Theoretical Background

Many researchers have recognised the need to use holistic and multidisciplinary approaches when studying or designing Health Information Technology (HIT) frameworks in healthcare (Lluch, 2011; Van Gemert-Pijnen et al., 2011). The HAF-CCS framework is designed to support the decision-makers in health organisations by covering multiple perspectives. It is also designed in a flexible way to be adaptable to changing market conditions. The decision process when adopting Cloud Computing is potentially a complex one and consequently there are many perspectives to be considered. Thus, addressing the issues of cloud adoption requires a multiple perspective framework. The research framework chosen to support this study will integrate more than one theoretical framework to make the HAF-CCS framework more robust and cover multiple aspects relevant to an organisation. TOE has been chosen as an underpinning concept for this research together with Information System Strategic Triangle (IS Triangle) and HOT- fit. Figure 4.2 shows the relationship between HOT-fit, IS Triangle and TOE and the HAF- CSS framework, and the following sections explain this relationship in detail.

Figure 4.2 The relation between HOT-fit, IS Triangle and TOE and the HAF-CCS framework

Technology-Organisation-Environment (TOE) Framework

The appropriate framework for studying Cloud Computing adoption is a framework that is aiming to study innovation decision-making at an organisational level. The Technology-

Organisation-Environment (TOE) Framework was introduced by DePietroet al. (1990). This framework focuses on the process by which an organisation adopts and implements technological innovations and how the technological context, the organisational context and the environmental context can affect the implementation of the new innovation. Technological context refers to all the technologies that are used by the organisation or that are available in the market (Baker, 2012). Organisational context represents the organisation’s internal characteristics and resources (Oliveira & Martins, 2011). Environmental context includes external elements that can affect the adoption of the technology such as government regulations and competitors (Baker, 2012). Oliveira and Martins (2011) suggested that the TOE framework is useful in studying the adoption decision-making process used with different types of IT innovation. TOE studies the adoption decision-making process at an organisation-level not at user-level, which makes it relevant for this project (Marston et al., 2011). Many researchers have studied technology innovation based on the TOE framework. Examples of this include RFID adoption in the healthcare environment (Lee & Shim, 2007), technology innovation in website development (Oliveira & Martins, 2008), in e-commerce (Liu, 2008), in Cloud Computing adoption by SMEs in England (Alshamaila et al., 2013), and in Cloud Computing adoption by hospitals in Taiwan (Low et al., 2011) and in developing countries (Senyo et al., 2015). The application of TOE covers features of the diffusion of innovation theory (DOI) such as innovation characteristics along with other factors, which makes TOE appropriate to support the study of Cloud Computing adoption in healthcare organisations (Alshamaila et al., 2013; Oliveira et al., 2014). Although the TOE framework has been implemented by many researchers for different technology innovations, some researchers argue that it does not contain all the required variables (Low et al., 2011). Researchers have combined the TOE framework with other theories to provide better understanding of IT innovation adoption (Oliveira & Martins, 2011; Baker, 2012). For example, Ibrahim and Jaafar (2015) combined the Model of External Influences on Environmental Awareness and Practices (MEAP) and Technology-Organisation- Environment Model (TOE) in an Environment Management System. Hence, for new complex technology adoption such as Cloud Computing, more than one theoretical framework is required to express a better understanding of the adoption decision (Low et al., 2011), as outlined in Figure 4.2.

Information Systems Strategy Triangle (ISST)

Business concepts must be taken into consideration by any decision-maker (Marston et al., 2011). One of the elements not sufficiently addressed in the TOE framework is business

concepts and therefore the factors identified though TOE need to be extended by combining them with other factors, such as strategic considerations (Zhu & Kraemer, 2005). Thus, the strategic triangle will be combined with the TOE framework to add the strategic value to the HAF-CCS framework, as illustrated in Figure 4.2.

The Information Systems Strategy Triangle (ISST) is a concept that emphasises the importance for organisations to have an alignment between three strategic perspectives (Business, Organisation and Information) (Pearlson, 2001). In ISST, the business perspective is the main perspective which affects all other perspectives and it represents the organisation’s business and financial drivers to adopt IT innovation, such as cost reduction and customer demand (Ho & Atkins, 2009). Organisational perspective refers to the internal issues of the organisation that can affect IT adoption (Pearlson, 2001). Information perspective includes technology capabilities and issues to be considered by the organisation (Ho & Atkins, 2009). Some researchers consider Cloud Computing as an innovative form of traditional IT outsourcing (Schneider & Sunyaev, 2014). This research will apply the business concepts of a strategic framework for outsourcing decision-making called Holistic Approach Business, Information, Organisation (HABIO) since other concepts are covered by the TOE framework. HABIO is a well-documented framework used for outsourcing (Alharbe et al., 2013; Ho & Atkins, 2006b, 2009).

Human, Organisation and Technology-fit (HOT-fit) Framework

Human factors are also critical in the adoption of any new IT innovation. Those factors should be considered carefully when making the decision to adopt Cloud Computing in a healthcare environment (Paré & Trudel, 2007). Researchers have argued that the TOE framework does not explain the effect of an individual or organisation’s characteristics on the adoption of IT innovation (Baker, 2012). Hence, the Human, Organisation and Technology-fit (HOT-fit) framework will be integrated with previous frameworks. HOT-fit was introduced in Yusof et al. (2008) as an evaluation framework for health information systems, as illustrated in Figure 4.2.

In HOT-fit, three dimensions (i.e. technology, human and organisation) have been integrated to evaluate HIS systems (Yusof et al., 2008). Human factors of HOT-fit include those related to the individuals inside the organisation (Lian et al., 2014b). Technology dimension contains the technical factors that can affect the system’s adoption (Yusof et al., 2008). Organisation dimension represents the impact of organisational attributes such as top management support

and organisation culture on the adoption decision (Yusof et al., 2008). This research applies some of the concepts of the HOT-fit model that relate to human perspective issues encountered by IT staff in healthcare organisations as applied by Lian et al. (2014). Technology and organisation factors of HOT-fit are not integrated, to avoid duplication with similar factors of the TOE framework (Zainuddin et al., 2015). The integration of HOT-fit and TOE has been implemented in a study on the adoption of Cloud Computing in hospitals in Taiwan (Lian et al., 2014b; Lian, 2017).

4.4 Holistic Approach Framework for Cloud Computing Strategic