Technological Forecasting & Social Change xxx (xxxx) xxx

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Technological Forecasting & Social Change

journal homepage: www.elsevier.com/locate/techfore

Role of big data analytics capability in developing integrated hospital

supply chains and operational flexibility: An organizational information
processing theory perspective
Wantao Yu a, Gen Zhao a, Qi Liu a, Yongtao Song b, *
a
Roehampton Business School, University of Roehampton, London SW15 5SL, United Kingdom
b
Institute of Management Science and Engineering, Business School of Henan University, Kaifeng, 475004, China

A R T I C L E I N F O A B S T R A C T

Keywords: Despite increasing research interest in big data analytics, exploring its important role in implementing supply
Big data analytics capability chain management practices in healthcare organisations is still one of the major challenges for both academics
Hospital supply chain integration and practitioners. We propose a research model theoretically grounded on organizational information processing
Operational flexibility
theory (OIPT) to investigate the roles of big data analytics capability (BDAC) in developing hospital supply chain
Organizational information processing theory
integration (SCI) and operational flexibility. The results from our analysis of survey data from a sample of 105
senior executives from the Chinese hospitals reveal that BDAC has a significant impact on three dimensions of
hospital SCI: inter-functional integration, hospital-patient integration, and hospital-supplier integration; and that
hospital-patient integration and hospital-supplier integration fully mediate the relationship between inter-
functional integration and operational flexibility. These findings extend and validate OIPT within the context
of big data-driven hospital supply chains, while also providing useful and timely guidance to healthcare prac­
titioners in developing data-driven SCI for better operational flexibility, especially to respond to the unprece­
dented disruption caused by the COVID-19 outbreak.

1. Introduction
Healthcare organizations operate in an increasingly uncertain envi­
ronment, with acute shortages of required resources and capabilities,
particularly the application of big data analytics (Wang et al., 2018a,
2019), relative to an ever-increasing number of older service users
requiring more healthcare services. Healthcare systems worldwide are
under immense structural challenges to meet normative healthcare
needs, and they have very little flexibility to respond to unusual events
such as natural disasters and epidemics. Consequently, developing
production/delivery flexibility to respond to changes has become a high
priority (Nair et al., 2013). The current coronavirus (COVID-19)
outbreak has presented a significant challenge for global supply chains
(DHL Resilience360, 2020; Ivanov and Dolgui, 2020). The need for
hospitals to manage their supply chains more flexibly to address the
current economic uncertainty and market volatility caused by the
COVID-19 outbreak have become more crucial (Ivanov, 2020; Ivanov
and Dolgui, 2020). Surprisingly, however, operational flexibility has
received little attention in the healthcare literature for decades (Butler
et al., 1996), as most healthcare research is orientated toward particular
aspects of service delivery, and business studies of the sector have lagged
behind the massive commercialisation of healthcare since the 1980s.
Hospital supply chain management (SCM) literature argues that the
integration of functions and activities throughout the supply chain is
recognized as a central component of efficient and flexible healthcare
delivery services (Chen et al., 2013; de Vries and Huijsman, 2011;
Nyaga et al., 2015; Rivard-Royer et al., 2002).
Although there has been increasing interest in examining hospital
supply chain integration (SCI), there is a lack of a systematic approach to
understand the concept (Chen et al., 2013). The majority of past
research has focused on the individual dimensions of hospital SCI,
especially hospital-supplier integration (e.g., Abdallah et al., 2017;
Alshahrani et al., 2018; Chen et al., 2013; Mandal, 2017), leaving out the
important central link of inter-functional integration; or it has consid­
ered only one or two specific dimensions of integration, which may hide
some important implications, and even lead researchers to draw

* Corresponding author.
E-mail addresses: wantao.yu@roehampton.ac.uk (W. Yu), zhaog@roehampton.ac.uk (G. Zhao), liuq@roehampton.ac.uk (Q. Liu), yongtao.song@hotmail.com
(Y. Song).

https://doi.org/10.1016/j.techfore.2020.120417
Received 29 April 2020; Received in revised form 14 October 2020; Accepted 16 October 2020
0040-1625/© 2020 Elsevier Inc. All rights reserved.

Please cite this article as: Wantao Yu, Technological Forecasting & Social Change, https://doi.org/10.1016/j.techfore.2020.120417
W. Yu et al.
inaccurate conclusions (Flynn et al., 2010; Yu, 2015). According to
organizational information processing theory (OIPT), an organization
can increase its information processing capacity by developing lateral
relations, such as intra- and inter-organizational processes and re­
lationships (Galbraith, 1974; Srinivasan and Swink, 2015). From an
OIPT perspective, we define hospital SCI as strategic collaboration of
both intra- and inter-organizational processes related to physical sup­
plies, information, and patient flow (de Vries and Huijsman, 2011;
Nyaga et al., 2015; Rivard-Royer et al., 2002). We conceptualise hospital
SCI as a multidimensional construct that comprises of inter-functional
integration, hospital-patient integration, and hospital-supplier integra­
tion. While inter-functional integration refers to interaction, informa­
tion sharing, and collaboration across departments or functions within a
hospital, hospital-patient integration and hospital-supplier integration
refers to strategic information sharing and collaboration between a
hospital and its patients and suppliers.
Consistent with OIPT, recent SCM research suggests that supply
chains have been revolutionized by big data analytics (Srinivasan and
Swink, 2018; Yu et al., 2019a). The healthcare literature also suggests
that healthcare organizations need to build information processing
capability through analysing and processing an immense volume, vari­
ety, and velocity of data to respond to high levels of uncertainty (Wang
et al., 2018a, 2019), in order to manage patients, information, and
material flows more effectively (de Vries and Huijsman, 2011; Drups­
teen et al., 2013). However, to date there is little empirical research
examining the effect of big data analytics on hospital SCM, and
healthcare organisations continue to struggle to reap the potential
benefits of big data initiatives (Wang et al., 2018a, 2019). Accordingly,
theoretically grounded on OIPT, this study seeks further understanding
of how hospitals can develop more integrated supply chains to boost
their operational flexibility, through building their big data analytics
capability (BDAC), a specific class of information processing capacities
(Dubey et al., 2019b; Srinivasan and Swink, 2018). More specifically,
this study addresses two research questions: (1) does BDAC help hos­
pitals develop SCI? and (2) how the three dimensions of SCI help hos­
pitals improve operational flexibility? Answering the questions is of
particular urgency given the important challenges faced by healthcare
practitioners due to the current COVID-19 outbreak (Ivanov, 2020;
Ivanov and Dolgui, 2020).
Building BDAC involves the use of advanced analytics techniques to
generate critical insights from processing and analysing vast amounts of
data (i.e., volume, varieties, velocity, veracity, and value), thereby
facilitating data-driven decision-making, which ultimately enables or­
ganisations to gain competitive advantage (Dubey et al., 2019a; Gupta
and George, 2016; Mikalef et al., 2019; Srinivasan and Swink, 2018).
Despite increasing research interest in BDAC, exploring its important
role in implementing SCM practices is still one of the major challenges
for both academics and practitioners (Dubey et al., 2019b; Mikalef et al.,
2019; Yu et al., 2019a). Although healthcare organisations invest
heavily in big data analytics with the hope that this will achieve more
effective healthcare transformation, they continue to struggle to fully
realise the potential benefits derived from its application (Wang et al.,
2018a, 2019; Wang and Hajli, 2017). We employ OIPT to improve un­
derstanding of how hospitals can develop SCI with the help of big data
analytics. OIPT suggests how organisations can analyse and process in­
formation effectively, especially when operating in highly uncertain
environments (Galbraith, 1974). Based on OIPT, we explore how
building information processing capabilities leads to improved SCI.
China provides an interesting research context as promoting the use
of big data in the healthcare industry is a national priority; in recent
years many hospitals has actively engaged in developing a cost-effective
and patient-centric healthcare system using big data (Zhang et al.,
2018). A large number of hospitals in China have implemented health
information systems (e.g., electronic health and medical record systems)
to capture large amounts of medical data, such as regional claims data
from the national health insurance program, administrative data, and
2
Technological Forecasting & Social Change xxx (xxxx) xxx
electronic medical records (Agrawal and Prabakaran, 2020; Zhang et al.,
2018). By adopting big data analytics technologies, China’s healthcare
system is now shifting its focus from traditional clinical approaches to
patient-centric digital solutions, which helps hospitals meet patients’
needs, thereby improving quality of care and organisational perfor­
mance (Agrawal and Prabakaran, 2020; Zhang et al., 2018). Big data
analytics has played a key role in the fight against the COVID-19
pandemic in China. By analysing and processing the epidemic data
with advanced analytics techniques, the Chinese health authorities and
hospitals have been able to facilitate their data-driven decision making
on appropriate actions, for example, tracking people’s movements
during coronavirus lockdown, understanding healthcare trends, and
managing pharmaceutical supplies for various medications (Liu, 2020;
Ting et al., 2020). However, to date there has been little empirical
research into the effect of BDAC on hospital SCI and flexibility in the
Chinese healthcare industry.
Our study is the first to provide empirical evidence of the relation­
ships between BDAC, the three dimensions of hospital SCI, and opera­
tional flexibility, using data from 105 senior executives from the Chinese
hospitals, thus making several contributions. Using OIPT as a theoretical
lens, this study fills research gaps by proposing a research model that
reconciles two different streams of literature (big data analytics and
integration in hospital supply chains) that have been treated indepen­
dently in extant research (Dubey et al., 2019b). We extend OIPT beyond
general organizational design factors to address the exploitation of
BDAC in the healthcare industry. This extended perspective of OIPT
helps explain how the development of BDAC helps hospitals increase
their information processing capacity for developing integration and
flexibility in the supply chain. Our research findings provide a unique
information processing perspective that helps healthcare practitioners
gain a more comprehensive understanding of information sharing and
coordination in hospital supply chains, offering increased understanding
of how to exploit BDAC to enhance hospital SCI and increase operational
flexibility. Hence, this study provides useful and timely guidance, as the
information processing capability to respond to unfolding events in
uncertain environments is of critical importance to healthcare practi­
tioners due to the current COVID-19 outbreak.
The remainder of this paper is organised as follows. In Section 2, we
develop a conceptual framework and review the literature on BDAC,
hospital SCI, and operational flexibility. We then develop research hy­
potheses in Section 3. We discuss the research method in Section 4 and
test the conceptual model in Section 5. Section 6 provides a discussion of
the research findings and managerial implications. We finally present
the conclusions, limitations of this study, and suggestions for future
research in Section 7.
2. Theory development and literature review
2.1. Organizational information processing theory (OIPT)
OIPT provides a promising theoretical lens to develop the research
model (see Fig. 1) that investigates the relationships between BDAC, the
three dimensions of hospital SCI, and flexibility. OIPT posits that orga­
nisations need to collect, analyse, and use information effectively and
efficiently, especially when executing complex tasks with extensive
levels of uncertainty and interdependence (Srinivasan and Swink, 2015,
2018), whereby uncertainty refers to “the difference between the
amount of information required to perform the task and the amount of
information already possessed by the organization” (Galbraith, 1973, p.
5). Organisations operating in dynamic and competitive business envi­
ronments must strive fit between information processing needs and their
information processing capacity to address uncertainty and foster
business performance (Flynn and Flynn, 1999; Galbraith, 1973). Orga­
nisations can increase their capacity to process information by investing
in vertical information systems and creating lateral relations (Galbraith,
1974; Srinivasan and Swink, 2015, 2018). Previous research on
W. Yu et al.
Fig. 1. Proposed research model.
manufacturing operations and SCM has employed OIPT to investigate
the importance of big data analytics in implementing SCM practices,
such as visibility (Srinivasan and Swink, 2018) and resilience (Dubey
et al., 2019b). Using OIPT as a theoretical lens, previous studies have
examined the role of SCI (Wong et al., 2011; Yu et al., 2019b) and the
role of various information processing alternatives in coping with
environmental complexity (Flynn and Flynn, 1999). However, little
attention has been paid to how hospitals enhance their information
processing capacity through SCI and BDAC for flexibility improvement
in healthcare delivery, especially during the current COVID-19
pandemic.
From an OIPT perspective, in this study we assert that hospital SCI
and BDAC emerge from the development of information systems: inte­
gration from lateral communication systems, and big data analytics from
vertical information processing systems (Srinivasan and Swink, 2018).
OIPT suggests that the creation of lateral relations is involved with
organizational processes and relationships, such as direct contact,
liaison roles, and integrating roles (Galbraith, 1974). In the healthcare
industry, access to valuable information can be facilitated by estab­
lishing external lateral relations with customers and suppliers (i.e.,
hospital-patient and hospital-supplier integration in the case of this
study), and internal integration across different functions within an
organisation (i.e., inter-functional integration in the case of this study).
Vertical information systems, as another way to increase information
processing capacity, allow an organization to process data efficiently,
thereby empowering the organization to adjust or create new business
plans quickly (Galbraith, 1974). In the healthcare setting, adopting a
wide range of clinical and operational information systems (e.g., elec­
tronic health record systems, laboratory information management sys­
tems, and real-time locating systems) helps a hospital analyse and
process data effectively, thereby producing business values and insights
that enable data-driven decision-making, operational planning, and
execution (Wang and Byrd, 2017; Ward et al., 2014). Accordingly, we
consider BDAC as a specific class of information processing capacities of
a hospital, made possible by its investment in medical information
systems (Srinivasan and Swink, 2018). Hence, we rely on OIPT as a basis
for investigating how hospital SCI and BDAC enhance a hospital’s in­
formation processing capability for flexibility improvement in health­
care delivery. Fig. 1 shows our conceptual framework.
2.2. Hospital supply chain integration
Integration has been an effective way to increase flows of
3
Technological Forecasting & Social Change xxx (xxxx) xxx
information, goods, and patients in hospital supply chains (Chen et al.,
2013; Drupsteen et al., 2013). Healthcare supply chain processes are
information intensive, requiring coordination and information exchange
within and beyond organizational boundaries with diverse stakeholder
groups (de Vries and Huijsman, 2011; Dobrzykowski and Tarafdar,
2015; Thompson, 1967). Based on the initial literature on SCI, mainly
concentrated on manufacturing (Flynn et al., 2010; Wong et al., 2011;
Yu et al., 2013), we extend the concept of integration to hospitals by
considering how hospitals collaboratively manage their intra- and
inter-organizational processes to achieve more effective flows of pa­
tients, information, and materials, with the objective of providing
maximum value to patients (de Vries and Huijsman, 2011; Nyaga et al.,
2015). We conceptualise hospital SCI as a multidimensional construct
comprising inter-functional integration, hospital-patient integration,
and hospital-supplier integration. In the parlance of OIPT, the three
dimensions of hospital SCI create information processing capabilities by
establishing internal lateral relations across key functions within the
hospital, and close and intensive coordination with patients and
suppliers.
2.2.1. Inter-functional integration
We build on manufacturing-based research (e.g., Flynn et al., 2010;
Swink and Schoenherr, 2015; Wong et al., 2011) to define
inter-functional integration as different departments and functions
within a hospital (e.g., outpatient/inpatient, medical, nursing, physical
medicine and rehabilitation departments) functioning as part of an in­
tegrated process through interaction, information sharing, and collab­
oration (Drupsteen et al., 2016). Building cross-functional coordination
is crucial for healthcare organisations, because all involved key activ­
ities and functions within the hospital should coordinate and cooperate
with one another (e.g., patient scheduling, daily adjusting, and perfor­
mance monitoring) (Drupsteen et al., 2016; White et al., 2011).
Inter-functional integration breaks down functional barriers and facili­
tates frequent, timely, and accurate communication and sharing of
real-time information across key functions in the hospital, which is ex­
pected to meet the requirements of patients and improve the perfor­
mance of healthcare delivery (Drupsteen et al., 2016; Flynn et al., 2010).
2.2.2. Hospital-patient integration
Hospital-patient integration is manifest in a hospital interacting
effectively with its patients to deliver timely, high-quality care (Dobr­
zykowski and Tarafdar, 2015). By effectively providing medical infor­
mation to patients, hospital-patient integration entails a deeper
W. Yu et al.
understanding of patient expectations, thereby enabling the hospital to
have to a more accurate and quicker response to patients’ evolving
needs by reconciling supply with demand (Dobrzykowski and Tarafdar,
2015; Wong et al., 2011). Hospital-patient integration is recognised as
crucial for increasing hospital productivity and patient care services.
Accurate, timely, and adequate communication and information inter­
change (e.g., patient health information, medical records, lab results,
prescriptions, and health insurance claims/transaction) between the
hospital (e.g., healthcare providers including physicians, nurses, and
hospital staff) and its patients improve quality of healthcare delivery,
and achieve more efficient clinical outcomes while ensuring more
effective and efficient resource commitments by health systems (Dobr­
zykowski and Tarafdar, 2015).
2.2.3. Hospital-supplier integration
We define hospital-supplier integration as “the extent to which the
business processes between a hospital and its key suppliers (e.g., inter­
organizational logistical activities) are strategically coupled and unified
as a whole” (Chen et al., 2013, p.392). Hospital-supplier integration
represents strategic inter-organisational collaboration that enables a
hospital to seamlessly and continuously coordinate with its suppliers for
the integration of information and materials across organizational
boundaries (Abdallah et al., 2017; Alshahrani et al., 2018; Chen et al.,
2013). Higher levels of integration between a hospital and its suppliers
are characterized by increased logistics-related communication, more
seamless coordination of the hospital’s logistics activities with those of
its suppliers, and more effective inbound and outbound distribution of
hospital supplies with its suppliers (Chen and Paulraj, 2004; Nyaga
et al., 2015).
2.3. Big data analytics capability (BDAC)
The manufacturing operations and SCM literature have provided
several definitions of BDAC (Dubey et al., 2019a; Srinivasan and Swink,
2018). In general, BDAC refers to “organizational facility with tools,
techniques, and processes that enable a firm to process, organize, visu­
alize, and analyse data, thereby producing insights that enable
data-driven operational planning, decision-making, and execution”
(Srinivasan and Swink, 2018, p.1851). In the healthcare industry, BDAC
acts as a hospital’s capability that enables it to collect, store, analyse,
and process immense volume, variety, and velocity of health data across
a wide range of healthcare networks to enhance data-driven decision
making and discover business values and insights in a timely fashion
(Wang et al., 2018a, 2019; Wang and Byrd, 2017). From an OIPT
perspective, by building BDAC, hospitals can apply various data visu­
alization analytical tools (e.g., interactive dashboards and systems) to
extrapolate meaning from external health data and perform visualiza­
tion of the information (Wang and Hajli, 2017), and various analytical
techniques (e.g., statistical methods and optimization) to process large
amounts of health data in various forms (e.g., text-based health docu­
ments, physician’s written notes and prescriptions, and medical imag­
ing) for harvesting business insights (Groves et al., 2013; Wang et al.,
2018a). The visualization reports generated from real-time data pro­
cessing can be displayed on healthcare performance dashboards, which
support the daily tasks of healthcare delivery providers (such as doctors
and nurses), thereby enabling them to make smarter, faster data-driven
decisions (Roski et al., 2014; Wang et al., 2018b).
2.4. Operational flexibility
Manufacturing-based research suggests that organisations need to
operate more flexibly to effectively respond to volatile and dynamic
markets (Dubey et al., 2019b; Srinivasan and Swink, 2018; Upton, 1994;
Williams et al., 2013). Operational flexibility has always been recog­
nised as an inherent part of the delivery of healthcare services due to the
necessary responsiveness towards individual patient expectations, yet
4
Technological Forecasting & Social Change xxx (xxxx) xxx
healthcare research has not explored the issue commensurate with its
importance (Butler et al., 1996). We define operational flexibility in the
healthcare context as a hospital’s ability to vary or adapt its operational
activities to cope with unexpected circumstances, thereby meeting pa­
tient requirements and obtaining a flexibility advantage (Butler et al.,
1996; Slack et al., 2016). In the interests of consistency and parsimony,
we capture external capabilities reflecting the ways that hospitals
change their production/delivery quantities and qualities to respond
quickly to changing patient needs (Slack et al., 2016; Williams et al.,
2013). In this study we assert that the hospital can leverage the skills and
flexibility of its healthcare delivery providers (i.e., multidisciplinary
healthcare professionals) and teams to introduce new types of treat­
ments (new product/service flexibility), deliver a wide variety of
treatments (mix flexibility), adjust the number of patients treated (vol­
ume flexibility), and reschedule appointments for patients (delivery
flexibility) (Butler et al., 1996; Nair et al., 2013; Slack et al., 2016).
3. Hypotheses development
3.1. Effects of BDAC on hospital SCI
According to OIPT, BDAC enables an organisation to quickly
combine and process multiple data formats that provide the organisation
with the required information processing capabilities for handling
variability and uncertainty, thereby achieving SCI (Srinivasan and
Swink, 2018; Wang et al., 2016). Healthcare organisations continue to
invest heavily in various clinical and operational information systems (e.
g., electronic health record systems), which is an important way in
which they can improve their information processing capability (Gal­
braith, 1973; Srinivasan and Swink, 2015).
A hospital’s ability to acquire, analyse and process the large amount
of healthcare-related data (e.g., electronic health records, diagnostic or
monitoring instrument data, pharmacy data, and patient-generated
data) being produced by the adoptions of the various healthcare sys­
tems (Wang et al., 2019; Wang and Byrd, 2017) enables different de­
partments and functional areas within the hospital to break down
functional barriers and operate as part of an integrated process. BDAC
helps hospitals process unstructured data (e.g., medical records, doctor
and nurse notes, prescriptions, and CT images) and transform them into
structured analysable format which can be effectively shared between
different departments within the hospitals (Kamble et al., 2019;
Raghupathi and Raghupathi, 2014).
According to OIPT, the adoption of big data analytics technologies
facilitates information interchange between physicians and patients,
thereby enhancing hospital-patient integration. Developing BDAC en­
ables hospitals to analyse and process real-time medical information
collected from various mobile devices (e.g., mobile health applications,
sensors, medical devices, and remote patient monitoring devices) to
monitor and track patient’s health condition for diagnosis, medication,
and treatment (Raghupathi and Raghupathi, 2014; Wang et al., 2018a).
BDAC helps the hospital and its healthcare providers to effectively
communicate with patients, towards achieving desirable patient out­
comes in healthcare delivery (Dobrzykowski and Tarafdar, 2015).
Collecting and processing managerial and clinical data provides
meaningful insights that help hospitals and their suppliers collaborate to
monitor, control and optimise stock levels (Chen et al., 2013) and to
meet patient demands and future market trends (Wang et al., 2018a).
Hospitals that invest in developing analytics capabilities (analysing and
processing the transaction related business information about inventory
level, production schedule and capacity, and delivery lead times) are
likely to build intensive and close coordination with key suppliers to
plan, fulfil, and deliver hospital supplies on a continuous basis (Chen
et al., 2013; Mandal, 2017). As such, developing BDAC has become a
necessary condition for hospital-supplier integration. Because of these
benefits, we expect that the presence of BDAC enables a hospital to
develop internal integration across different functions and strategic
W. Yu et al. Technological Forecasting & Social Change xxx (xxxx) xxx

collaboration with patients and suppliers, therefore we posit the exchanging real-time and complex information, and sharing their
following hypothesis: domain-specific knowledge and viewpoints, which enables the hospital
to improve efficiency to deliver timely service and improved patient
H1. BDAC has a significant positive effect on (a) inter-functional
experience (Dobrzykowski and Tarafdar, 2015; Mandal, 2017; Zepeda
integration, (b) hospital-patient integration, and (c) hospital-supplier
et al., 2016). Supporting information and insights obtained from
integration.
external sources (such as the feedback and suggestions given by pa­
tients) may lead to better planning for theatre and operating schedules,
3.2. Relationship between inter-functional integration and hospital-
and new possible treatments that respond to patients’ evolving needs,
patient integration and hospital-supplier integration
thereby enhancing flexibility in healthcare delivery (Bourlakis et al.,
2011; Dobrzykowski and Tarafdar, 2015). Hence, drawing upon OIPT,
Manufacturing-based research suggests that internal integration in­
we argue that developing inter-functional integration, hospital-patient
volves cross-functional communication, information sharing, and coor­
integration, and hospital-supplier integration enables hospitals to
dination that enable organizations to continuously gather demand data
improve operational flexibility:
from downstream customers and supply data from upstream suppliers,
thereby developing strategic collaboration with customers and suppliers H3. (a) Inter-functional integration, (b) hospital-patient integration,
(Yu et al., 2013; Zhao et al., 2011). In the healthcare context, we assert and (c) hospital-supplier integration are positively related to operational
that inter-functional integration and coordination between functional flexibility.
areas within the hospital enables greater external integration with the
hospital’s patients and suppliers. Inter-functional integration is recog­ 3.4. Mediating effects of hospital-patient integration and hospital-supplier
nised as a prerequisite for developing hospital-patient integration and integration
hospital-supplier integration. From an OIPT perspective, coordination
and information exchange amongst a hospital’s healthcare delivery Given the set of hypotheses (H3a, H3b and H3c), to better under­
providers enables the hospital to efficiently gather, interpret, synthesize, stand the effects of the three dimensions of hospital SCI on operational
and coordinate medical information (such as medical history, patient flexibility, in this study we turn to examine the mediating roles of
condition, and clinical data), thereby enhancing hospital-patient hospital-patient integration and hospital-supplier integration in the
communication and delivering improved experiences and value to pa­ relationship between inter-functional integration and flexibility. Based
tients (Dobrzykowski and Tarafdar, 2015). In addition, effective coor­ on the above evidence (H3a), we are interested in knowing if a direct
dination between functional areas within the hospital (e.g., outpatient, effect exists between inter-functional integration and flexibility. The
inpatient, and medical departments) enhances direct and frequent in­ absence of a significant coefficient for such a path would suggest that
formation exchange with its key suppliers, thereby managing collabo­ hospital-patient integration and hospital-supplier integration fully
rative planning activities such as stock monitoring, ordering, and mediate the effect of inter-functional integration on flexibility (Venka­
delivery scheduling (Chen et al., 2013). Hence, we hypothesize the traman, 1989).
following: According to OIPT, an organization performs business processes
within and beyond organizational boundaries (Galbraith, 1973;
H2. Inter-functional integration has a significant positive effect on (a)
Thompson, 1967), which suggests “the need to distinguish internal from
hospital-patient integration and (b) hospital-supplier integration.
external integration” (Wong et al., 2011, p.605). The SCM literature in
the manufacturing context suggests that a firm’s competitive advantage
3.3. Effects of hospital sci and operational flexibility
is driven not only by organizational (internal) resources, but also by
resources shared with its supply chain partners, such as building stra­
From an OIPT perspective, inter-functional integration entails cross-
tegic collaboration beyond organizational boundaries with customers
functional collaborations and information sharing that enable the hos­
and suppliers (Flynn et al., 2010; Wong et al., 2011; Yu et al., 2013). In
pital to manage and process richer information in ways that enhance
the context of this research, we use the tenets of IPT to investigate how
flexibility in healthcare delivery (Williams et al., 2013). Adequate
inter-functional integration can be effective in increasing flexibility in
communication and sharing of real-time information across business
healthcare delivery. We argue that such a link exists because of the
functions within the hospital makes its day-to-day operations more
presence of strategic collaboration between the hospital with its sup­
flexible, faster, and responsive. The foundation of this relationship be­
pliers and patients. With a low level of integration with patients and
tween inter-functional integration and flexibility is based on developing
suppliers, a hospital will be more likely to receive inaccurate or distorted
structures and routines for integrative information processing that en­
supply and demand information, which might lead to poor production
ables business units to identify patient needs and provide possible new
planning and a lack of flexibility in patient care delivery (Wong et al.,
treatments more quickly and accurately (Drupsteen et al., 2016; Srini­
2011). The arguments are also consistent with H3, hypothesizing that
vasan and Swink, 2015).
hospital-patient integration and hospital-supplier integration helps
According to OIPT, acquiring information about market changes and
hospitals achieve improved flexibility. Consistent with tenets of OIPT,
patient requirements through close collaboration with suppliers and
we argue that developing strategic collaboration with patients and
patients is important for newer goods and services development (such as
suppliers is imperative, as the initiating mechanisms to improve flexi­
new types of treatments and a wide range of new treatments), because
bility in patient care delivery, with hospital-patient and
hospitals are required to analyse and process external information for
hospital-supplier integration as the mediating mechanisms between
identifying and developing opportunities (Bourlakis et al., 2011; Man­
inter-functional integration and flexibility. Hence, we summarize these
dal, 2017). Establishing a close and intensive coordination with sup­
expectations in the following hypothesis:
pliers enables the hospital to gather and analyse richer information to
plan, fulfil, and deliver supplies on a continuous basis, thereby H4. (a) Hospital-patient integration and (b) hospital-supplier integra­
responding to supply and demand uncertainty for clinical requirements, tion positively mediate the relationship between inter-functional inte­
reducing the need for ad hoc conflict resolution, and increasing order gration and operational flexibility.
fulfilment quality (Chen et al., 2013; Mandal, 2017; Zepeda et al., 2016),
which leads to improved flexibility in healthcare services (e.g., serving
the optimum number of patients with available resources).
Healthcare professionals need to develop and maintain effective re­
lationships with patients, such as communicating effectively with them,

5
W. Yu et al. Technological Forecasting & Social Change xxx (xxxx) xxx

4. Research methodology than three indicators per construct, and commonality value greater than
0.40 (Osborne et al., 2008). Thus, the sample size is eligible to undertake
4.1. Data collection SEM in this study. In addition, the sample size is also comparable to
previous survey-based hospital SCM studies (e.g., Chen et al., 2013, n =
This study uses a cross sectional survey-based approach. A ques­ 117).
tionnaire was used to gather the primary survey data from hospitals in In this study, we evaluated non-response bias by comparing the early
China to test the theoretical framework. The data were collected during and late respondents relative to demographic parameters (Hair et al.,
December 2019 and February 2020. A total of 1000 hospitals were 2018). The t-tests revealed that there were no significant differences (p
randomly selected with the help of Provincial Hospital Associations in < 0.05) between the early and late respondents across number of em­
the different geographical regions in China. With the support of the ployees and hospital age. The results show that non-response bias was
Hospital Associations, we sent the survey invitations via WeChat not a significant problem in this study.
(China’s most popular messaging app) to senior executives performing The ex-ante and ex-post approaches were used to detect and control
full-time senior roles, such as directors and vice directors of hospitals any potential for common method bias (CMB). When designing the
and departmental directors (e.g., purchasing manager, operations questionnaire survey (ex-ante), we randomised the order of measure­
manager, information technology manager, director of materials man­ ment items to ensure the respondents could not identify the independent
agement, medical director, head of quality improvement, finance di­ and dependant variables; we also kept items simple, short, and carefully
rector, etc.), who were responsible for implementing various hospital worded to ensure that the respondents could answer the questions
operations and SCM practices. Moreover, most respondents had been in correctly. Furthermore, we promised respondents anonymity in the
their positions for more than ten years, which further suggests that they cover letter. These approaches were employed to help reduce the CMB in
had sufficient knowledge to answer the survey questions. On 30 January a self-report study (Podsakoff et al., 2003). After the data collection
2020, the World Health Organization (WHO) declared that the COVID- (ex-post), confirmatory factor analysis was applied to Harman’s
19 outbreak constituted a public health emergency of international single-factor model to further assess CMB because previous researchers
concern. In mid-February 2020 reminders were sent to non-respondents suggest that Harman’s single-factor test does not eliminate the possi­
using WeChat texts, but the majority of respondents replied that they did bility of CMB (Podsakoff et al., 2012). The CFA results suggest unac­
not have time to complete the survey due to their busy schedules as a ceptable data-model fit (χ2/df (859.515/189) = 4.548, CFI = 0.709, IFI
result of dealing with the COVID-19 outbreak. After consulting with the = 0.711, TLI = 0.676, RMSEA = 0.185 and SRMR = 0.112) (Hair et al.,
Hospital Associations, we decided to suspend the data collection. 2018; Hu and Bentler, 1999). Based on these results, we conclude that
Finally, a total of 105 usable responses were received (a response rate of CMB is not a significant threat to validity of the research findings.
10.5%). The respondents’ demographic characteristics and the charac­
teristics of their hospitals are reported in Table 1. Previous research (e. 4.2. Measures and control variables
g., Hair et al., 2018) has provided detailed guidance on the determina­
tion of the necessary sample size for structural equation modelling We adapted a number of existing valid measurement scales from the
(SEM): using a sample of at least 100 for a research model with five literature to design the instrument (see Table 2). To further establish
constructs or less with each theoretical construct more than three items content validity of the questionnaire and its measurement scales, we
measured variables with high commonality items can be generally conducted a pilot test with academic researchers and senior hospital
considered eligible for SEM. The number of samples collected for this executives. To ensure the quality of the data, we provided descriptions
study is 105, and the study consists of five theoretical constructs, more about the theoretical contracts (BDAC, hospital SCI and operational
flexibility), which helped respondents interpret survey questions
correctly and respond truthfully. All the constructs in the theoretical
Table 1 framework were measured using a seven-point Likert scale, with anchors
Demographic characteristics of respondents (n = 105). ranging from (1) strongly disagree to (7) strongly agree. We adapted the
Percent Percent measures of BDAC from Srinivasan and Swink (2018) and Wang et al.
(%) (%) (2018a), including the items that captured a hospital’s ability to use data
Respondent location Job titles visualization techniques, deploy healthcare dashboards that help in the
(geographical regions) decision-making process, gather information from disparate data sour­
Pearl River Delta 4.8 Director of the hospital 21.0 ces, and sort the information to perform root cause analysis. We con­
Yangtze River Delta 3.8 Vice director of the 14.3 ceptualised hospital SCI as a multidimensional construct including
hospital
Bohai Sea Economic Area 14.3 Director of purchasing 2.9
inter-functional integration, hospital-patient integration, and
Northeast China 21.0 Director of operations/ 11.4 hospital-supplier integration. We adapted the items developed by Im
general and Workman (2004) and Chen and Paulraj (2004) to measure
Central China 19.0 Director of information 1.0 inter-functional integration, which emphasise a hospital’s proactivity in
technology
sharing information across functional departments within the hospital.
Southwest China 16.2 Director of doctor- 2.9
patient relationship We adapted the measures of hospital-supplier integration from Chen and
Northwest China 21.0 Director of equipment 1.9 Paulraj (2004), which included the seamless integration of information
department and materials flows and logistics activities with key vendors/suppliers,
Number of employees Other senior executive 44.8 and an intensive and closely coordinated information exchange between
1 – 100 12.4 Hospital ownership
101 – 200 12.4 State-owned hospital 89.5
hospitals and vendors. We adapted Chen and Paulraj’s (2004) scale to
201 – 500 21.9 Private Chinese 9.5 measure hospital-patient integration, which included satisfying pa­
hospital tients’ evolving needs and providing reliable and timely services and
501 – 1000 19.0 Wholly foreign-owned 1.0 treatments for patients. The measures for hospital operational flexibility
hospital
were adapted from Slack et al. (2016), including items such as the
1001 – 3000 21.0 Hospital age (years)
> 3000 13.3 ≤10 2.9 introduction of new types of treatment (product/service flexibility), a
Years in current position 11 – 20 8.6 wide range of available treatments (mix flexibility), the ability to adjust
≤5 9.5 21 – 30 9.5 the number of patients treated (volume flexibility), and the ability to
6–10 10.5 > 30 79.0 reschedule appointments (delivery flexibility).
> 10 80.0
We included two control variables in the research model: hospital

6
W. Yu et al.
Table 2
Measurement model assessment: reliability and validity analysis.
Measurement Items
1. Big data analytics capability
We easily combine and integrate
information from many data sources
for use in our decision making
We routinely use data visualization
techniques (e.g., healthcare
dashboards) to assist users or decision-
maker in understanding complex
information
Our dashboards give us the ability to
decompose information to help root
cause analysis and continuous
improvement
We deploy healthcare dashboard
applications/information to our
directors’ communication devices (e.
g., smart phones, computers)
2. Inter-functional integration
We collocate employees to facilitate
cross-functional integration
Our directors from every function
regularly visit our patients
We freely communicate information
about our successful and unsuccessful
patient experiences across all
functions
All of our directors understand how
everyone in our hospital can
contribute to creating values for
patients
All functional departments work hard to
thoroughly and jointly solve problems
3. Hospital-patient integration
We anticipate and respond to patients’
evolving needs and want
We interact with patients to set
reliability, responsiveness, and other
standards
We deliver services and treatments that
satisfy and/or exceed patient
expectations
4. Hospital-supplier integration
Inter-organizational logistics activities
between our hospital and our major
key vendors/suppliers are closely
coordinated
We have a seamless integration of
logistics activities with our key
vendors/suppliers
Our logistics integration is characterized
by excellent distribution,
transportation and/or warehousing
facilities
Our inbound and outbound distribution
of hospital supplies with our vendors/
suppliers is well integrated
Information and materials flow
smoothly between our vendor/
supplier firms and our hospital
6. Operational flexibility
The introduction of new types of
treatment [product/service
flexibility]
A wide range of available treatments
[mix flexibility]
The ability to adjust the number of
patients treated [volume flexibility]
The ability to reschedule appointments
[delivery flexibility]
Model fit statistics: χ2 = 324.696; df = 179; χ2 / df = 1.814; CFI = 0.937; IFI = 0.938;
TLI = 0.926; RMSEA = 0.088; SRMR = 0.056
Technological Forecasting & Social Change xxx (xxxx) xxx
size (measured by the number of employees) and hospital age (measured
by the number of years since hospital foundation) (see Table 1). They
Factor α CR AVE were controlled because larger and older hospitals may have more re­
loadings sources for adopting digital technologies for the development of BDAC
0.947 0.948 0.820 and performance improvement than smaller and younger hospitals.
0.835
5. Data analysis and results
0.957
We analysed the survey data using SEM with the two-step analytic
approach (Anderson and Gerbing, 1988). The measurement model
(assessing the validity and reliability of the measures) was followed by
the structural model (assessing the strength of the hypothesized re­
0.984
lationships amongst the variables).
5.1. Measurement model assessment
0.836
The measurement scales were evaluated using confirmatory factor
analysis in terms of construct reliability, convergent validity, and
0.923 0.929 0.723 discriminant validity. The results reported in Table 2 indicate that the
0.780 Cronbach’s alpha (ranged from 0.819 to 0.947) and composite reli­
ability scores (ranged from 0.823 to 0.948) are well above the
0.806
commonly accepted cut-off value of 0.70 (Hair et al., 2018), which
0.901 provides sufficient evidence of reliability. Table 2 also shows that all
item loadings are statistically significant (p < 0.001) and greater than
0.70 (Hair et al., 2018; Hu and Bentler, 1999), and that average variance
extracted (AVE) values (ranged from 0.609 to 0.820) exceed the rec­
0.915
ommended cut-off value of 0.50 (Fornell and Larcker, 1981). Thus, these
results support the convergent validity of the theoretical constructs in
the model. As shown in Table 3, the square root of AVE of each theo­
0.841 retical construct is greater than the inter-construct correlations, thus
confirm discriminant validity (Fornell and Lacker, 1981). Therefore, the
0.819 0.823 0.609
0.701 measurement model reflects sound construct reliability and validity
necessary for testing the structural model.
0.791
5.2. Structural model assessment
0.843
After assessing the measurement model, we employed SEM to test
the structural model. Table 4 and Fig. 2 report the results of hypothesis
0.945 0.946 0.777 testing. Although hospital age and size were included as control vari­
0.795
ables in the analysis, neither of them has a positive effect on operational
flexibility. The model explains 39.1% of variance in inter-functional
integration, 78.7% of variance in hospital-patient integration, 67.4%
0.881 of variance in hospital-supplier integration, and 81% of variance in
operational flexibility. Table 4 indicates that BDAC is positively related
0.864
to internal-functional integration (β = 0.625, p < 0.001), hospital-
patient integration (β = 0.176, p < 0.05), and hospital-supplier inte­
gration (β = 0.414, p < 0.001), supporting H1a, H1b, and H1c. Internal-
functional integration positively affects hospital-patient integration (β
0.928
= 0.766, p < 0.001) and hospital-supplier integration (β = 0.496, p <
0.001), which provides support for H2a and H2b. Hospital-patient
0.932 integration β = 0.450, p < 0.05) and hospital-supplier integration (β
= 0.282, p < 0.01) are positively associated with operational flexibility,
suggesting that H3b and H3c are supported. However, our results found
0.922 0.925 0.755
0.854
no support for H3a (the effect of inter-functional integration on opera­
tional flexibility).
We employed a bootstrap method (with n = 2000 bootstrap resam­
0.872 ples) to test the mediation of hospital-patient integration and hospital-
supplier integration (Zhao et al., 2010). The bootstrapping analysis re­
0.907
sults are presented in Table 5. The indirect effect of hospital-patient
0.841 integration on the relationship between inter-functional integration
and operational flexibility is statistically significant at p < 0.01 with
90% CI = 0.355, 0.726. The direct effect of inter-functional integration
on operational flexibility is not significant (β = 0.248, n.s.). In addition
to the bootstrap method, the Sobel test was also performed, and the
results indicate that hospital-patient integration (z = 4.052, p < 0.001)
fully mediates the relationship between inter-functional integration and
7
W. Yu et al. Technological Forecasting & Social Change xxx (xxxx) xxx

Table 3
Inter-construct correlations.
Mean SD BDAC IFI HPI HSI OF
a
Big data analytics capability (BDAC) 4.667 1.657 0.906
Inter-functional integration (IFI) 5.314 1.318 0.628 0.850
Hospital-patient integration (HPI) 5.470 1.173 0.586 0.770 0.781
Hospital-supplier integration (HSI) 5.124 1.359 0.674 0.722 0.619 0.881
Operational flexibility (OF) 5.705 1.167 0.695 0.786 0.741 0.716 0.869
a
Notes: Square root of AVE is on the diagonal.
Correlation is significant at the 0.01 level (2-tailed).

6.1. Implications for research

Table 4
Structural model assessment: results of hypothesis test using SEM.
Out study extends OIPT to the healthcare SCM context by defining
Structural paths Standardised t- Hypothesis the three dimensions of hospital SCI and examining the associations
coefficient values testing outcome
amongst BDAC, hospital SCI, and operational flexibility in the context of
BDAC → Inter-functional 0.625*** 6.067 H1a: Supported China’s healthcare industry. OIPT posits that investment in vertical in­
integration
formation systems and creation of lateral relations enable organisations
BDAC → Hospital-patient 0.176* 1.973 H1b: Supported
integration to increase the capacity to process information for coping with complex
BDAC → Hospital-supplier 0.414*** 4.536 H1c: Supported tasks with high levels of uncertainty and interdependence (Galbraith,
integration 1973, 1974). In this study, three dimensions of hospital integration are
Inter-functional integration 0.766*** 5.855 H2a: Supported recognised as information processing capabilities that enable hospitals
→ Hospital-patient
to leverage lateral relations, to efficiently address inter-functional and
integration
Inter-functional integration 0.496*** 5.032 H2b: Supported inter-organizational interdependencies and processes (Galbraith, 1974;
→ Hospital-supplier Swink and Schoenherr, 2015). BDAC is recognised as a means for hos­
integration pitals to increase information processing capacity under contingencies
Inter-functional integration 0.248 1.429 H3a: Not
and exception scenarios (Srinivasan and Swink, 2018), for example,
→ Operational flexibility supported
Hospital-patient 0.450* 2.508 H3b: Supported
embracing uncertainty caused by the COVID-19 outbreak (Ivanov and
integration→ Operational Dolgui, 2020; Liu, 2020). Analysing and processing medical data with
flexibility advanced analytics techniques has played a crucial role in helping the
Hospital-supplier 0.282** 2.960 H3c: Supported Chinese health authorities and hospitals fight the COVID-19 pandemic
integration→ Operational
(Liu, 2020).
flexibility
Control variables Our study provides an initial examination of the association between
Hospital age → Operational 0.016 0.259 BDAC and hospital integration, and confirms empirical evidence of the
flexibility effect in China’s healthcare industry. Both healthcare and SCM re­
Hospital size → Operational − 0.034 − 0.549
searchers have suggested that a better understanding of the strategic
flexibility
Variance explained (R ) 2 implications of big data analytics in the healthcare supply chains is ur­
Inter-functional integration 0.391 gently needed (Srinivasan and Swink, 2018; Wang et al., 2019). The
Hospital-patient integration 0.787 healthcare literature suggests that big data analytics provides mean­
Hospital-supplier 0.674 ingful business insights that help healthcare organizations implement
integration
data-driven medical practice and improve quality and efficiency of
Operational flexibility 0.810
Model fit statistics: χ2 = 374.933; df = 219; χ2/df = 1.712; CFI = 0.933; IFI = 0.934; healthcare delivery (Wang et al., 2018a, 2019; Wang and Hajli, 2017),
TLI = 0.923; RMSEA = 0.083; SRMR = 0.061 while the SCM literature suggests that effective supply chain
*** decision-making often hinges upon the application of big data analytics
p < 0.001.
**
p < 0.01. (Gunasekaran et al., 2017; Srinivasan and Swink, 2018; Wang et al.,
*
p < 0.05. 2016). However, our knowledge regarding how big data analytics can be
applied into healthcare SCM practices and how it helps healthcare or­
operational flexibility. Similarly, the results also indicate that ganisations manage flows of patients, information, and materials along
the supply chains still remains limited. Thus, from an OIPT perspective,
hospital-supplier integration fully mediates the relationship between
inter-functional integration and operational flexibility. Hence, both this study contributes to the literature by providing empirical evidence
that hospitals investing in developing BDAC are likely to establish lateral
bootstrap test and Sobel test provide support for H4a and H4b, sug­
gesting that inter-functional integration affects operational flexibility relations between functional teams within the hospital, and outside the
hospital with patients and suppliers. China’s healthcare industry is
indirectly, through hospital-patient integration and hospital-supplier
integration. levelling up the adoption of big data analytics technologies (Agrawal
and Prabakaran, 2020; Zhang et al., 2018). The application of big data
6. Discussion and implications analytics enables hospitals to analyse medical data with an immense
volume, variety, velocity, and veracity, in order to support strategic
Our study extends OIPT (Galbraith, 1973, 1974) by applying a sys­ collaboration across a wide range of healthcare networks (Dobrzy­
kowski and Tarafdar, 2015; Srinivasan and Swink, 2018; Wang et al.,
tematic approach to understand the concept of hospital SCI, and paint­
2019).
ing an interesting picture of the associations between BDAC, the three
This study makes an important contribution to the SCM and
dimensions of hospital SCI, and flexibility. Reflecting on our findings, we
healthcare literature by employing a systematic approach to understand
identify the following contributions to both theory and practice.
the concept of SCI in the healthcare context (Flynn et al., 2010). To the
best of our knowledge, this is the first study to empirically explore
hospital SCI. From an OIPT perspective, we conceptualise hospital SCI as

8
W. Yu et al. Technological Forecasting & Social Change xxx (xxxx) xxx

Fig. 2. The model estimation results.

relationships lead to greater flexibility in patient care delivery (Srini­

Table 5
vasan and Swink, 2015, 2018). This provides a potential theoretical
Results of bootstrapping and Sobel tests for mediation.
argument to address the operational problems of lateral relations and
Structural Direct Indirect 90% CI for Sobel Result interdependencies inherent in hospital supply chains (Dobrzykowski
paths effect effect indirect test
and Tarafdar, 2015). To deliver high-quality healthcare services, hos­
effect
pitals should take into consideration feedback and suggestions from
IFI→HPI→OF 0.248 0.532** 0.355–0.726 z= Full
their patients and suppliers (Chen et al., 2013; de Vries and Huijsman,
4.052*** mediation
IFI→HSI→OF 0.248 0.150* 0.045–0.339 z= Full 2011). Hospitals need external integration with patients and suppliers
2.668** mediation that support external routines and processes that gather accurate
real-time demand and supply information, which is essential for
Note: IFI = Inter-functional integration; HPI = hospital-patient integration; HSI
= hospital-supplier integration; OF = operational flexibility; CI = bootstrap
strengthening information processing capabilities, especially when they
confidence interval; Standardized effects; 2000 bootstrap samples. execute operational tasks that involve high levels of uncertainty and
***
p < 0.001. interdependence (Galbraith, 1974; Srinivasan and Swink, 2015; Wong
**
p < 0.01. et al., 2011; Yu et al., 2019b). Our finding affirms Chen et al. (2013),
*
p < 0.05. who demonstrated the importance of one specific dimension of hospital
SCI, hospital-supplier integration, in improving supply chain perfor­
a multidimensional construct, and further examine how the three inte­ mance. However, their conceptualisation of SCI is incomplete, leaving
gration dimensions enable hospitals to deliver flexible and agile out the important central link of internal integration and
healthcare service for patients. Our findings reveal that inter-functional hospital-patient integration, which might hide some meaningful theo­
integration is an enabler of hospital-patient integration and retical and practical implications, and even lead the researchers to draw
hospital-supplier integration. This finding is consistent with the findings inaccurate conclusions (Flynn et al., 2010; Yu, 2015). Our finding lends
of previous manufacturing-based research (e.g., Yu et al., 2013; Zhao further support to the tenets of OIPT, establishing lateral relations with
et al., 2011), which contended that internal integration forms the their patients and suppliers enable hospitals to create information pro­
foundation upon which supplier integration and customer integration cessing capabilities for flexibility improvement (Galbraith, 1974). It is
must build. an important finding, since it is becoming increasingly important for
Our results indicate that functional teams within the hospital seem to healthcare organisations to make their operations and supply chains
be a prerequisite for establishing lateral relations with patients and more flexible due to the COVID-19 outbreak.
suppliers, which reinforces the important role of internal integration in
achieving hospital supply chain success in an uncertain environment
(Drupsteen et al., 2016). This is an important finding as previous studies 6.2. Implications for practice
have demonstrated that building effective physician-patient relation­
ships is one of the biggest challenges facing hospitals in China (He and Our research findings provide several useful and timely points of
Qian, 2016). When executing operational tasks that involve high degree guidance for healthcare executives and supply chain managers. First, as
of uncertainty and interdependence (Galbraith, 1974; Srinivasan and COVID-19 continues to spread, the need for healthcare organisations to
Swink 2015), hospitals progress from internal integration and processes operate flexibly has become more crucial in order to respond to the
toward effective management of external processes. Overall, the find­ exceptional demands on healthcare services caused by the COVID-19
ings extend OIPT to create a better understanding of the process of pandemic. We suggest that healthcare executives should consider
lateral relations development in the healthcare sector (Galbraith, 1974). investing in vertical information systems (such as adopting clinical and
Finally, by extending the applicability of OIPT, our study makes operational information systems) and creating lateral relations (such as
another important contribution to the literature by demonstrating the building cross-functional teams and strategic collaboration with patients
mediating role of hospital-patient and hospital-supplier integration. and suppliers). The development of such information systems enables
Consistent with tenets of OIPT, we find that the information processing hospitals to increase their capacity to process information, thereby
capabilities afforded by hospital-patient and hospital-supplier improving flexibility and agility, especially when they execute the
complex tasks that involve uncertainty and interdependence, like the

9
W. Yu et al.
current coronavirus outbreak.
Second, our study provides important insights for healthcare prac­
titioners who recognize the need for better collaboration and informa­
tion sharing in the hospital supply chains, but struggle to reap the full
benefits from the investment in health information systems and big data
analytics. Our research results provide established evidence that hos­
pitals in our sample indeed seize the benefits derived from the appli­
cation of big data analytics to develop cross-functional coordination
across functions within the hospital and close collaboration with pa­
tients and suppliers. These findings provide healthcare executives with a
more comprehensive understanding of how BDAC helps to develop an
integrated supply chain process.
Third, we suggest hospital leaders take a holistic view in managing
an integrated hospital supply chain. Inter-functional integration should
be developed first before building strategic collaboration with patients
and suppliers. However, managers should not expect internal integra­
tion efforts to directly improve flexibility. Hospitals should extensively
integrate their supply chain activities with suppliers and share medical
information with patients by pursuing a strategy with a broad arc of
integration. Healthcare executives should keep in mind that hospitals
need external integration with patients and suppliers to collect and
analyse accurate real-time demand and supply data essential for
strengthening information processing capabilities that allow greater
flexibility in healthcare delivery.
7. Conclusions and limitations
Based on OIPT, this study explores how hospitals increase their ca­
pacity to process information for achieving flexibility in healthcare de­
livery through investing big data analytics and establishing lateral
relations between functional teams within hospitals, and externally with
patients and suppliers (Galbraith, 1973, 1974). We extend the applica­
bility of OIPT and show that BDAC enables the hospital to develop intra-
and inter-organizational collaboration, and that the effect of
inter-functional integration on flexibility is mediated by both
hospital-patient integration and hospital-supplier integration. We also
provide useful and timely insights into the main challenges facing
healthcare executives regarding how hospitals can reap substantial
benefits from big data analytics to deliver flexible patient care service in
response to the COVID-19 outbreak.
This study has several limitations that provide opportunities for
future research. Previous research has argued that organizations with a
big data-driven culture are more likely to reap the full benefits of big
data initiatives (Dubey et al., 2019a). Future research might investigate
how data-driven culture helps hospitals that invest in developing data
analytics capabilities facilitate supply chain integration and improve
business performance. Prior research has acknowledged that trust is an
important mechanism to enhance inter-organizational collaboration
(Chen et al., 2013). Future research might investigate the moderating
and/or mediating role of trust in the relationship between data analytics
capability and integration in the healthcare supply chains. Our study
focused on collecting survey data from hospitals in China. Future
research might test and extend our theoretical model to different con­
texts and industries, which will help to establish the validity of empirical
findings identified in our study and address weaknesses of
cross-sectional studies. While we assessed CMB and confirmed that it is
not a significant threat to validity of the research findings, a longitudinal
study that examine how organisations develop strategic collaboration
with supply chain partners over time would help to reduce the possi­
bility of CMB and generate valuable insights for researchers and
practitioners.
10
Technological Forecasting & Social Change xxx (xxxx) xxx
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Wantao Yu is a professor of Supply Chain Management at the University of Roehampton.
His-research interests include supply chain integration, integrated green supply chain
management, and data-driven supply chains. His-work has been published in journals such
as International Journal of Operations & Production Management, British Journal of Man­
agement, International Journal of Production Economics, International Journal of Production
Research, Industrial Marketing Management, Production Planning & Control, Supply Chain
Management: An International Journal, and Decision Support Systems.
Gen Zhao is currently a PhD candidate at the Roehampton Business School, University of
Roehampton. He earned his master’s degree in Supply Chain Management and Logistics
from the University of Southampton.
Qi Liu is currently a PhD candidate at the Roehampton Business School, University of
Roehampton. He earned his master’s degree in Logistics & Supply Chain Management
from the University of Sheffield.
Yongtao Song is presently an associate professor at the Business School of Henan Uni­
versity, China. His-research interests include sustainable supply chain management,
quality management, and production management. He has published some journal papers
in Journal of Knowledge Management, Corporate Social Responsibility and Environmental
Management, Sustainability, Operations Management Research, Journal of Purchasing and
Supply Management, and Journal of Business and Industrial Marketing.