefit of Use and User Satisfaction. To test these
relationships hypotheses H1a to H3b were formulated

3. What is the relationship between the effectiveness of Information Systems and the performance of
hospitals in Suriname?
The relationship between the effectiveness of Information Systems and the performance of the hospitals
in Suriname is depicted in the relation between measurements of effectiveness as stated in point 1 and 2,
namely Benefits of Use and User Satisfaction directly and indirectly through the relation between the
Quality measures and Net Benefits. This relation is hypothesized in hypotheses H4b-c and H5b-d, while
Net Benefit from its side contributes to Intention of Use for which relation hypothesis H9 was
formulated.

The character of the research is the application of theoretical concepts and thus deductive. Using an
extended version of the DeLone and McLean IS Success model 2003 (see figure 1), I have derived the
research questions and formulated the hypothesis to be used in the thesis (see for discussion Chapter 4)
to test the relationships in the proposed model and by doing so I have addressed the research question of
this study.

In order to test the content validity of the proposed research model, a series of in-depth interviews were
conducted with representative respondents at the hospitals involved in the study. The capacity of the
MBA Thesis SRFHR0407023 7
different hospitals in terms of licensed beds, category of personnel, and users of IS and IS support
personnel are stated in Table 1.

Hospital Beds Personnel Target group

Name Physicians Nurses Others Total Users of Support staffTotal
ISs
LH 2 368 19 339 328 686 70 2 72
DKH 3 217 23 220 358 601 150 3 153
SZN 4 97 9 121 214 344 40 2 42
Total 682 51 680 900 1631 260 7 267

Table 1: Capacity of the hospitals in this study as per December 31, 2008

Source: Hospitals in study

1.3.3 Sample and Setting

1.3.3.1 Questionnaire Design

The survey items were adapted from previous studies regarding the D&M Model and the TAM Model
with some modification to reflect the context of the study. The measures of continuance
intention to use were adapted from the measures of Intention to Use in the Technology Acceptance
Model (TAM) with modification to reflect the intention to continue using IS. Each item was rated on a
Likert scale from 1 to 7 (Strongly Disagree to Neutral to Strongly Agree). The questionnaire of which
the Dutch version stated in Appendix 3 was used in the surveys is stated in Appendix 2.

The questionnaire was originally designed in English (see Appendix 2) and then translated into Dutch
for the survey. Afterwards the Dutch version of the questionnaire was checked and translated back into
English by an independent translator to ensure there was no loss of meaning during the translation as
suggested by Zikmund, (2003). The process showed there were no significant discrepancies between the

2
S’Lands Hospital
3
Diakonessenhuis
4
Strrekziekenhuis Nickerie
MBA Thesis SRFHR0407023 8
two versions. In addition to the back-translation process, the validity and reliability of the measurement
instrument were confirmed. The validity of the questionnaire, the ability to measure (Zikmund 2003),
was strengthened through an extensive review of IS and statistical literature.

In addition, a pre-test through 10 convenience samples was applied to determine if the intended
participants had any difficulty understanding the questionnaire, the length of the questionnaire, the
sequence of questions, the sensitivity of any of the items, if the time needed to complete it was sufficient
and whether there were ambiguous or biased questions (Cooper, 2003). Based on the feedback of the
pre-test, some small adjustments were made and the variable Use was increased from two to four items
to ensure its validity at the test. Draft questionnaires were sent to ten potential participants divided over
the different units of the potential participants in order to have a good representation of the target group.
The participants were users of IS of the Diakonessenhuis and IS support staff divided according to Table
2. The other two hospitals were not ready to participate when the pre-test was performed.

The pre-test was successful. Descriptive statistics were analyzed for any significant kurtosis or skew.
Scales means were tested on their values close to minimum or maximum, even as Confirmatory Factor
Analysis/test (CFA). 8 out of the 10 participants have responded with good feedback to apply some
small modifications regarding the comment of the respondents in the questionnaire instrument and
prepared the final draft. After modification of the questionnaire it was distributed among the three
hospitals. There was only one questionnaire for all participants. This in the context of developing a
more standardized questionnaire for the extended D&M Model which already have shown great
contribution to IS evaluation.

Department N users and IS staff Test group %

Account receivables 7 1 14
Purchasing 3 1 33
IT (IS support) 4 1 25
Finance 7 1 14
Others 129 6 5
Total 150 10 6

Table 2: Overview of test group in DKH

Source: Own research and information Planning and Control Department DKH

The survey questionnaire used in this study contains 11 parts capturing information for 10 latent
MBA Thesis SRFHR0407023 9
constructs and 1 part capturing demographical information of respondents containing 75 indicator items
specifically addressing the fifteen propositions formulated in the study. Part 11 contains 13 questions
capturing respondents’ demographic information, such as age, gender, department, highest educational
level and positions. The remaining parts comprised of 56 items on IS success (see Appendix 2 and 3).
All the items in part 1 to 10 were measured using a 7-point Likert scale ranging from 1 = strongly
disagree to 7 = strongly agree.

1.3.3.2 Sample and Data Collection Procedure

The sample of interest of this study is users of IS and people involved in the system development
process. I have chosen these respondents because they could provide valid information concerning
both the system development process and the quality of the final system. A number of steps have been
carried out to identify such a group of respondents. First, hospitals were selected based on the criteria
that the number of employees should be more than 100 and the existence of an appropriate IT
environment. Second, direct discussions with CIO, or IT department representatives were made,
introducing the study’s objectives and inviting appropriate candidates of their organization to
participate in this study. The reasons of contacting the IT department representative is that they are the
people who know which employees of their company have participated in system development and are
using the system. Sets of questionnaire, including a cover letter explaining the purpose of the study
were mailed to the IT department representatives. The questionnaire was administered through e-
mailing, including two e-mail reminders, internal mailing, and face to face distribution in the hospitals
in the week of 26 April to May 1, 2009. There was no incentive provided to the participants. Due to
the scale and stage of presenting the questionnaire users and support staff participating in the pre-test
were not excluded from questionnaire distribution. Participants at the pre-test got the revised
questionnaire just like other potential respondents to the survey. The IT department representatives
would then transfer the materials to the appropriate respondents. One and two weeks after the
questionnaires were sent a follow-up call was made to the IT representatives. As direct follow-up to
the potential respondents is not possible, this has affected the response rate of this study.

The questions were formulated in such a way that they were easily understood and will require 15 to 20
minutes to be completed. To ensure consistency and reliability the definition of the ISs under
examination was given in the cover letter of the questionnaire. Finally, the usable questionnaires will be
processed in SPSS. The population consist of 260 members and the sample size was set at 155 (60% of
MBA Thesis SRFHR0407023 10
population) because of feasibility reasons and to achieve the theoretical minima for both multiple
regression and SEM analyses. Response rate will be yielded. Respondents were divided by demographic
factors. According to Hair et al. (2006) the minimum sample size was set at 50 based on requirement for
multivariate regression while taking in consideration that the D&M model is a tested measurement
instrument and a participation of more than 15 respondents per indicator item is the general accepted
ratio. A sample size of 150 to 200 would be sufficient based on literature review but was not feasible
taking the circumstances in the hospital environment in consideration. So the focus was set a minimum
of 100 returning questionnaires yielding a planned response rate of 65%.

1.3.3.3 Data analysis

The proposed model has been tested using both conventional ordinary least square (OLS) regression
(descriptive analysis, data screening and a LISREL-like Structural Equation Modeling (SEM)
techniques with SPSS for Windows statistical application were used for data analysis.

SEM multivariate statistical techniques, which incorporate and integrate multiple regression and factor
analysis, were used. It is divided into two steps: confirmatory factor analysis (CFA) measurement model
estimation and SEM structural model analysis. CFA measurement model estimation has been performed
to ensure the reliability and validity of measures and constructs and SEM structural model analysis to
estimate casual relationships among constructs. It is critical that measurement of each construct is
psychometrically sound before testing the casual relationship among constructs.

Descriptive analysis
Minimal sample for sound estimations size should be 50 for multiple regressions, while SEM requires
150 to 400 respondents for studies with more than five constructs to get representative results out of the
survey at 95% significance and an alpha of 0.05.

Validation
Factor analysis has been performed to check for construct validity. Descriptive statistics is also
performed by computing an ANOVA and t-test was used for significance between groups of IS users
but due to lack of response of the government hospital result are not valid. Hypothesis testing is
performed by using linear regression analyses. Lastly, qualitative analysis of an open-ended question
included in the measurement instrument will also be conducted for triangulation purposes. All
quantitative and qualitative results are presented in the thesis.
MBA Thesis SRFHR0407023 11
Because the D&M Model is a multidimensional and interactive model I have used Structural Equation
Model (SEM), with SPSS statistic application as analyses tool. AMOS and LISREL were options too,
but lack of availability forced me to use SPSS to do the analysis. In the D&M Success Model, “system
quality” measures the technical success, “information quality” measures the semantic success, while
“service quality” measures IS support personnel productivity (Deming, 1981-82); Based on both process
and causal considerations the six dimensions of the D&M Model are interrelated. For example higher
system quality is expected to lead to higher user satisfaction and use leading to positive impacts on
organizational improvement. Data was collected from User and IS support staff. The relations identified
in the research Model are depicted in Figure 1, page 5. Descriptive analysis, data testing and Structural
Equation Modeling (SEM) techniques have been used for data analyses. The factors that affect users’
preferences for IS use were also examined on there impact on intention to use and usage of IS. In order
to enhance acceptance and increase usage of IS, it is important to understand how users experience and
decide on the selection and use of IS. So the relationship between IS characteristics, behavior beliefs
and behavior intention was examined to generate thoughts and provide recommendations for system
designers to improve IS system design, development and implementation. According to Fishbein and
Azjen’s Theory of Reasoned Action (TRA), Davis proposed the Technology Acceptance Model (TAM),
which aims to predict system acceptance and to diagnose design problems. According to TAM (figure 2,
page 12), user acceptance of any technology, measured by a person’s intention to use the technology, is
determined by two beliefs, namely: perceived ease of use and perceived usefulness, which mediate the
effects that external variables have on usage intention. In addition, perceived ease of use and use also
influences perceived usefulness.

Figure 2: Technology Acceptance Model

Source: Technology Acceptance Model (TAM) by Davis, 1989

MBA Thesis SRFHR0407023 12

Measurement Model estimation
Through data screening I searched for missing data. There are 75 items and 1 open ended question
measuring 10 constructs and I have searched for type of distribution and outliers. In order to ensure that
measures are psychometrically sound, item and constructs reliability, as well as convergent and
discriminant validity, has been assessed. Squared factor loading (SFL) have been used to test item
reliability, while Cronbach’s α and composite reliability ρ were used to test construct reliability. The
criteria which were set to be met are for SFL ≥ 0.50, Cronbach’s α > 0.70 and composite reliability ρ ≥
0.70. All constructs AVEs are presented in a “discriminant validity table” (see Table 7, page 64).

Structural Model Analysis

Path coefficients between constructs will be computed based on maximum likelihood estimation. Chi-
square (X2), Chi-square X2/df, Goodness of fit (GFI), Adjusted Goodness of Fit (AGFI), Norm Fit Index
(NFI), Comparative Fit Index CFI, Root Mean Square Residual (RMSR), and Root Mean Square Error
of Approximation (RMSEA) will be used to evaluate model fit.[1] The results of casual relationship with
estimate path coefficients is presented in a figure of structural model analysis in which the effects among
the different constructs will be presented in a descriptive and correlation matrix (see Table 7, page 64,
Appendix 8, 10 and 13).

1.4 Research material

There are different approaches for the evaluation of ISs. I have analyzed the different models and try to
determine if they are sufficient to solve my research questions (see Chapter 3). After literature review I
have found an extended version of the D&M IS Success Model 2003 the most appropriate model to
perform the evaluation of ISs I want to conduct. To determine the factors influencing the effectiveness
of IS I have used different previous studies and literature regarding ISs and the evaluation of ISs

1.5 Scope of research

The research of this thesis has been conducted in the period January 2009 up to May 2009. The study is
conducted within the framework of the master thesis project for the Master of Business Administration
(MBA) at the FHR Institute of Social Studies in co-operation with the Maastricht School of
Management, with specialization: Management and Accounting. The focus of the thesis is on the
evaluation of the effectiveness (success) of ISs in a hospital environment. The result of this study is an

MBA Thesis SRFHR0407023 13

evaluation of ISs in use at hospitals which will enable hospital management to improve the effectiveness
of the hospitals in general and the ISs in particularly.

1.6 Chapter Outline

This thesis is divided into 6 chapters. As noticed chapter 1 describes the design of the study, the research
problem and issues, framing this problem within the existing literature pointing out deficiencies in the
literature, and targeting the study for stakeholders. The remainder of this thesis is organized as follows.
Chapter 2 reports the background of the study. Chapter 3 reports the literature review and relevant
approaches for IS evaluating studies and highlights the research motivation. Chapters 4 provides an
overview of DeLone and McLean success framework as well as that of Seddons’ contribution to it and
concludes with the presentation of the proposed model for evaluating the effectiveness of ISs in
hospitals in Suriname in the current study. Chapter 5 describes the operationalization of the success
model in terms of methods, measures, findings and analyses (methodology). In Chapter 6 the emphasis
is on the final analysis, conclusions and recommendations. Finally this Chapter focuses on problems and
limitations of the study.

1.7 Problems and limitations

The present study only sampled users and IS staff from the three hospitals in the study, rather than all
users and IS support staff of all five general hospitals in Suriname. By surveying more users and IS
support staff in other hospitals with the same instrument may obtain more generalized data. In addition,
the research model should be tested for reliability and validity with different setting with various
information seeking contexts.

The research objective is evaluating the effectiveness of IS in a developing country. Taking this in
consideration the result of this study may not be applicable in general but under the given circumstances
and stage of development as Suriname and eventually countries in the same stage of development.

Data was generated by a survey and interview process. Although a quality control was used to identify
inconsistencies in the responses. Data are subject to the limitations of different levels of users and
support staff within and between the three hospitals, including respondent misunderstanding of survey
items, respondent fatigue, or forced-choice responses which may distort survey responses. Random
errors may also be a contributing factor.

MBA Thesis SRFHR0407023 14

1.8 Summary
The present chapter addresses the need for a conceptual framework for evaluating Information Systems’
effectiveness or success, which will help management to measure the impact of usage of information
systems an organizational performance.

The contribution of this study will be meaningful for both academics and business practices. First, it
addresses a gap by discussing the test of the D&M Model in a developing country and secondly is one
of the few studies testing an expended version DeLone and McLean (2003) IS Success Model
eliminating the attitude construct in the behaviour model. Thirdly, the findings of this study will be
valuable for staff of organizations involved in the study, because they provide guidance for customizing
and personalizing.

MBA Thesis SRFHR0407023 15

CHAPTER 2 BACKGROUND INFORMATION

2.1 Introduction
There is a lot of debating going on regarding the validity of various information systems in Suriname.
The fit, match and congruence between an information system and its organizational context will be of
increasing importance as information systems become more and more integral parts of organizations.
The primary objective of implementing information systems in health care is to help the organization
achieve its goals (Watson, 1993). Gory and Scot Morton (1971) suggest that the primary objective of an
IS in an organization is to support the decision making process.

The impact of information technology on value creation is essential in any organization either through
increasing revenues at marginal cost, or through reducing costs at marginal changes in revenue, and thus
enhancing operating benefits. Measuring the return on investment (R.O.I.) in information systems is
being debated in the IS literature. This debate is also growing in the business community. Evaluating IS
investment therefore is an important issue in organizations, but it is often overlooked. There is emerging
widespread a growing concern in organizations that IS investment does not deliver value and that many
objects do not meet business objectives (Fitzgerald, 1998).

2.2 Hospitals in Suriname

There are five general hospitals (three public and two private) in Suriname of which four are located in
the capital Paramaribo and one in the western district of Nickerie, the second largest city of Suriname. In
November 2008 three of the hospital CEOs visited hospitals and health care institutions in the
Netherlands to evaluate the problems and needs of their hospitals and see how Dutch health care
institutions could support this with their Dutch counterpart “Stichting Equally Equipped” 5. Stichting
Equally Equipped” is a foundation founded in 2007 to facilitate community services to Suriname and to
Suriname itself as a whole, with support of hospitals in the Hague area.

In his end of the year speech the Minister of Health, Dr. Celcius Waterberg announced renewing of
medical equipment for hospitals and policlinics, the creation of more training opportunities for health
care workers on different levels and the construction of a new kidney haemodialysis centre in 2009.

5
De Ware Tijd of November 11, 2008
MBA Thesis SRFHR0407023 16
According to the minister there is a lot planned for his ministry in 2009 6. He mentioned infrastructure
which will be financed by the French Developing Fund. New hospitals, policlinics en health care centres
in all districts and the interior (rural areas) will be financed with this fund, while renovation of the
historical part of the “Sint Vincentius Ziekenhuis”, a private hospital, and property of the Catholic
Church will be financed with the Sector Fund.

Minister Waterberg also mentioned private initiative for the construction of a hospital in the district of
Wanica, and elsewhere in the country, medical service centres and health care hotels. He was full of
praise to the preparation of the National Medicare, “Algemene Zorgverzekering (AZV)”. He believes
that the population as a whole will benefit from this system and that co-operation and teamwork of all
stakeholders in the health care industry will lead to positive results.

2.2.1 Information Systems in hospitals in Suriname

I had planned to examine all five general hospitals in Suriname. Afterwards I got approval from four,
but one (St. Vincentius Ziekenhuis) did not meet the IT standard set for this research, so it was not
included in the study. The three hospitals left have some modules of an ERP-system:”Microsoft
Business Solution Navision” installed in the last five years. Since the stage of development of the ERP
systems is not in the same stage, in the sense of modules operationalized I decided to do an overall
evaluation rather than an evaluation of separate modules, which match better with the time given to
complete the study. An overview of the ISs the hospitals have installed is given in Table 3.

2.2.2 Justification of research design

The purpose of the second research question was to investigate which ISs the hospitals in Suriname have
in place in comparison with the international standards and to evaluate how to design the study. I think
that by going wide when it comes to operationalize the constructs of the D&M Model in this initial stage
of evaluation enough interest is created for further research of the separate modules. So I have
concentrated on an overall evaluation approach in this study, to get the opinion of users and IS support
staff.

6
De Ware Tijd of December 31, 2008
MBA Thesis SRFHR0407023 17
 Hospital Module operationalized Program Implemented
LH 1. Finance 1. Navision (ERP) 2004
2. Medical Record System 2. Navision (ERP)
( in-patients, admissions and
operations)
3. Pharmacy system 3. Aposys
4. Laboratory system 4. In-house
(only for outpatients)
5. Usual standard applications 5. Microsoft Office
DKH 1. Finance (inter-faced with MRS) 1. Navision (ERP) 2006
2. Medical Record System (MRS) 2. Navision (ERP)
(in-patients, admission and
operations)
3. Accounts Receivables 3. Navision (ERP)
(customer items)
4. Liabilities = Suppliers 4. Navision (ERP)
5. HRM 5. In-house
6. Purchasing 6. In-house
(inventory and stock-keeping)
7. Archive 7. In-house
8. Outpatient System 8. In-house
9. CRP = Central Registration Point 9. In-house
(overall laboratory and roentgen
registration = highest yield for
Outpatients = 1st stage)
10. First aid/Emergency admissions; 10. In-house

SZN 1. Finance 1. Navision (ERP) 2006

2. Medical Record System 2. Navision (ERP)
(in-patients, admissions and
operations)

Table 3: Overall Information System of Hospitals

Source: Hospitals in study

Overall ISs contributes to organizational performance. As Overall ISs I consider the “Microsoft
Business Solution Navision”, consisting of the following modules: Finance, Medical Record System (in-
patients, intake and operations), Accounts Receivables, and Out-patient System are part of it and all
other Information Systems operationalized in the three hospitals.
Because of the size of the hospitals involved and their stage and level of automation it takes a lot of
efforts getting them in the study and even after getting approval of their management to do the study
MBA Thesis SRFHR0407023 18
their information was flowing very slowly, except from Diakonessehuis. Diakonessenhuis which is a
private hospital in comparison with the other two which are government owned is in a further stage of
automation so it was easier for them to participate optimally in this study.

2.2.3 Attributes which characterize a hospital IS

Regarding attributes, which characterize a hospital ISs I can say that related to de D&M model, which is
a generally used model in the model itself the attributes are almost the same when it comes to the design
of the study. The industry specifics are in the demographics. In content it could differ, but that’s more
on the details, e.g. hospitals consider utilization (occupancy) of beds as their main performance
indicator, which can also be applicable for any organization, when considering occupancy. So thinking
in an overall evaluation (assessment) of applications there is no difference. To distinguish the context of
the hospital environment the questions or statement in the questionnaire could illustrate the context but
due to the difference in stage of implementation, structure and culture in the three hospitals I was forced
to develop a more generalized applicable questionnaire, which covers the overall ISs of the hospitals in
the context and due to these circumstances became applicable also in all kinds of organizations and
industries taking the specifics of health care industry and the hospital environment also in consideration.
That’s why I have formulated all statements to be responded to on a standard Likert scale instead of
having a mixed of scalings, descriptive and open end question. The only descriptive part of my
questionnaire is the demographic part. All other information is quantitative and phrase as a statement on
the Likert scale using the scale of 1 to 7 due to a mix of experience, non-experience and professional
users and IS support personnel working in different fields and different levels. According to literature
study on a larger scale respondent will indicate more precisely what they think about the statement than
on a shorter scale of 5 or 3, which is more for a group of respondents which is highly experienced or for
professionals involved with the topic. Another argument is that IT using ERP systems is the fulfillment
of high level of standardization and so understanding or translating all specifics of any organization and
industry in one language.

MBA Thesis SRFHR0407023 19

CHAPTER 3 LITERATURE REVIEW

3.1 Introduction
This Chapter deals with the theoretical background of ISs and the Evaluation of these Systems. First, a
general overview of ISs is given. Then, background information is given on Medical Information
Systems (MEIS) as one of most critical information systems for hospitals followed by relevant
evaluation approaches and methods.

3.2 Information Systems

An Information System (IS) can be defined technically as a set of interrelated components that collect
(or retrieve), process, store, and distribute information to support decision making and control in an
organization 7. In addition to support decision making and control, information systems may also help
managers and workers to analyze problems, visualize complex subjects, and create new products.
Information Systems contain information about significant people, places, and things within the
organization or in the environment surrounding it (see Figure 3). Information is data that have been
shaped into a form that is meaningful and useful to human beings. Data in contrast, are streams of raw
facts representing events occurring in organizations or the physical environment before they have been
organized and arranged into a form that people can understand and use.
ENVIRONMENT

Customers Suppliers

ORGANIZATION
INFORMATION SYSTEM
INPUT PROCESS OUTPUT

FEEDBACK

Regulatory Stockholders Competitors

Agencies

Figure 3: Information System

Source: Kenneth C. Laudon and Jane P. Laudon, 2000

7
Kenneth C. Laudon and Jane P. Laudon, Management Information Systems, 6th Edition, Organization and
Technologogy in the networked enterprise, Prenhall 2000
MBA Thesis SRFHR0407023 20
3.3 ERP Systems

Enterprise Resource Planning Systems (ERP) system are defined as “configurable information systems
packages that integrate information and information-based processes within and across function
organization” (Kumar and Hillegensberg, 2000). 8 They promise the seamless (dovetailed) integration of
all the information flowing through an organization – financing and accounting information, supply
chain management, human resource information, customer information and the like. For managers who
have struggled with incompatible information systems and inconsistent operating practices, these
organizations-wide systems hold the promise of integrating all aspects of information and process within
and around the organization. The strategic value of ERP systems and the resources organizations invest
in then make evaluating and monitoring of their success important to both practitioners and researchers.
This is particularly true in view of the many reported cases of failures in implementing such systems.

There is a small but growing literature on the impact of ERP systems. The few studies are interviews,
case studies, and industry surveys (Tasi et al, 2005). The companies involved reported substantial
performance improvement in several areas thanks to their ERP systems, such as their ability to provide
information to customers, cycle times, and on-time completion rates. Based on Galbraith’s information
processing perspective (1973), Gattiker and Goodhue (2000) group ERP benefits into four categories:

1. Improvement of information flow across subunits through standardization and integration of

activities;
2. Enabling centralization of administrative activities such as accounts payable and payroll;
3. Reducing IS maintenance cost and increase the ability to deploy new IS functionality;
4. Facilitation transformation from inefficient business process toward accepted best of practice
processes.

Since the realization of ERP benefits depends on individual practices, studies on individual impacts are
conducted to measure the influence of ERP on employees and their productivity. Individual impact is
measured in terms of effectiveness, quality of work, and decision-making performance. For the ERP
impact on organizations, as Umble et al. (2003) suggest, it is important adopting effective measures
indicating how the ERP affects on-time deliveries, gross profit margin, customer order-to-ship time,
inventory turns, and so on. Therefore, organizational performance is measured in terms of reduction of

8
Moshe Zvan, Faculty of Management, Tel Aviv University, Israel, User Satisfaction in ERP systems: Some Empirical
Evidence, Working paper no 22/2003, Research no 07010100, (2003)
MBA Thesis SRFHR0407023 21
inventory cost, decrease in order-processing time, improvement on sales margin, and real-time sharing
of transaction information. Meanwhile, it is also imperative to measure the business process
improvement because ERP systems are often implemented to take advantages of best practice solutions
to enhance business operations.

3.4 Approaches and methods in use for the evaluation of Information Systems

3.4.1 Introduction
Evaluation represents a critical issue in ISs research and practice. Unfortunately in searching for a
success measure, rather than finding none, there are nearly as many measures as there are studies. The
reason for this is understandable when one considers that ”information”, as the output of and
information system of hospitals, can be measured at different levels, including technical level as the
semantic level and the effectiveness level. Shannon and Weaver (1949) defined the technical or system
level of communication as the accuracy and efficiency of the communication system which produces the
information. In this context, the semantic level as the success of the information system in conveying the
intended meaning; the effectiveness level, on the other hand it refers to the effect of the information on
the receiver.

According to Hamilton and Chervany, 1981) System Effectiveness has two general views: the goal-
centred view and the system-resource view. The goal-centred view focuses on the task objectives of
the system, or the organizational units utilizing the system, and then develops criterion measures to
assess how well the objectives are being achieved. Effectiveness is determined by comparing
performance with objectives. An example of this view of system effectiveness would be comparing
actual cost and benefits to budgeted cost and benefits. The system-resource view focuses on the
attainment of a normative state, e.g. standards for “good” practices. Effectiveness is conceptualised in
terms of resource viability rather than in terms of specific task objectives. For example, system
effectiveness in terms of human resources might be indicated by the nature of communication and
conflict between IS and user personnel, user participation in system development, or user job
satisfaction. In terms of technological resources, system effectiveness might be indicated by quality of
the system or service level. Just like Shannon and Weaver (1949), Hamilton and Chervany (1981)
conclude that the system resource model recognizes that systems fulfil other function and have other
consequences besides accomplishing of official objectives, and that these need to be considered in
assessing system effectiveness. Remarkable is that they don’t categorize that as efficiency just like
Shannon and weaver did but also categorize that as system effectiveness.
MBA Thesis SRFHR0407023 22
So approaches to the evaluation of IS could be distinguished in those concerned with efficiency and
those concerned with effectiveness. In practice, the two views should converge. In order to explain the
success, or lack of success, in meeting objectives, the semantic of systems resource need to be
investigated. In the next paragraphs I will discuss the approaches concerning the effectiveness of IS
which are considered of a higher level of evaluation than those of efficiency and are subject of this
study. Efficiency is concerned with lower-level, machine (or-quasi-machine) aspects, usually considered
outside the business or organization context, while effectiveness is more concerned with thinking about
the operation of the ISs within their context. This means examining in more detail the way they are used
by people in the course of their work and, in particular, examining the contribution of the system to the
organization, especially in financial terms.

3.4.2 A conceptual hierarchy of system objectives 9

System objectives broadly define the goals of the IS and embody the hierarchy of objectives for the
organization, running the gamut from a single strategic statement which is quite conceptual, to detailed
operational goals for the individual IS development project. Typically, the requirements definitions or
design specification for the information system is an operational description of the system objectives
and constitutes a reference point for IS development and operations personnel. A conceptual hierarchy
of objectives is depicted in Table 4, page 39. One of the primary objectives of IS function is to develop
and maintain information system that will enhance the organization’s ability to accomplish its
objectives. As mentioned above other researchers also mentioned that accomplishment of organizational
objectives can be evaluated from two perspectives for a specific information system, namely:
1. The efficiency with which the IS development and operational processes utilize assigned
resources (staff, machines, materials, money) to provide the information system to the user;
2. The effectiveness of users, or the users’ organizational unit, using the IS in accomplishing
their organizational mission

For the purpose of this study the emphasis is on the effectiveness-oriented objectives of this hierarchical
framework as depicted in Table 4, page 39. Systems’ effectiveness is ideally assessed in terms of

9
Scott Hamilton and Norman L. Chervany, MIS Quarterly, September 1981
MBA Thesis SRFHR0407023 23
information system’s contribution to accomplishment of organizational objectives, i.e., its effect on
organizational performance (Level 3). 10
The accomplishment of IS objectives can be assessed by performance measures. The purpose of next
paragraph is to provide an overview range of approaches for evaluating ISs’ effectiveness and to point
out the human and organizational issues attached to measurement and evaluation.

3.4.3 Relevant approaches to evaluate Information Systems

Some relevant approaches to the evaluation of the effectiveness of IS are:
1. Utilisation;
2. Cost-benefit analysis;
3. Non-financial approaches to IS effectiveness:
• Objective analysis;
• User or customer satisfaction surveys (Ives et al. 1983; Doll and Torkzadeh,1988);
• Service Level Monitoring
4. Combinatorial approaches:
• Multi-objective, multi-criteria analysis (Chanler, 1982: Vaid-Raizda 1983);
• Balanced scorecard (Kaplan and Norton, 1992);
• DeLone and McLean’s IS Success Model 1992;
• Updated DeLone and McLean’s Model 2003);
• The Seddon Model 1997
• Technology Acceptance Model (TAM) (Adams et al., 1992; Davis et al.,; Gefen and
Straub, 1997;; Amoako-Gyamah, 2004);

Sub 1: Utilisation
This measure, which can be seen to be the border between the efficiency and effectiveness zones, is
rarely used now, but it is worth mentioning for completeness. The argument here is that, if an
information system is used a lot, then it is in some way effective. A comparison here would be with
hospital beds occupancy. One could argue that months with most or all of the beds occupied are
“successful” and this is used in the hospital environment as a rough measure of effectiveness.

10
Organizational performance may include considerations of effects on the external environment. For example,
manufacturers typically include product safety (e.g., consumer injuries from automobile defects) within organizational
performance objectives, and even employ information systems to rack current owners and safety records.
MBA Thesis SRFHR0407023 24
There are a number of problems with this type of measures for information systems effectiveness:
• if utilisation is measured in terms of time online or number of keystrokes this is a poor
measure as users normally wish to minimize their effort (time online or keystrokes);
• in other context, perhaps low level data entry, operators may be paid on the basis of the
number of keystrokes and it is their financial interest to increase that number, regardless of the
benefits to the organization. In the 1970s and early 1980s, word processing operators paid in this
way used to cursorily tap the space bar for the same reason;
• certain systems may be mandatory: for example, hotel reservation clerks have no choice and
use the reservation system, no matter how bad it is;
• it ignores the value or importance of the task being performed: for example, some tasks are
performed rarely (perhaps annually or only in emergencies), but they could be crucial to the
running of the business.

Sub 2: Cost-benefit analysis

Cost benefit analysis quantifies the system’s effect on organisational performance in terms of dollar,
e.g., direct cost savings, tangible financial benefits. Cost/benefit analysis often used in capital budgeting
to assess the return on investment (R.O.I.).

Sub3: Non-financial approaches to IS effectiveness

Objective analyses or Post Installation Review

The focus of a Post Installation Review (PIR) is often on assessing whether the system meets the
required definition, i.e., “does the system do what it is designed to do?” However, the scope of the PIR
may include a post hoc review of the development and operations processes, an assessment of the
information and support provided, and analysis of the actual use process, and cost-benefit analysis of the
system effects on user performance.

User (or customer) satisfaction surveys (Ives et al., 1983; Doll and Torzadeh, 1988):
User satisfaction surveys, through questionnaires and/or interviews, focus on assessing the user’s
perceptions of the information and support provided by the IS support function. User’s satisfaction
surveys typically assess such aspects as the quality of reports, timeliness quality of service, and user
communication.

MBA Thesis SRFHR0407023 25

Service Level Monitoring
Service level monitoring focuses on assessing the information and support provided to the user based on
the terms established between IS support organization and user personnel. Assessments of the
information provided include turnaround times, response times, and error rates. Assessment of the
support provided includes the time required to respond to user problems and request for changes.

Sub 4: Combinatorial approaches

Recognizing the limitations of a single measure, the approaches outlined in this section attempt to
combine various techniques

Multi-objective, multi-criteria analysis (Chandler, 1982; Vaid-Raizada 1983)

Recognizing how difficult it is to attach financial figures to cost and benefits, the technique uses instead
the notion of utility. Managers can rank different outcomes according to their preferences and attach
weights to particular goals. This approach recognizes the different objectives of different stakeholders
(see organizational issues in paragraph 3.7) and can be used to expose conflicts. Software is available to
manipulate the weighted preferences and in theory, it can show the outcome that maximises total utility.
However, there are clear dangers in rusting the resolution of sensitive political issues to such a piece of
software; for example, should all stakeholders be given the same weight?

Balanced scorecard (Kaplan and Norton, 1992)

Managers using this approach try to recognize and measure aspects in addition to the obvious financial
ones. It attempts to set up an integrated set of performance measures that encapsulate an organization’s
strategic objectives. These measures need to be tailored to the individual organization and are drawn
from four quadrants:
1. financial – relevant financial measures;
2. customer – measures of customer service;
3. internal process – including issues such as quality and productivity;
4. learning and growth – measures of ability to improve and innovate.
Although the balance scorecard was originally marketed to evaluate entire organizations, it can be
adapted for the evaluation of information systems (Willcocks and Greaser, 2001).

MBA Thesis SRFHR0407023 26

On the positive side:
• it can be customised for individual organizations;
• it stretches beyond the financial aspects;
• it is closely related to an organization’s core objectives.

On the negative side:

• it can require a considerable amount of time and effort initially to determine the objectives and
design the measures;
• it requires skill and experience to do it effectively;
• it does not incorporate risk identification and management.

DeLone and McLean IS Success Model 1992

DeLone and McLean provide a general and comprehensive definition of IS success, that covers different
perspectives of evaluating Information Systems. According to DeLone and McLean, measurement of IS
success is critical for understanding the value and efficacy of IS management actions and IS
investments. They review the existing definitions of IS success and their corresponding measures and
classified them into six mayor categories. So, in 1992 they proposed a taxonomy and an interactive
model as the framework for conceptualising IS success. Driven by the need of a process to understand
IS and its impacts, they developed a multidimensional measuring model with interdependencies between
the different success categories (DeLone & McLean IS Success Model 1992). According to DeLone and
McLean the main dependent variables were: Use, Users satisfaction, Individual Impact and
Organizational Impact, while the main independent variables were: System Quality and Information
Quality (see Figure 4, page 28).

MBA Thesis SRFHR0407023 27

 Figure 4: D & M IS Success Model 1992

Source: W. DeLone and E. McLean, 1992

The description and examples of measures for the six dimensions are:
1. System Quality; denotes system performance like data accuracy, system efficiency, response
time, etc.
2. Information Quality; refers to the quality of the IS products, such as currency, relevance
reliability, and completeness;
3. Use; refers to the frequency an information system is used, examining items like the number
of functions used, frequency of access, and amount of connect time;
4. User Satisfaction; records the satisfaction level as reported by system users, including
overall satisfaction and satisfaction of interface, etc.
5. Individual Impact; refers to measuring the impacts brought about by the information system
on individual users, such as changes in productivity, decision model, and decision making;
6. Organizational Impact; requires the evaluation of the changes by the information system to
the organization, such as decrease in operating cost, savings in labor cost, and growth in
profits.

According to the D&M IS success model, both system quality and information quality influence use and
user satisfaction which in turn shape the impact of the system on individual users and the organization.
DeLone and McLean had consulted various sources – notably the communications research of Shannon
and Weaver (1949). The information “influence” theory of Manson (1978), as well as the empirical
management information systems (MIS) from 1981 – 1987 – to postulate their comprehensive and
multidimensional model of success. In spite of the passage of time since the Shannon and Weaver frame
work in 1949 and the Manson’s extension in 1978, both appear valid today for incorporating into a
workable framework of IS success model. The reason for the existence of different measures for IS

MBA Thesis SRFHR0407023 28

success is understandable when one consider that “information” as the output of a system can be
measured at different levels – the individual/personal/personnel level, the technical level, the semantic
level, and the effectiveness level – and different stakeholders are involved at each different level.

The D&M IS success model provides a more comprehensive approach to measure IS success and
organizes previous research into a more coherent model. It helps explain the often-conflicting results
and provide a base for related studies. Although they proposed the model and the interrelationships
between the multi-dimensions, DeLone and McLean did not test the model empirically. Many
researchers, such as Seddon and Kiew (1994), Goodjue and Thompson (1995), Taylor and Todd (1995),
Teng and Calhoun (1996), Igbaria and Tan (1997), Igbaria et al. (1997) and Wixom and Watson (2001),
have studied the associations between the measures identified in the IS success model by DeLone and
McLean (1992), and this immense popularity of D&M IS success model eloquently speaks of the
importance of IS success researches.

As I have seen throughout the study each of the dimensions of the D&M Model 1992 is likely to face
measurement problems, unless great care is taken their aggregation is likely to be even more
problematic.

Updated DeLone and McLean IS Success Model 2003

In response to the progress in IS applications, DeLone and McLean revised their original model and
proposed an update version in 2003. Service Quality was added into the success model, and Individual
Impact and Organizational Impact were combined into a single variable named “Net Benefits as shown
in Figure 5, page 30. To facilitate the advancement of its applications IS need not only to provide users
information products but also meet users’ flexible information requirements. Service Quality is thus
added into the modified model to measure the service-level success since system quality focuses more
on technology-level measure. Since it is difficult to describe the multi-dimensional aspects of IS use -
mandatory or voluntary use, informed or un-informed use, effective or ineffective use, DeLone and
McLean further suggested that “Intention to Use” may be adopted as an alternative measure for IS use in
some contexts. Certain net benefits can occur as results of IS use or Intention to Use and User
Satisfaction. Net benefits are the most important success measures as they capture the balance of
positive and negative impacts of ISs on organizations. Last but not least, positive net benefits will
encourage ISs system use intention and increase user satisfaction, while negative net benefits can
decrease the intention to use and IS user satisfaction.

MBA Thesis SRFHR0407023 29

So, the updated model also consists of six interrelated dimensions of IS success: Information Quality,
System Quality and Service Quality, Intention to Use and Use, User Satisfaction and Net Benefits (see
Figure 5). They suggest that ISs can be evaluated in terms of system-, information-, and service quality;
these characteristics affect the subsequent user or intention to use and user satisfaction. As a result of
using the system, certain benefits will be achieved. The net benefits will positively or negatively
influence users’ satisfaction and the further use of information system.

The Delone and Mclean Model of Information Systems Success: A ten year Update, William H. DeLone
and Ephraim McLean. The DeLone and McClean model proposes that System Quality, Information
Quality and Service Quality singularly and jointly affect both System Use and Users Satisfaction.
Additionally, the amount of System Use can affect the degree of User Satisfaction positively or
negatively – and the degree of User Satisfaction also affects System Use. System Use and User
satisfaction are direct antecedents of Net Benefits (individually, organizational and Societal).

Figure 5: Updated D & M IS Success Model 2003

nd
Source: Nunally, J. Psychometric Methods, 2 edition, McGraw-Hill, New York: NY, 1978

User Satisfaction is affected by System Quality, Information Quality, and Service Quality. User
Satisfaction may be affected by Use positively or negatively, as well as the reverse is possible. System
Use and User Satisfaction lead to the realization of Net Benefits, while the Net Benefit will then affect
System Use and User Satisfaction.

The Seddon Model 1997

A principal difference between Seddon’s and the D&M model lies in the definition and placement of
Use. Seddon (1997) argues for the removal of “information use” as a success variable in the causal
success model, claiming that use is a behavior, appropriate for inclusion in a process model but not in a
MBA Thesis SRFHR0407023 30
 causal/variance model. Seddon and Kiew (1994) recommend replacing use with usefulness, stating
that use only affects satisfaction when use is voluntary. They placed use outside a reviewed model of
systems success as it was deemed more a charact eristic of user behavior than a measure of system
success (Seddon, 1997).Seddon (1997) identifies three distinct models intermingled D&M IS success
model, each reflecting a different interpretation of IS Use.

Based on a number of studies that attempted to validate the original D&M model, Seddon concluded
that there is a conceptual difficulty in D&M’s 1992 model because it combines both process/causal and
variance models. The construct “Use” in the model actually has three meanings and the meaning shifts
in different parts of the model. Seddon re-specified D&M’s model into a pure variance model (see
Figure 6). Part of the model that is relevant to the current study is shown elaborated in Figure 1, section
3 as second variance model, the Behavior mode of Use.

Partial behavior model of IS Use

(not evaluated as either good or bad)

Observations, Personal Experience, and

Reports from Others

(Partial basis
for revised
expectations)

IS Succes Model
Figure 6: Seddons IS Success Model 1997

Source: Peter Seddon, 1997

Several researchers added new variables to the original model, combined exiting variables, or changed
the casual path in the DeLone and McLean model. Some studies identified conflicting results regarding
MBA Thesis SRFHR0407023 31
relationships among DeLone and McLean six original variables. For example, a positive relationship
was reported between user satisfaction and individual impact. However another study did not find a
relationship between the same variables. Figure 1, page 5 illustrates the extended DeLone and McLean
model to be empirically analysed in this research.

The Technology Acceptance Model (TAM)

One of the key measures of implementation of success is achieving the intended level of IT usage.
System usage reflects the acceptance of the technology by users (Venkatesh, 1999). The Technology
Acceptance Model (TAM) has served as basis for past researches on IS dealing with behavioural
intentions and usage of IT (Adams et al., 1992; Davis et al., 1989; Gefen and Straub, 1997; Amoako-
Gyampah and Salam, 2004) Figure 2.

As a well recognized theoretical basis for studying users acceptance, TAM (e.g. Davis, 1989) proposes
that users’ perceptions of a system’s ease of use and usefulness can influence how quickly and
efficiently users will adopt the new technologies. Thus, according to TAM, the easier a technology is to
use, and the more useful it is perceived to be, the more positive the user’s, attitude and intention towards
using the technology. Consequently, the usage of the technology increases. Recently, researchers have
explored personal and situational factors that influence users’ perceptions. One such factor is the users’
perception of his/her computer self-efficacy, i.e., proficiency at using technology (Igharia and Livari,
1995; Compeau and Higgins,1995; Venkatesg and Davis, 1996’; Venkatesh, 2000).
While users’ perceptions of computer self-efficacy have been shown to be important in their system
perceptions, knowledge workers need both computer and task proficiency to apply a workplace system
efficiently and effectively in performing their jobs. Thus, their perceptions of self-efficacy related to
both computer technology and the underlying task are likely to affect their perceptions about the system
and their intentions to use it as intended by the system developers.

3.5 Approaches to the evaluation of Medical Information Systems (MEIS)

Different frameworks and theories of information systems science, health economics and medical
informatics have been mix through into the area of medical information systems science, where they
have been lacking so far.

Previous research has applied a number of different approaches to the evaluation of medical information
systems, and information systems in general. Research has also provided taxonomies of different

MBA Thesis SRFHR0407023 32

evaluation approaches (DeLone et al. 1992 and update 2003; Fineberg et al. 1977; Grover et al. 1997;
Guyatt et al, 1986; Van der Loo et al. 1992). Taxonomies suggest that there is an effect between
different levels (see figure 7). For example, with the help of better diagnostic information physicians
might make better therapeutic decisions.

Figure 7: Levels of Clinical Efficacy related to use of diagnostic technology (Fineberg et al, 1997)

Source: Pekka Turunen and Hannu Salmela, 1998

User satisfaction indicates users’ satisfaction with information and system. Individual impact can be
seen as impact on physician’s diagnostic decision but also as other impacts, for example on time
reduction or increase. Patient outcome means change in patient’s health and organizational outcome for
example changes in personnel time, overhead cost, and interest cost.

Many researchers in information systems in general and medical information systems science in
particular have ended up concluding that the best way to evaluate information systems is to measure
organizational or patient outcome (Van der Loo et al. 1995; Hamilton et al. 1981; Ives et al. 1983). Such
assessment applies economic evaluation, especially cost-benefit analysis. Because information systems
may have organization-wide, intangible and long lasting effects and cost, economic evaluation of
information systems is considered difficult (Saarinen, 199349: see also Ives et al. 1993). The difficulty
in evaluation cost and benefits is often seen as a motivation to develop other methods to evaluate
information systems (Saarinen 1993). On the other hand, cost-benefit analysis focuses on the outcomes
or ends. Other evaluation approaches focus more on the implementation process, which produces the
outcomes.

A comprehensive evaluation of an information system requires multiple measures (DeLone et al. 1992;
Saarinen, 1993). Both improvements in information, improvements in individual decisions or actions, as
MBA Thesis SRFHR0407023 33
well as improvements in organization level can indicate IS effectiveness as success. The selection
between these measures is to a wide degree dependent on the values and objectives driving the
evaluation. The type of systems and the economic considerations of gathering the evaluation data need
to be considered as well.

In spite of the disagreement among researchers on the assumptions and evaluation factors of IS, the
following factors represent the common factors to evaluate health care information systems
performance.

a) IT integrated in IS;
b) software quality;
c) investment in training;
d) aligning corporate goals with technological investments;
e) customer services;
f) productivity;
g) cost-benefit analysis.

3.6 Measurement
It is easy to confuse measurement with something very precise, objective and “scientific”. However, as
Mason and Swanson (1981) make clear, there are many subjective and arbitrary aspects to measurement.
They argue that there are four stages to measurement, each permits considerable subjectivity:
1. identify the underlying dimension – decide what to measure e.g. functionality,
profitability;
2. define it by unit/scale – decide how to measure the dimension, e.g. there are various ways of
measuring functionality, etc.;
3. execute measurement – this refers to the methodology of carrying out the measurement and
includes: when to measure? How long? How often? and so on;
4. compare against criteria – the value of measurement must be judged as good or bad against
certain criteria and these may be set subjectively.

There are also temptations to:

• measure whatever is easier to measure;
• measure whatever gives the desired result.

MBA Thesis SRFHR0407023 34

And hence, Tapscottt’s First Law of Cost-Justifying Office Systems:

“The probability of a chooser accepting a cost-benefit analysis directly proportional to the degree to
which he/she is favourable inclined to the technology anyway.”

Tapcott (1982)

The final point is that what gets measured gets managed – managers and their staff are often judged
(evaluated) on certain measures (e.g. productivity) and these are naturally the issues they tend to focus
on in their work, neglecting issues (e.g. health and safety) on which they are not measured.

3.7 Organizational issues

IS investment appraisals normally result in the direct allocation, or re-allocation, of resources to
particular groups (or departments) within the organization. These resources include finance, jobs,
equipment, accommodation and prestige, and may have significant implications for the future both of
groups and individuals within the organization. Thus, it is often in the best interest of certain groups (the
winners) for a project to proceed and not in the best interest of other groups (the losers). Hence, together
with the uncertainties surrounding measurement and evaluation, there is potential battlefield for
organizational politics (see Willcocks and Lester, 1999)

“The rational elements are tools used by participants to gain new ground or to project ground already
won. They also serve as “facades” to mask political motives and legitimise self-interest.”

Franz and Robey (1984)

In many organizations, users departments increasingly have to use their budgets to pay for IS
developments and clearly it is normally in their interest to reduce this expenditure and save their
budgets. This provides further scope for political manoeuvres.

Other types of IS evaluation (e.g. post-implementation) may also have (slightly more) indirect
implications for the allocation of resources, including prestige and status. For example, organizations
will often carry out a post mortem to allocate blame, especially where the system development has failed

MBA Thesis SRFHR0407023 35

badly. Where the system is a success, this may also stimulate a re-allocation of resources. In each case,
there are considerable organizational and political implications.

3.8 Summary
Organizations are particularly concerned about the effectiveness of their Information Systems in terms
of evaluating them in their business context. In practice, the most common approaches are the financial
ones that stem from the notion of cost-benefit analysis, especially those concerned with investment
appraisal. However, there are some non-financial approaches as well as combinatorial approaches that
seek to get beyond mere finance. Nevertheless all approaches to IS evaluation must recognize both the
subjective nature of measurement as well as the organizational aspects that surround IS evaluation.

MBA Thesis SRFHR0407023 36

 CHAPTER 4 HYPOTHESES DEVELOPMENT AND PROPOSED
MODEL

4.1 Introduction
Evaluation of ISs is an integral part of the management control process. ISs in general, and especially
ERP systems are used organization-wide, and are part of organization’s automation packages in all
aspects of the organizational/business process. Due to its multidimensionality, its quantitative (scale)
and qualitative aspects, and multiple, and often conflicting, evaluator viewpoints it is expected that
measures of ISs success require different evaluation approaches dependent on the stage of development
of the organization and the ISs itself. At the pre-implementation stage and implementation stage subject
of study and evaluation (assessment) is the IS project. In the context of project management, an IS is
deemed effective (successful) if it accomplishes its objectives - not only to the management but also to
users, developer(s), and all personnel involved in IS implementation, use and support -, and the planned
activities are completed within the allocated time and budget. Yet the scenario at post-implementation
stage is quite different from the pre-implementation and implementation stage. In post-implementation
stage ISs provides various degrees of system, information and service quality. New users experience
these quality features by actually using the IS. Users are ether satisfied or dissatisfied with quality
features of IS. As discussed in the literature review in Chapter 3 measurement of overall ISs and ERP
effectiveness in post-implementation stage is more complicated than any unit or departmental IS
success since there are more users and departments with different needs involved.

4.2 Comparison of Evaluation Approaches

Several IS evaluation approaches currently employed to assess system effectiveness can be compared by
mapping them into the conceptual hierarchy (Hamilton and Chervany, 1981) (see Table 4. While many
different approaches have been suggested for effectiveness measurement, a selection of the frequently
employed in IS organizations were discussed in Chapter 3.The Scope of each evaluation approach is
depicted in Table 4 in terms of objectives being evaluated.

Evaluation of approaches was previously categorized as being either semantic level or effectiveness
level, and two approaches can be compared using the conceptual hierarchy. Effectiveness level is
objective oriented and determines whether the system has achieved desired “outcomes” or result”
objectives and focuses on assessing the accomplishment of Level 2 and 3 effectiveness oriented
MBA Thesis SRFHR0407023 37
objectives. Both semantic and effectiveness evaluative approaches are typically used in providing
evaluative information on system effectiveness.

Evaluation of IS effectiveness has been difficult due to its multidimensionality, its quantitative and
qualitative aspects, and the multiple evaluator viewpoints. Several suggestions can be made for IS
practitioners and IS researchers for evaluating IS effectiveness. For IS practitioners it is important to
incorporate multiple viewpoints of multiple objectives and performance measures into the assessing
system benefits to user organizational performance.
For researchers, the dependent variable in many studies is of the IS success or system effectiveness. To
measure system success it is important to incorporate multiple success criteria (objectives), differing
viewpoints on each criterion, and the varying importance of each criterion. In addition, the use of a
standardized validated instrument to measure system success is encountered in order to make research
results comparable. As recommended in previous studies and also in my analyses of the different
approaches, I decided to incorporate multi-evaluator viewpoints on system effectiveness into my
evaluation approach while using a combinatorial approach in my discussion in next paragraphs in an
attempt of measuring the dependent variable “IS effectiveness” or “IS Success”.

4.3 Applying the IS Success Models in research context

As recommended by previous researcher and based on literature review discussed in Chapter 3 I
consider the logic of an updated D&M IS Success Model a good framework for my research as
hospitals are in a post-implemental stage of both their ISs in general as well as the ERP system. Since
ISs implemented in the hospitals are considered as a whole to achieve organizational objectives all three
quality dimensions, namely system quality, information quality and service quality need to be included
in the proposed model.

Selection Procedure
Despite the ever increasing number of health care information systems, publish evaluation studies are
scarce. To my knowledge, no evaluation framework has been proposed specially for patient care
information systems. In my literature review I have examined a wide range of attributes for evaluating
such systems (see Appendix 1). My review has shown that the dimensions of success for IS defined by
DeLone and McLean are applicable to inpatient care IS. It is unlikely that one single factor is decisive in
the success of IS. Therefore a multidimensional construct, as proposed by D&M, is more appropriate for

MBA Thesis SRFHR0407023 38

the evaluation of IS. Studies have shown that the D&M frame work is useful in evaluating patient care
IS and should be explored in future evaluation research, with modifications to include contingent
factors, such as user involvement during system development and implementation and organizational
culture.

Levels in Conceptual Hierarchy Measures to Measure accomplishment of objectives

Hierarchy of Service User Post Cost

objectives Level Satisfaction Installation Benefit

Monitoring Survey Review Analysis
Efficiency-Oriented Objectives

3. Resource Investment Cost-

Benefit
Analysis
2. Production capacity

1. Resource Consumption

0. Requirements defini-
tion of IS
1. Information and Service User
1. Post implementation Review

Level Satisfaction
3. Combinatorial approaches
Support provided
Monitoring Survey
Effectiveness-Oriented

2. Objective analysis

2. Use Process and Utilisation

User performance
Cost-
Objectives

3. Organizational
Performance Benefit
Analysis

Table 4: Comparison of Evaluation Approaches in/ based on conceptual hierarchy

Source: Hamilton and Chervany, 1981

MBA Thesis SRFHR0407023 39

 4.3.1 Operationalization of variables and proposed IS Success Model

In order to empirically analyse the DeLone and Mclean Model, all variables in the model must be
operationalized. Existing measures of information system success that have acceptable psychometric
quality are used, extended with some identified in this study to strengthen the variables (constructs) and
re-structured for the context, while a general and standard approach is adopted. DeLone and McLean
recommended tested and proven measures from previous research and that is what has been done in this
research basically, while some re-structuring and shaping have been performed to get better tests results
both in this research as well as in future research no matter what the context. A brief description of the
selected items for the measurement instrument, the questionnaire from tested survey instruments in
information system literature is as follows:

Based on the Updated D&M Model 2003 and Seddons’ IS Succes Model 1997, discussed in Chapter 3,
75 items divided 56 dimensions (see Appendix 1) were used to operationalize the 6 success measures.
Items from attached questionnaire (see Appendix 3) were used to operationalize System Quality,
Information Quality and Service Quality, Perceived Ease of Use, Perceived Usefulness, Intention to Use,
Benefits of Use (System Usage), User Satisfaction and Net Benefits.

As depicted in Figure 1, the resulting model comprises nine interrelated constructs in an IS success
model and Behaviour model of IS Use, namely: System Quality, Information Quality, Service Quality,
Benefits of Use and Net Benefits for the IS Success model and Perceived Ease of Use, Perceived
Usefulness and Intention to Use for the Behaviour model of Use, while Use as behaviour also was
measured for verification reason in the context.

4.3.1.1. Variables of IS Success Model

System Quality (SQ) measures the desired operational characteristics of an IS, e.g. whether or not there
are bugs in the systems, the consistency of the user interface, ease of use, response rates in interactive
systems, quality of documentation, and sometimes, quality and maintainability of the program code”
(Seddon and Kiew, 1997). Seven dimensions and seven items were used to operationalized the System
Quality variable and are shown in Part 1 of the questionnaire (see Appendix 2, part 1): timeliness,
accuracy, ease of use, consistency (response time and availability), flexibility, integration and reliability.

MBA Thesis SRFHR0407023 40

Information Quality (IQ) is "concerned with how good is IS in terms of output. Patient information for
example must be precise, understandable, complete, and available on time, to name few; issues such as
format, content, timeliness, relevance, accuracy and reliability of information generated by an
information system. Not all applications of IT involve the production of information for decision
making (e.g., a word processor does not actually produce information) so Information Quality is not a
measure that can be applied to all systems (Seddon and Kiew, 1997). Those six dimensions were used to
operationalize the Information Quality construct in six items.

Service Quality (SRQ) is “concerned with consistency in what a variable should measure; a global
judgment of attitude relating to the superiority or excellence of service. The perception of service quality
results from the comparison of expectations with performance. In the hospital context Service Quality
refers to the perceived quality of the support and the service provided by the provider of the system
and/or the internal staff responsible for IS support and maintenance. This construct was measured in five
dimensions and a five-item-scale developed in the marketing area and then adapted to the IT context. So,
five dimensions and five items were used to operationalize the Service Quality variable as shown in part
3 of the questionnaire: responsiveness (service consistency), reliability, empathy, assurance (adequacy)
and support.

System Usage (SU) examines the actual use of information systems, the extent of use of information
systems in the users' jobs, and the numbers of information system packages used in the users' jobs. It is
expected that resources such as human effort will be consumed as the system is used. IS Use might be
measured in hands-on hours spent analyzing reports, frequency of use, number of users, or simply as a
binary variable: use/none-use. This variable was operationalzed in three dimensions; intensity,
frequency and scope of current research.

As mentioned before in this study this variable was operationalized applying Seddon’s Behavior model
and results were compared with respondents answers on Intention to Uses, so there is a verification to
what instant System Usage in the IS Success Model matches with Intention to Use in de Behavior Model
and actual Use. System Usage supported by the variables “Perceived Ease of Use”, “Perceived
Usefulness” 11 and “Intention to Use” from Behavior Model were operationalized in twelve dimensions

MBA Thesis SRFHR0407023 41

and fourteen items. System Use and its supporting variables in this study are shown in section 4, 5, 6 en
7 of the questionnaire.

User Satisfaction (US) examines the successful interaction between the information system itself and
its users. User Satisfaction is an important means of measuring user’s opinions about ISs. This variable
was operationalized using the following dimensions: satisfaction with the specifics, content, accuracy,
format, ease of use, timeliness, information satisfaction and overall satisfaction. The instrument consists
of eight dimensions and nine items. User Satisfaction is a subjective evaluation of the various
Consequences: Individual, Organizational, and Societal (depicted in the top-right corner of Figure 6)
evaluated on a pleasant-unpleasant continuum. Of all the measures in Figure 1 and 6 User Satisfaction is
probably the closest in meaning to the ideal Net Benefits measure (Seddon and Kiew, 1997).

Net Benefits to Individuals, Organizations, and Society are the most important success measures as they
capture the balance of positive and negative impacts of ISs on users (e.g. radiologist, technologists,
physicians and hospitals in general/ valuates the benefits of the Information System for the users and is
operationalized by “Benefits from the end-users’ view (BU) and Net Value from organizational view
(NV). As the “impacts” of IS have involved beyond the immediate user, researchers have suggested
additional IS impact measures, such as work group impacts, inter-organizational and industry impacts,
customer impacts and societal impacts. Former implicates a clearly continuum of ever-increasing
entities, from individuals to national economic accounts, which could be affected by IS activity. So the
choice in this study is done based on the systems being evaluated and their objectives. Rather than
complicate the model with more than 3 success measures for Net Benefits “impact” measures for net
benefits from organizational and societal end of view were kept in a single category called “Net
Benefits” while assuming in this study that organizational and societal benefits are equal. Although for
some studies, such finer granularity may be appropriate such further refinements will be resisted for sake
of parsimony. “Net Benefits” success measures are most important, but they cannot be analyzed and
understood without “system quality”, “information quality” and service quality”.

Benefits from end-users’ view (BU) examines effect of the information system on the users
performance. In this research the benefits from end-users’ view (BU) variable were operationalized by

MBA Thesis SRFHR0407023 42

five dimensions: improved individual productivity, decision effectiveness, learning, task performance
and problem identification in five items.

Net value from organizational view (NV) or Net Benefits from organizational (NB) examines the
influence of the information system on overall organizational performance. The instrument was to
operationalize the overall organizational impact variable. This measure was chosen because it measures
the impact of information system in areas that are highly important to all types of organizations. These
areas include reduction of enhancement of internal operations, overall productivity gains, improvement
of organization image, service effectiveness, and increased sales and profit. There are six dimensions
and six items measuring the impact of information systems in these areas.

Net Nenefits (NB) is an idealized comprehensive measure of the sum of all past and expected future
benefits, less all past and expected future cost, attributed to the use of an Information Technology
Application. Any use of resources (including, learning to use, and/or using the system is a cost. To
measure Net Benefits, one has to adopt some stockholder’s point of view about what is valuable and
what not. (Seddon and Kiew, 1997)

4.3.1.2 Variables of Behavior Model of Use

Perceived Ease of Use (PEU) is concerned with the degree to which a person believes, that using a
particular system would be free of efforts (Davis, 1989) and is operationalized in four dimensions:
processing customers request - derived in current study from Dr. Timothy Jung’s (2009): Customer
Usage; receiving customer order, accepting customer orders and customer service request, assessing
low-cost carrier e-airline system success -, user friendliness, information search and ease of use and five
items.

Perceived Usefulness (PU) concerns the belief, that using a system would enhance job performance
(Davis, 1989) and is operationalized in five dimensions: task innovation (effectively), task productivity,
(user) efficiency (data processing correctness, report preparation and distribution timeliness), customer
satisfaction and management control and five items. “Confirmed expectations” are positively related to
“user satisfaction” with IS because it implies realization of the expected benefits of the system. Lastly,
MBA Thesis SRFHR0407023 43
while initial acceptance (usage) of IS is an important first step toward realizing success, long-term
viability of an IS its eventual success depends on it continuous use “system continuance” rather than
first-time use. It is than hypothesized that system continuance will be positively associated with user
satisfaction, net benefits and confirmed expectations.

Intention to Use (IU) is concerned with the fact that a person’s intention to perform a behavior is the
best predictor of his behavior (Fashbien) and is operationalized in four dimensions and five items. The
dimensions are: behavior, target, situation in which performing and time of performing. Important for
the Intention to perform a behavior construct is the repeated-observation criterion. According to
Fishbein & Ajzen there should be a high relation between a person’s intention to perform a particular
behavior and his actual performance of that behavior. Within the framework of Fishbien & Ajzen,
intentions are viewed as the immediate antecedents of corresponding overt behaviors. The apparent
simplicity of this notion is somewhat deceptive. However it is often impossible or impractical to
measure a person’s intention immediately prior to his performance of the behavior, the measure of
intention obtain may not be representative of the person’s intention at the time of the behavior
observation. Intervening events that may lead to changes in intentions will therefore also have to be
taken into consideration. For example, a person intends to buy a car three months hence, any change in
his financial position, the price of the car, or the availability of gasoline may influence his intention and
must therefore be taken into account if accurate behavior prediction is to be achieved. Barring such
changes in intentions, an appropriate measure of intention will usually allow accurate prediction of
behavior.

Attitudes and Intentions

As Intentions have often been viewed as the “conative component of attitude” and it has usually been
assumed that this conative component is related to the attitude’s affective component attitude has been
left out of the model as recommended by Fisgbien & Ajzen. This conceptualization has led to the
assumption of a strong relation between attitudes and intentions. Fishbein & Ajzen’s stated that “a
person forms beliefs about an object; he automatically and simultaneously acquires an attitude towards
the object”.

MBA Thesis SRFHR0407023 44

4.4 Measures of IS Success Model and proposed Framework
Unfortunately, combining variance and process models is exactly what D&M attempted to do (see
Figure 5, page 30). The result is that many of the boxes and arrows in D&M’s model can, and do, have
both a variance and an event-in-a-process interpretation. The result is a level of muddle thinking that is
likely to be sub-optimal/counter-productive for future IS research.

In an effort to overcome the problem mentioned above, Seddon and Kiew presented a re-specified and
slightly extended version of the Updated D&M IS Success Model 2003. The re-specified model retains
most of the features of the Updated D&M model, but eliminates the confusion caused by the multiple
alternative meanings for the boxes and arrows. They did it by splitting Updated D&M model into two
variance models, namely the main model the IS Success Model and a sub-Model for IS Use and so
eliminating the process model interpretation of the D&M model.

By clarifying the three meanings of IS Use in the D&M model, introducing four new variables
(Expectations, Consequences, Perceived Usefulness, and Net Benefits to Society), and reassembling the
link between the variables, it has been possible to develop a re-specified and slightly extended model of
IS Use & IS Success shown in Figure 6, page 31..

The three meanings of “IS Use” in the D&M Model are:

1. Use as a variable that Proxies for the benefits from Use:
2. Use as the Dependent Variable in a Variance Model of Future IS Use.
3. IS Use as an event in a Process Leading to Individual or organizational Impact.

In other words, the reason that D&M’s model seems to say so much, is that it is actually a combination
of three models:
1. a variance model of IS Success, where the independent variables are probably System
Quality, Information Quality and Service Quality, and the dependent variables are IS Use (as
Meaning 1 proxy for Benefits from Use) and User Satisfaction;
2. a variance model of IS Use as a behavior (Meaning 2 for IS Use);
3. a process model of IS Success, where IS Use is a Meaning 3 event that necessarily precedes
outcomes such as User Satisfaction, Individual Impact, and Organizational Impact.

MBA Thesis SRFHR0407023 45

Starting at the top left of Figure 6, page 31 the behavioral variance model asset that, all other things
being equal, higher level of Expectations about the net benefits of future IS Use (henceforth
Expectations) will lead to higher levels of (Meaning 2) IS Use. The other things that would be held
equal would include factors such as subjective norm and perceived behavioral control (Taylor and Todd,
1995). Expectations might be measured by an instrument such as Davis’s (1989) Perceived Usefulness,
or in money terms (if that were possible), or by some other special-purpose instrument.

In case of mandatory use of a system by various members of an organization, it is the Expectation of

senior management (for whom use is not mandatory) that determine IS Use, not the Expectations of their
employees (who may prefer not to use it). Comparing this Expectation in the behavior model to the
D&M model leads to the implications that IS Use under Meaning 2 for IS Use seems to imply that
System Quality, Information Quality, Service Quality and User Satisfaction are part of a causal variance
model that predicts future IS Use. This is not so plausible as its seems, as the problem is that no matter
how good a system has been in the past, past benefits is not a sufficient condition for future benefits.
Rather, potential users will use the system that they hope will offer higher net benefits in the future.
Thus in Figure 6, it is more correct to show Expectations of net future benefits, and not the four
variables in the Updated D&M’s model 2003 as the casual variables that drives IS Use. Moving
clockwise in Figure 6, the consequences of IS Use are represented by the block of text labeled
“Individual, Organizational, and Societal Consequences of IS Use” (henceforth Consequences). The
Consequences are intended to be value-neutral description of outcomes attributed to IS Use, not
measures of IS Success. Consequences attributed to IS Use can include indirect outcomes. Workers and
managers may have different goals. Even if they agree on what the outcomes of system use are (the
Consequences), they may draw different conclusions about the success of the system. The arrow from IS
Use to Consequences in Figure 6 represents the hypothesis that more IS Use implies more
Consequences. 12

In advantages of modeling Consequences explicitly in Figure 6 is that while it seems valid to

hypothesize that more Use implies more Consequences, it is not necessarily true that more Use implies
more benefits. For example, for non-volitional users more Use may mean more distress. Thus, Figure 6,
Consequences have been separated from Net Benefits (D&M’s Impacts) to make it clear that IS Success
measurement requires the adoption of someone’s point of view. Without knowledge of that point of
view, it is impossible to hypothesize relationships between IS Use and IS Success. Moving clockwise

12
Use-Consequences Silver et al (1995) Information Technology Interaction Model (Figure 7)
MBA Thesis SRFHR0407023 46
again, the larger rectangle at the bottom of Figure 6 contains the re-specified model of IS Success. The
idea behind this positioning of the IS Success model (the large rectangle) relative to the Use and
Consequences variables at the top half of Figure 6 is that based on observations, personal experience,
and reports from others about the Consequences of IS Use, the observer makes judgments about various
aspects of what he/she regards as system success. IS Success is thus conceptualized as a value judgment
made by an individual, from the point of view of some stakeholders. The dotted vertical arrow from
Consequences to Success indicates that there is no clear casual relationship from Consequences to
Success. Perhaps if one could measure the importance of each Consequence, one might be able to
calculate a weighted-sum-of-outcomes measure of IS Success (Ajzen and Fishbien, 1980).

Stepping inside the large rectangle labeled “IS Success Model,” we find a rather complex set of variance
model relationships between seven IS Success measures arranged in three columns. This IS Success
model is the logical equivalent of Figure 4, page 28; all six of the original D&M IS Success Model 1992
success measures appear here. System Quality, Information Quality, User Satisfaction, Individual
Impacts and Organizational Impacts are shown explicitly. Use appears as an example measure at the
bottom of the Other Benefits from Use column (column 3) as “Volitional IS Use.” In additional, two
new variables, Perceived Usefulness and Net Benefits to Society, have been added to the model.

a. Measures of the independent variables (column 1):

The two variables in column 1 of the IS Success model are System Quality, Information Quality. These
variables defined in Figure 4, page 28 are identical to D&M’s variables of the same name. In terms of
relationships between these two variables, it is hypothesized in Figure 5 that System Quality,
Information Quality and Service Quality which is added in this updated model are independent
variables. For example, if the designer gets the specifications wrong, a technically high-quality system
may produce useless information. This seems to be consistent with D&M’s model.

b. General Perceptual Measures of the Net Benefits from IS Use (column 2)

As indicated in the discussion of Figure 4, page 28 the four remaining classes of variables on the
downstream side of D&M’s model are really only classifications of measures of Benefits from IS Use. A
pie can be cut up in many ways, and in Figure 6 the primary cut is based on the distinction between two
general purpose perceptual measures of Net Benefits (that seems likely to be applicable in almost all
situations) and all other measures. The two general perceptual measures (Perceived Usefulness and User
Satisfaction) appear in column 2, and other measures (which include Meaning 1 IS Use) are grouped in
column 3.
MBA Thesis SRFHR0407023 47
A weakness with the two general measures is that they are both perceptual. Perceptual measures are
distrusted because people do not necessarily say what they believe, nor do what they say. Worse still,
perceptions can be downright wrong. Notwithstanding these difficulties, Perceived Usefulness and User
Satisfaction are potentially useful for many studies, because they are conceptually meaningful, and
relatively easy to measure. The next few paragraphs define the meanings of these two variables.

User Satisfaction
With respect to User Satisfaction, Naylor et al. (1980) define the general concept “Satisfaction” as “the
result of the individual taking outcomes that have been received and evaluate them on a pleasant-
unpleasant continuum.” Applied to on an IS context, Users Satisfaction is a subjective evaluation of the
various outcomes of IS Use on a pleasant-unpleasant continuum. In this case, the relevant outcomes are
the Consequences depicted in the top-right corner of Figure 6.

The hypothesized relationship between Perceived Usefulness, User Satisfaction, and two Quality
variables in column 1 of Figure 6 is based on the theoretical and empirical work reported by Seddon and
Kiew (1994). They argue that first, the existence of factors related to Systems Quality and Information
Quality in the most User Satisfactions instruments (e.g., Ives et al.’s (1983) User Satisfaction measures,
and Doll and Torkzadeh’s (1988) End User Computing Satisfaction is evidence to support the use of
these two factors (System Quality and Information Quality) as independent variables in a variance
model of User Satisfaction. Second, for very similar reasons, System Quality and Information Quality
should also be influential in determining Perceived Usefulness. Thirdly, User Satisfaction taps a wider
range of needs, cost, and benefits of IT application use than Perceived Usefulness, 13 so Perceived
Usefulness may validly be included, along with the other two factors (System Quality and Information
Quality), in a variance model of User Satisfaction.
Relationships between the four variables in columns 1 and 2 may thus be represented by two OLS
regression models, with Perceived Usefulness and User Satisfaction, respectively, as dependent
variables. These relationship are shown in the path diagram at the left of the IS Success model in Figure
6 (arrows indicate hypothesized causality).

13
For instance a very cheap old computer may still be useful for word processing but many people would not be
satisfied with it. So satisfaction must involve the weighing up of a wider range of factors than mere usefulness.
MBA Thesis SRFHR0407023 48
Compared to the D&M model these variables are very similar. The two differences are, in the first place
that Perceived Usefulness occupies the slot filled by IS Use in D&M model. Here like Meaning 1 Use in
D&M’s model, it proxies here for Benefits from Use. Secondly, D&M’s arrow pointing up from User
Satisfaction to IS Use is modeled in Figure 6 by the feedback arrow from IS Success to Expectations.
This feedback relationship is discussed shortly.

c. Other measures of the Net Benefits of IS Use (column 3). D&M’s classification of IS Success
measures by whether they measure to individual or an organization is helpful and is retained in column 3
of the IS Success model in Figure 6. In addition, new category, Net Benefit to Society, has also been
added because there are clearly situations, e.g. of impacts of widespread/extensive use of IS, where the
unit of analysis needs to be our whole society, and not just one or more individuals, or one or more
organizations.

Net Benefit is a weighted sum of many positive and negative factors, and that a first –approximation
weighting of each factor can be estimated using an ordinary least squares (OLS) regression model. It
follows that if the variables semantically closest in meaning to Net Benefits are treated as proxies for
Net Benefits (dependent variable), the other IS Success variables can be treated as independent variables
in the OLS regression model. 14

In Figure 6, the six left-pointed arrows in the IS Success model have been drawn to indicate that User
Satisfaction and Perceived Usefulness are both likely to be semantically closer to the notion of Net
Benefits than the other measures. Figure 6 shows that User Satisfaction is dependent on six variables
(System Quality, Information Quality, Perceived Usefulness, Net Benefits to Individuals, Net Benefits
to Organizations, and Net Benefits to Society. Perceived Usefulness is hypothesized to depend on the
same six variables, excluding itself. This may not be valid in all situations; it needs to be tested
empirically.
The final relationship to describe in Figure 6 is the feedback path from IS Success to Expectations in the
behavior model. All other things being equal, it is hypothesized that higher Net Benefits from past use
will lead to higher Net Benefits about net future benefits. Since User Satisfaction has been chosen in
Figure 6 as the variable closest in meaning to Net Benefits, the arrow representing this feedback path in
Figure 6 has been drawn from User Satisfaction to Expectations. However, if a more comprehensive or

14
In terms of OLS regression, avoids having to say that variable x causes variable y.
MBA Thesis SRFHR0407023 49
reliable measure of Net Benefit existed in the IS Success model, feedback arrow would be from that
more comprehensive measure to Expectations.

That completes the description of the IS Success model in Figure 6, page 31 which will be applied in
this study, after some modifications. The focus of the re-specified model is very much the same as
D&M’s. All seven categories of IS Success measure that D&M identified in their comprehensive and
valuable survey, and of the three meanings for IS Use implicit in their model, are present in the
proposed model in Figure 1. Meaning 1 for IS Use, as a proxy for Benefits from Use, appears at the
bottom of column 3 of the IS Success model as an example ‘Other” measure of net benefit. Meaning 2
for IS Use, the behavior, appears in the box labeled IS Use in the IS Use model. However, because of
the need to maintain clear definition for all variables, Meaning 3 for IS Use (the process-model
meaning) has been omitted deliberately from Figure 6.

In this study also the process side has been taken in consideration in terms of measuring current use.
This as an indication and for confirmation consideration of previous studies that intentions, which are
difficult to approve differ from realization, because as mentioned above people often act different then
they intended.
Although Perceived Usefulness has shown in different studies (Davis (1989, 1993) and Davis et al.
(1989) and others that it is an important predictor of IS future use I consider it important to test and have
this confirmed in the context of this study. If people use IT because they expect it will be useful, it
would seem eminently sensible to measure success by whether they found it is actually useful. It is
therefore argued that the IS Success model is strengthened by including Perceived Usefulness explicitly
as a key IS Success measure in Figure 6. 15

In the re-specified model, the feedback loop from Perceptions back to Expectation explicitly recognizes
the importance of learning. The model in Figure 6 asserts that Expectations are continuously being
revised in the light of new experiences with the system. In the clockwise fashion, revised expectations
lead to revised levels of IS Use, which in turn lead to revised perceptions of IS Success, and ultimately,
to revised expectations. This important variable was not incorporated in the studies of Davis et al.’s
1989 TAM, Figure 2, page 12.

15
Perceived Usefulness was the IS Success measure chosen by Franz and Robey (1986)
MBA Thesis SRFHR0407023 50
Although D&M in Figure 4 did not set out to build a model that predicts IS Use, it seems likely that the
arrows in Figure 6 from Use down to User Satisfaction, and from User Satisfaction up to Use, were
intended to recognize the possibility of this sort of learning effect.

The research model for post-implementation ISs used to guide the study is shown in Figure 1, page 5 is
a multidimensional model, and the dimensions are interrelated as discussed above. ISs are first
implemented and exhibit various degrees of system, information and service quality. Users and
managers then experience these quality dimensions by using ISs for their works and decisions. Users
and managers can be either satisfied or dissatisfied with the ISs. The intention to use ISs and the three
quality dimensions influence the individual value of using ISs. Collective values of using ISs trigger
influence on organizational performance. Sequencing relative individual works from
business/organizational processes, the individual impacts also collectively affect User Satisfaction.
The entire research suggest that there can be positive benefits from automation, process redesign
activities, and increased timeliness or output quality associated with successful ISs system development,
as these effects have not been studied statistically in the specific context of ERP systems this study tries
to contribute in a while to this gap by a central scope on ERP systems among others ISs in this study.

Based on above discussion the relationships in the proposed model in Figure 1 are:
NB = ƒ1 (SQ, IQ, SRQ, BU, US) - success model
BU = ƒ2 (SQ, IQ, SRQ, IU, PEU, PU) - success and behavior model
US = ƒ3 (SQ, IQ, SRQ, PEU, PU, IU, BU) - success and behavior model
IU = ƒ4 (PEU, PU, US, SQ, IQ, SRQ, BU, US, NB) - relationships in behavior model itself
and with success model
PU = ƒ5 ( PEU ) - behavior model

Where NB is Net Benefits (Organizational and Societal), BU is Benefits of Use (Individual), SQ is

System Quality, IQ is Information Quality, SRQ is Service Quality, IU is Intention to Use, PEU is
Perceived Ease of Use, PU is Perceived Usefulness and US is User Satisfaction.

According to the theoretical basis of the DeLone and McLean, extended with that of Davis and Seddon,
the hypotheses that follow directly from the proposed research model are summarized in Table 5:

MBA Thesis SRFHR0407023 51

 Code Hypothesis Model
H1a System Quality is positively related to ISs Benefits of Use IS Success model
H1b System Quality is positive related to ISs User Satisfaction IS Success model
H2a Information Quality is positively related to ISs Benefits of Use IS Success model
H2b Information Quality is positively related to ISs User Satisfaction IS Success model
H3a Service Quality is positively related to ISs Benefits of Use IS Success model
H3b Service Quality is positively related to ISs User Satisfaction IS Success model
H4a User Satisfaction ISs is positively related to users’ Intention to Use ISs Link both models
H4b-c User Satisfaction ISs is positively related to Net Benefits hospital IS Success model
H5a Benefits of UseISs is positively related to ISs User Satisfaction IS Success model
H5b-d Benefits of Use ISs is positively related to Net Benefits hospitals IS Success model
H6a Perceived Ease of Use ISs is positively related to Intention to Use ISs Behavior Model
H6b Perceived Ease of Use ISsis positively related to Perceived Usefulness ISs Behavior Model
H7 Perceived Usefulness ISs is positively related Intention to Use ISs Behavior Model
H8 Intention to Use ISs is positively related to Benefits of Use ISs Link both Models
H9 Net Benefits hospitals is positively related to Intention of Use ISs Link both Models

Table 5: Research hypotheses

Source: Prior studies; Shih-Wen Chin, 2006

These hypotheses were tested as set out in Chapter 5, Methodology (see for research model with
hypothesis Appendix 14, page 116.

MBA Thesis SRFHR0407023 52

CHAPTER 5 RESEARCH METHODOLOGY

5.1 Procedures and Sample

The objective of the study is to empirically test the inter-relationships between the variables in the
proposed model for the evaluation of the effectiveness of post-implementation ISs and identify the
factors contributing to high-quality ISs. Such “why questions” can be answered by using the case study
method (Yin, 2003). A quantitative approach is used to analyse a series of event exhibiting some
theoretical principles. The purpose is to examine in details the dynamics present in relevant
organisations and conceptually interpret the significance of various factors that influence the
effectiveness of ISs. In this regard conceptualisation of the case study methodology is followed in an
attempt to understand the concepts involved in the field of success model in ISs and define the
substantive domain of these concepts and their relationships. The literature review in Chapter 3 offers
the opportunity to formulate a general research proposition and to identify factors of potential interest in
evaluating the success model of ISs, These factors are further explored by conducting questionnaire
surveys in the three different hospitals with implemented ERP systems among other ISs in the period of
April 26 till May 12, 2009.

Selection of the three hospitals is based on the need to collect detailed data about the Overall ISs
implementation process in each hospital. The selected hospitals vary significantly in terms of
organization size, type of patients, management approach, as well as in the degree of “success” in their
Overall ISs implementation efforts.

In all three cases, an initial interview was conducted, observations and results obtained from initial
interview were reviewed, and a second meeting or e-mail correspondence with the same interviewees
was conducted for necessary elaboration and clarification.

When interviewed by the researcher for collecting archival data IS and financial managers at the three
selected organizations frequently refer to internal documents or seek help of in-house and external
experts in responding to researcher’s inquiries. The researcher also met with those experts who were
able to provide more detailed information. After taken the interview the results were processed and the
questionnaire was designed and pre-tested according to the framework mentioned in previous sections,

MBA Thesis SRFHR0407023 53

and then sent to the three hospitals registered at the Ministry of Health with more than 100 employees
and an identified automation organization.

The following sections present the data obtained from these questionnaires with regard to the driving
forces and principles for Overall ISs implemented in the three hospitals, as well as significant issues
related to the implementation process.

The study further aims to propose a success model for post-implementation ISs and empirically test the
inter-relationships between those dependent variables in the proposed model. In the survey,
questionnaires were sent to 148 users and 7 IS support staff of the three hospitals in April 2009. A total
of 99 questionnaires were returned to researcher. The response rate was 64%. While this is higher than
expected as mentioned in 1.3.3.2, the participation of the different hospitals is much skew between the
private hospital and the two public hospitals. This was caused by difference in coordination approach of
the surveys among the private and the public hospitals. Overall there were no questionnaires deleted
because of incomplete answers, so all 99 questionnaires were left for analysis. The effective response
rate stays 64%. Table 3 presents essential information about ISs implementation within the three
hospitals as provided by the coordinators at the hospitals and confirmed by the users en support staff.

Among the returned questionnaires, 69 (70% response rate) were completed by participants of DKH, 14
(14% response rate) by participants of LH and 12 (12% response rate) by participants of SZN. 4
questionnaires had no hospital name on them but could be traced by a unique reference number given
per hospital after collection of returned questionnaires for completeness check of processing. Because of
time constraints the four questionnaires were left out from specification under the respective hospitals.

Demographics

From the 99 responses 90% represents finance and administrative professions while only 10% represents
the core professions of a hospital, namely: technicians 2%, nurses 3% and medical assistants 5%.
Respondents worked primarily (95 %) in executive professions while 5% had a senior management
profession. 8% had an academic degree, while 3% held an under-graduate degree and 45% had a high
school diploma. At the gender side there were 87% women and 13% men. 59% of the respondents use
computers 1 to 5 years and only 4% has more than 10 years experience with computers. 60% of the
respondents have experience with an IS before using current ISs of which 25% has used medical
information systems before.
MBA Thesis SRFHR0407023 54
Furthermore the respondents of DKH complaint about congestion of the in ERP system due to less
licensing, while some computer are slow, more automation overall and at department level is
appreciated as well as more ICT and IS education. Finally it is interesting to report that 59% of
respondents are 31 to 50 years old while 16% are 51 to 60 years, which seems reasonable for a good IS
environment (see Appendix 6 for hospital sample, page 95).

Instrument Validity
With regard to data analysis, composite reliability coefficient (Cronbach’s alpha) has been computed in
order to assess the internal consistency of each scale. Table 6 presents the results associated with the
assessment of the internal consistency of each scale. The composite reliability coefficients of all the
scales range from 0.698 to 0.898. The scale for Use was adjusted after the pre-test from two to four
items which just like previous research have shown not to be a strong predictor of IS Success and so in
the D&M model the weakest predictor of Net benefits. This modification failed to increase reliability of
the scale so the instrument with the two-item scale was used to confirm the internal reliability of the
construct.

Nr. Scale Dimensions N of items Cronbach

α
1 System Quality (SQ) 7 7 0.766
2 Information Quality (IQ) 6 6 0.865
3 Service Quality (SRQ) 5 5 0.896
4 Perceived Ease of Use (PEU) 4 4 0.886
5 Perceived usefulness (PU) 5 5 0.898
6 Intention to Use (IU) 4 5 0.881
7 System Usage (SU) 3 2 0.698
8 User Satisfaction (US) 8 9 0.870
9 Benefit of Use (BU) 5 5 0.736
10 Net Benefits (NB) 6 6 0.874

Table 6: Results of factor analysis of constructs scale

Source: Own research

MBA Thesis SRFHR0407023 55

 A survey methodology was used for data collection. The study aims to examine the effectiveness of
ISs in a hospital environment testing an extended version of the DeLone and McLean IS Success
Model 2003. Data was used for data analysis. Structural Equation Modeling (SEM) is the primary
analysis used to examine the proposed hypotheses developed in fulfilling the study objectives. The
SEM results have been interpreted relative to the implications in the health sector.

5.2 Case Evidence

5.2.1 Introduction
The 2006-2011 Policy Paper of the Ministry of Health identified two core problems in the health care
system: financing and lack of trained personnel. The focus of the Ministry’s policies for 2006-2011 is to
stop the decline of the health care sector. Measures planned to regulate and organize the system include
institutionalization of a National Health Council; strengthening of management, upgrading health
legislation, continued privatization of government hospitals, the Regional Health Service, and other
institutions, and restoration of health care facilities in the interior. The government will implement “a
compulsory national health insurance system for the total population, including mechanisms to regulate
salaries of service providers, to control prices of drugs and other inputs, and to control the cost of
intramural care.” Financial policies will focus on ending open-end financing of hospitals, budgeting,
including the limit of government expenditure to 6% to 8% of GNP, are addressed in the Policy Paper
(see Appendix 11 for indication of distribution of spending by payer). Intramural care should be limited
to less than 52% of the health care budget. The role of the hospitals should be emphasized on the
support of primary health care. Furthermore supply of clinical care will be organized and procedures
will be implemented regarding extension of high level clinical care. This will be done by support of:
• Training of radiologists and assistant radiologist;
• Finalization of constructing Mother and Child center of LH;
• Improvement of automation within the hospitals; start evaluation of automation;
• Support systems sector wide:
o Improvement of Purchasing, Communication, and Information Systems by
implementation of a National Health Information System (NHIS);
o Implementation of professional procurement;
o Professionalism in Public Relations (PR) and Communication.
• Upgrading hospitals;
• Upgrading Streekziekenhuis Albina.

MBA Thesis SRFHR0407023 56

There are four general hospitals in Paramaribo, one in the district of Nickerie and one in Albina of
which less information is available. There is one psychiatric hospital. There are 0.27 beds per 10,000
population: 387 in Academic Hospital, 368 in s’Lands Hospital, 217 in Diakonessen Hospital, 287 in St.
Vincentius Hospital (a Roman Catholic hospital), and 97 in Streekziekenhuis Nickerie (Nickerie District
Hospital). According to last census of 2004 the population of Suriname was 492,829 inhabitants with
and annual growth of 1.40% (see Appendix 12). The combined occupancy rate of the four major
hospitals in Paramaribo is 70%, a rate that increased slightly from 62% in the last decade. The average
length of hospitalization is 11 days. The Academic Hospital is the largest hospital in Suriname and was
the first mover with a department for emergency for medicine, and has an average of 33,959 admissions
yearly. Physicians are graduates from both the Medical School of the University of Suriname and
Medical Schools from abroad. The Central School of Nursing and the intramural training programs of
the Academic Hospital and the St. Vincentius Hospital are training nurses and nursing auxiliaries, but
the programs cannot keep up with the demand. The Nursing School has a new program for bachelor’s
degree Nursing.
Unfortunately the Academic Hospital and St. Vincentius Hospital were not able to participate in this
study but I hope they can benefit from the outcome.

The National Health Information System (NHIS) unit and the Bureau of Public Health at the Ministry of
Health are major end points for national health data analysis and dissemination. Most of the health data
and information reaches the NHIS unit through the reports of the Bureau of Public Health (which
remains health data and is the analytical unit of the Ministry of Health), the medical registration of
hospitals, the Regional Health Services and the Medical Mission, and professional health associations.

At the moment of the study the latest auditors report regards the Draft Management Letter of the interim
audit of 2008 dated January 30, 2009. The auditor’s opinion for fiscal year 2007 was a disclaimer of
opinion. In the Draft Management Letter the auditor reports: non existence of Administrative Policy
Manual and performing of the quarterly budget variance analyses for the first quarter 2008.

5.2.2 Case Background‘s Lands Hospital

The ‘s Lands Hospital is the oldest hospital in Suriname and has shown its right to exist. There is a
discussion going on regarding the formal status of ‘s Lands Hospital (LH). In this discussion it is
doubted if the foundation “Stichting ‘s Lands Hospital” which should have been established since
MBA Thesis SRFHR0407023 57
August 22, 1983 exist or not, and if the hospital is a department, unit or section of the Ministry of
Health. The publication of the registration in the Register of Foundations and the by laws of the hospital
are missing. The hospital has a long history. The activities started in 1688, when city hall and church
were housed in one building and has actually 368 licensed beds. In 1693-1695 plans were made to build
a hospital which then became ‘s Lands Gasthuis Paramaribo. The large number of stationed military
personnel made it necessary to build a ‘military hospital’. A start was made in 1758 and the hospital was
completed in 1760. The civilian hospital burnt down to ground in 1821. Thus the military hospital
became also a civilian hospital. The military hospital (LH) was expanded and renovated in 1849.

The s’Lands hospital has several special functions. Almost half of all babies that are born yearly in
Suriname (see Appendix 12) are delivered in this hospital. The Mother and Child Health Department
offers prenatal services and provides women with Pap tests. The hospital also performs rental dialysis.
Nearly 60% of patients admitted yearly are covered by the Ministry of Social Affairs and 24% by the
State, while this is 559 admissions from the interior yearly. On average 1,385 babies are delivered
yearly in this hospital. The hospital has a policy of linking hospital with primary level services and
maintains a general polyclinic that is open to the public until 23:00 hours daily and also during the
weekend. It has a department for community and home based care to limit the duration of stay in the
hospital.

There is a contradiction in data derived from different sources. Much is forgotten and a lot has to be
kept secret with the spirit of love. The course of the story would be better understandable if it coupled
with the history of Suriname in which the colonial relation with the Netherlands is at the corner and
developments in health care in Suriname a central focus point. Also shortage in funds and political
constrains have pressed a stamp at the history of LH both in the past and present.

At the moment of the study there was no business plan or policy paper of the hospital available while
the latest auditors report regards the fiscal year ending per December 31, 2000. The auditors’ opinion is
a disclaimer of opinion. In his report of February 23, 2005 the auditor reports three causes of the
backlog. Firstly: wrong processing of contributions of patients of the Ministry of Social Affairs by IS.
Secondly: the difficulties in presenting reconciliation between general ledger and control account
outstanding accounts receivables and liabilities and thirdly: that the hospital is qualitatively and
quantitatively under staffed.

MBA Thesis SRFHR0407023 58

5.2.3 Case Background Diakonessenhuis
The Diakonessenhuis (Deaconesses’ hospital or Nursing home) was established in 1962 by a joint
cooperation of the Protestant Churches in Suriname and is one of the two private general hospitals in
Suriname in the capital, Paramaribo. It starts in the Netherlands in 1955 when a small group of men
chaired by Dr. M.A. Melle who initiated to establish a protestant’s health care organization even
supported by regional health care as a core. To achieve this goal they also established an executive
committee in Paramaribo which afterwards rolled into a foundation in 1958, “Surinaamse Stichting
Diakonessenarbeid” (Surinamese Foundation for Deaconesses work). The objectives of the foundations
are: public service, nursing, and care for pregnant women, senior citizens, the ill and disabled, perform
social and social-medical work, establish and maintain one or more policlinics and hospitals etc.. The
hospital is annex a convent (nurses’ home) and is situated at the Ziniastraat. Starting with 30 licensed
beds in 1961 the hospital has grown to 217 licensed beds today.
Management of the hospital is formed by representatives of the Moravian Church, the Lutherian
Congregation and the Reformed Congregation. Executive management granted to three directors,
namely a Medical-Director, a Financial-Director and a Nursing Director. Furthermore there is a Medical
Management which is chaired by a Medical Doctor of the hospital. Spiritual care for patients, nursing
personnel and other personnel, which is an integral part of the services, is the responsibility of the house
preacher and his staff. The hospital is a general hospital and is open for everybody no matter what
ethnicity or religion, in case of availability. Diakonessenhuis has a good reputation and image in health
care in Suriname, and got the change to achieve its objectives. The hospital succeeds in balancing
medical and missionary goals while there was also as much as possible attention for the deaconesses. In
this regard it is remarkable to mention the cooperation between the Medical Mission of the Moravian
Church (MEDIZEBS) which covers health care for the greater part of the population in the interior, de
Medical Mission Suriname (MZS) which covers health care for the upland Amerindians and Maroons
(descendants of runaway slaves) and the “Pater Ahlbrinck Stichting Stichting” (P.A.S.) (Father
Ahlbrinck Foundation) which covers health care for the lowland Amerindians. The management of the
Diakonessenhuis is responsible for managing the federation of those three foundations which are known
as Medical Mission. This responsibility will be taken over by the Medical Mission Suriname, a national
non-governmental organization established in 2001 with history working with the Amerindians and
Maroons in the interior which is contracted by the Ministry of Health to provide health care services in
this area for 60,000 persons. This organization is meant to be the successor of the three organizations
mentioned before. The Diakonessenhuis personnel consist of capable medical doctors, nurses and other
staff and it plays an important role in the health care in Suriname. It cooperates extensively with the

MBA Thesis SRFHR0407023 59

Ministry of Health and participates in the hospital board and the preventive care of the Administration
for Public Health (BOG) (Bureau Openbare Gezonheidszorg) Malaria, National Immunization Program.
There is also a partnership with the St.Vincentius Ziekenhuis in Waspar and other activities. Also the
work of D.O.V.E. (DOOR ONDERLINGE VERBONDENHEID EEN) which covers all kinds of
services to the Diakonessenhuis is worth mentioning. D.O.V.E. deals with services at social and
community level for patients in the hospital, and consists among others of offering literature, toilet
articles etc., placement of plants, installation of nursing call or pager system, for the children’s
department etc. This group is very important for Diakonessenhuis and is of understanding to all
personnel.

In the past 30 years the Diakonessehuis has grown consistently, and has acquired a significant place in
Suriname’s health care system. Despite this the Diakonessenhuis nowadays suffers a financial problem.
The last five years the Diakonessenhuis was financed with gifts from friends and this will be continued
in the in coming years. However the solution to this problem should be found in a sound cost-benefit
structure of operational cost and revenues based on activity based costing, or health fund tariffs filled up
with government subsidy. The financial problem is discussed extensively the last few years with both
the Minister of Health and the Hospital Board, and there is nothing to be desired that the
Diakonessenhuis will solve this problem.

At the moment of the study there was no policy paper of the hospital available nor an auditors’ opinion
on the financial statements as per December 31, 2005 compiled by the auditor.

5.2.4 Case Background Streekziekenhuis Nickerie

The Streekziekenhuis Nickerie (District Hospital) is a basic hospital and was established in 1991. The
requirements for a basic hospital are minimal availability of at least one of next physicians: an internist,
a pediatrician, a gynecologist, a general surgeon, an anesthetist and an urologist. Nickerie District
Hospital has an operating room, an obstetrics department, an X-ray facility, and a medical laboratory.
The hospital is one of the tree public hospitals and has two emergency physicians and two room
physicians for support and control of in-patients. Furthermore the hospital gets support from Paramaribo
of the following physicians: a radiologist, an internist, an ophthalmologist (eye doctor), a dermatologist,
and a neurosurgeon. The physicians keep policlinics during weekends. The hospital was renovated in
the course of during 1993-1996 with a loan of 8 million US dollars from the Inter- American
Development Bank. The major problem faced by this hospital is the lack of medical specialists. The
MBA Thesis SRFHR0407023 60
hospital has 97 licensed beds of which 68 for SZF and patients with a card of the Ministry of Social
Affairs.
Although the hospital has to be operated on a break-even base it doesn’t get subsidy from the
government. The latest auditors’ report covers a backlog from December 1999 till December 31, 2004
and is dated January 31, 2007. The auditors’ opinion is a disclaimer of opinion. In his report the auditor
reports among other findings concerning the organization that the Accounting Information System did
not have the possibility to process adjustments and that nether accounting nor automation were
functioning sufficiently.

5.3 Respondent Characteristics

The sample represents three hospitals with an ERP system among other ISs. Participants in the study are
148 system users and 7 IS support personnel, experienced, well educated and on average employed with
their organizations for 12.5 years. To remedy the situation of relatively limited responses, the study has
put together the data of all respondents for analysis. It should also be noted that the three hospitals differ
from each other in timing of their IS implementation, composition and structure. Experientially based
differences in organizational positions, or the user’s role in the development of the application, may
cause differing frames of reference.

5.4 Research Instrument and Variable Measurement

5.4.1 Research Instrument

The research instrument contains a series of statements to which participants note their level of
agreement and disagreement on a 7-point Likert scale ranging from strongly agree (score = 7) to
strongly disagree (score = 1). Please consult Appendix 2 for a complete listing of statement items. Each
of the statements is used as an indicator variable that measures the latent dimension and constructs of
interest in this study.

“System Quality” (SQ) in the ISs environment measures the desired features of the ISs . Timelines,
system accuracy and flexibility are examples of qualities that are valued by users of ISs. “Information
Quality” (IQ) captures the ISs content issue. ISs document content should be personalized and complete.
“Service Quality” (SQ), the total overall support delivered by the service provider, applies regardless of
whether this support is delivered by the IS support department or not.

MBA Thesis SRFHR0407023 61

I measured participants’ perceptions of System Ease of Use (PEU) using several statements such as: “It
will be easy to get ISs to do what I want to do”, ISs will be flexible to interact with: “My interaction
with ISs will be clear an understandable”, and ISs will be easy to use. Perceptions of System Usefulness
(PU), on the other hand, are measured with statements like “Using ISs will increase my productivity”
and using ISs will improve my job performance”. I measure participants’ behavioural Intention to Use
(IU) the system as intended by developers with several statements. One statement was “I intend to use
the ISs in electronic mode, rarely printing out copies of work papers as I proceed through my tasks”.
This statement mirrors the hospital’s emphasis on using ISs system in electronic mode (i.e., not printing
out the electronic work papers and thus bypassing the system). Other statements measuring IU relate
mostly to the particular professional task performed by participants by participants, e.g. “I intend to use
ISs in planning and tailoring related programs”.

I measured System Usage (SU) using statement such as: “I use the ISs extensively (100% of my job
time)” and “I use the IS seven days a week (1=1day and 7=7 days).

I measured Benefit of Use from end-users’ view (BU) using statements common to three sample groups,
e.g., “ISs allow me to communicate with other users in an effective way”, ISs help me effectively to
manage and store knowledge that I need” and “ ISs help me to identify problems in an early stage”. The
statements items measuring task Net Value from organizational view” (NV) or “Net Benefits (NB) are
specific to the work roles performed by the participants. For example, I prepare assessed agreement with
statements such as “ISs enhance competitiveness or create strategic advantage”. “ISs establish and
maintain a good image”, and “ISs have dramatically increased our service capacity”.

5.4.2 Variable measures

Items used to operalitionalize the constructs were adopted from relevant previous researches. The
adopted items were validated, and the changes in wording were made to tailor the instrument for this
research. To determine if the 7 System Quality items, 6 Information Quality items, 5 Service Quality
items, 4 Perceived Ease of Use items, 5 Perceived Usefulness items, 5 Intention to Use items, 2 System
Usage items, 9 User Satisfaction items, 5 Benefits of Use, and 6 Net Benefits items could be reduced to
a smaller group of meaningful factors, a principal component analysis was conducted based on the
responses obtained from all participants surveyed in the study. With no item dropped, ten components
with eigenvalues greater than one emerged; the best results were obtained with varimax rotation. Results
of confirmatory factor analysis indicated that a priory assumption was substantiated with a ten-factor
MBA Thesis SRFHR0407023 62
solution, and the loading of the ten components are presented in Table 6. All the Cronbach’s alpha
coefficients of the ten constructs are 0.698 and greater. The reliability values based on Cronbach’s alpha
are all greater than the recommended minimum of 0.5 (Hair et al. 2006). Based on the extensive
examination of the psychometric properties of the scales, the study concludes that each variable
represents a reliable and valid construct.

5.5 Data Analysis and Discussion

Path analysis has been adopted to test the proposed model as well as to check the relationship among the
constructs. The hypothesized paths in the proposed model in Figure 1, and described in paragraph 4.4
were tested using SPSS 17.0., with 95% likelihood.

5.5.1 Model testing

The instrument validation in terms of content validity was continued by analyzing Pearson correlation.
Table 7, Figure 8 and Appendix 8 show the descriptive statistics and correlation matrix and path
analysis ranging from 0.204 to 0.660, which produced a significance level between 0.000 and 0.024.
Thus strengthen content validity in the instrument validation.

The structural variance models were evaluated on the basis of five goodness-of-fit measures. A widely
used fit measure is the statistical significance of the chi-square statistic which indicates whether the
model has a poor fit with the data. The drawback of the chi-square test is that significance is sensitive to
sample size and number of parameters in the model (Bentler and Bonett, 1980), and as a result, the test
may provide an inappropriate indication of poor fit. In the current analysis, the proposed IS success
structural model factors are treated as dependent variables. The descriptive statistics and correlation
matrix related to the formulated hypotheses are stated in Table 7, Figure 8 and in Appendix 8 all
relationships in the proposed structural model are stated.

MBA Thesis SRFHR0407023 63

 Construct Mean Std. NB BU US IU PU SQ IQ SRQ PEU
Dev.
1. NB 28.84 5.188 1
2. BU 23.25 4.157 0.560* 1
3. US 41.35 7.440 0.552* 0.645* 1
4. IU 23.31 5.105 0.387* 0.381* 0.204** 1
5. PU 26.75 4.382 0.404* 1
6. SQ 30.49 6.008 0.450* 0.585* 1
7. IQ 38.034 6.167 0.476* 0.572* 0.631*** 1
8. SRQ 24.84 5.205 0.220** 0.283* 0.369*** 0.332*** 1
9. PEU 19.02 3.964 0.415* 0.660* 1
Correlations are significant at *p-value < 0.01; **p-value < 0.05 (2-tailed), ***not hypothesized

Table 7: Descriptive statistics and Correlation Matrix

Source: Own research

Appendix 8 presents the parameters and the p-values of the assumed path for the ISs success measures.
As indicated, all path coefficients depicted in Figure 8 were as hypothesized. The paths from Perceived
Ease of Use (PEU) to Perceived Usefulness (PU) and Intention to Use (IU) were significant, as was path
Perceived Usefulness (PU) to Intention to Use (IU). Perceived Ease of Use shows to be a strong
predictor of Perceived Usefulness.

The path from Intention to Use (IU) to Benefits of Use (BU) was also significant. These results were
slightly different from Shih-Wen Chien (2004). The study further indicates that Perceived Usefulness
and Perceived Ease of Use both had a significant total effect on Intention to Use.
Further, Figure 8 shows that the relationship between Service Quality and Benefit of Use, the
relationship between Service Quality and User Satisfaction, the relationship between Benefit of Use and
User Satisfaction, the relationship between User Satisfaction and Net Benefits, the relationship between
Benefits of Use and Net Benefits, and Net Benefits and Intention to Use are all significant at a 0.01
statistical significant level. The latter confirms a positive relationship between the individual impact and
process improvement or organizational impact.

MBA Thesis SRFHR0407023 64

 .387

Figure 8: Path Analysis Results

Source: Own research

5.5.2 Quality dimensions in Proposed IS Success Model

Appendix 10 presents both the relationships among the success measures variables. It is very interesting
to notice that, all three quality dimensions, System Quality, Information Quality, and Service Quality
play important roles in influencing IS’s Benefits of Use and IS User Satisfaction. It reveals the fact that
most ISs, at post-implementation stage, are complicated systems required to provide excellent System
Quality; users are therefore in great need of the service provided by the IS support department.

MBA Thesis SRFHR0407023 65

5.5.3 Net Benefits of Use in Proposed IS Success Model
The results support the hypothesized impact of User Satisfaction on Benefit of Use via feedback of
Intention to Use, as assessed by System Dependence and suggested by the DeLone and McLean (1992)
and Seddon (1997) models. The relationship between Benefit of Use and User Satisfaction in this model
is a significant one taken in consideration that User Satisfaction can support user’s voluntary use of ISs.
A close look at the causal structure of Seddon’s model supports specification of a relationship between
Perceived Usefulness and User Satisfaction. Perceived usefulness influence users Satisfaction the in
return influence expectations about future benefits, thereby affecting ISs Use. ISs Use and its associated
consequences provide feedback to Perceived Usefulness, assessed as Net Benefits accrue. However, the
study has empirical identified the factors that influence Perceived Usefulness on Intention to Use. What
prompts users is to truly appreciate the benefits of ISs come from the three quality dimensions and the
behavior aspect from System usage.

With the addition of a non-directional path between Perceived Usefulness and Benefits of Use (System
Usage) in the proposed model structural model, the effect size of User Satisfaction on System Usage
was reduced, while a strong relationship between dependence on IS and Perceived Usefulness was
observed. ISs provide necessary information for users’ job performance, but using other means to obtain
this information is laden with procedural complexities. If information is perceived as useful because it is
job relevant and not available through other means, then ISs will be used regardless of persons overall
satisfaction with ISs.

This study implicates that Benefit of Use is directly influenced by, System Quality, Information Quality,
and Service Quality. The results suggest that the effect of System Quality and Information Quality on
Perceived Usefulness via User Satisfaction and Benefits of Use is substantially greater than the effect of
Perceived Ease of Use on Perceived Usefulness. In the D&M model Perceived Usefulness is directly
influenced by beliefs concerning Perceived Ease of Use and Information Quality through their effects on
Uses Satisfaction and System Usage. Here too, the effects of Information Quality on system
dependence, the measure Benefit of Use is taken into account here, and User Satisfaction, are greater
than the effects of Perceived Ease of Use on these variables. Perceived Usefulness, as an attitudinal
measure of Benefits of Use, is influenced by User Satisfaction and System Usage. In comparison with
the study of Shih-Wen Chien the results indicate that in contexts where effective task execution
substantially depends on information delivered by the system, beliefs about Information Quality are

MBA Thesis SRFHR0407023 66

more dominant in shaping IS Success than beliefs about Perceived Ease of Use, this as an effect of
mandatory use.

5.5.4 User Satisfaction in Proposed IS Success Model

Although User Satisfaction is extensively adopted by researchers and practitioners to evaluate IS
Success, important issues pertaining to its meaning and measurement across population subgroups have
not been adequately examined. To achieve the greatest usefulness in decision-making, instruments like
end-user computing satisfaction (EUCS), which is designed to evaluate system success, should be
robust. That is, they should be able to facilitate comparisons by providing equivalent measurements
across diverse samples that represent the variety of conditions or population subgroups present in
organizations.

Both the D&M (1992) and the Seddon (1997) models specify User Satisfaction ad influenced by beliefs
about Benefits of Use, System Quality and Service Quality. These relationships are consistent with
TAM, where attitudes towards System Usage are influenced by beliefs about the system. Given the
position of Benefits of Use in the Individual Impact category of the D&M Model, User Satisfaction is
caused by Benefits of Use and Net Benefits. On the other hand, in the Seddon Model, Perceived
Usefulness impacts User Satisfaction. To the instant that Perceived Usefulness, as an attitudinal measure
of realized net benefits, is similar to the expectations of future to be realized by using ISs, Seddons’
Model confirms the specifications TAM that finds beliefs concerning Perceived Usefulness capable of
strengthening User Satisfaction and thereby influences System Usage. However, results of this empirical
study suggest that Perceive Usefulness and Perceived Ease of Use can exert indirect influence on
Benefits of Use and User Satisfaction through Intention to Use.

5.5.5 Beliefs in Proposed IS Success Model

D&M 1992 and Seddon (1997) models focus both on beliefs concerning System Quality that embedded
Ease of Use as considered in TAM. Moreover, the two models take Information Quality into
consideration, as a belief that not is explicitly considered in TAM. Perceived Usefulness is an attitudinal
measure of Net Benefits. Seddon’s model elaborates the causal structure of TAM by separating beliefs
concerning expectations of Net Benefits associated with System Usage and general perceptual measures
of Net Benefits associated System Usage. Perceived Usefulness is an attitudinal measure of realized net
MBA Thesis SRFHR0407023 67
benefits and is influenced by beliefs concerning Information Quality and System Quality. In this study
Perceived Ease of Use and System Quality are separated since Perceived Ease Use tends to concern
more with individual perceptions while System Quality is usually an inherent feature of the system
itself. By influencing attitudes concerning realized net benefits, both System and Information Quality
influence expectations of net benefits in a different way than Intention to Use that equates to belief
about Perceived Usefulness, Perceived Ease of Use as embedded in TAM. The D&M Model does not
explicitly take either Perceived Usefulness or Perceived Ease of Use in consideration.

5.5.6 Net Benefits in Proposed IS Success Model

Performance management or integral management, for example the balanced scorecard allows
organizations to see the positive and negative impact of ICT and so ISs activities as factors crucial for
the organization as a whole. The value of performance management rises if it is used to coordinate a
wide range of ISs management processes, such as individual and team goal-setting, performance
appraisal and rewards for IS support personnel, resources allocation, and feedback-based learning.
Management from both IS member and projects are likely to benefit from a systematic framework based
on goals and measures that are agreed upon in advance.

5.5.7 Summary
Using the path methodology for confirmation in this study it appears that Benefits of Use (r = 0.560, p =
0.000) and User Satisfaction (r=0.552, p=0.000) influence Net Benefits significantly and directly while
both Benefits of Use (r = 0.916) and Information Quality (r = 0.583 had a strong total effect on Net
Benefit (see Appendix 13 for direct, indirect and total effects)]

Finally we can conclude that System Quality and Information Quality seem to be strong predictors of
User Satisfaction, while Benefits of Use is a strong predictor of User Satisfaction and on their turn both
Benefits of Use and User Satisfaction are strong predictors of Net Benefits and thus of organizational
performance. The above mentioned relationships confirms the intercalations between the constructs and
indicates in what instant Net Benefit is influenced by the different measures, while Net Benefits in turn
is a good predictor of Intention to Use and keeps the cycle going on.

MBA Thesis SRFHR0407023 68

CHAPTER 6 CONCLUSIONS AND RECOMMENDATIONS
The primary purpose of this study was is to understand the relationship between the effectiveness or
success of Information Systems and organizational performance in the hospital environment in
Surname. Secondly, to examine if this relationship leads to productivity improvement and thirdly
addressing the three main research questions and finally addressing the central question of the thesis. To
address the central question in this thesis in a systematic way I found an extended version of the
Updated DeLone and McLean IS Success Model 2003 incorporating the behavior aspect of use from
Davis’s Technology Acceptance Model (TAM) elaborated by Seddon in his IS Success Model 1997 the
best tool to help me addressing it. As a result of this fifteen hypotheses were formulated and the test
results presented in this thesis confirm the relationship and in what instant the factors involved influence
the effectiveness of IS on organizational performance in hospitals in Suriname.

6.1 Conclusions
As discussed in Chapter 5 the instant to what the different factors influence the effectiveness of
Information Systems in hospitals Suriname is positive and multidimensional. The fundamental factors
influencing effectiveness of Information Systems on organizational performance in hospitals in
Suriname are six interesting factors: System Quality, Information Quality, Service Quality, User
Satisfaction, Benefits of Use and Net Benefits for the IS Success Model, while for the behavior aspect
of Use which influence Benefits of Use those factors are: Perceived Ease of Use, Perceived Usefulness
and Intention to Use.

The participants in this study were 99 users and IS support staff of three general hospitals in Suriname
with at least 100 personnel and an identified automation organization. Regression analysis, OLS and
SEM was conducted to test the proposed hypothesis.

After testing the hypothesis the strongest or main factors influencing the effectiveness on organization
are as summaries in Chapter 5: User Satisfaction and the Benefits of Use are the strongest and main
factors predicting Net Benefits directly and Information Quality indirectly and so those three are the
main factors influencing the effectiveness or success of Information Systems on organizational
performance in hospitals in Suriname.

Notwithstanding the fact that Benefits of Use is offering a high contribution to User Satisfaction the
contribution from User Satisfaction to Intention to Use is low. This is primarily caused by Service
MBA Thesis SRFHR0407023 69
Quality which is offering a low contribution to User Satisfaction so user cannot benefit from his/her
Intention to Use due to the weakness in Service Quality.

On the positive side, respondents see the benefits of computers for their own education as well as source
of information. Access to up-to-date information provided in the context of the display of information
may be the “carrot” that designers can offer users who otherwise may be reluctant to use computer
systems.

On the negative side respondents results show that the use of information system by the core professions
in the three hospitals is underdeveloped and there is a significant difference in approach and culture
between private and public hospitals.

6.2 Recommendations
To improve the ability to evaluate Information Systems’ effectiveness the next recommendations are
offered:
1. define and/or derive appropriate system objectives and measures of accomplishment:
Since ultimate effects of an Information System on organizational performance may not be
direct and immediate, and since the value of information is only realized in its use, a focus on
definition of level 2 objectives of the hierarchy of System Objectives and measures is
recommended, namely the behavior Process of IS Use, Benefits of Use and Users performance;
that’s why System Usage was stressed double in the study. For example, organizational
objectives and performance measures might be expressed in sales revenues, customer
satisfaction, morale, and return on investment and profit contributions. System objectives in
terms of the behavior Process of IS Use and User organisational performance reflect IS effect on
these organizational processes, including changes in decision makers, changes in the decision
making process, and changes in user organizational performance. Surrogate measures of the
utility IS in supporting organizational processes are recommended for assessing IS effectiveness,
including User Satisfaction, Information Satisfaction and System Utilization.

MBA Thesis SRFHR0407023 70

2. develop a general view for evaluation IS:
a. develop a goal centred view;
Determine task objectives of the system, or the organizational units utilizing the
system, and then develop criterion measures to assess how well the objectives are being
achieved. Effectiveness is determined by comparing performance to objectives. An example
of the goal-centred view of systems effectiveness would be comparing actual cost and
benefits to budgeted costs and benefits;
b. develop a system-resource view;
System effectiveness is determined by attaining a normative state, e.g., standards for “good”
practices. Effectiveness is conceptualised in terms of resource viability rather than in terms
of specific task objectives. For example, system effectiveness in terms of human resources
might be indicated by the nature communication and conflict between IS and user personal,
user participation in system development, or user job satisfaction. In terms of technological
resources, system effectiveness might be indicated by the quality of the system or service
level.

In assessing system effectiveness, the evaluation approach would partially depend on which of
these two views is considered. In practice, the two views should converge. In order to explain the
success or the lack of success resources need to be investigated.
3. enlarge the range of performance being evaluated:
The intangibles qualitative effects of IS on organisational processes, Level 2 objectives of
conceptual hierarchy and performance, Level 3 of conceptual hierarchy are often more
significant for assessing system effectiveness. Since objectives and measures are typically
efficiency-oriented and easily quantified, a need exist to enlarge the range of performance being
evaluated to include Level 2 effectiveness oriented objectives. Build appropriate capacity for
useful effectiveness data analysis, data management and presentation at all levels and in different
applications and organizational processes
4. recognize the dynamic of the IS implementation process:
The dynamic nature of the IS implementation process suggests that evolutionary changes in
objectives will occur because of learning by users and IS support personnel and changes in the
environment. Thus implementation of an IS is viewed as a planned organization change which
will modify users’ work system to improve its functioning. This view explicitly emphasizes the
importance of considering effects of technical change on the user organizational processes and
MBA Thesis SRFHR0407023 71
 the dynamic nature of IS implementation. IS effectiveness is explicitly conceptualised in terms
of achievement of objectives and the “institutionalisation of change”, e.g., ongoing user training,
use of IS services, and IS support.
5. incorporate multiple dimensions and multiple viewpoints into evaluations of IS:
Account for differing evaluator viewpoints. The establishment of realistic mutually agreed upon
definitions of appropriate objectives and measures of accomplishment at the outset of the system
development should be prescribed. Differing viewpoints need to be considered not only in
initially establishing these objectives and measures, but also in assessing system effectiveness.
6. improve user support:
Establish Service Quality evaluation system. IS support personnel should be trained regularly in
all aspect, e.g. professional skills in IT and support, social skills and service in relation with
integral management to assure higher data quality, timeliness and promotes communications an
resolution problems. Continually improve user education; improve user understanding and
awareness through education, improved data accuracy, improved inventory control and
production scheduling, improved coordination between functional groups, and improved
customer satisfaction.
7. link fragmented Information Systems hospitals with interfaces to the ERP system:
The defragmented Information System within the hospitals should be linked with the ERP
system. After achieving this stage link integrated Information System of individual hospitals with
Information System of other health care institutions, organizations, programs, units and the
Ministry of Health without disrupting the decentralized databases, by achieving shared forms and
operational definitions, developed through central and decentralized data warehouses (including
metadata), Thus frequent communication between entities mentioned above, and easy access to
overall health care data and related information throughout the health care sector will be
established.
8. regular evaluations:
Establish regular evaluation of Information Systems within the hospitals and within the
health care industry to improve and maintain the quality of both Information System and
Evaluation System (IS Success Model). Appropriate statistics are needed.

9. use simple routine questionnaire:

Simple routine questionnaire and formal observational assessment of demands and needs are
very useful to determine inequities in services problems to access and concerns that can be
addressed and assist in planning of services an distribution of resources. Also, these
MBA Thesis SRFHR0407023 72
 processes can be monitor whether best practices are met.
10. carefully design of security features:
Carefully design of security features and clear communication with core professions;
Concerns of core professions about computers because of loss of personal and professional
privacy should be addressed by both careful designing of security features and clear
communication with clinicians about how captured clinical information is going to be used.

6.3 Limitations
Just like in most studies on net benefits of IS success, the analysis in this study is limited by both
data and empirical specifications concerns. The data covers only the three hospitals involved; the
other hospitals in Suriname with successfully implement ISs and ERP systems may have been
overlooked. Another misestimation also might be the extent of adoption when some hospitals
combine other ISs with ERP from Microsoft Business Solution Navision and reverse and ERP from
Microsoft Business Solution Navision with those of other ERP packages. Moreover, the study focus
in three larger and general hospitals with more than 100 personnel and an identified automation
environment may render the results inapplicable to smaller hospitals. Nevertheless, this samples
does enable us to measure the success or effectiveness of IS on organizational performance,
achieving thereby a significant advantage.

6.4 Implications for Future Research

Taking in consideration that Suriname is a developing country and Health Care suffers a lot under
the social, economic and political circumstances I suffered some delay in searching for information
in general and at the public hospitals particularly. So applying concepts and models will be relative.
As this will not influence the overall results of the study I will consider it as a real evaluation and
thus a fundamental stage in evaluating the ISs in the hospital environment in Suriname. The
availability and accessibility of co-ordinators and respondents of the public hospitals was not easy
for successfully gathering of the required information.

Future studies should repeat this study for public and private hospitals separately as well as whether
any difference exists between the different subgroups of IS users, e.g. executives, mid-level
managers, end users and IS support personnel in terms of their ISs and ERP success model so as to
provide more comprehensive evaluation approach.. Differences in objectives and their importance
might also be studied as a measure of managerial effectiveness. Further studies are needed to

MBA Thesis SRFHR0407023 73

 distinguish between evaluating different applications and evaluating how extensively and ERP
system is adopted for certain organizationally relevant functions. Careful consideration should be
given to the preparation time of the study, time and circumstances in the period of both preparation
and execution of the study as well as the size and nature of the sample; e.g. low-level administrator
may not be able to distinguish between problem solving and decision rationalization, but this
distinction may be more apparently engaged in scientific or analytical works.

Another issue for further study is a more in depth analysis on the factors reviewed by this study.
Proper weights should be assigned to relevant factors based on the special features of individual
industries (such a size and type of the industry) as they can help evaluate IS success model in a more
accurate and precise manner.

To attract current users, IS support personnel, physicians, nurses, and other core professions using
the ISs accessing up-to-date information provided in this context of the display of clinical
information may be one “carrot” that designers can offer them who otherwise may be reluctant to
use new ISs.

MBA Thesis SRFHR0407023 74

 BIBLIOGRAPHY

1. Ahmad Mashhour and Zakira Zaatreh, A framework for evaluating the effectiveness of
Information Systems at Jordan banks; An Empirical Study, Journal of Internet banking and
Commerce, April 2008.

2. Algoe, Maltie, Suriname Health System Profile 2006 for MPH 1105, Coordinator NHIS –MOH,
2006.

3. Anderson, Sweeney, Williams, Feema and Shoesmith, Statistics for Business

Hair, Joseph F, Jr, Black, William C., Babin, Barry J., Rolf, Anderson, Rollph E., and Tatham,
Ronald L, Multivariate Data Analyses, 6th Edition, Pearson, Prentice Hall, 2006.

4. Arens, Alvin, A, Elder, Randal J., Beasley, Mark S. Beasley, Auditing and Assurance Services, An
Integrated Approach, 12th Edition, Prentence Hall, Upper Saddle River, New Jersey 07458, 2008.

5. Crape, Byron, PhD., Health Information Systems Assessment of Suriname, Assessment of the
Suriname Health Information Systems for now and the future, The Ministry of Health Suriname
and the Pan American Health Organization, 2007.

6. Creswell, John W., Research Design, Quantitative, and Mixed Methods Approaches, 3rd Edition,
University of Nebraska-Lincoln, 2009.

7. DeLone, William H. and McLean, Ephaim R., Information Success. The Quest for the Dependent
Variable. Information Systems Research 1992.

8. DeLone, William H. and McLean, Ephaim R., The DeLone and McLean Model of Information
Systems Success: A Ten-Year Update, Journal of Management Information Systems, Volume 19
No. 40: 9-30, Spring 2003

9. De Ware Tijd, Ziekenhuisdirecteuren naar Nederland, Local Newspaper, November 11, 2008

10. De Ware Tijd (2008). Waterberg bij afsluiting 2008: “Medisch equipment en

MBA Thesis SRFHR0407023 75

 Opleidingsmogelijkheden op stapel”, Local Newspaper, December 31, 2008

11. Grover, Varun and Jeong, Seung Ryul and Sergers, Albert H., Information Systems
effectiveness: The construct space and patterns of application. Information & Management,
1996.

12. Hamilton, Scott and Chervany, Norman L., Evaluating Information System effectiveness
– Part I: Comparing Evaluation Approaches, MIS Quarterly, 1981.

13. Hamilton, Scott and Chervany, Norman L., Evaluating Information System effectiveness
– Part II: Comparing Evaluator Viewpoints, 1981.

14. Ives, Black. Olson, Margerethe H. and Baroudi,Jack, 1983, The Measurement of User
Information Satisfaction, Communications of the ACM, 1983.

15. Kaplan R. S. and Norton, The Balanced Scorecard, Measures that Drive performance, Harvard
Business Review, Volume 70, No. 1: 71-79,January-February 1992.

16. Laudon, Kenneth C. and Laudon, Jane P., Management Information Systems, 6th edition,
Organizational and Technology in the networked enterprise, Prenhall 2000.

17. Marshall B. Romney and Paul J. Steinbart, Accounting Information Systems, 10th edition,
Prenhall, 2006.

18. Meijeden van der, M.J., Tange H.J., Troost, J., and Hasman, A.,Determinants of Success of
Inpatient Clinical Information Systems: A Literature Review, The Journal of American Medical
Information Association, May-June 2003.

19. Seddon, Peter B., A Re-specification and Extension of the DeLone and McLean Model of IS
Success, Department of Information Systems, The University of Melborne, Parkville, Victoria
3052, Australia, Information System Research vol. 8, No. 3, September 1997.

20. Pekka Turunen and Hannu Salmela, The cost-benefit approach to medical information systems
evaluation, Turku School of Economics and Business Administration, Institute of Information
MBA Thesis SRFHR0407023 76
 Systems, Turku Centre for Computer Science, TUCS Technical Report No 195, September 1998
ISBN 952-12-0252-1 and ISSN 1239-1891, 1998.

21. Rackaityte Renata, AIS effectiveness of criteria and indicator, setting up system, Luthuanian
University of Agricultue, 2003.

22. Shih-Wen Chien, An extension of D&M Model, ERP Implementation Environment –High Tech
manufacturing Firms in Taiwan, 2004.

23. Van der Loo, R.P., Van Gennip, E. M. S. J. and Baker, A, R., Evaluation of automated
information systems in health care; an approach to classifying evaluative studies. Computer
Methods and Programs in Biomedicine, 1995.

24. www.szn.sr May 29, 2009 19:55 hours, Last update: May 22, 2009.

25. Yin, Robert K, Case Study Research, Design and methods, Sage Publications, Inc, 3rd Edition,
Applied Social Research Methods Series, Volume 5, 2003.

26. Gitman, Lawrence J., Principles of Managerial Finance, 11th Edition, Pearson Education, ISBN
0321311507, 2006

MBA Thesis SRFHR0407023 77

APPENDIX 1: Description of data set
Description of Data set

Var. Variable description Part # Variable Question

code in quest. type in survey
System Quality (SQ) DeLone & McLean (1992) 1
SQ1 Timeliness 1 Metric 1SQ1
SQ2 Accuracy 1 Metric 1SQ2
SQ3 Ease of use (convenience of access) 1 Metric 1SQ3
SQ4 Consistency (availability/error recovery) 1 Metric 1SQ4
SQ5 Flexibility (response/turnaround time) 1 Metric 1SQ5
SQ6 Integration 1 Metric 1SQ6
SQ7 Reliability 1 Metric 1SQ7

Information Quality (IQ) Rai et al (2002) 2

IQ1 Format 2 Metric 2IQ1
IQ2 Content 2 Metric 2IQ2
IQ3 Timeliness 2 Metric 2IQ3
IQ4 Relevance 2 Metric 2IQ4
IQ5 Accuracy (precision) 2 Metric 2IQ5
IQ6 Reliability (completeness) 2 Metric 2IQ6

Service Quality (SRQ) DeLone & McLean (2003) 3

SRQ1 Responsiveness 3 Metric 3SRQ1
SRQ2 Reliability 3 Metric 3SRQ2
SRQ3 Empathy 3 Metric 3SRQ3
SRQ4 Assurance 3 Metric 3SRQ4
SRQ5 Support 3 Metric 3SRQ5

Perceived ease of use (PEU) Davis (1989) 4

PEU1 Processing customers request (Actual research, 2009) 4 Metric 4PEU1
PEU2 User friendliness 4 Metric 4PEU2
PEU3 Information search 4 Metric 4PEU3
PEU4 Ease of use 4 Metric 4PEU4

Perceived Usefulness (PU) Davis (1989) = BI = IU =Use

(TAM) 5
PU1 Task innovation (effectivety) 5 Metric 5PU1
PU2 Task productivity 5 Metric 5PU2
PU3 (User) Efficiency 5 Metric 5PU3
PU4 Customer satisfaction 5 Metric 5PU4
PU5 Management control 5 Metric 5PU5

Intention to Use (IU) = Behavior Intention (BI) Bedard et

al. (2003) 6
IU1 Behavior (Fishbein & Ajzen) 6 Metric 6IU1
IU2 Target (Fisbein & Ajzen) 6 Metric 6IU2
IU3 Situation in which performing (Fisbein & Ajzen) 6 Metric 6IU3
IU4 Time of performing (Fisbein & Ajzen) 6 Metric 6IU4
IU4 Time of performing (Fisbein & Ajzen) 6 Metric 6IU5
MBA Thesis SRFHR0407023 78
 System Usage (SU) 7
SU1 Intensity (hours spent, number of users) 7 Metric 7SU1
SU2 Frequency (or simple binary variable: use/none use) 7 Metric 7SU2
SU3 Scope (overall) 7 Metric 7SU3

User Satisfaction (US) DeLone & McLean (1992) 8

US1 Satisfaction with specifics 8 Metric 8US1
US2 Content (Doll et al, 1988) 8 Metric 8US2
US3 Accuracy (Doll et al, 1988) 8 Metric 8US3
US4 Format (Doll et al, 1988) 8 Metric 8US4
US5 Ease of Use (Doll et al, 1988) 8 Metric 8US5
US6 Timeliness (Doll et al, 1988) 8 Metric 8US6
US7 Information satisfaction 8 Metric 8US7
US8 Overall Satisfaction 8 Metric 8US8
US8 Overall Satisfaction 8 Metric 8US9

Benefits of Use from end-users' view (BU) Martinsons, et

al. (1999) = Benefits of Use (BU) 9
BU1 Improve individual productivity 9 Metric 9BU1
BU2 Decision effectiveness 9 Metric 9BU2
BU3 Learning 9 Metric 9BU3
BU4 Task performance 9 Metric 9BU4
BU5 Problem identification 9 Metric 9BU5

Net value from organizational view (NV) Martinsons, et

al., (1999) = Net Benefits (NB) 10
NB1 Operating cost reduction 10 Metric 10NB1
NB2 Overall productivity gains 10 Metric 10NB2
NB3 Improvement of organizational image 10 Metric 10NB3
NB4 Service effectiveness 10 Metric 10NB4
NB5 Increased sales/revues/profit 10 Metric 10NB5
NB6 Increased work volume 10 Metric 10NB6

Demographic variables 11
Non
DM1 Hospital name 11 metric 11DM1
Non
DM2 Department/Unit 11 metric 11DM2
Non
DM3 Job description 11 metric 11DM3
DM4 Years in current position 11 Metric 11DM4
DM5 Years in current hospital 11 Metric 11DM5
Non
DM6 Highest level of education 11 metric 11DM6
Non
DM7 Position in Organizational Hierarchy 11 metric 11DM7
DM8 Age 11 Metric 11DM8
Non
DM9 Gender 11 metric 11DM9
DM10 Length of use 11 Metric 11DM10
DM11 Experience with computers 11 Metric 11DM11
DM12 Experience with Health Care Systems 11 Metric 11DM12

Prepared by: Delano Gefferie

MBA Thesis SRFHR0407023 79
APPENDIX 2: Questionnaire; English version

Paramaribo, April 15,

2009

To: All users and IT-staff of hospitals in Suriname

Thesis project: Evaluating the effectiveness of Information Systems in a hospital environment

Dear users/IT-staff,

Herewith I send you a questionnaire related to my thesis project at Maastricht School of Management
in cooperation with the Lim A Po Institute for Social studies. You are requested to fill out this questionnaire
regarding my research concerning the effectiveness of Information Systems in hospitals in Suriname.

The purpose of this study is to learn more about what factors are influencing organizational performance
in a hospital environment and what impact they have on the performance of the hospitals in Suriname.
This research will provide the management of the hospitals in Suriname with information, needed to improve
the effectiveness of the Information Systems they have in place in particular and hospital management in
general. You are eligible to participate, because you are registered as user or developer of information
Systems in your hospital. In this research s'Lands Hospital, Diakonessenhuis and Streekziekenhuis
Nickerie are participating.

You are requested to fill out the attached questionnaire. The survey will last approximately 10-15 minutes and
there is no need asking for your name during this survey. Questionnaires completed should be sent within
14 days to the coordinator of your hospital. For s'lands Hospital Mrs. Scholsberg-Lieveld, Secretary of CEO
, Diakonessenhuis, Mrs. A. Fitz Jim, Manager Planning and Control and for Streekziekhuis Nickerie
Mr. Lalay, Financial Manager.

You can obtain further information about this study or voice concerns or complaints about the study
by e-mailing or calling the researcher, Delano Gefferie, at [email protected] or mobile
8819239

Thanks in advanced.

Kind regards,

Delano Gefferie

MBA Thesis SRFHR0407023 80

 Evaluating effectiveness of Information Systems on performance in a Hospital Environment

THE QUESTIONNAIRE (for all users of Information Systems and IS support staff)

Please provide the following information? All information you provide will be confidential and
will not be identified with you.

Part 1: System Quality (SQ)

This following sections of the survey conveys your own personal feeling concerning the use of the Information Systems
you use on your department or unit of the hospital. You will be asked "To what extent are the following statements accurate".
Please use the scale for this answers:

Check each scale in the position that describes your

Please follow these instructions: evaluation
1 of the factor being described?
Check each scale, do not omit any?
Check only one position for each
2 scale?
3 Check in the space on scale from 1 to 7 with X
1 = Very Strongly Disagree
2 = Strongly Disagree
3 = Disagree
4 = Neutral
5 = Agree
6 = Strongly Agree
7 = Very Strongly Agree
Work rapidly. Rely on first
4 impression!
5 The qualifications strongly disagree and strongly agree at the beginning and the end of the
scales are stated to support your orientation!
This questionnaire consists of eleven (11) parts. Verify after completion if all parts have
6 been
filled in!

To what extent do you agree with the following statements?

1 Information Systems provide up-to-date information. 1 2 3 4 5 6 7
disagree agree

2 Information Systems are accurate. 1 2 3 4 5 6 7

disagree agree

3 The Systems are easy to learn and to use. 1 2 3 4 5 6 7

disagree agree

4 Systems are available when I need it. 1 2 3 4 5 6 7

disagree agree

5 Systems are flexible. 1 2 3 4 5 6 7

disagree agree

6 Information Systems are integrated. 1 2 3 4 5 6 7

disagree agree

7 The systems are not subject to frequent problems and crashes. 1 2 3 4 5 6 7

disagree agree

Part 2: Information Quality (IQ)

1 Information is provided in a format which is useful for me. 1 2 3 4 5 6 7
disagree agree

MBA Thesis SRFHR0407023 81

 2 The Information Systems provide output that is exactly what you need. 1 2 3 4 5 6 7
disagree agree

3 I get the information I need in time. 1 2 3 4 5 6 7

disagree agree

4 I have more relevant, useful and significant information. 1 2 3 4 5 6 7

disagree agree

5 The systems provide accurate and clear information. 1 2 3 4 5 6 7

disagree agree

6 The information is not subject to misinterpretation and discussions. 1 2 3 4 5 6 7

disagree agree

Part 3: Service Quality (SRQ)

1 Support/IT-staff give prompt service to users. 1 2 3 4 5 6 7
disagree agree

2 IT staff performed the task in and at the time they had promised 1 2 3 4 5 6 7
disagree agree

3 Relation with IS/IT-staff is good. 1 2 3 4 5 6 7

disagree agree

4 IT/IS staff have the knowledge to do their job well 1 2 3 4 5 6 7

disagree agree

5 IT department has up to date hardware and software. 1 2 3 4 5 6 7

disagree agree
Evaluation of overall Information Systems

Part 4: Perceived Ease of Use (PEU)

1 It will be easy to get Information Systems to do what I want to do. 1 2 3 4 5 6 7
disagree agree

2 Information Systems will be flexible to interact with. 1 2 3 4 5 6 7

disagree agree

3 My interaction with Information Systems will be clear and understandable. 1 2 3 4 5 6 7

disagree agree

4 Information Systems will be easy to use. 1 2 3 4 5 6 7

disagree agree

Part 5: Perceived Usefulness (PU)

1 Using Information Systems will enhance my effectiveness on the job 1 2 3 4 5 6 7
disagree agree

3 Using Information Systems increase my productivity. 1 2 3 4 5 6 7

disagree agree

2 Using Information Systems will make my job easier 1 2 3 4 5 6 7

disagree agree

4 Using Information Systems will enable me to accomplish task faster 1 2 3 4 5 6 7

disagree agree

5 Using Information Systems improve my job performance. 1 2 3 4 5 6 7

disagree agree
MBA Thesis SRFHR0407023 82
 Part 6: Intention to Use (IU)

1 I Intend to use Information Systems in performing analytical procedures. 1 2 3 4 5 6 7

disagree agree

2 I Intend to use Information Systems in planning and tailoring related programs. 1 2 3 4 5 6 7

disagree agree

3 I intend to use Information Systems in electronic mode, rarely printing out copies 1 2 3 4 5 6 7
of work papers as I proceed through my tasks. disagree agree

4 I intend to use Information Systems to help me make decisions 1 2 3 4 5 6 7

disagree agree

5 I intend to increase use Information Systems 1 2 3 4 5 6 7

disagree agree

Part 7: Use (SU)

1 I use the Information Systems extensively (100% of my job time) 1 2 3 4 5 6 7

disagree agree

2 I use the Information Systems seven (7) days a week (1 = 1 day and 7 is 7 days) 1 2 3 4 5 6 7
disagree agree

3 I am not forced by management to use the Information Systems at my disposal 1 2 3 4 5 6 7

I use the Information Systems because it is totally mandatory disagree agree

4 I use all Information Systems within the organization 1 2 3 4 5 6 7

disagree agree
Evaluation of overall Information Systems

Part 8: User satisfaction (US)

1 Information Systems provide sufficient information for effective decision making. 1 2 3 4 5 6 7
(objectives and alternatives) disagree agree

2 Information Systems provides reports that seem to be just about exactly what 1 2 3 4 5 6 7
I need. disagree agree

3 Accuracy of output information is high. 1 2 3 4 5 6 7

disagree agree

4 Information Systems reports are in a format which allow me to perform my duties 1 2 3 4 5 6 7

effectively. disagree agree

5 Users understand the systems well. 1 2 3 4 5 6 7

disagree agree

6 I get the information I need to perform my job effectively in time. 1 2 3 4 5 6 7

disagree agree

7 Output information is relevant (to intended function). 1 2 3 4 5 6 7

disagree agree

8 User’s feeling of participation is sufficient. 1 2 3 4 5 6 7

disagree agree

9 Overall satisfaction of the Information Systems is high. 1 2 3 4 5 6 7

disagree agree
Evaluation of overall Information Systems
MBA Thesis SRFHR0407023 83
 Part 9: Benefit of Use from end-users' view (BU)
1 Information Systems allow me to communicate with other users in an effective way. 1 2 3 4 5 6 7
disagree agree

2 Information Systems provide me with sufficient support in all stages of the 1 2 3 4 5 6 7

decision making process. disagree agree

3 Information Systems help me effectively manage and store knowledge that I need. 1 2 3 4 5 6 7
disagree agree

4 The Information Systems provide the information required to perform my duties. 1 2 3 4 5 6 7

disagree agree

5 Information Systems help me to identify problems in an early stage. 1 2 3 4 5 6 7

disagree agree

Part 10: Net Benefits from organizational view (NB):

1 Information Systems enhance competitiveness or create strategic advantage. 1 2 3 4 5 6 7
disagree agree

2 Information systems enable the organization to respond more quickly to change. 1 2 3 4 5 6 7

disagree agree

3 Information Systems have dramatically increased organizational productivity. 1 2 3 4 5 6 7

disagree agree

4 Information System projects provide organizational success. 1 2 3 4 5 6 7

disagree agree

5 Information Systems establish and maintain a good image. 1 2 3 4 5 6 7

disagree agree

6 Information Systems have dramatically increased our service capacity. 1 2 3 4 5 6 7

disagree agree
Evaluation of overall Information Systems

Part 11: Demographic Information

1 Hospital name:

2 Department/Unit:
Years Years
3 Job description: (check one) in position in hospital
Technician
Nurse
Pharmacist
Physician
Physician assistant
Other (specify):
MBA Thesis SRFHR0407023 84
 4 Highest level of education: (check one) Physician Nurse
High
school
Associate degree
Some college
Bachelor's degree
Master's degree
Post master's degree
Other (specify):

5 Position in Organizational Hierarchy/Position Classification:

Operational level
Lower Management
Middle management
Upper Middle Management
Senior management

6 Age:

7 Gender: Male Female

8 Length of time (in months) you have used Health Care System/Accounting Information System (choose one):

9 Have you used other computer systems before?

Yes No

10 If your answer was Yes to question 7, was it a Health Care System?

Yes No

11 Use of IS:

Frequency of use times weekly times monthly

Times spent hours weekly hours monthly

Evaluation of overall Information Systems

Your opinion is important. Please add any comment here:

Thank you for participating in this study!!!

Evaluating of overall Information Systems
Source: Own research

MBA Thesis SRFHR0407023 85

APPENDIX 3: Questionnaire; Dutch version
Paramaribo, 27 april 2009

Aan: Gebruikers en IT-personeel Ziekenhuizen in Suriname

Afstudeerproject: Beoordeling/Evaluatie van de Effectiviteit van Informatie Systemen (als geheel) in ziekenhuizen

Geachte gebruikers en IT-personeel,

met het Lim A Po Institute for Social studies een questionaire toekomen met het verzoek deze in te vullen
i.v.m. mijn onderzoek naar de effectiviteit van geautomatiseerde Informatie Systemen in ziekenhuizen
in Suriname.

Het doel van het onderzoek is na te gaan in welke mate de effectiviteit van geautomatiseerde Informatie
Systemen van invloed is op de performance van de ziekenhuizen in Suriname en de mate, waarin de
de verschillende factoren, die hierbij van invloed zijn een rol spelen.
Dit onderzoek zal het management van de ziekenhuizen in Suriname de nodige informatie voor verho-
ging van de effectiviteit van de geautomatiseerde Informatie Systemen verschaffen en zo en bijdrage
leveren aan het verhogen van de effectiviteit van de ziekenhuizen in het algemeen en de Informatie
Systemen in het bijzonder. De Informatie Systemen, die in dit onderzoek als een geheel worden geëva-
lueerd en waarop u zich derhalve bij invulling van de questionaire voordurend op moet richten zijn:
1. Het Navision Systeem met de reeds geoperationaliseerde modules;
2. Alle Informatie Systemen, waarvan u buiten het Navision Systeem gebruik maakt.
De Informatie Systemen genoemd onder punt 1 en 2 zullen bij de invulling van de questionaire
dus steeds gezamenlijk worden gewaardeerd.

U bent vanwege u betrokkenheid als gebruiker of als ontwikkelaar van een of meerdere Informatie Systemen
binnen uw ziekenhuis gekozen om deel te nemen aan het onderzoek, waarin het Diakonessenhuis, het s'Lands
Hospitaal en het Streekziekenhuis Nickerie participeren. U wordt gevraagd bijgaande questionaire
in te vullen. Het invullen hiervan zal ongeveer 15-20 minuten duren en het vermelden van uw naam is
niet vereist. De ingevulde formulieren worden binnen 5 dagen terug verwacht bij de coördinator van uw
ziekenhuis. Voor het s'Lands Hospitaal is dat, mevrouw Scholsberg-Lieveld, Directie Secretaresse.
Voor het Diakonessenhuis, mevrouw A. Fitz Jim, Manager Planning and Control en voor het Streek-
ziekenhuis Nickerie, de heer O. Lalay, Financial Manager.

Indien u vragen mocht hebben ben ik gaarne bereid die te beantwoorden. Mijn contact informatie is als volgt:
Telefoon: 08819239
E-mail: [email protected]

Bij voorbaat dank voor uw medewerking!

Met vriendelijke groet,

Delano Gefferie

MBA Thesis SRFHR0407023 86

 (Vragenlijst (voor gebruikers van Informatie Systemen en IS ondersteunend personeel)
Nr……………..

Gelieve de volgende infomatie te verstrekken! Alle verstrekte informatie zal vertrouwelijk worden behandeld en niet
met u in verband worden gebracht.

In de volgende delen van de vragenlijst kunt u uw eigen mening geven over de door u in het ziekenhuis en op uw afdeling
ingebruikzijnde Informatie Systemen als geheel. Uw wordt gevraagd "In welke mate de gestelde beweringen juist zijn".
Gelieve bij de beantwoording uitsluitend gebruik te maken van de opgegeven schaal:

Volg deze instructies:

Geef bij elke bewering uw waardering in de positie, die uw mening het beste weergeeft:
1.. Gebruik elke schaal, sla geen enkele over?
2.. Vul slechts een beoordeling/waardering/positie per schaal in?
3.. Geef uw beoordeling op de schaal van 1 tot en met 7 aan met een X, onder het cijfer, dat u kiest:
1 = Ten Stelligste Oneens
2 = Zeer Oneens
3 = Oneens
4 = Neutraal
5 = Eens
6 = Zeer Eens
7 = Ten Stelligste Eens
4.. Reageer snel en vertrouw op uw eerste indruk over de factor, die u dan beoordeeld!
5.. De aanduidingen oneens en eens bij het begin en eind van de schalen zijn slechts bedoeld om
u te ondersteunen in uw oriëntatie!
6.. Deze questionaire bestaat uit elf (11) delen. Controleer na de invulling als u alle delen heeft invulgevuld!

In welke mate bent u het eens met de volgende beweringen?

Deel 1: Systeem Kwaliteit

1 De Informatie Systemen leveren tijdige informatie af. 1 2 3 4 5 6 7
oneens eens

2 De Informatie Systemen zijn nauwkeurig/accuraat. 1 2 3 4 5 6 7

oneens eens

3 De Informatie systemen zijn makkelijk aan te leren en te gebruiken. 1 2 3 4 5 6 7

oneens eens

4 De Informatie Systemen zijn beschikbaar wanneer ik ze nodig heb. 1 2 3 4 5 6 7

oneens eens

5 De Informatie Systemen zijn flexibel in gebruik. 1 2 3 4 5 6 7

oneens eens

6 De Informatie Systemen zijn gekoppeld (geïntegreerd). 1 2 3 4 5 6 7

oneens eens

7 De Systemen zijn niet onderhevig aan (vrij van) regelmatige problemen en noodsituaties 1 2 3 4 5 6 7
oneens eens

Deel 2: Informatie Kwaliteit

1 Informatie wordt in een voor mij bruikbare presentatie vorm/samenstelling/format verstrekt. 1 2 3 4 5 6 7
oneens eens

2 De Informatie Systemen leveren de output/uitvoering/resultaten op die ik nodig heb. 1 2 3 4 5 6 7

oneens eens

MBA Thesis SRFHR0407023 87

 3 Ik krijg de benodigde Informatie op tijd. 1 2 3 4 5 6 7
oneens eens

4 Ik krijg ter zake dienende/relevantere, bruikbare en belangrijke Informatie. 1 2 3 4 5 6 7

oneens eens
5 De Informatie Systemen leveren nauwkeurige/accurate/zuivere en duidelijke informatie af. 1 2 3 4 5 6 7
oneens eens

6 De informatie is niet vatbaar voor verkeerde interpretatie en meningsverschillen. 1 2 3 4 5 6 7

oneens eens
Evaluatiie van Informatie Systemen als geheel
Deel 3: Service Kwaliteit
1 Ondersteund en IT-personeel verleend onmiddellijk ondersteuning aan gebruikers. 1 2 3 4 5 6 7
oneens eens

2 Ondersteunend en IT-personeel voeren hun taken naar behoren en zoals afgespro- 1 2 3 4 5 6 7

ken uit. oneens eens

3 De relatie met het ondersteunend en IT-personeel is goed. 1 2 3 4 5 6 7

oneens eens

4 Ondersteunend/IT-personeel beschikt over de kennis om hun werk goed te kunnen 1 2 3 4 5 6 7

doen. oneens eens

5 De IT-afdeling heeft bij de tijdse/moderne apparatuur/hardware en programmatuur/ 1 2 3 4 5 6 7

software. oneens eens

Deel 4: Zichtbaar (aannemelijk) gemak bij gebruik

1 Het zal makkelijk zijn d.m.v. de Informatie Systemen te doen wat ik wil. 1 2 3 4 5 6 7
oneens eens

2 De Informatie Systemen zullen flexibel zijn in het gebruik. 1 2 3 4 5 6 7

oneens eens

3 De omgang met de Information System zal duidelijk en verstaanbaar zijn. 1 2 3 4 5 6 7

oneens eens

4 De Informatie Systemen zijn makkelijk/simpel om mee te werken. 1 2 3 4 5 6 7

oneens eens

Deel 5: Verwacht gebruik (aannemelijk nut) in de toekomst

1 Het gebruik van de Informatie Systemen zal mijn effectiviteit op het werk verhogen. 1 2 3 4 5 6 7
oneens eens

3 Het gebruik van de Informatie Systemen zal mijn arbeidsproductiviteit verhogen. 1 2 3 4 5 6 7

oneens eens

2 Het gebruik van de Informatie Systemen zal mijn werk makkelijker maken. 1 2 3 4 5 6 7
oneens eens

Het gebruik van de Informatie Systemen zal mij in staat stellen mijn werk sneller af te
4 krijgen. 1 2 3 4 5 6 7
oneens eens

5 Het gebruik van de Informatie Systemen zal mijn taakuitvoering verbeteren. 1 2 3 4 5 6 7

oneens eens

Deel 6: Beoogd gebruik

1 Ik ben van plan de Informatie Systemen te gebruiken bij analytische werkzaamheden. 1 2 3 4 5 6 7

MBA Thesis SRFHR0407023 88
 oneens eens

2 Ik ben van plan de Informatie Systemen te gebruiken in planning en aanpassing van samen- 1 2 3 4 5 6 7
werkende/gekoppelde programma's. oneens eens

Ik ben van plan de Informatie Systemen in de electronische mode te gebruiken en weinig

3 uit te 1 2 3 4 5 6 7
te printen bij mijn taakuitvoering. oneens eens

4 Ik ben van plan de Informatie Systemen te gebruiken bij het nemen van beslissingen. 1 2 3 4 5 6 7
oneens eens

5 Ik ben van plan het gebruik van de Informatie Systemen te verhogen 1 2 3 4 5 6 7

oneens eens
Evaluatiie van Informatie Systemen als geheel
Deel 7: Systeem gebruik
1 Ik gebruik de Informatie Systemen intensief (100% van mijn werktijd). 1 2 3 4 5 6 7
oneens eens

2 Ik gebruik de Infomatie Systemen zeven (7) dagen in de week (1 = 1 dag en 7 is 7 dagen). 1 2 3 4 5 6 7

oneens eens

3 Ik ben niet verplicht door de leiding om de mij ter beschikking gestelde Informatie Systemen 1 2 3 4 5 6 7
te gebruiken. oneens eens

4 Ik gebruik alle Informatie Sytemen binnen de organisatie. 1 2 3 4 5 6 7

oneens eens

Deel 8: Gebruikerstevredenheid
1 De Informatie Systemen leveren toereikende/voldoende informatie voor effectieve 1 2 3 4 5 6 7
besluitvorming (doelstellingen en
alternatieven). oneens eens

2 De Informatie Systemen leveren exact de rapportages, die exact nodig heb af. 1 2 3 4 5 6 7
oneens eens

3 Accuratesse/zuiverheid van de output/uitvoer informatie is hoog. 1 2 3 4 5 6 7

oneens eens

4 De Informatie Systemen leveren de verslagen in de format/samenstelling, die mij in staat 1 2 3 4 5 6 7

stellen mijn taken effectief te doen. oneens eens

5 De gebruikers kunnen goed omgaan met de Informatie Systemen. 1 2 3 4 5 6 7

oneens eens

6 Ik krijg de informatie, die ik nodig heb om mijn werk effectief te doen op tijd. 1 2 3 4 5 6 7
oneens eens

7 Output/uitvoer informatie is relevant voor mijn functie. 1 2 3 4 5 6 7

oneens eens

8 Het gebruikers' gevoel van betrokkenheid/er bij behoren is voldoende. 1 2 3 4 5 6 7

oneens eens

9 De algehele tevredenheid/satisfactie over de Informatie Systemen is hoog. 1 2 3 4 5 6 7

oneens eens

Deel 9: Voordelen gezien vanuit de belevingswereld van de gebruiker

1 De Informatie Systemen maken effectieve/doelgerichte communicatie met andere 1 2 3 4 5 6 7
gebruikers mogelijk. oneens eens

MBA Thesis SRFHR0407023 89

 4 De Informatie Systemen geven me voldoende ondersteuning in alle fasen van het 1 2 3 4 5 6 7
besluitvormingsproces. oneens eens

3 De Informatie Systemen ondersten me effectief bij het managen/leiding geven en 1 2 3 4 5 6 7

het opslaan van de nodige kennis. oneens eens

4 De Informatie Systemen leveren de voor mijn werk vereiste informatie. 1 2 3 4 5 6 7

oneens eens

5 De Informatie Systemen ondersteunen me om problemen in een vroeg stadium te 1 2 3 4 5 6 7

identificeren. oneens eens

Deel 10: Uiteindelijke waarde creatie vooruit de organisatie bezien

1 De Informatie Systemen verhogen de concurrentiekracht en/of creëren strategische 1 2 3 4 5 6 7
voordelen. oneens eens

2 De Informatie Systemen stellen de organisatie in staat om snel te reageren op ver- 1 2 3 4 5 6 7

anderingen. oneens eens

3 De Informatie Systemen hebben de productiviteit in het algemeen sterk verhoogd. 1 2 3 4 5 6 7

oneens eens

4 De implementatie van Informatie Systemen maakt de organisatie succesvol. 1 2 3 4 5 6 7

oneens eens

5 De Informatie Systemen vestigen en zorgen voor een blijvend goede reputatie 1 2 3 4 5 6 7

voor de organisatie. oneens eens

6 De Informatie Systemen hebben de klantgerichtheid sterk verhoogd/verbeterd. 1 2 3 4 5 6 7

oneens eens
Evaluatie van Informatie Systemen als geheel

Evaluatie effectiviteit geautomatiseerde Informatie Systemen (als geheel) in ziekenhuizen in Suriname

Nr. …

QUESTIONAIRE (voor alle gebruikers van Informatie Systemen en IT personeel)

Gelieve de volgende infomartie in te vullen! Alle informatie zal confidentieel worden behandeld.

Deel 11: Algemene informatie:

1 Naam ziekenhuis:

2 Afdeling:

Jaren jaren

3 Functie (kies één) in functie in ziekenhuis

Technicus

Verpleegkundige

Apotheker
MBA Thesis SRFHR0407023 90
 Medicus

Medisch assistent

Anders (vul in):

4 Hoogst genoten opleiding Medicus Verpleegkundige

Middelbare school

Diploma

Universiteit

Bachelor's graad

Master's graad

Post master's graad

Anders (vul in):

5 Plaats in de ziekhuishuis Hierarchy

Uitvoerend niveau

Lager management

Middle management

Senior management

6 Leeftijd:

7 Geslacht: Mannelijk Vrouwelijk

Periode (in maanden of jaren) gedurende welke u reeds gebruik maakt van de huidige geautomatiseerde Informatie
8 Systemen:

Maanden Jaren

9 Heeft u eerder gebruik gemaakt van andere computer systemen?

Ja Nee

10 Als het antwoord op vraag 9 Ja is, was of waren het Medisch Informatie Syste(e)m(en)?

Ja Nee

11 Gebruik van de geautomatiseerde Informatie Systemen in het ziekenhuis (als geheel):

Frequentie van gebruik: keren per week keren per maand

Bestede tijd: uren per week Uren per maand

MBA Thesis SRFHR0407023 91

 Uw mening is belangrijk. Gelieve uw opmerkingen hier te vermelden:

Bedankt voor uw deelname aan dit onderzoek!!!

Evaluatie van Informatie Systemen als een geheel

Source: Own research

MBA Thesis SRFHR0407023 92

APPENDIX 4: Results pre-test

Reliability analysis
n=8

Nr. Scale Dimensions N of items Cronbach

α
1 System Quality (SQ) 7 7 0.869
2 Information Quality (IQ) 6 6 0.860
3 Service Quality (SRQ) 5 5 0.833
4 Perceived Ease of Use (PEU) 4 4 0.873
5 Perceived usefulness (PU) 5 5 0.995
6 Intention to Use (IU) 4 5 0.935
7 System Usage (SU) 3 2 0.581
8 User Satisfaction (US) 8 9 0.963
9 Benefit of Use from end-users view (BU) 5 5 0.940
10 Benefits of Use from organizational View (BU) 6 6 0.966

Confirmatory factor should be > 0.5 and ideal 0.7: Hair et al (2005)

Source: Own research

MBA Thesis SRFHR0407023 93

APPENDIX 5: Indication of human resources in health sector in Suriname

Source: Ministry of Health; Suriname Health Profile 2006 for MPH 1105

MBA Thesis SRFHR0407023 94

APPENDIX 6: Hospital sample

Demographics
HOSPITAL

Cumulative
Frequency Percent Valid Percent Percent
Valid DKZ 69 69.7 72.6 72.6
LH 14 14.1 14.7 87.4
SZN 12 12.1 12.6 100.0
Total 95 96.0 100.0
Missing System 4 4.0
Total 99 100.0

Department

Frequency Percent
Valid missing 13 13.1
adm. 1 1.0
afd. inkoop 1 1.0
automatisering 1 1.0
bedden huis 2 2.0
boekhouden 2 2.0
boekhouding/financiële
zaken 1 1.0

centrale inkoop 1 1.0

chirurgie 2 2.0
cm 2 2.0
crp 1 1.0
debiteuren 1 1.0
debiteuren administratie 1 1.0
facturatie 1 1.0
fin. bewakings unit 1 1.0
finan. adm 12 12.1
finan.adm 1 1.0
gym. 1 1.0
gyn 1 1.0
help desk2 1 1.0
inkoop 1 1.0
int.mn. 1 1.0
it 1 1.0
jc 1 1.0
kinder afd. 1 1.0
lab 2 2.0
lab adm. 1 1.0
loon adm. 3 3.0

MBA Thesis SRFHR0407023 95

 med. adm. 1 1.0
med. arch 1 1.0
med. reg. 13 13.1
med.adm. 1 1.0
med.administratie 1 1.0
medische adm. 1 1.0
mr 1 1.0
opname 2 2.0
opname adm. 1 1.0
p&o 1 1.0
paramedische dienst 1 1.0
pers. zaken 2 2.0
pl & ltnl 1 1.0
planning en control 1 1.0
planning/ controle 2 2.0
poliklinieken 1 1.0
poort adm. 1 1.0
ro 1 1.0
rontgen 1 1.0
salaris administratie 1 1.0
systeembeheer 1 1.0
vj 1 1.0
vk- bk 2 2.0
zorgmanagement 2 2.0
Total 99 100.0

Profession

Cumulative
Frequency Percent Valid Percent Percent
Valid Technician 2 2.0 20.0 20.0
nurse 3 3.0 30.0 50.0
medical assistant 5 5.1 50.0 100.0
Total 10 10.1 100.0
Missing System 89 89.9
Total 99 100.0

MBA Thesis SRFHR0407023 96

 prof_other

Frequency Percent
Valid 24 24.2
adm 1 1.0
adm. 4 4.0
adm. kracht 4 4.0
adm. medew. 11 11.1
adm. medewerker 2 2.0
adm.kracht 9 9.1
administratie 1 1.0
afd. inkoop(adm) hfd
inkoop 1 1.0

afd. secr. 4 4.0

afd.secr. 1 1.0
afdelings secr 2 2.0
applicatie beheerder 1 1.0
boekhouder 1 1.0
chef loon adm. 1 1.0
crediteuren adm. 1 1.0
finad 2 2.0
hrm medewerker 1 1.0
junior adm.medew. 2 2.0
junior medew. med. reg. 1 1.0
leiding gevende 1 1.0
manager 1 1.0
manager pl & ltnl 1 1.0
med secretaresse 2 2.0
med. adm. 2 2.0
med.secretaresse 2 2.0
medew. med. reg 1 1.0
medewerkster opname 1 1.0
medische adm. 1 1.0
personeelsfunctionaris 1 1.0
secretaresse 2 2.0
sen. adm. medew. 1 1.0
senior medewerker sa 1 1.0
sr medew.pz 1 1.0
sub hfd. 1 1.0
systeembeheer 1 1.0
teamleader klinische fact 1 1.0
teamleider/en adm 1 1.0
verpl. secr. 1 1.0
zorgmanager 2 2.0
Total 99 100.0

years_function

MBA Thesis SRFHR0407023 97

 Cumulative
Frequency Percent Valid Percent Percent
Valid 1-5 years 23 23.2 39.0 39.0
6-10 years 8 8.1 13.6 52.5
11-15 years 13 13.1 22.0 74.6
16-20 years 3 3.0 5.1 79.7
21-25 years 4 4.0 6.8 86.4
26-30 years 5 5.1 8.5 94.9
> 30 3 3.0 5.1 100.0
Total 59 59.6 100.0
Missing System 40 40.4
Total 99 100.0

years_hospital

Cumulative
Frequency Percent Valid Percent Percent
Valid 1-5 years 18 18.2 27.7 27.7
6-10 years 6 6.1 9.2 36.9
11-15 years 23 23.2 35.4 72.3
16-20 years 7 7.1 10.8 83.1
26-30 years 6 6.1 9.2 92.3
> 30 5 5.1 7.7 100.0
Total 65 65.7 100.0
Missing System 34 34.3
Total 99 100.0

Education

Cumulative
Frequency Percent Valid Percent Percent
Valid high school 45 45.5 73.8 73.8
diploma 5 5.1 8.2 82.0
university 7 7.1 11.5 93.4
bachelors degree 3 3.0 4.9 98.4
masters degree 1 1.0 1.6 100.0
Total 61 61.6 100.0
Missing System 38 38.4
Total 99 100.0

MBA Thesis SRFHR0407023 98

 degree_other

Cumulative
Frequency Percent Valid Percent Percent
Valid 76 76.8 76.8 76.8
alg. econ.(net afgerond) 1 1.0 1.0 77.8
docent verplk i.c 1 1.0 1.0 78.8
drogist 2 2.0 2.0 80.8
imeao 1 1.0 1.0 81.8
inkoop manangment 1 1.0 1.0 82.8
iol 2 2.0 2.0 84.8
iol/hbo 1 1.0 1.0 85.9
lbgo 1 1.0 1.0 86.9
master in health services
mgt. 1 1.0 1.0 87.9
mcsa 1 1.0 1.0 88.9
mulo 4 4.0 4.0 92.9
mulo. med. reg. 1 1.0 1.0 93.9
pd/mba 1 1.0 1.0 94.9
thans bezig met masters 1 1.0 1.0 96.0
ulo 2 2.0 2.0 98.0
ulo/mietov 1 1.0 1.0 99.0
ulo/mulo 1 1.0 1.0 100.0
Total 99 100.0 100.0

q11_5_a

Cumulative
Frequency Percent Valid Percent Percent
Valid executive level 57 57.6 78.1 78.1
lower management 6 6.1 8.2 86.3
middle management 5 5.1 6.8 93.2
senior management 5 5.1 6.8 100.0
Total 73 73.7 100.0
Missing System 26 26.3
Total 99 100.0

AGE

Cumulative
Frequency Percent Valid Percent Percent
Valid 20-30 15 15.2 16.7 16.7
31-40 35 35.4 38.9 55.6
41-50 24 24.2 26.7 82.2
51-60 16 16.2 17.8 100.0
Total 90 90.9 100.0
Missing System 9 9.1
Total 99 100.0

MBA Thesis SRFHR0407023 99

 gender

Cumulative
Frequency Percent Valid Percent Percent
Valid man 12 12.1 13.2 13.2
women 79 79.8 86.8 100.0
Total 91 91.9 100.0
Missing System 8 8.1
Total 99 100.0

number of months in use of advanced information system

Cumulative
Frequency Percent Valid Percent Percent
Valid 88 88.9 88.9 88.9
5 2 2.0 2.0 90.9
0 1 1.0 1.0 91.9
10 1 1.0 1.0 92.9
108 1 1.0 1.0 93.9
12 1 1.0 1.0 94.9
18 1 1.0 1.0 96.0
24 1 1.0 1.0 97.0
6 2 2.0 2.0 99.0
9 1 1.0 1.0 100.0
Total 99 100.0 100.0

Number of years using advanced IS

Cumulative
Frequency Percent Valid Percent Percent
Valid 1-5 years 58 58.6 81.7 81.7
6-10 years 9 9.1 12.7 94.4
11-15 years 4 4.0 5.6 100.0
Total 71 71.7 100.0
Missing System 28 28.3
Total 99 100.0

use week

Cumulative
Frequency Percent Valid Percent Percent
Valid 1-10 hours 57 57.6 96.6 96.6
31-40 hours 1 1.0 1.7 98.3
more than 40 hours 1 1.0 1.7 100.0
Total 59 59.6 100.0
Missing System 40 40.4
Total 99 100.0

Source: Own research and hospitals in study

MBA Thesis SRFHR0407023 100

Open Question
Comments

64 missing
1. English: With the view from my position I think that the information system works well but point of focus/importance
is the information processed by all users
Dutch : Bekeken van uit mijn werk vind ik dat het informatie systeem goed werk levert maar het gaat om de
informatie die ingevoerd wordt door alle gebruikers
2. English: It takes too long to get the final invoices out of the system after control activities and postings
Dutch : Bij controle werkzaamheden te langdradig en steeds doorboeken totdat uiteindelijke fact. uit de bus komt
3. English: Please start every part with a short explanation of the topic to avoid difference of interpretation
Dutch : Bij de enquête gaarne korte uitleg bij de verscheidene kopstukken/delen i.v.m. interepretatie verschillen
4. English: Management of the hospital should learn to listen to employees/subordinates. I am still not satisfied with
the performance of the system/how the system works and how problems are solved/handled. Too often
trust is on Dk-nr. They forget often that the system is a “chain” and not fragmented “parts/eyelets”.
Dutch : De beleidsmakers v/h huis zouden moeten leren luisteren naar hun medewerkers. ik ben nog steeds niet
tevreden hoe het systeem werkt en problemen worden opgelost. Men vertrouwd te vaak alleen de te
gebruiken dk- nr. men vergeet te vaak dat het systeem een ketting is en geen losse "oogjes"
5. English: The implementation of Navision was a step in the right direction; especially for the administrative part there
Is more “transperancy” now
Dutch : De implementatie van navision was een stap in de goede richting; vooral voor het administratief gedeelte is
er meer "openheid" in zaken gekomen
6. English: Still there is no 100% automation. dropping “Grote Beer” for “ Account View” is a change but no
improvement. Efficiency and effectiveness leave much to be desired still.
Dutch : Er is nog steeds geen sprake van 100% automatisering. De overstap van progamma "grote beer" naar
accountview " is een verandering, maar geen verbetering. effectiviteit en efficiency laten nog veel te
wensen over
7. English: Navision is used daily on regular base but if someone else logged in I cannot use it anymore.
Dutch : er wordt dagelijks gebruik gemaakt van Navision een aantal keren p/dag als er een ander gebruiker in nav
zit kan ik daarna geen gebruik maken van Navision
8. English: Some questions are formulated negatively what forced me to go back to the scale of every statement again
and again. The questionnaire is compile at a certain level that not all levels will understand
Dutch : Er zijn vragen die negatief geformuleerd zijn, wat maakt dat je iedere keer weer naar de antwoord mogelijk-
lijkheden moet kijken. De vragenlijst is op een bepaald niveau opgesteld, dat niet alle "lagen" zal begrijpen.
9. English: Automated IS are used in this hospital and we and get the information we need.
Dutch : Geautomatiseerde info systemen wordt wel gebruikt in dit ziekenhuis en we kunnen wel informatie krijgen
10. English: It is impossible to imagine life today without information systems in actual setting in the hospital
environment. Of course it always could be better and more effectively.
Dutch : Gebleken is dat informatie systemen in zijn huidige vorm een niet weg te denken proces is binnen het
ziekenhuis wezen. Uiteraard kan het altijd nog beter en effectiever
11. English: Please use other font (difficult to read, font size too small.
Dutch : Gelieve andere letter type te gebruiken (moeilijk te lezen, te kleine lettertype
12. English: Implementation of an Information System is a must but the system should be accessible at any time during
working hours. Some of the PCs are slow which irritate users but influence user-friendliness in a positive
way/sense (shorter waiting time at admission is shorter) and providing information is faster
Dutch : Het hebben van een IS is noodzakelijk, maar het systeem moet op elk tijdstip v/d dag (zolang we in dienst
zijn) toegankelijk zijn. Sommige PCs zijn traag, wat irritatie met zich mee brengt. dat het de klant
vriendelijkheid bevodert is goed(kortere wachttijden bij opname) en leveren bepaalde inf. snel uit.
13. English: It’s always a pleasure/good/nice to have proper/sufficient ISs to do your job adequately/well.
Dutch : Het is altijd fijn om een goede informatie systeem te hebben om je werk naar behoren te doen.
14. English: the system works/performs well. I use the system for recording/input. I am not part of management.
Dutch : het systeem functioneert goed. ik gebruik het voor het invoer werk. ik maak geen beleid uit
15. English: The system could be qualified as reasonable and good. The system offers a lot of opportunities. For
questionable changes. It would be useful/convenient/handy if the other departments were
automated too, so some manual procedures/tasks/activities could be skipped/deleted. The system or the
computers are still to slow to process the required information/requests/orders.
Dutch : Het systeem is redelijk tot goed te noemen.hte systeem biedt teveel mogelijkheden voor abusievelijke
veranderingen. Het zou handig zijn indien ook de overige afdelingen geautomatiseerd waren, waardoor
bepaalde handmatige werkzaamheden konen vervallen. Het systeem of de computers zijn nog traag in de
verwerking van de gegevens en/ of opdrachten
16. English: The system is not always user-friendly if it comes/is regarding my/ to my specific task of payroll
administrator. For sure it need some modifications to make my job easier.
Dutch : Het systeem is t.a.v. mijn specifieke werkzaamheden van honorarium niet al te vriendelijk. Het behoeft
zeker nog enkele aanpassingen om mijn werk te kunnen vergemakkelijken

MBA Thesis SRFHR0407023 101

17. English: The system could be reliable and up to date and perform well if all users follows the right procedures when
using the system. That’s why refreshment training is needed from time to time/regularly.
Dutch : Het systeem kan betrouwbaar en up to date zijn en ook goed werken wanneer alle gebruikers de juiste
Handelingen plegen tijdens het gebruiken van het systeem. Daarom is van tijd tot tijd een refreshment
Nodig
18. English: It was not so clear to me which ISs were meant
Dutch : Het was voor mij niet zo duidelijk over welke geautomatiseerde systemen het ging
19. English: The IS performs pretty good/well
Dutch : Het werkt redelijk goed
20. English: The more extensive/ the more comprehensive the better the information.
Dutch : Hoe uitgebreider hoe beter en meer info.
21. English: I use the system daily
Dutch : ik ben elkedag gebruiker v/d geaut.info syst(en)
22. English: Unfortunately I am not a user of one of the ISs, therefore I cannot give an opinion about the ISs. My per-
ception is that based on the results/output of the ISs which I receive from users to fulfill my duties.
Dutch : Ik ben helaas geen gebruiker van een der informatie systemen en kan derhalve geen oordeel hieromtrent
vellen mijn perceptie is veelal gebaseerd op de resultaten/ output van de informatie systemen die ik van
gebruikers tbv mijn werkzaamheden ontvang
23. English: I consider ISs in hospitals as very efficient, in particular for information and PR purposes
Dutch : Ik vind de geautomatiseerde info. systemen in zieken huizen zeer efficiënt, vooral als het gaat om
Informatie en PR
24. English: In our hospital Navision is used daily. Access/licensing is not enough. That keeps things waiting/ “It delays
the process somewhat.
Dutch : ln ons ziekenhuis wordt er dagelijks gewerkt in Navision. Er is weinig licentie. Dat houdt wel een beetje op.
25. English: IS is a usual tool. It could be good if this tool could be teach from/starting at primary/elementary school
Dutch : Informatica is een alledaags gebruikte hulpmiddel het zou ook goed zijn als dit hulpmiddel ook vanaf de
basis school gegeven zouden worden
26. English: Information system is not so good when comparing to former system. Patient information can not be
displayed so you have to make phone calls to ask for explanation/clarification.
Dutch : Informatie systeem vind ik niet zo goed in vergelijking met het vorige systeem. informatie van patiënten zijn
ook niet echt te zien waardoor je toch telefonisch contact moet leggen met andere afdelingen
27. English: Font is to small; scale of 1 -7 is not logical; questions are varying/different; definition of IS is not clear.
Dutch : Letter gr te klein categorisering 1-7 onlogisch, vraagstelling veranderend,definitiering info syst niet helder
28. English: More benefits could be generated if everyone use the system in the right way and record data accurate
Dutch : Men kan meer profijt ontvangen van het systeem, wanneer iedereen correct en secuur invoert
29. English : Users of Navision should be informed regularly about new developments concerning Navison.
Dutch : Men moet het personeel die met navision werken steeds meer informeren over nieuwe ontwikkelingen in
Navision
30. English: Mister to be honest, your assessment is unrealistic.
Dutch : Meneer als ik eerlijk mag zijn vind ik uw waardering onrealistisch.
31. English: Not everyone has the same authorization to access the information system.
Dutch : Niet iedereen heeft de zelfde rechten om toegang te krijgen in het informatie systeem.
32. English: Sometime there is no access to the system because there are more colleagues logged in. they keep you
waiting too long before you get access to the system
Dutch : Soms krijg je geen toegang tot het systeem want je wordt gegrendeld door je mede collega's. men laat je
lang wachten voordat je licentie krijgt
33. English: I disagree with the description of the different subjects/points/variables but I agree with the other
parts of the questionnaire.
Dutch : Uw punten beschrijving vind ik juist niet op z'n plaats, maar betreffende het overige ben ik wel mee eens.
34. English: I consider it a good development in the communication but the system is not always online/ready, slow and
difficult to find/search for particular parts
Dutch : Vind het een goede ontwikkeling in de communicatie het systeem werkt echter niet altijd; langzaam,
moeilijk
om bepaalde onderdelen te vinden
35. English: Former computer system was easier in use/to work with. Actual computer system is down more often so
work delays; in stead of the statement “neutral” the statement “other opinion” could be used/stated.
Dutch : Het vorig computersysteem was veel makkelijker; het huidig computer systeem valt vaker uit waardoor 't
werk niet vlot verloopt; ipv de bewering "neutraal" zou de bewering "andere mening" kunnen worden
geplaatst

Source: own research and hospitals in study

MBA Thesis SRFHR0407023 102

APPENDIX 7: Hypothesized relationships and correlation

H0 1a : System Quality is not related to IS Benefits of Use

HA 1a : System Quality is positively related to IS Benefits of Use
Results show a significant and medium 16 correlation between System Quality and Benefit of Use, r =
.450; p = .000. Therefore Hypothesis 2 (H0 1a) can be rejected.

H0 1b : System Quality is not related to User Satisfaction

HA 1b : System Quality is positively related to IS User Satisfaction
Results show a significant and large correlation between System Quality and User Satisfaction, r = .585;
p = .000. Therefore Hypothesis 2 (H0 1b) can be rejected.

H0 2a : Information Quality is not related to IS Benefit of use

HA 2a : Information Quality is positively related to IS Benefits of Use
Results show a significant and medium correlation between Information Quality and IS Benefit of Use, r
= .476; p = .000. Therefore Hypothesis 2 (H0 2a) can be rejected.

H0 2b : Information Quality is not related to IS User satisfaction

HA 2b : Information Quality is positively related to IS user satisfaction
Results show a significant and large correlation between Information Quality and User Satisfaction, r =
.572; p = .000. Therefore Hypothesis 2 (H0 2b) can be rejected.

H0 3a : Service Quality is not related to IS Benefit of Use

HA 3a : Service Quality is positively related to IS Benefit of Use
Results show a significant and small correlation between Service Quality and IS Benefit of Use, r =
.220; p = .016. Therefore Hypothesis 2 (H0 3a) can be rejected.

H0 3b : Service Quality is not related to IS user satisfaction

HA 3b : Service Quality is positively related to IS user satisfaction
Results show a significant and small correlation between Service Quality and IS user satisfaction, r =
.283; p = .002. Therefore Hypothesis 2 (H0 3b) can be rejected.

16
Correlation strengths: small: r .10 - .29; medium r .30 - .49; large r .50 – 1.00 (Pallant, 2007)
MBA Thesis SRFHR0407023 103
H0 4a : User Satisfaction is not related to users’ Intention to Use
HA 4a : User Satisfaction is positively related to users’ Intention to Use
Results show a significant and small correlation between User satisfaction and user’ intention to use, r =
.204; p = .024. Therefore Hypothesis 2 (H0 4a) can be rejected.

H0 4b : User Satisfaction is not related to Net Benefits

HA 4b-c: User Satisfaction is positively related to Net Benefits
Results show a significant and large correlation between User satisfaction and Net Benefits, r = .552; p
= .000. Therefore Hypothesis 2 (H0 4b) can be rejected.

H0 5a : Benefit of Use is not related to User Satisfaction

HA 5a : Benefit of Use is positively related to User Satisfaction
Results show a significant and large correlation between benefits of use and user satisfaction, r = .645; p
= .000. Therefore Hypothesis 2 (H0 5a) can be rejected.

H0 5b : Benefit of Use is not related to Net Benefits

HA 5b-d: Benefit of Use is positively related to Net Benefits
Results show a significant and large correlation between Benefits of use and Net Benefits, r = .560; p =
.000. Therefore Hypothesis 2 (H0 5b) can be rejected.

H0 6a : Perceived Ease of Use is not related to Intention to Use IS

HA 6a : Perceived Ease of Use is positively related to Intention to Use IS
Results show a significant and large correlation between perceived ease of use and intention to use, r =
.660; p = .000. Therefore Hypothesis 2 (H0 6a) can be rejected.

H0 6b : Perceived Ease of Use is not related to Perceived Usefulness.

HA 6b : Perceived Ease of Use is positively related to Perceived Usefulness.
Results show a significant and medium correlation between perceived ease of use and perceived
usefulness, r = .415; p = .000. Therefore Hypothesis 2 (H0 6b) can be rejected.

H0 7 : Perceived Usefulness is not related Intention to Use IS

HA 7 : Perceived Usefulness is positively related Intention to Use IS
Results show a significant and medium correlation between perceived usefulness and intention to use, r
= .404; p = .000. Therefore Hypothesis 2 (H0 7) can be rejected.
MBA Thesis SRFHR0407023 104
H0 8 : Intention to Use is not related to Benefits of Use
HA 8 : Intention to Use is positively related to Benefits of Use
Results show a significant and medium correlation between perceived usefulness and intention to use, r
= .381; p = .000. Therefore Hypothesis 2 (H0 8) can be rejected.

H0 9 : Net Benefits of hospitals is not related to Intention of Use

HA 9 : Net Benefits of hospitals is positively related to Intention of Use
Results show a significant and medium correlation between perceived usefulness and intention to use, r
= .387; p = .000. Therefore Hypothesis 2 (H0 8) can be rejected.

Source: Own research

MBA Thesis SRFHR0407023 105

APPENDIX 8: Overview Alternative Hypothesis and testing results

Code Alternative Hypothesis Test Result p-value

H1a System Quality is positively Pearson Accept r = .450

related to IS Benefits of Use p = .000

H1b System Quality is positively Pearson Accept r = .585

related to IS User Satisfaction p = .000

H2a Information Quality is positively Pearson Accept r = .476

related to IS Benefits of Use p =.000

H2b Information Quality is positively Pearson Accept r = .572

related to IS User Satisfaction p = .000

H3a Service Quality is positively Pearson Accept r = .220

related to IS Benefits of Use p =.016

H3b Service Quality is positively Pearson Accept r = .283

related to IS User Satisfaction p =.002

H4a User Satisfaction is positively Pearson Accept r = .204

related to users’ Intention to Use p = .024

H4b-c User Satisfaction is positively Pearson Accept r = .552

related to Net Benefits hospitals p = .000

H5a Benefit of Use is positively Pearson Accept r = .645

related to User Satisfaction p = .000

H5b-d Benefit of Use is positively Pearson Accept r = .560

related to Net Benefits hospitals p = .000

H6a Perceived Ease of Use is Pearson Accept r = .660

positively related to Intention to p = .000
Use IS

MBA Thesis SRFHR0407023 106

H6b Perceived Ease of Use is Pearson Accept r = .415
positively related to Perceived p = .000
Usefulness.

H7 Perceived Usefulness is Pearson Accept r = .404

positively related Intention to p = .000
Use IS

H8 Intention to Use is positively Pearson Accept r = .381

related to Benefits of Use p = .000

H9 Net Benefits of hospitals is Pearson Accept r = .387

positively related to Intention of p = .000
Use

Correlation strengths: small: r .10 - .29; medium r .30 - .49; large r .50 – 1.00 (Pallant, 2007)

Source: Own research

MBA Thesis SRFHR0407023 107

APPENDIX 9: Descriptive statistics

System Information Service Perceived Perceived

Quality Quality Quality Ease of Use Usefulness
N Valid 98 98 98 96 97
Missing 1 1 1 3 2
Mean 4.3622 4.4466 4.9286 4.7595 5.3567
Median 4.4286 4.3333 4.8000 4.7500 5.2000
Mode 5.00 5.00 4.00 5.00 5.00
Std. Deviation .83897 1.01454 1.03446 .98318 .87427
Minimum 2.43 1.83 2.60 3.00 3.00
Maximum 7.00 7.00 7.00 7.00 7.00

Statistics

Intention to User
Use Satisfaction Benefit of Use Net Benefits Use USE_high
N Valid 94 98 95 94 97 97
Missing 5 1 4 5 2 2
Mean 4.6793 4.5557 4.6663 4.8333 4.1048 4.5309
Median 4.9000 4.5903 4.6000 4.8333 4.2500 4.5000
Mode 5.00 5.00 5.00 5.00 4.00 5.00
Std. Deviation 1.03400 .82484 .83112 .87171 .89852 1.40834
Minimum 1.40 2.33 2.40 2.00 1.75 1.00
Maximum 7.00 7.00 7.00 7.00 6.75 7.00

Source: Own research

MBA Thesis SRFHR0407023 108

APPENDIX 10: Overall results final tests Structural Equation Model

Correlations 1

Information
System Quality Quality Service Quality Benefit of Use

System Quality Pearson Correlation 1 .631** .369** .450**

Sig. (1-tailed) .000 .000 .000

N 98 98 98 95

Information Quality Pearson Correlation .631** 1 .332** .476**

Sig. (1-tailed) .000 .000 .000

N 98 98 98 95

Service Quality Pearson Correlation .369** .332** 1 .220*

Sig. (1-tailed) .000 .000 .016

N 98 98 98 95

Benefit of Use Pearson Correlation .450** .476** .220* 1

Sig. (1-tailed) .000 .000 .016

N 95 95 95 95

**. Correlation is significant at the 0.01 level (1-tailed).

*. Correlation is significant at the 0.05 level (1-tailed).

Correlations 2
System Information Service User
Quality Quality Quality Satisfaction
System Quality Pearson 1 .631** .369** .585**
Correlation
Sig. (1-tailed) .000 .000 .000
N 98 98 98 98
Information Pearson .631** 1 .332** .572**
Quality Correlation
Sig. (1-tailed) .000 .000 .000
N 98 98 98 98
Service Quality Pearson .369** .332** 1 .283**
Correlation
Sig. (1-tailed) .000 .000 .002
N 98 98 98 98
MBA Thesis SRFHR0407023 109
User Satisfaction Pearson .585** .572** .283** 1
Correlation
Sig. (1-tailed) .000 .000 .002
N 98 98 98 98
**. Correlation is significant at the 0.01 level (1-tailed).

Correlations 3

User Satisfaction Intention to Use Net Benefits

User Satisfaction Pearson Correlation 1 .204* .552**

Sig. (1-tailed) .024 .000

N 98 94 94

Intention to Use Pearson Correlation .204* 1 .387**

Sig. (1-tailed) .024 .000

N 94 94 91

Net Benefits Pearson Correlation .552** .387** 1

Sig. (1-tailed) .000 .000

N 94 91 94

*. Correlation is significant at the 0.05 level (1-tailed).

**. Correlation is significant at the 0.01 level (1-tailed).

Correlations 4

Use User Satisfaction Net Benefits

Use Pearson Correlation 1 .243** .178*

Sig. (1-tailed) .008 .044

N 97 97 93
**
User Satisfaction Pearson Correlation .243 1 .552**

Sig. (1-tailed) .008 .000

N 97 98 94
* **
Net Benefits Pearson Correlation .178 .552 1

Sig. (1-tailed) .044 .000

N 93 94 94

**. Correlation is significant at the 0.01 level (1-tailed).

*. Correlation is significant at the 0.05 level (1-tailed).

MBA Thesis SRFHR0407023 110

 Correlations 5

USE_high User Satisfaction Net Benefits

USE_high Pearson Correlation 1 .312** .200*

Sig. (1-tailed) .001 .028

N 97 97 93

User Satisfaction Pearson Correlation .312** 1 .552**

Sig. (1-tailed) .001 .000

N 97 98 94

Net Benefits Pearson Correlation .200* .552** 1

Sig. (1-tailed) .028 .000

N 93 94 94

**. Correlation is significant at the 0.01 level (1-tailed).

*. Correlation is significant at the 0.05 level (1-tailed).

Correlations 6

Perceived Ease Perceived

of Use Usefulness Intention to Use

Perceived Ease of Use Pearson Correlation 1 .660** .415**

Sig. (1-tailed) .000 .000

N 96 96 93

Perceived Usefulness Pearson Correlation .660** 1 .404**

Sig. (1-tailed) .000 .000

N 96 97 94

Intention to Use Pearson Correlation .415** .404** 1

Sig. (1-tailed) .000 .000

N 93 94 94

**. Correlation is significant at the 0.01 level (1-tailed).

MBA Thesis SRFHR0407023 111

 Correlations 7

Intention to Use Benefit of Use User Satisfaction

Intention to Use Pearson Correlation 1 .381** .204*

Sig. (1-tailed) .000 .024

N 94 92 94

Benefit of Use Pearson Correlation .381** 1 .645**

Sig. (1-tailed) .000 .000

N 92 95 95

User Satisfaction Pearson Correlation .204* .645** 1

Sig. (1-tailed) .024 .000

N 94 95 98

**. Correlation is significant at the 0.01 level (1-tailed).

*. Correlation is significant at the 0.05 level (1-tailed).

Correlations 8

Benefit of Use Net Benefits

Benefit of Use Pearson Correlation 1 .560**

Sig. (1-tailed) .000

N 95 94

Net Benefits Pearson Correlation .560** 1

Sig. (1-tailed) .000

N 94 94

**. Correlation is significant at the 0.01 level (1-tailed).

Source: Own research

MBA Thesis SRFHR0407023 112

APPENDIX 11: Indication of distribution of spending by payer

Source: Ministry of Health; Suriname Health System Profile 2006 for MPH 1105

MBA Thesis SRFHR0407023 113

APPENDIX 12: Indication of Health Status and Outcomes Vital Statistics

Source: Ministry of Health; Suriname Health System Profile2006 for MPH 1105

MBA Thesis SRFHR0407023 114

APPENDIX 13: Direct, indirect and total effects of constructs

Direct Effects Indirect Effects Total Effects

Construct BU US NB BU US NB BU US NB

SQ 0.450 0.585 - - 0.290 0.575 0.450 0.875 0.575

IQ 0.476 0.572 - - 0.307 0.583 0.476 0.897 0.583
SRQ 0.220 0.283 - - 0.142 0.279 0.220 0.425 0.297
BU - 0.645 0.560 - - 0.356 - 0.645 0.916
US - - 0.552 - - - - - 0.552

Source: Own research

MBA Thesis SRFHR0407023 115

APPENDIX 14: Research Model with hypotheses

3. Partial Behavioral Model of IS Use

Perceived
Perceived Perceived
Perceived
H6b
Ease
Ease of
of Use
Use Usefulness
Usefulness

1. Measures of Three H6a H7

Quality Dimensions
Intention
Intention
System
System to
to Use
Use
Quality
Quality
H1
a H9
H8
H4a
H1

Information
Information H2a
b

Quality
Quality Net
H2 Benefit
Benefit H5b-d Net Benefits
Benefits
b of
of Use
Use c
a b-
H3 H5a H 4
Service
Service H3b User
User
Quality
Quality Satisfaction
Satisfaction 4. Other Measures of Net
Benefits of IS Use

2. General Perceptual Measure of

Net Benefits of IS Systems

Source: Previous studies and own research

MBA Thesis SRFHR0407023 116