Complements or Substitutes? Culture–Technology Interactions in Healthcare

The U.S. government recommends that hospitals adopt Computerized Provider Order Entry (CPOE) systems to improve the quality problems that plague U.S. hospitals. However, CPOE studies show mixed results. We hypothesize that CPOE effectiveness depends on the prevalence of patient safety culture within a hospital. Using organizational information processing theory, we describe how patient safety culture and CPOE enable healthcare organizations to better process information. Specifically, we posit that CPOE complements some aspects of patient safety culture and substitutes for others. Using ridge regression, we empirically test this proposition using data from 268 hospitals and multiple data sources. Results show that while CPOE complements the patient safety dimensions of handoffs and transitions, feedback and communication about error, and organizational learning, CPOE substitutes for the dimension of management support for safety, in the context of our dependent variable. As organizations work to implement new systems, this research can help decision-makers understand how culture impacts such initiatives and account for culture when anticipating effects.