Analysing the use of a computerized system by hospital managers

Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil. Confl icts of interest: there are no confl icts of interest to declare. Abstract Objective: To analyze the use of a computerized system by hospital managers, evaluating their satisfaction related to the usefulness and ease of use of system. Methods: Case study, with a non-ex perimental design, conducted in a general hospital. The instrument used was based on the technological acceptance model. The population was composed of 63 managers and, based on the inclusion criteria, 60 managers were included in the study sample. Results: The system was considered useful by 90.5% of managers, while 84.7% agreed on its ease of use. The analyzed external variables (age, ease of using the technology, provision of training and technical support, computer availability, and favorability of use), showed an infl uence on satisfaction with the ease of use. The age and provided training did not infl uence satisfaction on the usefulness of the system. Conclusion: The managers showed greater satisfaction with the usefulness of the system when compared to the ease of use, due to the characteristics of the system and the institution.


Introduction
Information is the power key of this technological era.More access to information means more opportunity to choose, decide and guarantee better living conditions, health, resources, and finances. (1)In the health area, considering the exponential increase in data and information resulting from scientific evolution, resources have begun to be developed and implemented to ensure the good use and management of information. (2)ontributing to this evolution, computerized systems (CS) are considered essential in health care, strengthening the business competitiveness and also the continuous improvement of health care. (3)In this scenario, the computerization of health records is an irreversible trend in the hospital environment; however, several factors are involved in the acceptance and utilization of technology information and communication resources by professionals.
Thus, it is necessary to plan the adoption of such technologies, considering user satisfaction regarding usefulness and ease of use, as this perception directly influences the belief that a system can increase work performance, which will influence the use of the system. (4,5)herefore, it is necessary to understand the conditions under which computerized systems are adopted by health institutions, so that necessary improvements can be sought which make their use more favorable. (6)The research scenario is a hospital institution that is a regional reference site for supplementary health care in the Unimed Health System.
The institution where the research was conducted, seeking to improve its work processes, adhered to the practices of computerization, and a computerized system was implemented in all areas of care, support, and management, making its use compulsory.However, it was unknown how its employees evaluated this tool, and what factors are critical to satisfaction with the system.
Based on these observations, this study aimed to analyze the use of a computerized system by hospital managers, evaluating their satisfaction and ac-ceptance regarding usefulness and ease of use, seeking to identify the external variables that influenced manager satisfaction.

Methods
This was a case study, with a non-experimental design, conducted in a general, private, medium-sized hospital in the southern area of the state of Minas Gerais.The instrument adopted to perform the research was based on the technological acceptance model (TAM), (7) to measure perceived usefulness and ease of use, correlating with external variables.
The population consisted of multiple professionals, who either directly or indirectly were involved in the hospital management process.To verify the correlation of the variables, the Spearman's correlation test was used.
Inclusion criteria were: employees of the hospital, with a minimum of six months' management time, who occupied positions of supervision, coordination, or direct and/or indirect leadership, users of the computerized system, and those who were not on a medical or maternity leave, or on vacation, and who agreed to participate in the research, by signing the Terms of Free and Informed Consent Form.
The variables of the study were: age, variables of the TAM attributes (perceived usefulness, and ease of use), and the external variables: ease of use of technologies, initial training and system updates, technical support by the information technology team, computer availability, and favorability of use of the system.The study was submitted to the Research Ethics Committee of the Federal University of São Paulo, and received Approval No. 1,150,876.Data collection was conducted from September to November of 2016.

Results
Sixty respondents took part in the study.The age ranged from 24 to 55 years, with the largest age group being those between 30 and 39 years (71.6% of the sample).There was a predominance of females, 78.3%, and 68.6% of managers had lato sensu specialization.Most of the managers were nurses (55%), followed by members of the multidisciplinary team (30%).
Participants demonstrated greater satisfaction with the usefulness of the system, compared to the ease of its use.Data showed that 90.5% of the participants considered the system to be useful for their functions, while 84.7% of the participants considered the system to be user-friendly.The issues that presented disagreement among participants were re-lated to the agility of the system, attendance of all of their work processes, ease of finding what they were looking for in the system, clarity, and ease of use of resources such as icons, reports, pages, and screens.
The age variable showed influence only in the satisfaction with the ease of use, and without correlation with the perceived usefulness of the system.
The external variables that showed correlation with the two constructs were: ease of use of technology, provision of technical support by the information technology team, number of computers available to managers to access the system, and favorability to use the system (Tables 1, 2 and 3).
Table 1.Correlation of the variables, "Ease of use of technology" and "I like to use the computerized system", with the constructs, perceived usefulness and ease of use

Discussion
The ease of use of technology is a factor that influences its acceptance.Individuals with better computing skills are more likely to manipulate technology tools.A study conducted in Austria concluded the need for development of all those involved in the use of health systems, from hospital managers, health professionals, the information technology industry to academia. (8)n addition to development, the institution also needs to ensure integration among health professionals and have the technological resources available, because some adaptation of this professional is necessary.In this technological scenario, the professional can or cannot be interested in learning and knowing the tools that will be beneficial to them in their activities. (9)This study corroborates findings of those authors, demonstrating that the ease of using technological devices influenced both the satisfaction with the usefulness of the system, and with the ease of use.
The second question, in which the external variables were correlated with the constructs of perceived usefulness and ease of use, was related to favorability of use of the system by the managers.The results for this question influenced, in a significant way, the perception of the individuals in relation to perceived usefulness, as well as ease of use on all the correlated issues, leading to the conclusion that the less the manager likes to use the system, the less positive will be his evaluation.
The result translates the opportunity for the institution to involve its management staff, listening and engaging them in the processes of system improvement, understanding the fact that not liking to use the computerized system limits its satisfaction and, consequently, its use.
The user's negative perception of technology is a factor associated with the difficulty of following and using technological innovations.In this sense, it is important that designers of all systems seek to develop graphic interfaces with good usability, aiming to meet the professional expectations, with the objective of not hindering the acceptance for use. (10)he resistance of health professionals in the use of computerized systems is presented in the literature as the main lack of favorability of using the system contributed to the resistance in accepting and understanding how positive its deployment can be. (11)owever, even in facing the impasses such as resistance in accepting systems, technology has become an indispensable tool in the health field.Thus, even if there are difficulties and great challenges to systematize the use of technology by professionals, the institution must have a strong interest in overcoming these difficulties. (12)ble 3. Correlation of the variables, "Technical support by the information technology team" and "Availability of sufficient computers for use", with the constructs of perceived usefulness and ease of use Construct issues: perceived usefulness and ease of use The study also showed that the variables related to initial and training updates presented a correlation only with the ease of use construct, evidencing that the training of the professionals favors and facilitates the use of the system.
Training is fundamental to improve the person's abilities with technology, favoring the perception of its usefulness.and one's facility to handle the system.Lack of knowledge about the system may lead to non-use of the system.Thus, training generates skills that have a great influence on the use of the systems. (7)he adoption of technological innovations requires behavioral and structural changes in work processes, focused on training, and training for future users, with a view to facilitating their use and acceptance, as well as guaranteeing necessary resources. (13)he variables related to the technical support resources of the IT team, and the availability of sufficient computers, were shown to be relevant, demonstrating that these factors deserve greater senior management attention, guaranteeing IT technical support and the availability of sufficient machines, aiming to facilitate the managers' perceptions about using the system.
The lack of available resources hampers the use of computerized systems within health institutions.The institution that uses a computerized system requires compliance with minimum resources, with a view to the effective management of its performance. (10)upporting this logic, another study conducted by informatics nurse specialists in the USA, during the periods of 2004, 2007, and 2011, showed that the unavailability of resources was an important issue for the acceptance of technology. (11,14)In a literature review which included 12 articles on advantages and disadvantages of computerized system implementation -patient electronic record (PER), in six institutions, the need for large investments in hardware, software, equipment and training of all the professionals involved, as impact factors in the process of technology implementation, were mentioned. (14)iven the scenario of difficulties and challenges, it is fundamental that the institution institute actions to guarantee the necessary resources for the use of computerized systems, understanding that their use brings benefits, which overcomes the obstacles, related both to logistics and acceptance by the professionals involved. (15)

Conclusion
The analyzed variables presented a higher correlation with the construct ease of use, when compared to perceived usefulness.The conclusion showed that managers demonstrated satisfaction with the usefulness of the system, but they did not present the same satisfaction with ease of use, due to characteristics of the system, and structural and organizational conditions of the institution.
The study contributes to highlighting the need for educational institutions to include, in the training of health professionals, preparation for using technologies, aiming at training in the use of informatics as a support for management, especially during nursing education, as nurses are the professionals most present in the hospital environment, and consequently those who manage the service.It should also be emphasized that this study may also contribute as a research base for other studies related to the subject, as well as an improvement tool for health managers who seek improvement in health information management and informatics.

Table 2 .
Correlation of the variables, "Initial training" and "Training and system updates", with the constructs, perceived usefulness and ease of use 2G.The available features (icons, reports, pages, and screens) are clear and easy to use