Validation of a quantitative instrument measuring critical success factors and acceptance of Casemix system implementation in the total hospital information system in Malaysia

• Published in: BMJ open 2024-08, Vol.14 (8), p.e082547
• Main Authors: Mustafa, Noor Khairiyah, Ibrahim, Roszita, Awang, Zainudin, Aizuddin, Azimatun Noor, Syed Junid, Syed Mohamed Aljunid
• Format: Article
• Language: English
• Subjects: Adult; Attitude of Health Personnel; Costs; Cross-Sectional Studies; Data collection; Discriminant analysis; Efficiency; Executive information systems; Factor Analysis, Statistical; Female; Health care delivery; Health care expenditures; health economics; Hospital administration; Hospital Information Systems - standards; Humans; Investigations; Malaysia; Male; Medical records; Middle Aged; Objectives; Original Research; Public Health; quality in health care; Quality of service; Questionnaires; Reproducibility of Results; Success factors; Surveys and Questionnaires - standards; Technology Acceptance Model; Validity
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-082547

ObjectivesThis study aims to address the significant knowledge gap in the literature on the implementation of Casemix system in total hospital information systems (THIS). The research focuses on validating a quantitative instrument to assess medical doctors’ acceptance of the Casemix system in Ministry of Health (MOH) Malaysia facilities using THIS.DesignsA sequential explanatory mixed-methods study was conducted, starting with a cross-sectional quantitative phase using a self-administered online questionnaire that adapted previous instruments to the current setting based on Human, Organisation, Technology-Fit and Technology Acceptance Model frameworks, followed by a qualitative phase using in-depth interviews. However, this article explicitly emphasises the quantitative phase.SettingThe study was conducted in five MOH hospitals with THIS technology from five zones.ParticipantsPrior to the quantitative field study, rigorous procedures including content, criterion and face validation, translation, pilot testing and exploratory factor analysis (EFA) were undertaken, resulting in a refined questionnaire consisting of 41 items. Confirmatory factor analysis (CFA) was then performed on data collected from 343 respondents selected via stratified random sampling to validate the measurement model.ResultsThe study found satisfactory Kaiser-Meyer-Olkin model levels, significant Bartlett’s test of sphericity, satisfactory factor loadings (>0.6) and high internal reliability for each item. One item was eliminated during EFA, and organisational characteristics construct was refined into two components. The study confirms unidimensionality, construct validity, convergent validity, discriminant validity and composite reliability through CFA. After the instrument’s validity, reliability and normality have been established, the questionnaire is validated and deemed operational.ConclusionBy elucidating critical success factor and acceptance of Casemix, this research informs strategies for enhancing its implementation within the THIS environment. Moving forward, the validated instrument will serve as a valuable tool in future research endeavours aimed at evaluating the adoption of the Casemix system within THIS, addressing a notable gap in current literature.