Investigating the influence of artificial intelligence on quality management in healthcare centers

Introduction

The exponential growth of information technology (IT) has enabled a wide range of facilities in healthcare organizations.¹ Quality management (QM) governs the overall activities of a healthcare center (HC) to provide sophisticated patient care services.^2,3 The existing literature suggests that healthcare IT can improve the service quality and the efficiency of healthcare. The lack of IT knowledge and infrastructure are barriers to deploying IT applications. Saudi Arabia's Vision 2030 encourages an organization to automate its activities to satisfy the patients' demands. However, the automation processes are in the infancy stage and require training sessions to educate employees and other healthcare professionals (HCPs) to adopt the new working environment.⁴

On the other hand, recent research reveals that HCPs are reluctant to accept and utilize the latest technologies. A robust pre-assessment model for gauging the expectations and perceptions of HCPs should be developed before deploying newer technologies.⁵ A better understanding of HCPs’ level of technology awareness can support IT designers in building a user-friendly system.⁶

The essence of healthcare IT is communication. It enables an opportunity for HCPs to share critical information. These communication channels are supported by hardware solutions that have been carefully selected and installed, and timely and effective maintenance services.⁷ The healthcare industry relies heavily on the IT sector. The primary purpose of IT implementation is to enhance the population's health status by offering patients higher levels of comfort and confidence.⁸ The exponential increase in the population has led to HCPs handling more patients. Also, routine responsibilities must be completed on schedule and without delays. IT makes patient treatment more accessible, faster, and more convenient.^9,10 In recent times, patients can access more medical facilities.

Additionally, the use of technology mitigates the risks of healthcare management. IT has also made it easier for healthcare practitioners, including physicians, nurses, researchers, and physicians, to access patient information and data quickly and easily. There are several types of health IT.^11,12 The Electronic Medical Record (EMR) is among the most prevalent and highly discussed. Patients' medical information, such as medical history, medication, laboratory test results, and other clinical data, may be found here in a digital format. It is expected that EMRs will eventually displace paper-based medical records, making it easier to read and maintain track of patients' medical histories.^13,14 Furthermore, transmitting a patient's digital records between healthcare providers is easier and faster. They have access to their patient's EMRs from any location. Patients may also access their medical records and reports using an IT application, which benefits physicians and their patients.

The newer technologies, including machine learning (ML) tools and artificial intelligence (AI) based key performance indicators (KPIs), are being introduced in HCs to improve the quality of service.^15,16 The relationship between IT and QM has been investigated in several studies. Few studies have attempted to examine the role of recent technologies in governing the crucial activities of healthcare.

There is a correlation between aging and medical care, which might result in unplanned and frequent visits to the hospital.¹⁷ Healthcare systems for the elderly can benefit significantly from advances in Internet-of-things (IoT) technology.¹² Many countries strive to manage people's demands because of the strain on public health care and the lack of necessary resources. In the past, the healthcare system was physician-centric; now, it is patient-centric. Health and other ambient assisted-living technologies are integrated into smart homes, enabling older adults to interact with HCs.^12,18 Nonetheless, older adults are reluctant to use the technology due to the complex infrastructure. Thus, HCs are not deploying advanced technology to treat people in remote places and older adults. Recent studies on IoT and smart homes indicate the advantages of such a system for the elderly and a significant push toward developing new underlying technologies and service offerings. On the other hand, there are a lack of data demonstrating how the perception of HCPs might influence healthcare systems. In addition, there is limited information about the association between current IT technologies and QM.

With its ability to minimize costs, and monitor and reduce medical mistakes, IT is a significant health care innovation. Increasing numbers of experts and policymakers are becoming increasingly concerned about this issue of a low adoption rate.

Although health IT systems have been supported for a long time, it is crucial to understand why certain hospitals or care providers are hesitant to embrace such technology.¹⁹ Research in this area frequently incorporates case studies, surveys, or interviews. Two of the most significant impediments to healthcare providers adopting health IT is the cost and a lack of available IT skills.⁸ There is a demand for identifying the factors affecting HCPs adopting the new technologies, and how these technologies could support an HC to enhance its QM dimensions. Therefore, the researcher intends to examine this study's relationship between IT and QM dimensions. In addition, the study identifies HCPs’ perception of IT applications in maintaining HCs. According to the existing literature, no studies examine the role of advanced IT applications in HCs.

The contributions of the proposed study are as follows:

The rest of the study is structured as follows: The Literature review outlines the existing literature and proposed hypotheses. The research methodology is presented in the Methods. The Results and Discussion highlight the study's outcome. The Limitations section offers the study's limitations. Finally, the Conclusions concludes the study with its future implications.

Literature review

The lack of global health IT standards is one of the factors affecting QM.^1,20 IT vendors present their own set of technical documentation, which causes complexity in training HCPs. Many research studies reported the challenges a healthcare organization faces in automating its core activities. Patients' EMRs should include a single overview of their treatment, including a standard reporting format, content, and language to ensure access to all care team members.^21,22 Healthcare providers should not be burdened by this centralization, which may not necessitate more financial resources. Instead, it necessitates more time to properly teach patients how to use EMRs.

Mine et al.²³ proposed a theoretical framework for evaluating the existing IT tools and their ability to apply QM principles successfully. Aggarwal et al.,²⁴ reported that there is no statistically significant evidence between IT and QM. They focused on the technical aspects of IT. According to Hsu et al.,²⁵ future research should investigate the association between QM and IT tools and techniques. Kraus et al.,²⁶ discussed the digital transformation in healthcare and its outcome.

The current literature revealed that insufficient consideration had been devoted to developing accurate and relevant assessment instruments to evaluate hospital QM aspects. Mosadeghrad²⁷ discussed the 10 dimensions: management and leadership, strategic quality planning, quality culture, training and education, employee management, customer management, supplier management, resource management, information management, and process management.

Sun & Medaglia² developed a technique for monitoring QM procedures in Chinese hospitals. It comprises eight different QM dimensions: senior management, quality policy, training, process management, customer focus, staff relations, and quality and analysis information. Quality management approaches were shown to be the most effective in various situations. Managers of healthcare facilities may use the tool to understand QM procedures to provide a better service to patients. Algunmeeyn et al.²⁸ carried out a qualitative study at Jordan's two private hospitals and revealed that the top management's teamwork, communication, training, commitment, and support were primary facilitators of total quality management (TQM) adoption. Kumar et al.²⁹ studied Indian manufacturing sectors using an analytical hierarchy method. They determined that QM's dimensions were customer focus, leadership and people management, supplier focus, and continuous improvement. Figure 1 reflects the widely discussed QM dimensions. Most studies emphasized the QM dimension and its relationship with IT.

Figure 1. Quality management dimensions.

Theoretical framework and hypotheses

Based on the existing literature, the researcher framed the theoretical framework to investigate the relationship between IT and QM dimensions. Figure 2 outlines the proposed framework. QM is a dependent variable, whereas IT knowledge, IT infrastructure, KPIs, ML tools, and HIoT are independent variables.

Hypothesis 1 (H1): There is a significant relationship between IT knowledge and QM.

Hypothesis 2 (H2): There is a significant relationship between IT infrastructure and QM.

Hypothesis 3 (H3): There is a significant relationship between KPIs and QM.

Hypothesis 4 (H4): There is a significant relationship between ML tools and QM.

Hypothesis 5 (H5): There is a significant relationship between HIoT and QM.

Figure 2. Proposed theoretical framework.

Methods

In this study, the researcher follows a mixed-method approach to achieve the study's goal. Figure 3 highlights the research methodology for identifying the perception of HCPs on the role of IT in maintaining a quality of service in HCs. According to the hypotheses, a questionnaire is prepared to receive the participants' responses based on the dependent and independent variables. A total of 57 questions are presented in the questionnaire. The quantitative section contains 44 questions, whereas the qualitative section includes 13 questions. The researcher adopts a number of measures from the critical studies to ensure content validity. A 5-point Likert scale ranges from 1—strongly disagree to 5—strongly agree. Initially, the questions on IT knowledge are adapted from.³¹ The questions investigate the participants' perception on IT knowledge, and cover IT competence, technical and managerial knowledge, and training sessions.

Figure 3. Research methodology.

To evaluate the relationship between IT infrastructure and QM, five questions are adapted from.³³ The topics such as software, hardware, and other resources are presented in the section. Likewise, six questions are included in the KPI section. The first three questions are adapted from Ref. 47 and the remaining questions are developed according to the current work environment of Saudi Arabian HCs. ML tools and HIoT are the current concepts in HCs. Amann et al.³⁶ discussed the role of ML tools and HIoT in HCs. The researcher asked two IT experts to suggest some questions. Based on the existing literature^36,37 and expert suggestions, six and five questions are included in ML tools and HIoT sections, respectively.

Finally, to measure QM dimensions, six questions are adopted from Ref. 31. The questions cover QM dimensions and their relationship with IT in HCs.

Results

A total of 233 participants recorded their responses. Table 2 represents the demographic information of the participants. It classifies the participants into multiple categories to support the study's goal. The findings outline that the number of male participants (53.65%) is higher than the number of female participants (45.92%). The majority of participants are managers (57, 24.46%), whereas physicians are the smallest group of participants (37, 15.88%). However, the total number of HCPs is 77, representing more than 30% of participants. In addition, most participants have more than six years of experience, supporting the research to draw a meaningful insight.

Figure 4 highlights the Pareto chart of the mean value of the dependent and independent variables. For instance, the ML tools variables obtained a mean value of 4.3. This denotes that a more significant number of participants believe that ML tools and techniques could support the HCPs to identify a disease at earlier stages.

Figure 4. Mean value of independent and dependent variables.

Table 3 presents the item loadings of the variables. It is evident from the outcome that each variable has achieved reasonable item loading and communality. For instance, IT knowledge items are loaded with values ranging from 0.90 to 0.91. The items achieved the communality ranges from 0.81 to 0.84, Eigenvalue of 3.31, and Cronbach's alpha of 0.93.

Table 4 reflects the values of AVE and CR of the dependent and independent variables. The outcome ensures that the importance of variables is significant and greater than the minimum AVE and CR. In addition, the Goodness of fit index is 0.924, representing the proposed model's effectiveness.

Table 5 highlights the correlation analysis outcome of the variables. There is a positive correlation between each variable. In addition, the prior results ensure a significant inter-correlation between items in each variable.

Finally, Table 6 denotes the regression outcome for each hypothesis. It is evident that R2 and standardized parameters support the proposed hypotheses. For context, H1 is supported by R² = 0.54 and remaining H2, H3, H4, and H5 are by 0.56, 0.69, 0.67, and 0.85, respectively.

Discussion

The study's findings outline the influence of IT on leadership, information and analysis, and other dimensions of QM. First, the demographic information shows a higher number of male than female participants. However, there is no impact of sex differences in the proposed study. In addition, more than 100 participants have more than six years work experience, supporting this study's extract relevant responses for QM. The findings also confirm the findings of,^1,16 and,⁴⁸ which emphasize the importance of experienced employees in a survey. The studies,^9,24 and⁴⁹ suggest that the employee's knowledge and experience support an organization in improving the quality of service.

Second, the outcome indicates the association between IT knowledge and QM dimensions. It follows the findings of,^24,25,37 and⁵⁰ that reflect the significant positive influence of HCPs’ IT knowledge in treating patients. The qualitative findings highlight that the participants perceive IT knowledge as a tool for identifying the shortcomings of the work environment. On the other hand, some participants demanded a training session to improve their IT knowledge. They argued that the recent technologies are challenging to learn in a limited duration.

Third, the significant relationship between IT infrastructure and QM denotes the crucial part of IT in HCs. The results follow the outcome of the studies that described the benefits of IT infrastructure. In contrast, studies^11,20 argued that the IT infrastructure is not a significant factor in quality practices. However, the participants accepted that a better IT infrastructure could support HCs in serving the patients with a high-quality service. Few participants indicated that the lack of IT infrastructure inhibited the management from deploying recent technologies.

Fourth, the mixed-method approach identifies the association of KPIs and information and analysis, which is one of the dimensions of QM. HCs managers shared their experience in evaluating HCP performance using KPIs. Studies^51,52 confirm the importance of KPIs. Similarly, The authors proposed a useful KPI and method to apply in HCs.⁸ However, this study finding suggests a thorough evaluation of the KPI to ensure its accuracy.

Fifth, the findings outline the role of ML tools and techniques in HC applications. Saudi Arabian HCs started experimenting with ML tools in diagnosing patients. The participants' attitude highlights that the ML tools positively influence QM practices. Some physicians require a set of training programs and seminars to learn emerging technologies. It follows the findings of the studies^36,37 in which the authors emphasize the importance of training sessions.

Finally, the results indicate that the introduction of HIoT mitigates the risks in HC management. Mainly older adults can access treatment through IoT devices from their residences. On the one hand, the technology is not entirely functional in a significant number of HCs in Saudi Arabia. On the other hand, physicians and managers emphasized that the HIoT can support them in identifying dangerous diseases. The results also favor the findings of studies^8,12 that discuss the advantages of emerging technologies.

Limitations

This research study has some shortcomings, all of which need to be taken into account to assess the possibilities for more research in the future. This study employed a survey questionnaire to collect data in a cross-sectional design. It should be highlighted that future studies could use longitudinal research designs to remove supporting evidence between variables over time. In the context of Saudi Arabian Hospitals, a more extensive investigation is needed to determine the barriers to implementing QM. In addition, this research was only conducted in Saudi Arabia's healthcare service sector. Future research should expand its scope to include other service industries, such as education and banking. It should focus on the influence of QM implementation on other possible performance metrics, such as strategy performance, rather than just focusing on this study's QM dimensions. Finally, the study's findings are based on HCPs. As a result, the subsequent research should be gathered using data methodologies such as interviews and surveys with patients.

Conclusions

The study intends to identify the influence of IT on the QM dimensions. The recent literature discusses the role of emerging technologies in HCs and how they support management to render effective service to patients. A mixed-method approach is followed in this study in order to achieve the study's goal. The findings reveal a significant relationship between IT knowledge, IT infrastructure, KPIs, ML tools and techniques, HIoT, and QM dimensions. For instance, IT knowledge and infrastructure support HCs to monitor overall activities and improve productivity. In addition, HCPs believe that the emergence of ML tools and techniques could offer a protective environment for patients and older adults. This study's contribution is an investigation of the influence that IT has had on QM techniques. This collection of management best practices has gained widespread attention and adoption in recent years. Researchers and management may benefit from the relationship between IT and QM. However, a literature review reveals two fundamental shortcomings in studying the link between IT and QM. As a result of the absence of empirical data, IT is frequently characterized solely in terms of its technological aspects. For this reason, the researcher establishes a multidimensional IT definition and uses a structural model to test the assumptions about the relationships between variables. Managers must understand that IT may influence competitive performance without having a direct impact; it can enhance QM practices. IT-related skills and QM practices prevalent in the significant QM projects are described in depth in this research.

Ethical approval

The author obtained ethical approval (IRB07-12052022-42) from the Institution Research Board, Almaarefa University.

Consent

Prior to the survey, the author explained the objective of the study to the participants and gained their informed written consent.

Author profile

Dr Nasser Ali Aljarallah is working as an Assistant Professor at AlMajmaah University, Kingdom of Saudi Arabia. In addition, he leads various scientific committees and has received patents and awards. He completed his PhD in business administration and quality management at University of Hull, UK. He has published many research articles in the field of quality management and business administration.