THE EFFECT OF IT GOVERNANCE ON HOSPITAL NETWORK OPERATIONS: AN

EXPLORATORY CASE STUDY

by

Jackson Ivan Isiko

Copyright 2021

A Dissertation Presented in Partial Fulfillment

of the Requirements for the Degree
Doctor of Management In Organizational Leadership with a Specialization in Information
Systems

University of Phoenix
 ABSTRACT

This study was an exploratory case study about the effect of IT Governance (ITG) on

hospital network operations. This study sought to understand stakeholders' perceptions on the use

of ITG and the relationship of ITG to critical health care infrastructures such as hospital IT

networks and network operations. This study explored stakeholders' perceptions by

understanding how the IT governance body and IT governance practices implemented at the

hospital affect IT Network Operations' efficiency at a hospital in the Western United States of

America. In a qualitative exploratory simple case study, the researcher triangulated evidence

from interviews, document review, and observation to reach a holistic understanding of the

impact of ITG on hospital network operations and health care services. Five major themes

emerged from this study, namely: (a) The ITG value creation process leads to IT agility for the

Hospital's IT network operations; (b) ITG is used for strategic alignment between the hospital's

governance practices and IT Network operations; (c) IT governance is used to measure the

performance of IT Network operations; (d) IT governance uses configuration management tools

to manage IT assets; (d) ITG is used for risk management and risk mitigation for IT-related risks.

The key recommendations to IT practitioners are: (a) Training and retraining employees in IT

best practices such as COBIT 5 and ITIL V5 to raise awareness about the ITG value delivery

process; (b) Constant communications about ITG can help improve the perception of IT

governance and IT governance at the hospital; (c) Implement a balanced scorecard (BSC) as a

performance management tool for IT network operations; (d) ITG should dedicate more time and

resources to the stewardship and accountability of IT assets at the hospital; and (e) The Hospital's

strategic leadership team should ensure that cybersecurity efforts are well funded to respond to

emerging information security risks effectively and proactively.

iii
 DEDICATION

I dedicate this study to my loving wife Stephanie, my friend, partner, and eternal

companion. You relentlessly but patiently encouraged me to continue to the end of my doctoral

journey, especially when I felt like giving up. You and our kids endured almost a decade of me

doing homework, even while on vacation. I remember several family trips and vacations where I

stayed at the hotel or at the campground in our motor home to work on and submit my

homework while you entertained the kids. To my mother, although you passed away when I was

12 years old, you instilled in me the value of education and hard work at a very young age. To

my father, you tough me that I would be successful through handwork and commitment to

education. You also sacrificed almost everything that you had to put me through school. To

Florence Isiko, you took care of me and raised me like your own son after my mother and uncle's

passing, and I will always be grateful for your love and support. To Bill Knowlton, Tom Hatch,

Michael Loosli, you helped me with the financial backing to attain my bachelor's degree in

Information Technology. I will never forget your financial support to help me earn my

undergraduate degree. To Herbert Shades, confidant in life and business partner, you have

always supported my academic endeavors. To Kagabo Robert, I am grateful for the educational

and dialogic guidance you gave me during my doctoral journey. Finally, to my Heavenly Father,

it is through his grace and mercy that a young man from a poor African family was able to

overcome all odds to gain a doctoral degree.

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 ACKNOWLEDGMENTS

Isaac Newton is noted to have said that “If I have seen further, it is by standing on the

shoulders of Giants” (Fawcett et al., 2015). It is on the shoulders of academic giants and church

leaders in my life that I have been able to learn and grow. To Dr. John C. Sienrukos, my

dissertation chair, Dr. Jennifer Lapin, and Dr. Donald Munday, my committee members, for your

continual feedback and guidance through the final doctoral course. To my University of Phoenix

peers, you provided unwavering support and dedication throughout my doctoral Journey.

v
 TABLE OF CONTENTS

Contents…………………………………………………………………………..……………Page

List of Tables……………………………………………………………………………..............ix

List of Figures………………………………………………………………………….................x

Chapter 1: Introduction .................................................................................................................... 1

Background of the Problem ................................................................................................ 1

Problem Statement .............................................................................................................. 5

Purpose of the Study ........................................................................................................... 6

Population and Sample ....................................................................................................... 8

Significance of the Study .................................................................................................... 9

Nature of the Study ........................................................................................................... 10

Research Questions ........................................................................................................... 15

Theoretical Framework ..................................................................................................... 15

Definition of Terms........................................................................................................... 16

Assumptions, Limitations and Delimitations .................................................................... 17

Chapter Summary ............................................................................................................. 18

Chapter 2: Literature Review ......................................................................................................... 20

Title Searches and Documentation ................................................................................... 21

Historical Content ............................................................................................................. 23

Current Content ................................................................................................................. 27

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 Theoretical Framework Literature .................................................................................... 30

Methodology Literature .................................................................................................... 34

Research Design Literature ............................................................................................... 43

Conclusions ....................................................................................................................... 45

Chapter Summary ............................................................................................................. 45

Chapter 3: Research Methodology ................................................................................................. 47

Research Method and Design Appropriateness ................................................................ 48

Research Questions ........................................................................................................... 50

Population and Sample ..................................................................................................... 50

Informed Consent and Confidentiality.............................................................................. 53

Instrumentation ................................................................................................................. 55

Pilot Study......................................................................................................................... 58

Credibility and Transferability .......................................................................................... 59

Data Collection ................................................................................................................. 64

Data Analysis .................................................................................................................... 67

Chapter Summary ............................................................................................................. 73

Chapter 4: Analysis and Results .................................................................................................... 74

Research Questions ........................................................................................................... 74

Data Collection ................................................................................................................. 75

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 Demographics ................................................................................................................... 80

Pilot Study......................................................................................................................... 82

Data Analysis .................................................................................................................... 82

Results ............................................................................................................................... 91

Chapter Summary ........................................................................................................... 106

Chapter 5: Conclusions and Recommendations ........................................................................... 107

Research Questions ......................................................................................................... 108

Discussion of Findings .................................................................................................... 109

Limitations ...................................................................................................................... 115

Recommendations to Leaders and Practitioners ............................................................. 115

Recommendations for Future Research .......................................................................... 119

Chapter Summary ........................................................................................................... 119

References .................................................................................................................................... 122

Appendix A: Informed Consent Form.......................................................................................... 150

Appendix B: One-on-One IT governance Interview Protocol ..................................................... 155

Appendix C: The Effect of IT Governance (ITG) on Hospital Network Operations Observational

Protocol ........................................................................................................................................ 158

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 LIST OF TABLES

Table 4.1: Interview Participant Demographics ............................................................................. 81

Table 4.2: Second Level Codes, Categories And Emerging Themes ............................................ 84

Table 4.3: Emergent Themes From The Study .............................................................................. 87

Table 5.1: Research Questions And Corresponding Emergent Themes ...................................... 111

ix
 LIST OF FIGURES

Figure 4.1: The codes, categories and emergent themes of the study. ........................................... 86

Figure 4.2: Showing a map of emergent categories and themes of the study ............................... 87

Figure 4.3: Showing the emergent themes in MAXQDA ............................................................. 92

x
 Chapter 1

Introduction

This study was an exploratory case study about the effect of IT Governance (ITG) on

hospital network operations. The research sought to understand the perception of stakeholders on

the use of ITG and the relationship of ITG to critical health care infrastructures such as hospital

IT networks and IT network operations. Understanding the effects of IT governance in hospitals

could help improve health care services through well managed Health Information Systems

(HIS) (Yang et al., 2013). In this qualitative exploratory case study, the researcher used

interviews, document review, and observation to understand the effect of IT governance on

hospital network operations and health care services by asking good research questions,

exercising good listening skills, good project and document management helped the researcher

succeed in the research. The researcher in this chapter covers: (a) the background of the problem,

(b) problem statement; (c) the purpose of the study; (d) population and sample; (e) significance

of the study; (f) nature of the study, (g) the research questions, (h) conceptual framework; (i)

definition of terms; and (j) assumptions, limitations and delimitations of the research.

Background of the Problem

Due to the ubiquity of IT in all sectors, there is an increased dependence on Information

technology and IT services in almost every organization in the 21st century (Ko & Fink, 2010).

Peterson (2004b), argued that information technology governance (ITG) had emerged as a

fundamental business imperative because the effective implementation of ITG leads to the

creation of business value and wealth. There is a relationship between IT governance and

corporate governance. Organizations should seek to strengthen those relationships for business

agility and competitiveness (Ko & Fink, 2010; Jairak & Praneetpolgrang, 2013). ITG is an

1
integral part of corporate governance; as such, ITG tends to benefit from the mature and well-

defined processes of corporate governance. ITG is likely to be well defined and implemented in

an organization by covering risk management, information security, service quality, IT asset

management and IT alignment to the corporate vision of the business (Subsermsri et al., 2015).

Research shows a positive correlation of organizational performance when organizations have

alignment between business and IT strategy (Reynolds & Yetton, 2015). The challenge however,

is that good corporate governance and IT governance is often found lacking in many

organizations (Jairak & Praneetpolgrang, 2013; Subsermsri et al., 2015). Sound corporate

governance is not only essential in the business world but critical in the health care industry

(Jamali et al., 2010). In addition to good corporate governance, CEO support for IT governance

tends to be related to the need for fascial responsibility regarding IT investments and the

alignment of IT investments to organizational goals (Wilkin et al., 2016). Although sound

corporate governance is necessary for the successful implementation of IT governance in the

health care industry, sound corporate governance is also often found lacking in the health care

industry. Because sound corporate governance is usually found lacking, IT governance as a

subcomponent of corporate governance is often found lacking as well.

IT departments in an organization are likely to succeed if they are in a position to

continuously offer cost-effective services in a timely manner (Gerdewal & Seçim, 2014), the

rising cost of IT expenditure in organizations, failed IT projects, and the negative impacts that

organizations face as a result of failed IT projects have led to an increased amount of scrutiny of

IT department and a demand for IT accountability (Phillips, 2014; Asgarkhani et al., 2017). In

addition to increased demand for IT accountability, there is increased demand by the IT industry

and compliance requirements that have forced organizations to implement best practices and

2
frameworks such as Control Objectives for Information Technology (COBIT) framework

(Phillips, 2014, Bowen et al., 2007). Information Technology Infrastructure Library (ITIL),

International Organization for Standardization (ISO), and the International Electrotechnical

Commission (IEC). Of all IT governance (ITG) frameworks, ITIL is the most adopted IT

governance framework (Nicho & Muamaar, 2016; Marquis, 2006). ITIL is a collection of best

practices for IT operations initially developed by the British government (Worthen &

Framingham, 2007). The implementation of ITIL as an IT governance framework however, can

be a long, complicated, and challenging task for many organizations and their IT departments

(Nicho & Muamaar, 2016). IT Governance is used to align IT services to strategic business

goals to improve IT services and perform continuous improvement of IT services to meet both

business and a business’s customer needs (Wautelet, 2019). The implementation of good ITG

and IT best practice frameworks call for good IT strategies. Monat (2006), posited that without

clear information technology strategies and flexible leadership styles aligned to serving

organizational needs, businesses might struggle to succeed in the 21st century. Teo, Abd Manaf,

and Choong (2013) contended that the demand for effective IT governance is on the rise as

businesses and governments continually increase their dependence on IT Network Services. Well

managed and well-governed IT functions can lead to very effective and efficient IT processes

that are responsive to business needs (Phillips, 2014).

IT success requires good corporate and IT governance practices, Clarke and Branson

(2012) argued that good corporate governance is an essential component of market integrity,

efficiency, and financial growth of an organization. However, entrepreneurs, investors, and

corporations sometimes lack the flexibility to craft governance that can quickly respond to

changes in technology, competition, and customer needs. Most organizations require a certain

3
degree of governance, including corporate governance and IT governance (Doherty et al., 2012).

Although IT governance plays a critical role in regulating how IT services are delivered to an

organization, poor implementation of IT governance processes could increase the time IT

departments and businesses take to continuously provide improved IT Network Operations and

Network Services to their customers in environments such as hospitals.

IT governance is a subset of corporate governance, corporate governance is an

organizational practice concerned with maintaining a balance between economic and social

goals, individual and communal goals in a way that is designed to optimize organizational

resources through accountability and good stewardship of an organization's resources (T. Clarke

& Branson, 2012). Researchers such as (C. T. Clarke, Branson, 2016; Phillips, 2014) suggested

that almost all organizations in the 21st century are affected by poor IT governance, which

includes services such as IT Network Services and Network Operations. To solve the IT

governance challenges faced by many organizations, best practices such as ITIL, ISO 2000, and

COBIT have been established and adopted by the IT industry to help organizations to effectively

support and govern their IT operations and services (Gerdewal & Seçim, 2014). Although best

practices such as ITIL can be used to implement ITG in an organization, best practices such as

COBIT have been used as a proxy for IT management practices and a control mechanism for

managing enterprise-wide IT practices, the COBIT framework is particularly perceived to be an

effective best practice for IT governance (Phillips, 2014). However, despite the existing IT

governance best practices such as ITIL and COBIT many organizations implement IT

governance poorly and ended up with IT governance process that are not aligned with business

goals, strategy and mission (Nicho & Muamaar, 2016), furthermore, the implementation of IT

governance best practices in many organizations has not translated into IT alignment with the

4
organizations objectives in a way that IT is used to sustain the business (Improving Strategic

Alignment: A Case Study, 2015) . Poor implementations of IT governance could result into a

miss alignment between IT practices and corporate goals (Hiekkanen et al., 2015; Phillips,

2014). The miss alignment between business and IT goals and objectives could lead to poor

service delivery of IT network services and the continuous service improvement of IT services as

a whole (Ahmad et al., 2013a). Poor IT governance could also minimizes shareholder value and

diminishes the relationship between the principal (owners of the business) and agents (managers

that run the business), as suggested by Donaldson and Davis (1991).

Problem Statement

The main problem is that poor information technology governance (ITG) has often led

to failed IT projects and implementation of effective IT operations in organizations that heavily

rely on IT for business operations (Ako-Nai & Singh, 2019). ITG governance is often found

lacking in critical healthcare IT infrastructures such as IT networks; poor IT governance could

impact the quality of IT services delivered by an IT department (Jairak & Praneetpolgrang,

2013). ITG is used to align IT services to strategic business goals in an effort to improve IT

services and perform continuous improvement of IT services to meet both business and a

business’s customer needs (Wautelet, 2019). Although ITG plays a critical role in regulating

how IT services are delivered to an organization, poorly implemented IT governance processes

could increase the time IT departments and businesses take to continuously provide improved IT

Network Operations and Network Services to their customers in environments such as hospitals.

To compound the problem of the lack of ITG in hospitals is the fact that health care

organizations are complex systems that heavily depend on good governance and multiple levels

of the governance process; corporate governance in hospitals may include Clinical governance,

5
medical governance, research governance (Delaney, 2015). Good cooperate governance in health

care works to reduce the level of discordance between the different entities within a health care

organization such as IT to improve service delivery, and patient care is critical to a hospital's

success (Delaney, 2015).

Effective ITG could mitigate the impact of network operations and service delivery of

health care services (Jairak & Praneetpolgrang, 2013; Subsermsri et al., 2015). Because

healthcare providers often deal with the lack of good corporate governance (Jairak &

Praneetpolgrang, 2013); poor corporate governance, in many cases, leads to poor ITG in hospital

environments that may lead to catastrophic health care system outages and may lead to poor

patient care. Corporate Leaders in the health care industry need to institute an effective ITG

process that will mitigate the risk of health system failures that could cause poor patient care.

The specific problem is that ITG governance is often found lacking in critical health care IT

infrastructures such as IT network operations. Yet, network operations and network

infrastructure are at the heart of the effective service delivery of health care services. This

research will seek to answer the question, what is the relationship between IT governance and

hospital network operations?

Purpose of the Study

A previously noted in the introduction of this chapter, this study used an exploratory

qualitative single case study to understand stakeholders' perceptions on the use of ITG and the

relationship of ITG to critical health care infrastructures such as hospital network operations. The

study also sought to explore how the IT governance body and IT governance practices

implemented at a hospital in the Western United States of America affect IT Network

Operations' efficiency at the hospital. This study: 1) Contributes to the knowledge of

6
professionals such as IT managers, Network engineers, Hospital administrators, and other

hospital stakeholders about the significant contributions that IT governance could have on

hospital network operations. 2) The research findings also contribute to the understanding of IT

professionals and hospital administrators about how to effectively implement IT governance as a

way to improve the alignment of network operations the strategic, goals, and missions of the

hospital.

Because many IT network services may take a long time to implement, leading to

frustrated customers, poor patient care, and lost business in settings such as a hospital, there is a

need to reexamine the role that corporate governance processes and IT governance processes

play in organizations such as hospitals in the Western United States of America. This study

examined the processes IT departments use to effectively govern IT Network Services' service

delivery and improve on existing IT Network Services at a hospital in the Western United States

of America. The findings of this research may provide important information to the hospital

board of directors, leaders such as the Chief Technical Officer (CTO), Chief Information Officer

(CIO), IT managers and hospital administrators with tools and practices on how to improve their

processes to reduce the time it takes to implement IT Network services to the business and its

customers but at the same time implement effective IT governance practices that are aligned with

the goals, mission, and strategy of the hospital.

The location of the research was at a hospital in the Western United States of America.

The research was feasible based on the researchers' proximity to the study site unit and the use of

online tools such as Microsoft Teams to conduct interviews, observations, and the hospitals' IT

governance website to conduct a document review. The three primary sources of evidence used

were interviews, observation, and document review of the existing IT governance process.

7
 Population and Sample

The goal in both qualitative and quantitative studies is to select a sample that would most

appropriately help answer the research question (Meltzoff, J., & Cooper, 2018), In qualitative

research, a sample-sized between 10-30 participants among a homogeneous population is

considered adequate (Boddy, 2016). This study explored a purposive sample of 11 current IT

employees and hospital administrators responsible for IT governance and part of the change

advisory body (CAB). The employees interviewed include: The Chief Technical Officer (CTO),

IT directors, IT managers, Network Engineers, and IT service desk personnel. The study

examined how IT governance processes and practices impact IT network operations at a Hospital

in the Western United States of America. Because of the COVID 19 pandemic health

restrictions, face-to-face interviews were not possible. Interviewee participation involved

participating in 30-45 minutes semi-structured interviews using Microsoft Teams during the

month of January 2021. Document review and observation was used to collaborate findings from

interview data to validate the ITG processes used at the Hospital during the research period. The

main reason for conducting interviews and document review was to evaluate how the

implementation of ITG impacts the Network operations of a hospital in the Western United

States of America.

Participation was strictly confidential; the interviewees were assigned pseudonyms,

making it impossible to trace back to the respondents personally identifiable details. Participants

will have the right to receive a link to the dissertation which will include the study results; the

desertion may be published in academic libraries such as ProQuest and IT academic Journals

such as the Journal of Information Technology.

8
 Significance of the Study

Although multiple studies have been conducted about the effects of corporate governance

and IT governance on an organization as the study by Nfuka and Rusu (2011) about the effect of

critical success factors on IT governance performance and a study by (Hiekkanen et al., 2015;

Salah, Rahim, & Carretero, 2010) about IT alignment and corporate governance in general,

current literature is silent about the effects of IT governance on hospital network operations.

The researcher used a case study of a hospital to understand hospital stakeholder perceptions

about the relationship of IT governance on network operations at the Hospital, this kind of

research had not been done before. The Goal of the study was to understand the relationship

between IT governance and the effects of IT governance on critical health care infrastructures

such as IT networks at a hospital in the Western United States of America. The findings from

this study may help hospital stakeholders implement and exercise IT governance best practices to

improve the service delivery of IT services by aligning the IT network operations department to

the goals, mission, and strategy of the organizations.

The findings in this study will also inform IT practitioners about the best way to

implement IT Governance specifically tailored to network operations; increased understanding of

how IT governance can be improved on in a hospital setting may not only improve hospital

network operations but could also lead to improved health care service delivery. The research

will contribute to the academic community by informing future researchers about some of the

benefits of effectively implementing IT governance in a hospital.

9
 This research used a single exploratory case study at one Hospital in the Western United

States of America. Simple case studies tend to be subjective; more research using multiple case

studies should be conducted to examine the differences in IT governance between several

hospitals in the Western United States of America and across the nation. Quantitively and mixed

methods studies may also be undertaken across hospitals in the Western United States of

America and across the United States to further measure the impact of IT governance on hospital

network operations on health care services at hospitals in the United States. Such studies would

allow the researcher to triangulate data from different sources and environments; triangulating

data from different sources of evidence, both qualitative and quantitative, may be wholistic

enough to serve as a ground to recommend and provide the most effective IT governance best

practices for Hospital Network Operations, and the role of network operations in improving

patient care.

Nature of the Study

The research design that was used is a simple exploratory case Study. Exploratory case

studies are used to explore a phenomenon in which the interventions being used has no clear set

of outcomes (Baxter Pamela & Jack, 1990). Research instruments and research design are at the

heart of the research study; as such, researchers should endeavor to design research instruments

as flawlessly as possible regardless of the research methods in use (Brewer et al., 2015). Case

studies are qualitative research designs used to explore a time, space-bound, and context-bound

phenomenon. Case study investigators explore real-life single our multiple bound systems over

time using in-depth data collection involving multiple sources of information (Alpi & Evans,

2019; Hyett et al., 2014b) also posited that a qualitative case study explores a real-life ,

contemporary bounded system. Case study evidence can be collected from interviews,

10
observation, document review, and physical artifacts (Alpi & Evans, 2019), case studies may use

multiple sources of data to gain a nuanced view from multiple perspectives (Farquhar et al.,

2020a). A case study, especially a single case study, is bounded because case studies focus on a

single entity (Jensen & Rodgers, 2001). Hyett et al., (2014a) suggested that a case study research

is an investigation and analysis for a single or multiple cases to capture the complexity of the

object of study (Hyett et al., 2014a).

Further, a case study is a design of inquiry that can be applied to many fields, mainly in

which a researcher develops and in-depth analysis of a case such as a program, an event, activity,

or processes in an organization (Creswell & Creswell, 2018). Although case studies cannot be

used for generalization in social research, case studies are used to study human behavior because

they are down-to-earth and attention-holding (Stake, 1978). Case studies are also bounded

systems; as suggested by (Alpi and Evans 2019; Hyett et al., 2014a), the meaning of a bounded

system in a case study is derived from the characteristic of cases study designs, case studies are

context-bound or specific to a unit of study, a case can be a bounded system such as an

institution (Stake, 1978) , time-bound, for example, a year or 6 months as the period of study.

Case boundaries are kept in focus to determine what is in scope and what is out of the scope of

the study (Stake, 1978).

Case Studies may be used to develop an understanding of an organization such as an IT

department as a case (Yin, 2016), describe how the IT department works, point out some themes

that emerge from talking to IT employees throughout the data collection period. Using a case

study approach, a researcher can see how the IT department works and the impact an IT

department has on an organization.

11
 Questionnaires and interviews are commonly used question-answering research

instruments in qualitative research (Rowley, 2014). Online surveys are an excellent example of

quantitative instruments (Leman, 2010). Shin (2016) used quantitative instruments such as

surveys and qualitative instruments such as interviewing on focus groups and experts to

understand how cross-platform services provide unified experiences across multiple devices that

users can use to watch content using platforms such as televisions, computers, and handheld

devices. In quantitative studies, researchers use web best tools to develop a questionnaire and

post the questionnaires online or distribute the questionnaires using email. In qualitative studies,

Face to face interviews are used, interviews may be recorded, transcribed, and coded to

determine merging themes from the interviewees. A qualitative case study was used because

qualitative case studies seek to answer the “why” and “how” questions of a research

phenomenon (Yin, 1981) and (Yin, 2016).

For anonymity purposed, the case considered for inquiry is only referred to here as a

hospital. Therefore, a hospital in the Western United States of America was considered for this

case study. Researchers may use a combination of three forms of data collection, such as

document review, interviews, and direct observations of participants (Cunningham et al., 2017).

The researcher used Microsoft Teams to conduct semi-structured interviews for the CIO, IT

directors, IT managers, Network engineers, and service management experts at the hospital.

After interviews were conducted, interviews were be first transcribed before the data

could be analyzed as recommended by Nascimento and Steinbruch (2019). Preparation of data

from audio to transcripts is usually the next logical sequence after interviews are

recorded(McLellan et al., 2003). Transcription is used in qualitative research to show evidence

about a particular phenomenon that constitutes a certain interest in a study; transcription is

12
largely shaped by the institutional culture, academic environment, and background of the

researcher (Nascimento & Steinbruch, 2019). Due to the complexity of the data transcription

process, many researcher tend to dislike the process; researchers can use data transcription

technologies such as voice recognition software (VRS) as a strategy to ease and increase the

speed of the data transcription process for audio recordings (Matheson, 2007). The researcher

generated transcripts from data recordings that were later used for further analysis by coding,

categorizing and analyzing themes that emerged from the data.

The next phase of qualitative research after collecting data is analysis and interpretation

of qualitative data; data analysis is a dialectic process of making sense of qualitative data; it is

the process generating new insights from raw data into intelligible accounts (Cunningham et al.,

2017), during research analysis researchers engage in categorization, abstraction, comparison,

dimensionalization, integration, iteration, and refutation of data (Spiggle, 1994). Qualitative

analysis is an inductive approach of understanding what is going in on within an inquiry through

a process of continually hunting for themes and concepts that emerge from the collected data,

researchers do not impose themes and concepts that should emerge out to the data prior to the

analysis of the data (Srivastava & Hopwood, 2009). Using and induction approach of data

analysis allows patterns and themes to emerge from the data based on what the researcher wants

to know from the data based on the theoretical framework of the researcher, the researcher's

subjective perspective, researcher ontological and epistemological perspective (Srivastava &

Hopwood, 2009).

The key to qualitative research analysis is mastering the art of reflexivity and data

iteration as the researchers reviews, analyze, and revisits with analyzed data over and over to

13
discover new and emerging themes from the data and how those themes inform the researchers

inquiry (Srivastava & Hopwood, 2009).

An expert data analysis process and steps for case study design suggested by Srivastava and

Hopwood (2009), recommended that data analysis should focus on three main questions the

questions are 1) what are the data telling me?, 2). What is it that I want to know from the data?

3). What are the dialectical relationships between what the data is telling me what I want to

know? Data analysis is a meaning-making process that should consist of examining,

categorizing, tabulating, testing, or recombining both qualitative and quantitative evidence to

address the initial proposition of a study (Yazan & De Vasconcelos, 2016).

During data analysis, the initial skill that qualitative researchers may need to master is the

skill of examining, categorizing commonly referred to as coding qualitative data; qualitative

researchers that wish to become proficient at doing qualitative analysis must learn to code well

and efficiently. However, it is not possible for researchers to claim final coding authority because

there is no standard approach to coding neither is coding the only way for analyzing qualitative

data (Saldaña, 2016; Onwuegbuzie, Frels, & Hwang, 2016).

A code in qualitative research is a word or short phrase that symbolizes salient, essence-

capturing, and or evocative attributes for a proposition of language-based on visual data. Coded

data could consist of interview transcripts, observation notes, journal analysis, documents,

drawings and artifacts, email correspondences and much more, coding is not a precise science,

rather it is an interpretive act (Saldaña, 2016). Coding is not a linear process but an iterative and

reflective process (Srivastava & Hopwood, 2009). Once coding has been done, it becomes easier

for researchers to tabulate test or recombine qualitative evidence to address the initial proposition

of a study.

14
 Research Questions

Many case studies begin with a pilot exploratory research question, the purpose of the

pilot exploratory question is to identify the research questions or procedures to be used in the

subsequent research study (Yin, 2016; Robert, 2014). The researcher did not need to conduct an

exploratory case study to determine if the researcher had the correct research question and topic

for the research because it was clear to the researcher that the research question was feasible

based the literature reviewed.

Main research question

This research addressed the following research question (RQ):

RQ 1: What is the relationship between IT governance and hospital network operations?

Interviews, document review and observations conducted by the researcher were guided by the

following sub questions (SQ):

SQ 1: How is IT governance of network operations used to deliver value to the Hospital?

SQ 2: How is IT governance of network operations used for strategic alignment to the Hospital's

goal and mission?

SQ 3: How is IT governance of network operations used for performance management?

SQ 4: How is IT governance of network operations at the Hospital used for resource

management?

SQ 5: How is IT governance of network operations at the Hospital used for risk management?

Theoretical Framework

This research work is situated in the literature on corporate governance; as posited by

Joslin & Müller (2016), corporate governance is the system used to control and direct companies

(Yusof, 2016). IT governance works under the umbrella of corporate governance. Corporate

15
governance is situated in agency theory, stewardship theory, transaction cost economics,

stakeholder theory, shareholder theory, and resource dependency theory. Christopher (2010) also

noted that corporate governance principles are informed by theories such as agency theory; as

such, one of the foundations of corporate governance is agency theory. The epistemological

background of agency theory is rooted in economics and has for decades been used by scholars

across several disciplines such as organizational behavior, law, marketing, health care, and

accounting (Bendickson et al., 2016). Agency theory has its roots in the work of a German

sociologist Max Weber; agency theory is based on the concept of risk-sharing between two

parties; the two parties are the principal and agent (Bendickson et al., 2016), the principal is the

business owners or shareholders and the agents are the managers of the business, in agency

theory, one party acts on behalf of another (Shapiro, 2005), in this case, the managers of a

business are agents delegated to act on behalf the principal the stake holders of the business. The

main focus of agency theory is control (Asgarkhani et al., 2017), in the context of IT governance,

the principles of agency theory are used to control, direct and govern IT operations. IT

governance therefore is built on the foundation of agency theory, agency theory is one of the

guiding theories of corporate governance.

Definition of Terms

The section below defines technical terms used in this dissertation that readers might not

be familiar with. The definition of terms is used to increase understanding of the study.

Governance: It the process by which organizational leaders such as board of directors

use management to guide an institution in fulfilling its cooperate mission and protect an

organizations assets (Hamidovic, 2010)

16
 IT governance: IT governance is a framework used to encourage desirable IT

implementation, accountability, and behavior in an organization (A. E. Brown & Grant, 2005).

Furthermore, ITG governance is concerned with the IT delivery of value to the business and the

mitigation of IT risks (Hamidovic, 2010).

Corporate Governance: Is how a firm is run to meet the interests of the firm’s stake

holders (Tagesson & Collin, 2016), corporate governance is used to direct and monitor the

business affairs of an organization (Pardis et al., 2016)

Agency theory: Is a theory rooted in economics where one party say an agent

(management team) represents another party principal(business owners such as stakeholder)

(Jiang et al., 2012)

ITIL: IT infrastructure Library (Hamidovic, 2010)

COBIT: Control Objectives for IT (Phillips, 2014; Lapão, 2010)

IT organizational alignment: Is the business value that IT contributes to the business in

terms of relationship and congruence.

Assumptions, Limitations and Delimitations

The researcher assumed that the research participants were be willing to share

information about IT governance during the data collection phase of the research. The researcher

also assumed that the Hospital would provide document review and access to their environment

to allow the research review and observe the IT governance process. This study is a qualitative

simple case study; qualitative findings and interpretations tend to be subjective because

researchers may make assertions about a phenomenon based on their assumptions about the

nature of text data, the researcher’s influence on text interpretation, and the validity checks used

to justify text interpretations (Lacity & Janson, 1994). Quantitative research explains research

17
findings based on facts primarily through objective measurements (Firestone, 1987). Researchers

using qualitative research use multiple techniques, and the inquiry process is flexible as the

researcher sees fit for a given scenario (Cypress, 2017), the kind of flexibility that qualitative

research calls into question the research validity of the research findings since the researcher is

sometimes the instrument of the research (Cypress, 2017). Good qualitative research must

therefore demonstrate research rigor, reliability, and validity (Barusch et al., 2011a; Thomas &

Magilvy, 2011). Quantitative research rigor is equivalent to reliability and validity in quantitative

research (Thomas & Magilvy, 2011), qualitative research rigor can be demonstrated through the

researcher's ability to show credibility, transferability, dependability, and confirmability of their

research findings (Thomas & Magilvy, 2011). Therefore, as a limitation, it is hard to demonstrate

research rigor and generalize conclusions based on a single exploratory case study conducted at

one Hospital in the Western United States of America, as previously noted in this study, simple

case studies tend to be subjective. Future research using multiple case studies should be

conducted to examine the differences in IT governance between several hospitals in the Western

United States of America and across the United States of America.

Chapter Summary

This chapter introduced an exploratory case study about the impact of IT Governance

(ITG) on hospital network operations. In this study, the researchers sought to seek to understand

the role of IT governance and the effects of IT management on critical health care infrastructures

such as IT networks. Understanding the impact of IT governance in hospitals could help

improve health care services through well managed Health Information Systems (HIS) (Yang et

al., 2013). In this qualitative explanatory simple case study, the researcher used interviews,

18
document review, and observation to understand the impact of IT governance on hospital

network operations and health care services.

Poor IT Governance tends to lead miss alignment between IT practices an organization's

missions, goals and overall strategy (Improving Strategic Alignment: A Case Study, 2015). In

this chapter, the researcher has introduced the concept of IT governance as a framework used to

encourage desirable IT implementation, accountability and behavior in an organization (A. E.

Brown & Grant, 2005). IT governance is a subset of corporate governance, corporate governance

is the process by which organizational leaders such as board of directors use management to

guide an institution in fulfilling its cooperate mission and protect and organizations assets

(Hamidovic, 2010). IT governance and IT activities need to be aligned to an organizations goals,

missions and strategy to be successful (Improving Strategic Alignment: A Case Study, 2015).

Chapter 2 will focus on the literature review of IT governance.

19
 Chapter 2

Literature Review

This literature view covers IT governance and the effects of IT governance on hospital

network operations. The value of technology is not just in its possession; organizations need to

effectively govern IT resources for business success (Lanka, 2015). Information technology has

become an indispensable aspect of running business in the 21st century; organizations need to

have reliable IT departments that can cater to business needs and that are aligned to the business

needs of an organization; the process of creating reliable IT departments requires good IT

governance (Bianchi & Sousa, 2016; Lanka, 2015). Due to the ever-increasing dependence on

information technology by almost all organizations, the heightened risk of IT failure and miss

management of IT assets has led to an increased amount of IT scrutiny by business

organizations(Phillips, 2014). Although various bodies and IT governance frameworks have

contributed to the ITG framework such as the Information Systems Audit and Control

Association (ISACA) and Information Technology Governance Institute (ITGI), some of the

well-known ITG best practices are COBIT (Control Objectives for Information and Related

Technology), ITIL (Information Technology Infrastructure Library), and ISO17799: 2000

(International Standards Organization). There is no silver bullet answer to IT governance, the

solution lies between fine-tuning organizational structures, process and relational mechanisms of

an organization (Jairak & Praneetpolgrang, 2013). In health care, Health Information Systems

(HIS) have the potential to enhance productivity, lower costs, reduce medical errors and reduce

human resources strain in the health care industry (Yang et al., 2013; Rice, 2015), suggested that

HIS systems are increasingly becoming pivotal to the delivery of patient care because HIS

systems health care providers conveniently collect, organize and analyze patient information.

20
The following sections will highlight the historical literature, current literature and researchers

that have contributed to the common body of knowledge concerning IT governance.

Title Searches and Documentation

The list below is a list of some of the keyword’s searchers used by the researcher to

search the literature during the research literature review. The researcher used the University of

Phoenix online library to search for the content, other online libraries such as Academia.edu and

ERIC.ed.gov were used to search for content about IT governance:

1. "hospital governance" AND "information technology”

2. "information governance" AND ("hospital network" OR "hospital networks”)

3. “IT governance” AND ("hospital network" OR "hospital networks”) AND “A

case study"

4. “IT governance” AND (“hospital IT network" OR "hospital IT networks”)

AND “A case study"

5. "hospital governance" AND "information technology” AND “Case Study”

6. "IT governance” and "Case Study"

7. "IT governance” and "A case study"

8. Although the hospitals IT governance process were strong, IT governance at the

hospital was week when it came to measuring "outcome metrics”

9. "constant comparative data analysis" AND "Case study”

10. "constant comparative data analysis”

11. "constant comparative data analysis" AND "Case Study" AND "IT Governance”

12. "IT governance" and “Agility"

13. "IT governance" and "strategic alignment”

21
14. "IT governance" and "performance management”

15. "IT governance" and “IT resource management”

16. "IT governance" and "risk management”

17. Governance

18. IT governance

19. IT governance in hospital networks

20. IT governance in non-hospital networks

21. Health Information systems

22. IT governance for health providers is necessary

23. Corporate Governance

24. Agency theory

25. IT governance alignment to corporate governance

26. Network operations governance

27. Impact of IT governance on Network operations

28. ITIL and IT governance

29. Benefits of cooperate governance to an enterprise.

30. The challenges of IT governance to an enterprise.

31. IT governance in hospitals

32. IT best practices

33. Complexities of IT governance

34. IT governance in the 21st century

35. IT governance success stories

36. IT governance failures.

22
 37. Effective IT governance

38. Effective Governance

39. Global IT governance initiatives

40. Triangulation

Historical Content

The aim of the historical context of section paper is to provide a historical context of

Information Technology Governance (ITG) and the benefits of ITG in environments that heavily

depend on Information Technology (IT) such as hospital computer networks in the healthcare

industry, the health care industry uses ITG to standardize and optimizes processes to enjoy a

competitive advantage that comes from effective and well-controlled IT practices. Although

ITG is a broad field generally categorized into IT decision domains such as: (a) IT Infrastructure,

(b) IT architecture, (c) Business Application Needs, (d) IT Investment, and (e)Prioritization

Decisions and IT principles (Weill & Woodham, 2005; Köbler et al., 2010). The focus of this

historical literature review is on IT governance for network operations in hospital environments

ITG for network operations falls under the IT architecture domain.

IT governance is a specific field of corporate governance which rose from the backdrop

of the increased importance of IT in enterprises and businesses today (Köbler et al., 2010). By

the beginning of the 21st century, many organizations heavily relied on information technology

to maintain a competitive advantage. However, many organizational information systems faced

threats that arose from poor or weak controls. As a result, IT governance rose from the need to

minimize information security risks and poor IT controls (Abu-Khadra et al., 2012). The attack

on the world trade center on September 11, 2001, raised both government and private sector

attention to securing and governing Information Technology assets of an organization(Hawkins

23
et al., 2003). Turel and Bart (2014), also noted that the collapse of large corporations such as

Enron and WorldCom that primarily resulted from the lack of good ITG controls to protect large

corporations such as Enron from cooperate fraud led to a new reality that Information security

risks could no longer be ignored by cooperate and government leaders, consequently, IT

governance quickly became a top management issue (Lainhart IV, 2000). Organizational leaders

increased their involvement in IT matters, and various studies suggested that that board member

oversight had the potential to influence organizational performance (Turel & Bart, 2014;

Lainhart IV, 2000). Heightened information security risks and legal requirements to secure

enterprise information systems such as mandated by the Sarbanes-Oxley act in 2002 gave rise to

IT governance frameworks such as the Control Objectives for Information and Related

Technology (COBIT) maturity model and the Information Technology Infrastructure Library

(ITIL) best practices (Abu-Khadra et al., 2012).

The other reason that led to the rise of ITG is that IT is highly integrated and co-evolves

with business, many top executives could no longer ignore or simply delegate what IT does,

growing scrutiny of IT operations, budgets, and contributions to a business’s competitive

advantage leads to IT governance (Peterson, 2004a). The rise of strategic management of IT

resources as a means to increase organizational performances led many business leaders to pay

more attention to IT activities as a way to gain and maintain a competitive advantage (Turel &

Bart, 2014). ITG describes the decision making roles and responsibilities among the different

stakeholders in an organization; ITG also defines the rights of decision-makers, processes, and

monitoring of decision making (Peterson, 2004b; Weill, 2004). ITG enables organizations to

align IT and business goals (Ali & Green, 2012).

24
 In the past two decades, the government in the United States of America faced a

challenge of moving hospitals and physicians into the digital error; hospital leaders and

physicians needed to start viewing Health Information systems as a mainstream technology and

as part and parcel of the medical practice before the digital transition could occur (Blumenthal,

2010). The digital divide in the health care industry was due primarily to the fact that the health

care industry was underfunded, which led to challenges such as poor patient information privacy

(Cotter, 2007). Because the health care industry was underfunded (Cotter, 2007) and behind the

curve when it came to the adoption of information technology for business operations (Zhang et

al., 2013), the federal government in the United States of America led efforts for the adoption of

HIS systems to effectively manage electronic patient records, the adoption of electronic records

management systems led to benefits such as quality, efficiency, and provider satisfaction in the

health care industry (Buntin et al., 2011).

The need to digitize the healthcare industry led to another set of challenges, the rise in

complexity and sophistication of the IT capability in hospitals, increased IT complexity led to the

increased importance of IT governance in the health care industry (Bradley et al., 2012). The rise

in medical IT led to a requirement that IT managers standardized and optimized processes

(Köbler et al., 2010; Hoerbst, Hackl, Blomer, & Ammenwerth, 2011) observed that in order for

health care providers to remain competitive and cost-effective, they needed to innovate, invest in

technology and govern IT effectively using best practices such as the Information Technology

Infrastructure Library (ITIL). ITIL is a collection of best practices for IT operations first

developed by the British government 20 years ago (Worthen & Framingham, 2007), ITIL offers

guidelines that are most suitable for enterprise IT operations and ITG (Marques, Oliveira, Dias,

& Martins, 2011; Ahmad, Amer, Qutaifan, & Alhilali, 2013b).

25
 The other dimension that led to the birth of ITG was the need for CIO to show their

relevance to the CEO, Ellen Pearlman (2004) argued that IT leaders such as the CIOs needed to

prove their relevance to the Chief Executive Officers (CEOs) of the organization through

valuable business contribution such as securing and effectively managing IT department and IT

assets, effective governance of IT assets led to a partnership with the business and enabling

business competitiveness by integrating IT with business strategies to attain business

goals(Lainhart IV, 2000). However, according to Buchwald, Urbach, & Ahlemann (2014), the

challenge that many organizations faced is that the leadership skills needed to offer IT

governance in many organizations that rely on technology were found lacking. The lack of good

IT leadership was compounded with the rising demand for IT leaders to secure organizational

assets (Silic & Back, 2014).

As illustrated in the preceding paragraphs, corporate governance is critical for ensuring

that critical decisions are consistent with an organizations vision, values, and strategy; IT

governance is crucial for ensuring that IT-related decisions match companywide objectives

(Jeanne & Peter, 2004) also known as IT alignment with business goals mission and object. Most

firms that registered economic success in the past two decades succeed because of their ability to

leverage IT investments (Weill & Ross, 2005; Weill & Woodham, 2005). Just like IT

governance is crucial for the success of many businesses, IT governance is crucial for the success

of Hospital operations Network operations.

The historical context of this paper has illustrated the historical background of ITG; it

was noted that the lack of ITG in organizations could have led to scandals, financial scandals

such as the case of Enron heightened information security risks and the need for CIOs to prove

their worth to the business led to heightened scrutiny of cooperate governance and IT governance

26
as a sub-set of cooperate governance. Just like ITG was crucial for the success of many

corporations in the past twenty years, ITG is essential in the health care industry when it comes

to effectively managing hospitals. We will now look at the current context of IT governance in

the past five years.

Current Content

This section is to provide the current context of Information Technology Governance

(ITG) and the benefits of ITG in environments that heavily depend on Information Technology

(IT) such as hospital computer networks in the healthcare industry. The health care industry uses

ITG to standardize and optimizes processes in order to enjoy a competitive advantage that comes

from effective and well-controlled IT practices. Due to the pervasive dependence on IT in almost

all sectors, organizations and society as a whole has raised concerns about ITG (Sergio, B;

Keungoui, K; Hyeunyoung, Y; Junseok, 2018). Although IT governance makes it possible for

organizations to meet organizational challenges and create business value, many organizations

still face challenges of how to effectively govern IT in an organization(Altemimi & Mohamad

Shanudin, 2015). The other challenge that decision-makers face is justifying the cost of IT to

business because, in many cases, it is not evident that IT investments improve an organization's

performance (Ilmudeen & Bao, 2018). The two combined challenges about how to effectively

create value and how to optimize IT investments highlights why effective ITG is essential for the

success of organizations.

As previously noted in the historical context section about the origins of ITG, ITG

resulted from the corporate failures of large corporations in the 1990s that highlighted that

corporate failures reached beyond poor and week corporate governance but that there was week

IT controls and practices that needed to be reformed as part of the efforts to reform and regulate

27
cooperate governance (Ako-Nai & Singh, 2019). The collapse of large corporations such as

Enron and WorldCom that mainly resulted from the lack of good ITG controls to protect large

corporations such as Enron from cooperate fraud led to a new reality that Information security

risks could no longer be ignored by the cooperate and government leaders (Turel & Bart, 2014).

Organizational leaders increased their involvement in IT matters, and various studies suggested

that that board member oversight had the potential to influence organizational performance

(Turel & Bart, 2014). In recent years, the rise of strategic management of IT resources as a

means to increase organizational performances has led many business leaders to pay closer

attention to IT activities as a way to gain and maintain a competitive advantage (Turel & Bart,

2014). The lack of good IT leadership was compounded with the rising demand for IT leaders to

secure organizational assets (Silic & Back, 2014). ITG plays a critical role in securing an

organizations data, especially in sectors such as health care (Mbonihankuye et al., 2019).

In the past five years, IT governance has made it possible for organizations to generate

value and maintain a competitive advantage (Altemimi & Mohamad Shanudin, 2015; Selig,

2016), also noted that in recent years, organizations have increasingly become dependent on IT

because IT is an integral part of a business and business operations, as such organizations must

pay special attention to how IT is governed in their organization by the use of comprehensive IT

governance frameworks. In some instances, CIO innovation can be attributed to good ITG and

good IT strategies (Liebe et al., 2017). CIO innovation following ITG best practices enhances an

organization's competitive advantage.

Businesses that operate in a knowledge economy operate in highly volatile and uncertain

environments, such environments require knowledge management and the effective

implementation of IT, one of the aims of corporate IT governance is to optimize IT investments

28
to achieve business objectives, the real increase in business value demands that business and

technology managers work in tandem (Lombardi et al., 2016). The relationship between IT-

based synergy’s and corporate based synergies reduce the tension between IT and business and

lead to an alignment that contributes to business success (Kude et al., 2018). The success of IT

management and business value creation could be largely attributed to Professionalisms of

Information Management (PIM) (Liebe et al., 2018), PIM is a subset of ITG. Another key driver

of IT governance has been the consumerization of IT, the consumerization of IT is mostly driven

by the ever-changing demands of customers, and organizational leaders now require more

control of IT practices (Wayne Gregory et al., 2018). Poor governance and control of IT

operations have often led to the failure of IT projects and implementation and effective IT

operations in organizations that heavily rely on IT for day-to-day businesses operations (Ako-Nai

& Singh, 2019), such as in the health care sector.

Just like any industry, the health care industry has significantly benefited from

information technology and the benefits of IT and good ITG practices. In the health care

industry, HIT and communications systems are indispensable together with the administrative

support structures that support health information systems (Thye et al., 2017). In a qualitative

case study by Islam (2015), it was discovered that the use of Information technology such as the

internet and electronic devices to manage patient records contribute significantly to enhancing

health service transparency, and a reduction in corruption in the health care industry, which lead

to improved health care. Good ITG generally drives HIT innovation, well-structured

environments with good IT strategies enhance an organization’s ability to promote IT

Innovation, as observed in other sectors. Hospital executives that adopt IT governance are likely

to choose IT projects that will contribute to organizational sustainability and projects that will

29
positively add value to an organizations stake holders such as employees and customers (Ako-

Nai & Singh, 2019), good information management systems enable good decision making in

hospitals and allow hospitals to remain agile and competitive (Gordon, 2010).

Although ITG is essential for the success of many organizations, in a study conducted in

14 German hospitals, it was discovered that CEOs that are less IT savvy were less inclined to

trust their CIOs and were less willing to invest in newer technology and innovations compared to

CEOs that were IT savvy (Thye et al., 2018). The goal for decision-makers in organizations is to

increase IT awareness; as business leaders such as CEOs become more aware of the benefits of

IT then the CEOs are more likely to support IT investments.

In this section, the researcher reviewed and presented how the current literature of ITG

contributes to the success of all sectors with a specific focus on the health sector. It was noted

that the lack of ITG in organizations could have led to scandals such the financial scandals in the

1990s that led to heightened information security risks and the need for CIOs to prove their

worth to the business that resulted from increased scrutiny of cooperate governance and IT

governance. In the last five years, ITG has increasingly become relevant for companies in

maintaining a competitive advantage. Just like ITG was crucial for the success of many

corporations in the past twenty years, ITG is vital in the health care industry when it comes to

effectively managing hospital IT networks and network operations.

Theoretical Framework Literature

As previously noted in chapter 1, this research work is situated in the literature on

corporate governance, as posited by Joslin & Müller (2016), corporate governance is the system

used to control and direct companies (Yusof, 2016). According to C. T. Clarke and Branson

(2016), corporate governance is concerned with maintaining a balance between economic and

30
social goals, between individual and communal goals in a way that sought to optimize

organizational resources through accountability and good stewardship of an organization's

resources.

Corporate governance is situated in agency theory, stewardship theory, transaction cost

economics, stakeholder theory, shareholder theory and resource dependency theory. Christopher

(2010) also noted that corporate governance principles are informed by theories such as agency

theory, as such one of the foundations of corporate governance is agency theory as noted by

(Christopher, 2010; Donaldson & Davis, 1991). The epistemological background of agency

theory is rooted in economics and has for decades been used by scholars across several

disciplines such as organizational behavior, law, marketing, health care and accounting

(Bendickson et al., 2016) Agency theory has its roots in the work of a German sociologist Max

Weber, agency theory is based on the concept of risk-sharing between two parties, the two

parties are the principal and agent (Bendickson et al., 2016), the principal are the business

owners or shareholders and the agents are the managers of the business, in agency theory, one

party acts on behalf of another (Shapiro, 2005), in this case the managers of a business are agents

delegated to act on behalf the principal.

Although agency theory is not sufficient to explain corporate governance (Yusof, 2016),

this research used agency theory as the underpinning theory for cooperate governance.

Furthermore, agency theory is used as the guiding principle between business owners such as

shareholders and their agents, the managers (Christopher, 2010; Joslin & Müller, 2016). The

agents represent the principals in their business transactions, the more aligned the agents to the

principal's interests, the lesser the communication gap and discord between principals and agents

(Christopher, 2010). In an organization, the board or principal delegates responsibilities to the

31
manager the agent through the use of policies and the use of measuring and monitoring measures

issued by the board of directors used as a form of corporate governance to measure whether IT

managers are delivering the promised value for the business (Posthumus & Von Solms, 2008).

Using agency theory, many hospitals in the United States are governed by governing boards that

continuously seek to improve the quality of patient care (Jiang et al., 2012).

Corporate governance is used to formulate the rules under which the agents operate to

satisfy the principals(owners of the business) interests (Donaldson & Davis, 1991). IT

governance is a subset of corporate governance, and IT governance practices should be aligned

with corporate governance (Ferguson et al., 2013). IT governance seeks to align IT practices

with an organization’s strategy, vision, and mission (Posthumus & Von Solms, 2008). Aligning

IT governance to corporate governance could minimize agency loss and creates effective IT

operations (Ferguson et al., 2013). Since IT governance practices are derived from corporate

governance practices, it is essential to understand corporate governance before attempting to

understand ITG. IT managers as agents, seek to maximize the value of the principal's investment

through exercising good corporate stewardship and agency (Donaldson & Davis, 1991; Joslin &

Müller, 2016). IT governance aims at developing structures and processes used by the

organization to direct and control the enterprise to add value to the business and balance the risks

associated with IT processes in an organization (Ferguson et al., 2013). Dawson et al. (2016)

posited that IT governance is a broader concept that goes beyond the effective and efficient

supply of IT services and products. The supply of IT services and products is the primary

concern of IT management guided by concentrating on transforming information technology of

an organization to meet both current and future demands of the business as well as the needs of

the businesses customers, IT governance therefore is concerned with instituting controls over IT

32
management to create value and sustain benefits (Dawson et al., 2016). Due to the rising

organizational dependence of Information Technology in organizations, many organizations now

have increased interest in IT governance (Peterson, 2004b). Organizations with poor IT

governance tend to face challenges such as information inaccuracy, inefficient IT operating

costs, run away IT costs, and sometimes the ultimate extinction of the IT department (Ali &

Green, 2012). Due to the importance of the effective operation of an IT department, it is in the

best interest of an organization such as a hospital to ensure that IT departments and network

operations are governed effectively.

According to Mueller et al. (2008), enterprise IT governance drives and sets the goals that

must be accomplished by IT governance. As a subset of corporate governance, IT governance is

concerned with the leadership and organizational structures, process, and relational mechanism

the ensures that an organization’s IT systems serve the strategic and sustainability goals of an

organization (Haanappel et al., 2011). Corporate governance encompasses IT systems, IT

infrastructure, IT communication systems, and software that organizations rely on to run

business operation. Although Clarke and Branson (2012) argued that good corporate governance

is an essential component of market integrity, efficiency, and financial growth of an

organization. Doherty et al. (2012) argued that entrepreneurs, investors, and corporations lack

the ability to craft governance that can quickly respond to changes in technology, the

competition, and customer needs. The lack of adequate IT governance may lead to poor

stewardship of IT resources, long, slow, and sometimes misaligned IT governance processes,

which affects the speed and quality of services delivered to an organization's customers such as

patients at a hospital.

33
 Although many firms enjoy above-average industry returns due to good IT governance

practices (Weill & Woodham, 2005; Weill, 2004), in the health care industry, poor Corporate

governance has led to information system failures resulting from health care system failures in

organizations that lack of good corporate governance (Delaney, 2015). In some instances, poor

corporate and IT governance has led to network outages, delayed network improvement projects,

and insecure networks that could translate into poor patient care (Delaney, 2015). In

environments such as the health care industry, it is crucial that hospital administrators effectively

manage ITG for improved and reliable patient care in hospitals. Hospital network operations are

at the heart of the effective delivery of communication pathways and the security of data at

hospitals. Despite the significant research dedicated to IT governance in business cooperation’s

and hospitals, current literature indicated little to no literature concerning the effects of IT

governance on hospital network operations.

Methodology Literature

In this section, the researcher covers some of the methods that were used by researchers

in previous research work related to this research and how this research will contribute to the

body of knowledge of IT governance using similar research methods such as purposeful

sampling. Qualitative research primarily deals with words and numbers (Stenman, 2019). This

study sought to understand the effect ITG has on network operations in environments such as

hospitals, the researcher identified categories and themes that emerged from talking to IT

managers and IT employees in an IT department about their perceived effect of IT governance

processes on network operations at a hospital. Using a case study helped the researcher

understand the effect of IT governance on network operations through processes such as the

change management process.

34
 Qualitative research designs may take forms such as narrative, phenomenology, ground

theory, ethnography, and case study (Creswell, 2009). However, despite the quality work

produced by many qualitative research efforts, qualitative researchers continue to be critiqued for

lack of scholarly rigor (Gioia, Corley, & Hamilton, 2013; Daniel, 2018). Maintaining research

validity is a critical component of qualitative research designs; in both quantitative and

qualitative instruments, there are three major validity items as identified by (Heale & Twycross,

2015; J. W. Creswell, 2014) the three items are: Content validity, construct validity and criterion

validity. Using content validity guidelines, researchers may seek to implement research

instruments that accurately measure all aspects of the research constructs, such as the time it

takes to implement IT services and solutions in an organization. Researchers may use construct

validity to ensure that research instruments measure hypothetical constructs or concepts of

interest in a given research study. Lastly, researchers may use criterion validity to determine the

extent to which the research instruments are related to other research instruments that measure

the same variable.

Positivists and interpretivists research paradigms have divergent views of how research

results may be evaluated; positivists use validity, reliability, and generalizability, while

interpretivists may find generalizability of little value when applied to peoples lived experiences

(Carcary, 2009). Although qualitative research is not inferior to quantitative research, qualitative

research has been criticized for decades for its lack of scientific rigor compared to quantitative

research (Casey & Murphy, 2009), to this extent, qualitative researchers should seek to conduct

and report research findings with the highest possible quality (Casey & Murphy, 2009).

Quantitative researchers showcase their quality of work through rigor and validity, while

qualitative researchers enhance the quality of their work by showing that their work is credible

35
and trustworthy (Casey & Murphy, 2009). The trustworthiness of a qualitative research is a

concept that refers to the degree of confidence and interpretation of data in an effort to increase

the quality of a research(Connelly, 2016). The trustworthiness of qualitative research is founded

on the principles of credibility, transferability, dependability, authenticity, and confirmability

(Casey & Murphy, 2009; Connelly, 2016). Carcary (2009), further posited that qualitative

researchers could enhance the confirmability aspect of trustworthiness of a study by establishing

an audit trail; an audit trail allows users to audit the events, influences, and actions of the

researcher.

Daniel (2018), recommended four dimensions that researchers can use to demonstrate

qualitative research rigor, the four dimensions are Trustworthiness, Auditability, Credibility, and

Transferability or TACT. The TACT framework and approach complementary to the approach

of verifying credibility, confirmability, dependability, and transferability as suggested by

Langtree, Birks, & Biedermann (2019), using the TACT framework helps researchers to provide

a better process for undertaking and reporting outcomes of qualitative research and for exploring

different dimensions of rigor (Ben,2018). Both approaches suggested by Daniel (2018)) and

Langtree et al. (2019) can help qualitative researchers explore different dimensions for assessing

the outcomes of a qualitative researcher.

As argued by Heale and Twycross (2015), qualitative researchers are expected to

demonstrate a level of research rigor when conducting qualitative research. Research rigor is

demonstrated through objectivity, reliability, and validity in social research; demonstrating

objectivity, reliability, and validity in qualitative research is not an easy task (Barusch et al.,

2011b). Demonstrating research rigor in qualitative research may not be easy to achieve mainly

because qualitative research assumes a constructivists approach where meaning is constructed

36
based on the researcher’s perceived reality of the lived experiences of the research subjects

(Daniel, 2018). Qualitative research paradigms are primarily founded on relativism and

prepositionally or standpoint of the researcher and the role of community in research, voice,

reflexivity, reciprocity, and fluidity between the researcher and researched (Barusch et al.,

2011a). Because knowledge building and formation of qualitative research primarily emerge

from relationship building between the researcher and the researched and the perceived reality of

the researched (Wa-Mbaleka, 2017), critics of qualitative research are led to question the

relationships that form the context in which qualitative research work is developed and may call

into question the credibility, reliability, and validity of a given research (Barusch et al., 2011a).

To establish the credibility of a given study, qualitative researchers can generate confidence in

their qualitative research through the use of methods such as prolonged engagement during data

collection, persistent observation, triangulation, which is a process of comparing several data

types and sources, peer debriefing, negative case analysis, and member checking(Barusch et al.,

2011a; Wa-Mbaleka, 2017), suggested that researchers could strengthen their researcher through:

(1) Making a strong case for qualitative research in the title, abstract and keywords; (2) Stating

the relevance of the research in the introduction; and (3) Starting qualitative research with a clear

research question.

A combination of Content validity, construct validity, and criterion validity and TACT

framework could be used as tools to build confidence in skeptics that may not readily accept

qualitative case studies as a valid research method. Although providing rigor or trustability in

qualitative research is necessary, research rigor is not sufficient for ensuring high-quality

research, qualitative researcher rigor that does not translate to good research, good research must

37
also be evaluated on the basis of its relevance to the profession and its potential impact to social

justice (Barusch et al., 2011a).

Despite the fact that case studies face criticism for lack of rigor, case studies have been

widely used to provide management fields with some of the most insightful findings about

management as a discipline (Ellinger & McWhorter, 2016). Creswell, Stake, Meriam and Yin are

considered to be key methodologists of case study research and have provided procedures to

follow when conducting qualitative case study research (Yazan & De Vasconcelos, 2016), case

studies are used to explore a phenomenon of interest (Ellinger & McWhorter, 2016), case studies

are used across paradigms, disciplines that require a careful examination of a phenomenon under

investigation (VanWynsberghe & Khan, 2007; Yazan & De Vasconcelos, 2016). Case studies

are used to help develop an understanding of a problem or process; in this case, Case study

helped the researcher understand the effect that Information Technology governance (ITG) has

on hospital network operation in the Western United States of America (Alpi & Evans, 2019;

Hyett, Kenny, and Dickson-Swift (2014a).

Case studies may be used to collect evidence using multiple tools sources such as

interviews, observation, document review, and physical artifacts (Jennifer, 2000; Yazan & De

Vasconcelos, 2016); in this study, the interviews were used as the main source of case study

evidence. Case study research heavily depends on the researcher's ability to ask good questions

(Jennifer, 2000). The purpose of interviewing is to allow a researcher to enter into the interview

participant's perspective (Jennifer, 2000). Interviews are necessary when a researcher cannot

observe the behavior or phenomenon of a study but may also be used in combination with other

qualitative evidence collection tools such as observation, as noted by Jennifer(2000). The

researcher used interviews as one of the three tools used for data collection.

38
 Qualitative researchers often uses purposive samples as a strategy to increase

understanding of an individuals or groups experiences by selecting information-rich cases and

selecting individuals, groups and organizations that will provide the most information about a

specific research phenomenon (Devers & Frankel, 2000), a purposive sample is a process of

handpicking research participants (Knechel, 2019), qualitative researchers seek specific

participants with rich experiences about a research phenomenon (Knechel, 2019). Although

qualitative researchers may use as many participants as possible until a point of saturation is

reached (Knechel, 2019), in this study, the researcher chose a purposive sample of 11 interview

participants. Mason ( 2010), posited that there is a point of diminishing returns that researchers

need to be aware of. More data in qualitative research does not necessarily lead to more

information; one occurrence of data is as useful as many occurrences in qualitative research

because qualitative research is all about sense making of a social phenomenon as opposed to

creating generalizations based on frequencies that occur in sample data. Existing literature

suggests that there are no clear guidelines about how many participants and interviews a

researcher needs to conduct before reaching the point of saturation or simply a point where no

new information can be gathered from the research participants (Guest, Bunce, & Johnson, 2006;

Young & Casey, 2019). Paradoxically, qualitative researchers often have to make a decision

about the anticipated sample size of their study before data collection starts for resource planning

and for research approval purposes (Young & Casey, 2019). In an empirical research conducted

by Young & Casey (2019), to determine the point at which data collection and analysis produces

little or no change to the codebook, transcripts reviewed from previous studies revealed that 73%

of codes were identified in the first six interviews and 92% with in the first 12 interviews, Guest

et al. (2006), suggested that 12 to 16 participants is when a point of saturation was reached,

39
Francis et al. ( 2010) reached a point of saturation after 10 interviews. However, when

conducting research in cross-cultural groups and homogeneous groups, the number could range

between 20 to 40 before a point of saturation is reached (Young & Casey, 2019). The researcher

reached a point of saturation on the 9th interviewee participant.

As illustrated by Guest et al. (2006), Young and Casey (2019), Francis et al. (2010) and

many other scholars, establishing a minimum sample size is an elusive topic which may come

down to two things 1) “the researcher has had it all” and 2) “the researcher understanding it all”

(Young & Casey, 2019), before the point of saturation is reached. Some studies may reach a

point of saturation with just a few samples while others may not (Young & Casey, 2019).

In a case study about Maternal Healthcare Services in the Ketu South Municipality,

Ghana by Amu and Nyarko (2019), the researchers used a purposeful case study to purposively

select participants because the target population had a higher chance of providing the

information need about Mental Health care services, the selected participants would help the

researchers to understand there research problem better. Ako-Nai & Singh (2019), used a

purposive sample method to identify and assess the aspects of IT governance implemented by 23

companies listed on the Johannesburg Stoch Exchange in South Africa.

Amu & Nyarko (2019), suggested that the sample size followed the principle of thematic

saturation; participants may be interviewed until no new themes are generated from the

participants. There are no hard numbers about what constitutes a qualitative research sample

size, some scholars suggest 12-20, some suggest between 10 to 100 participants (Tuckett, 2004),

qualitative researchers tend to rely on small samples with the aim of studying a phenomenon in-

depth and detail. Purposeful samples using a small number of participants that can satisfy the

need for a detailed in-depth study (Tuckett, 2004).

40
 Qualitative researchers may also use flexible research designs that change as the research

progresses (Tuckett, 2004) up to a point where the researcher feels like they have reached a point

of data saturation, a point where no new information can be gathered from the research

participants (Guest et al., 2006; Young & Casey, 2019) or a point of diminishing return. Devers

& Frankel (2000), suggested that qualitative research is similar to a rough sketch design to be

filled in by the researcher as the study proceeds after the main research question is defined and

resources secured for the research, qualitative research can be likened to an abstract drawing,

qualitative researchers can make the research more concrete by developing a sampling frame that

will be used to answer the research question, developing a sampling frame takes into account

identifying specific sites, objects, and a commitment of participants in the study(Devers &

Frankel, 2000). In a study conducted by Best et al. (2018), where a purposive sample of senior-

level managers such as board members, executive directors, funder and academics were to

selected as participants. This research used a purposive sample of the CTO, IT directors, service

management managers, IT network engineers and Change advisory board (CAB) members as

interview and observation participants.

The benefits of purposive samples is that purposive samples are selected due to a

predetermined criterion, and data may be collected until a point of saturation is reached (Guest et

al., 2006). The advantage of a purposeful sample, which is that the research participants are

hand-picked, is also a weakness of case studies, as such, the findings of a case study are subject

to criticism for the lack of bias (Knechel, 2019), purposive samples largely depend on the

researcher's judgment to select research participants, handpicking research participants may be

called into question by critics of qualitative research because qualitative research has been

criticized for decades for its lack of scientific rigor compared to quantitative research (Casey &

41
Murphy, 2009). Qualitative researchers should seek to conduct and report research findings with

the highest possible quality (Casey & Murphy, 2009). After sampling strategies to be used have

been defined, researchers must now turn their attention to the strategy for choosing the most

appropriate technology tools for data management and analysis.

Selecting the right sample of research participants is crucial to building the

trustworthiness of qualitative research (Knechel, 2019). Because it is logically impossible to

include every participant in a study, researchers use sampling mechanisms such as random

sampling or snowball sampling to enroll research participants (Knechel, 2019). A qualitative

researcher should endeavor to avoid or mitigate the level and impact of sampling error simply

defined as the difference between the sample and population that it is meant to represent the

sampling bias defined as the systematic enrollment of participants who are either over or under

represented as a subgroup relative to the research population (Knechel, 2019).

Although probability sampling using techniques such as simple random sampling,

stratified random sampling, cluster sampling, and systematic sampling are considered ideal in

quantitative research , non-probabilistic sampling such as convenient sampling and snow balling

sampling are used in qualitative research because qualitative researchers look for individuals

with reach experiences that can meaningfully contribute to the phenomenon under study

(Knechel, 2019). Snowballing is a convenient, non-probabilistic, and nonrandom method of

recruiting research participants through referrals; one research participant refers to another who

in turn, refers to another (Geddes et al., 2018) until the researcher reaches a point of data

saturation. Snowballing can be an effective technique for recruiting participants under

investigation who may be hard to find due to low numbers of potential participants and are

42
hidden, for example, research about participants that fit a particular sexual orientation (Browne,

2005).

Although snowball sampling is frequently advocated and employed by qualitative social

researchers, snowballing sampling is prone to faltering and failure (Geddes et al., 2018). As a

mitigation measure to the likely failure of snowball sampling, researchers can use alternative

forms of networking such as horizontal networking; horizontal networking is a process used by

the researcher is encouraged to look further and cast the net much wider and shallower drawing

on both strong and weak ties in the process, a wide variety of research participants are gained

using a horizontal networking approach as opposed to drilling down vertically through social

networks (Geddes et al., 2018).

Research Design Literature

Fiss(2015), suggested that cases are historically used to study organizations and

organizational process, cases of study limit boundaries of a real-world phenomenon to time and

space (Fiss, 2015). Research preparation should begin with a good research question and

proposition, good research questions may be followed by a good research design as one of the

preliminary decisions that may need to be made before evidence collection begins (Jennifer,

2000), qualitative researchers also need to be careful when articulating their research design to

show how their research design demonstrates academic research rigor (Jennifer, 2000).

Ebneyamini and Sadeghi Moghadam(2018) submitted that some of the preliminary

decisions that need to be made before researchers start collecting data are (1). Defining the

research framework, this can be done through conducting a literature review and constructing a

theoretical framework; (2). Identifying a research problem and building a research question or,

crafting and sharpening research questions; and (3). After formulating a good research question

43
(s), researchers should begin by identifying the population or the entire collection of the cases

that the researcher is interested in (Knechel, 2019), the researcher should then create a criteria for

including participants who have experienced an event, and identify the sample size. Sampling

may include the selection of a subset of the case study that should be included in the study

(Knechel, 2019), and finally, how researchers can know when a point of participant and data

saturation has been reached to stop collecting data (Knechel, 2019).

Selecting the case and selecting the sample (Ebneyamini & Sadeghi Moghadam, 2018),

need to be made relative to the types and sources of evidence (Plümper et al., 2019). Paton

(2015) posited that defining the boundaries of a case study such as how many sites will be part of

the study and how many people will be in the study is another crucial phase of defining the

boundaries of a case study, Paton (2015), further recommended about 15 people that should be

part of a study in the case of case study research, research can be single or multiple case studies

with multiple sites.

The primary advantage of using case study and a purposeful sample to understand a

phenomenon such as the role that the effect of IT governance on network operations at a hospital

in the Western United States of America is the opportunities for researchers to get a holistic view

of the process being studied from participants that are likely to meaningfully contribute to the

phenomena under inquiry (Ebneyamini & Sadeghi Moghadam, 2018) because case studies help

researcher gain an in-depth understanding of a specific social phenomenon. After the key

preliminary decisions were made, such as selecting a case, and the research question was

defined, the researcher turned to the sampling and evidence collection methods to be used.

44
 Conclusions

Both historical and current literature review suggests that Good corporate governance

translates to good IT governance, IT departments that adhere to business needs and that are

aligned to the business needs of an organization, the process of creating reliable IT departments

requires good IT governance (Bianchi & Sousa, 2016). Good ITG are likely to lead to well

managed Health Information Systems (HIS), well maintained HIS, have the potential to enhance

productivity, lower costs, reduce medical errors and reduce human resources strain in the health

care industry (Yang, Kankanhalli, Ng, & Lim, 2013). Although good corporate and IT

governance is critical for the success of many of organizations, good corporate governance, and

ITG for network operations is particularly essential for the success of health care organizations,

IT governance is often found lacking for IT network operations, this research explored the effect

that ITG has on network operation and the role ITG for network operations in hospitals can have

on patient care.

Chapter Summary

In this chapter, the researchers has reviewed both germinal and seminal literature bout IT

governance and why it is essential to align IT governance to corporate governance for the

success of an organization (Peterson, 2004a; Turel & Bart, 2014). IT governance helps

organizations to meet a competitive advantage, and IT is an integral part of business today

(Altemimi & Mohamad Shanudin, 2015; Selig (2016). One of the key underpinning theories of

IT governance is agency theory; agency theory is one of the underpinning theories of corporate

governance (Christopher, 2010; Donaldson & Davis, 1991), IT governances practices of an

organization should be aligned with corporate governance practices, goals, mission, and strategy.

Finally this chapter reviewed case studies and how case studies are suitable for studying

45
organizations and organizational processes (Fiss, 2015). This study used an exploratory case

study using purposive sample participants such as the CTO, IT directors and network engineers

that would meaningly contribute to the research phenomenon; case studies have been used to

understand research phenomena such as the effect of IT governance on network operations at a

hospital in the Western United States of America. Chapter 3 focused on research methodology.

46
 Chapter 3

Research Methodology

As previously noted in chapters 1 and 2, the purpose of this simple exploratory case study

was to explore the effect that IT governance (ITG) has on network operations at a hospital in the

Western United States of America. This chapter reviews an exploratory case study and the data

collection methods used to collect data about IT governance's perceived effects on network

operations. The researcher used a triangulation method to compare and contrast evidence from

three data sources: interviews, document review, and observation. A case study research method

was used because case studies are commonly used to understand organizations and

organizational processes. Chapter three also presents the main research question of the research

"What is the relationship between IT governance and hospital network operations" and sub-

research questions used to investigate further the perceived effect of IT governance on hospital

network operations. A purposeful sample of 11 IT employees and hospital administrators was to

capture the perceptions. The purposive sample was used to explore research participant's

perceived views about the role of IT governance in network operations. All research participants

were required to read and sign an informed consent form; the informed consent form allowed the

researcher to collect data from research participants. After the research participants signed the

informed consent form, the research participants were asked to scan the informed consent form

and send it back by email to the researcher.

Credibility and transferability were established by triangulating data sources such as

interviews, document review, and observation. The data analysis process was conducted using an

iterative process that continued throughout the data collection process and after the data

collection process. Additionally, after the data collection process, the researcher began intense

47
data analysis by bringing together all the collected information from sources such as interviews,

field notes from observation, and IT governance documents into a single case study database.

Data from interviews, IT governance documents, and observation notes were imported into a

computer-aided design and analysis software MAXQDA Analytics Pro 2020 for Mac OS, release

20.3.0.

The researcher engaged in a constant comparison process to generate categories and

themes from the data collected from interviews transcripts, observation field notes, and IT

governance documents. Using MAXQDA Analytics Pro 2020 for Mac OS, release 20.3.0, the

researcher started the data analysis by reviewing, reading, re-reading, developed a coding

scheme to help identify emerging themes from the data and how the emerging themes answered

the research question.

Research Method and Design Appropriateness

This study was an exploratory case study that explored the effects of IT governance on

network operations at a hospital. Case methods are used as research methods of choice to study

complex real-life phenomena (Bhatta, 2018). This study used a case study method to answer how

and why questions about the effects of IT governance on network operations.

Alpi and Evans (2019) noted that case studies are qualitative research designs used to

explore a time, space-bound, and context-bound phenomenon; an investigator explores real-life

single our multiple bound systems over time using in-depth data collection involving various

sources of information. Hyett et al. (2014a) posited that a qualitative case study explores a real-

life contemporary bounded system. Yin (2018) suggested that case studies may be used if the

researcher sought to answer: (a) "how" or "why" questions of a social phenomenon; (b) the

researcher has little or no control over the behavioral events of the research; and (c) the focus of

48
the study is mostly contemporary as opposed to being historical. Case study evidence can be

collected from interviews, observation, document review, and physical artifacts(Alpi & Evans,

2019). A case study, especially a single case study is bounded because case studies focus on a

single entity (Coso Strong & Sekayi, 2018; Jensen & Rodgers, 2001). Hyett et al. (2014)

contended that case study research is an investigation and analysis for single or multiple cases to

capture the object of the study's complexity (Hyett et al., 2014a). Case study is a design of

inquiry that can be applied to many fields, especially in which a researcher develops and in-depth

analysis of a case such as a program and an event, activity, or processes in an organization

(Creswell, John W.; Creswell, 2018). Although case studies cannot be used for generalization in

social research, case studies are used to study human behavior because they are down-to-earth

and attention-holding (Stake, 1978). As suggested by (Alpi and Evans, 2019; Hyett et al. 2014;

Creswell, John W.; Creswell, 2018; Coso Strong & Sekayi, 2018) the meaning of a bounded

system in a case study is derived from the characteristic of cases study designs. Case studies are

context-bound or specific to a unit of study; a case can be a bounded system such as an

institution (Stake, 1978) , time-bound, for example, a year or six months as the period of study.

Case boundaries are kept in focus to determine what is in scope and what is out of the scope of

the study (Stake, 1978).

Case Studies may be used to develop an understanding of an organization such as an IT

department as a case, describe how the IT department works, point out some themes that emerge

from talking to IT employees during the data collection period. Using a case study approach, a

researcher can investigate and come to an understanding about an organization such as an IT

department and how the IT department works, and the impact an IT department has on an

organization. In qualitative case studies, researchers seek to study a phenomenon within its

49
context (Farquhar et al., 2020); a case study can also be defined as an empirical inquiry that

investigates a contemporary phenomenon in-depth and within a real-life context (Farquhar et al.,

2020; Bhatta, 2018). Yin (2017), posited that the main focus of a case study is usually concrete

entities such as a person or group of people, an organization, a community, program, process,

policy, institutional practices, and organizational events such as decision making within a

defined context and boundaries. Case boundaries are conditions that fall within the boundaries of

the case in a case study such as time period of the study, social groups that are part of the study,

organizations, and geographic locations of the study (Yin, 2018). One example of case

boundaries is the example of project scope, similar to out-of-scope projects, and scope creep in a

project is the concept of cased study boundaries. If case study boundaries are not well defined,

such as who will be studied, the location of the study and the time frame of the study, case study

research is likely to be out of scope.

Research Questions

The researcher relied on the three methods of data inquiry for triangulation. Triangulation

is generally a concept used to measure the distance between two points and the relative position

of points.(Farquhar et al., 2020b) In social research, triangulation is used as a metaphor to

explain using different data sources in qualitative research methods such as case studies

(Farquhar et al., 2020b, Morse, 2015). The researcher used document triangulation using sources

such as document review, interviews, and observation.

This research addressed the following research question (RQ):

RQ 1: What is the relationship between IT governance and hospital network operations?

Interviews, document review and observations conducted by the researcher were guided by the

following sub questions (SQ):

50
SQ 1: How is IT governance of network operations used to deliver value to the Hospital?

SQ 2: How is IT governance of network operations used for strategic alignment to the Hospital's

goal and mission?

SQ 3: How is IT governance of network operations used for performance management?

SQ 4: How is IT governance of network operations at the Hospital used for resource

management?

SQ 5: How is IT governance of network operations at the Hospital used for risk management?

Population and Sample

A research population is the superset or larger universe of what the researcher wishes to

study(Gentles, Charles, Ploeg, & McKibbon, 2015), and the sample is the representative subset

of the superset of what the researcher wishes to study. The goal in both qualitative and

quantitative studies is to select a sample that would most appropriately help answer the research

question(Meltzoff, J., & Cooper, 2018). In qualitative research, a sample-sized between 10-30

participants among a homogeneous population is considered adequate(Boddy, 2016). This study

explored a purposive sample of 11 current IT employees responsible for IT governance. The

participants interviewed were also part of the change advisory body (CAB). CAB meetings were

comprised of 10 to 15 participants depending on the number of changes presented. Documents

reviewed Included IT governance documents and articles retrieved the hospitals IT governance

online portal. (Emerson; 2015; Gentles, Charles, Ploeg, & Ann McKibbon, 2015) defined

sampling as the acts, processes, or techniques used to select a representative part of a population

to determine parameters or characteristics of the whole population. More specifically, sampling

is the selection of specific data sources from which data that answers a research question is

51
collected (Gentles, Charles, Ploeg, & Ann McKibbon, 2015); sampling decisions are highly

critical to improving the quality of research work done (Suri, 2011).

In quantitative research, probabilistic sampling methods such as random sampling could

be used (Meltzoff, J., & Cooper, 2018). Random samples tend to represent their parent

population reasonably well, and the entire community has an equal chance of being included in

the research (Meltzoff, J., & Cooper, 2018). However, in qualitative research, nonprobabilistic

sampling methods such as purposive samples may be used to select research participants (Yin,

2018; Meltzoff, J., & Cooper, 2018), although the definition of purposeful sampling is fraught

with ambiguity and a lack of clarity as observed by (Gentles, Charles, Ploeg, & Ann McKibbon,

2015), purposeful sample is where participants are selected based on what the researchers

determine as the most suitable candidates to answer the research question (Meltzoff, J., &

Cooper, 2018), purposeful samples are used to select information-rich cases. Information rich

cases could be comprised of individuals that are knowledgeable and experienced about a

research phenomenon (Palinkas et al., 2015). This study used a purposeful sample of current IT

employees' who are part of the IT governance body, the IT employees were comprised of

Network Engineers, IT managers, IT directors, the Chief Technical Officer (CTO) and Service

desk leadership team in the IT department. This group of participants were purposefully selected

because of their roles and knowledge in the IT department and their roles in respect to IT

governance at a hospital in the Western United States of America. The researcher worked with

the leadership team at the hospital responsible for network operations at the hospital to

purposefully select participants that could most appropriately help answer the research question.

The employees interviewed included but not limited to: Network Engineers, IT managers,

IT directors, the Chief Technical Officer (CTO) and Service desk leadership. The study also

52
explored the perceived realities of the sample IT employees about how IT governance processes

and practices impact IT network operations at a hospital in the Western United States of

America. Interviewee participation involved participating in 30-45 minutes semi-structured

interviews using a Microsoft collaboration tool called Microsoft Teams. Microsoft Teams was

used to conduct interviews and change advisory board meetings (CAB) during the month of

January 2021, the researcher attended three CAB meetings for the purpose of observation in

addition to the 11 interviews conducted. Document review and observation was used to

collaborate findings from interview data to validate the ITG processes and their effects on the

hospitals network operations during the research period. The main reason for conducting

interviews, document review, and observations to increase the credibility of the findings by

corroborating evidence from multiple sources about the effect ITG implementation has on

Network operations of a hospital such as a hospital in the Western United States of America.

Research participation was strictly confidential; the interviewees and their responses were

labeled with pseudonyms making it impossible to trace back to the respondents.

Informed Consent and Confidentiality

Researchers should ensure that they seek participant consent, ensure research

participant's confidentiality, and privacy of personal protected information, seeking participant

consent provides a level of accountability and responsibility throughout the research process

(Williams & Pigeot, 2017). Informed consent is used to determine the self-determination of

individual research participants and their willingness to participate in research (Miller &

Boulton, 2007). Miller and Boulton (2007), defined informed consent as a concept that defines

what is regarded as a level of the appropriate relationship between the researcher and research

participant. Informed consent is when informed participants make their wish known to

53
participate in a study (Williams & Pigeot, 2017; Miller and Boulton, 2007). Confidentiality in

qualitative research is a tool used for the management of data protection and privacy of research

participants (Williams & Pigeot, 2017), the goal of confidentiality is to prevent harm associated

with research participants sharing of identifiable research data (Yu, 2008). During qualitative

research, researchers are likely to run into an issue such as deductive disclosure or internal

confidentiality; deductive disclosure happens when individual traits and characteristics are

identifiable in the research report through deduction by the reader (Kaiser, 2009). To protect

research participants from unwarranted disclosure, researchers should protect the privacy of

research participants by keeping private data confidential. Privacy is the protection of

information that research participants share about themselves form intrusion; privacy can be of

two forms, privacy of the person and information privacy (Woogara, 2005). The research

participants signed an informed consent form before attending an interview session. The

informed consent form was sent to the participants by email; the informed consent form was

then signed by the research participants, scanned and sent back by email to the researcher

Research data is kept secure by following the University of Phoenix and institutional review

board research guidelines on confidentiality. The recorded research participant interviews and

observation notes are stored on a locally encrypted and password-protect hard drive on the

researcher's computer. Both local copies and iCloud copies are encrypted; file transfer to the

researcher’s iCloud account uses end-to-end encryption of local and in-transit data. Redundant

password-protected copies of interview transcripts, observation notes, and transcripts will be

kept on the researcher's iCloud drive for at least three years after the interviews are collected.

The protected files are only accessible to the researcher using two-fact authentication technology

to ensure added security. Personally, identifiable research participant data is kept at a minim. For

54
example, personally identifiable information has been removed from the transcripts and replaced

with pseudonyms for identifiers after interviews were transcribed and validated by the research

participant; the pseudonym list will be kept in separate password protected. Personally,

identifiable information and raw data from interviews is stored in a different password-protected

file. The data will be kept for three (3) years. The research interview and observation transcript

data will be destroyed by deleting the files from the researcher's local hard drive and redundant

copies from the researcher's iCloud account. Audio recordings from the interviews will be stored

until the interviews have been recorded and validated by the research participants within three to

six months. Both interview and observation audio recordings will be destroyed by file deletion of

the audio recording. Audio files will also be destroyed by deleting any media that may contain

the participant's audio record. The researcher's interview field notes will be destroyed by

shredding after three years from the research field notes collection date. The researcher obtained

data access and permission from the Hospital that granted the researcher permission to conduct

interviews, observations, and document review. See Appendix A for the Informed Consent Form.

Instrumentation

Data collection requires directly probing research participants for rich information and

description and clarification of their lived experiences (Polkinghorne, 2005), in this study, the

researcher used an exploratory single case study to investigate and collect evidence about the

effects of IT governance on hospital network operations. The researcher used interviews,

observations, and document analysis to collect evidence because interviewing, observations, and

document analysis are the key sources of evidence in qualitative research (Chenail, 2011;

Polkinghorne, 2005). As part of the data collection process, one of the objectives of scientific

research is to attain trustability by ensuring that the research process is valid and reliable through

55
its data collection methods (Louise & Alison, 1994). The sections below illustrate why

interviews, observations and document review were used as research instruments for this study.

Instrumentation: Interviews

In this study, semi-structured interviews were used because of two main reasons. The

first reason is that semi-structured interviews are well suited for the exploration of the perception

of opinions of the respondents in a research phenomenon. The second reason is that it is almost

impossible to use standardized questionnaires in case studies due to the varied educational and

professional backgrounds of participants (Louise & Alison, 1994). Standardized questionnaires

attempt to standardize stimulus and assume that respondents share the same vocabulary and that

every respondent's words carry the same meaning (Louise & Alison, 1994). However, evidence

collection methods such as questionnaires tend to take into account the fact that not every word

carries the same meaning to every respondent; semi-structured interviews increase reliability and

validity through the equivalence of meaning across participant's responses (Louise & Alison,

1994). Although semi-structured interview present disadvantages such as language barrier if

research participants do not speak the same language as the researcher, semi-structured

interviews have benefits such as the researcher's ability to probe respondents to clarify their

responses and benefits such as increasing social interaction with respondents that is necessary for

building rapport between a researcher and respondents (Louise & Alison, 1994).

Using semi-structured interviews, a researcher can rearrange the interview, clarify the

questions, and increase the engagement of the research participants. Researchers using

qualitative semi-structured interviews should also be aware that semi-structured interviews are

only an excellent tool depending on the researcher's ability to manage and analyze verbal

conversations effectively. Therefore interpersonal skills such as humility, humor are needed to

56
both establish rapport but also to establish trust with participants (Newton, 2010). Semi-

structured interviews were be used because interviews are a superior form of data collection in

qualitative research compared to other forms of data collection, such as questionnaires.

Interviews can be used build raptor and an environment where participants can feel comfortable

sharing the needed information in a research phenomenon (O'Keeffe, Buytaert, Mijic, Brozovic,

& Sinha, 2016). The researcher used semi-structured interviews to clarify information during the

interview or information from other sources, such as document review and observation. The

researcher audio recorded interviews in addition to taking notes to record participant responses

and observations.

Instrumentation: Observation

Direct observation or participant observation is a commonly used data collection method

used to collect information about people's lived experiences in a social phenomenon.

Observation evidence is often a vital tool for providing additional information about the studied

topic (Yin, 2018). Observation is used for studying individual behavior; the researcher used a

non-participant observation method for this research to understand how IT governance affects

network operations by observing IT governance in practice. The researcher attended and

observed three critical IT governance meetings. The meetings attended were change advisory

(CAB) meetings. The researcher attended CAB meetings to observe the IGT process's

implementation and other IT governance-related deliberations within the IT department. The

researcher's findings from the three observation meetings helped to validate and collaborate some

of the findings from interviews and document reviews.

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Instrumentation: Document review

Document review or document analysis can also be used as the primary tool of data

collection or as a secondary type of data collection; document analysis can be used to provide a

historical context of the research. Documents and artifacts are ready sources of qualitative data

for a qualitative researcher (Yazan, 2015); document artifacts used in this research were online

content collected from the hospital’s IT service management website. The researcher reviewed

documents relevant to the hospital's IT governance processes stored on the IT service

management website. The IT service management website had process documents and policies

such as (a)IT service management definitions; (b) Change Management Process for Standard

Change; (c) Change Management Process for Normal Change; (d) Change Management Process

for Emergency; (e) Change Management Policy; (f) Release Management Process; (g) Release

Management Policy; (h) Service Level Management Policy; (i) Service level management

process; (j) Incident management process; (k) Configuration management polity (l) change

management process; (m) Configuration management process; (n) Asset Management Policy;

and (o) Service Level Management Policy. The IT governance documents provided content

relevant to topics ITG and the possible effect that the IT governance processes and policies have

on IT operations. The IT governance documents provided insights about the quality-of-service

delivery and how ITG regulates how services are rendered to the Hospital.

Pilot Study

A field test or pilot study may be conducted to determine if the research topic is feasible

and that the data collection instruments such as interview questions are likely to gather the

relevant information that inform the research; field test may also be done to determine if the data

collection tools are reliable (Creswell, John W.; Creswell, 2018). The researcher did not conduct

58
a pilot study due to Covid 19 related restrictions that led to limited access to the site and research

participants. The researcher also had to accommodate that the IT team members to be

interviewed were under pressure to build new Covid 19 testing sites and other Covid 19 related

projects. Additionally, the researcher was advised by management at the Hospital that the

research participants did not have ample time to engage in a preliminary pilot study and then the

actual research. Therefore, the researcher relied on the three methods of data inquiry for

triangulation to improve the study finding’s credibility. As previously mentioned in chapter

three, triangulation compares several data types and sources: peer debriefing, negative case

analysis. Member checking of data sources was also used to show the research's content validity.

The researcher used document triangulation using sources such as document review, interviews,

and observation.

Credibility and Transferability

In this study, credibility was achieved by triangulation; transferability was acquired by

the use of thick descriptions in chapter 4 research findings that readers from other contexts can

relate to. Transferability was also achieved using semi-structured interviews, document review of

IT governance process, and observation of IT governance processes such as the change advisory

body. The three methods were used to explore how stakeholders at a hospital in the Western

United States of America feel about network operations' IT governance processes. The findings

from one hospital are likely to apply to other hospital network operations in United States of

America or any other country. Using semi-structured interviews, document review, and

observation helped to triangulate both research data collection and analysis. The researcher used

semi-structured interviews, document review, and observation because of the richness of

59
information the researcher would get from using a combination of interviews, document review

and observation of research participants.

Qualitative researchers need to demonstrate a level of reliability, credibility or trustability

of their study (Fusch et al., 2018). One of the ways to achieve credibility and transferability is

through triangulation of data from different data sources. Triangulation using semi-structured

interviews, document review of IT governance process, and observation of IT governance

processes such as the change advisory body meetings was used to explore how stakeholders at a

hospital in the Western United States of America feel about the IT governance processes for

network operations. The triangulation of data collected from semi-structured interviews,

document review, and observation was also used in the data analysis process. To establish the

credibility of this study, the researcher used semi-structured interviews, document review, and

observation because of the depth of the information the researcher could get from using a

combination of interviews, document review, and observation of research participants (Fusch et

al., 2018). The paragraphs below illustrate why qualitative researchers must establish credibility

and transferability of their research.

Researchers using qualitative research use multiple techniques to achieve research

credibility; one of the benefits of the qualitative research process is that qualitative research is

flexible as the researcher can adjust the research process as they see fit for a given scenario

(Cypress, 2017). Qualitative research is not value-free because qualitative researchers bring their

own biases to the research process (Fusch et al., 2018) . The researcher's bias and the kind of

flexibility that qualitative research offer calls into question the research validity of the research

findings since the researcher is the main instrument of the research (Cypress, 2017; Fusch,

Fusch, & Ness, 2018). Proper qualitative research must, therefore, demonstrate research rigor,

60
reliability, and validity (Barusch et al., 2011a; Thomas & Magilvy, 2011). Quantitative research

rigor is equivalent to reliability and validity in quantitative research (Thomas & Magilvy, 2011),

qualitative research rigor can be demonstrated through the researcher's ability to show

credibility, transferability, dependability, and confirmability of the research findings(Thomas &

Magilvy, 2011). Maintaining research validity is a critical component of qualitative research

designs, in both quantitative and qualitative instruments, there are three major validity items as

identified by (Heale & Twycross, 2015; J. W. Creswell, 2014).

To establish the credibility of a given study, qualitative researchers can generate

confidence in their qualitative research through the use of methods such, prolonged engagement

during data collection, persistent observation, triangulation which is a process of comparing

several data types and sources to provide deeper insights and meeting (J. B. Brown et al., 2015),

peer debriefing, negative case analysis, and member checking. (Barusch et al., 2011a; Wa-

Mbaleka, 2017), suggested that researchers could strengthen their researcher through (1) Making

a strong case for qualitative research in the title, abstract, and keywords; (2). Stating the

relevance of the research in the introduction; and (3) Starting qualitative research with a clear

research question. Cutcliffe and McKenna (1999), maintained that qualitative researchers could

improve the credibility of their research by allowing a colleague to participate in the

categorization and coding process of a transcript as a method to guard against the researcher's

bias. In addition to using colleagues to participate in the coding and theme development process,

research participants or member checking may also be used to validate research findings

(Candela, 2019). Interviewees were asked to review their interview transcripts and some of the

emerging themes from the interviews as a measure of reducing distortions, inaccuracies and

misinterpretations in the data collection and data analysis process.

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 Complementary to allowing other experts to participate in the coding process and

research participants participating in the data validation process. Triangulation was used as a

mechanism for achieving validity and confidence in the findings of the study (Medlin, 2012),

Farquhar et al. (2020), postulated that triangulation contributes to both internal and external

validity of qualitative research, triangulation is used to increase the richness of research

information and findings (Stavros & Westberg, 2009), triangulation is used as a tool to mitigate

the researchers bias by triangulating multiple sources of data to extrapolate meaning from data

using multiple realities or viewpoints (Fusch et al., 2018). Triangulation is particularly a good

tool in qualitative case study research because triangulation contributes to research validity

through the convergence of findings from multiple sources (Farquhar et al., 2020c), as a

validation strategy for qualitative research, triangulation is not restricted to the use of only one

method, theory and data source (Santos et al., 2020). Triangulation may consist of three main

elements, convergence, complementarity and divergence of participant views, in a case study

research conducted by Cooper, Stavros, and Dobele (2019), about the domains of influence

exploring negative sentiment in social media, face-to-face, semi-structured, open-ended

interviews, netnographic (netnography a form of ethnography that examines online cultures and

life) examination were used to triangulate case study data. In a study that sought to understand

relationship marketing in the context of an industry evolving in its strategic approach to

marketing, interviews, participant observation, and document review were used as data sources

to triangulate a diversity of research data (Stavros & Westberg, 2009). Based on the sample

studies (Medlin, 2012; Stavros & Westberg, 2009; Farquhar, Michels, & Robson, 2020), the

common three methods used for triangulation in case studies are interviews, document review,

and observation. Therefore, for the reasons cited in this section, the triangulation of qualitative

62
data from interviews, document review, and observation provided the best path to establishing

credibility. The next section will focus on the value of transferability in qualitative research.

Transferability in qualitative research is comparable to research validity in quantitative

research; transferability is a qualitative research construct that suggests that the findings from

one study and context could offer applicable lessons in another context (Daniel, 2018),

triangulation collaborates data from multiple viewpoints to increase understanding of a particular

theme and to provide validation of the findings from various sources (Stavros & Westberg,

2009), using various data sources increased transferability of the of the findings of a qualitative

study (Stavros & Westberg, 2009). To show that transferability has been exercised by a

researcher, the researcher should show how the content of interviews, the behaviors, and

observed events are generally representative of the lived experiences of participants and if such

representation could be used in other contexts (Daniel, 2018). Although it is almost impossible to

guarantee transferability of research findings from one context to another, qualitative researchers

are encouraged to use thick descriptions of themes as a strategy to allow readers to compare the

instances of a phenomenon described in a research report to their own situations and contexts

(Shenton, 2004). The researcher used thick descriptions of themes in the research report to allow

readers to extrapolate themes that may be applicable to their own findings. The researcher also

encourages future studies to use multiple case studies or quantitative research methods to

improve understanding of the phenomenon about the Effect of IT governance on network

operations in multiple hospitals in the Western United States of America and the United States,

such efforts will increase the ability to transfer findings from one hospital to another.

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 Data Collection

The sections below illustrate how the researcher collected data using interviews,

observations, and document reviews. The researcher used interviews, observations, and

document reviews as a data triangulation method to understand the research participants

perceived realities of the effects of IT governance on IT network operations at a hospital in the

Western United States.

Data Collection: Interviews

As noted in chapter 1 and in this chapter, the data collection process was conducted by

collecting and triangulating data from multiple sources such as semi-structured interviews,

document review, and observation. Data were primarily collected using semi-structured

interviews from a purposive sample of 11 interview participants. A purposive sample was used

because purposive samples are intentionally used to select participants and data that enrich the

findings of a particular study (Marton, 2013). A purposive samples is also known as judgment

sampling where participants are deliberately chosen due to their qualities and rich experiences

(Etikan, 2016; Higginbottom, 2004). The purposive sample using a maximum variation sample

(MVS) was used because using a purposive MVS allows the researcher to select participants

with a wide range of experience (Etikan, 2016). Using MVS the researcher interviewed

participants whose IT experiences ranged from 3 years in the company to over thirty years in the

organization, research participants included service management managers, network engineers,

firewall engineers, IT directors and the CTO. Using the MVS approached help the researcher

gain greater insights into the research phenomenon. Research participants included in this study

were chosen because of their experience with IT governance at the Hospital.

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 The researcher worked with the IT leadership at the hospital to identify and handpick

research participants that were likely to contribute to the study's purpose. After the participants

had been identified, the researcher sent recruitment emails to the chosen research participants;

the recruitment emails included a sample interview protocol and informed consent form attached

in appendix A and B of this paper. Each research participant was requested to sign the informed

consent form before participating in the 30-45 minutes interview. As per the university of

phoenix IRB requirements, the researcher obtained a signed Premises, Recruitment, and Name

(PRN) use permission form document that allowed the researcher to collect data at the hospital's

IT department in the Western United States of America. All interviews were conducted in

January 2021. The researcher reached a point of saturation by the 9th interview participant.

Although scheduled and conducted on separate days through the month of January 2021,

Interviews and observations were conducted during the same period. See appendix B for the

One-on-One IT governance Interview Protocol used as a guide to conduct semi structured

interviews.

Data Collection: Observation

Due to Covid-19 related restrictions, the researcher conducted observations using

Microsoft Teams. The researcher attended three IT CAB meetings to observe the hospital's

governance body responsible for approving and reviewing network operations-related changes

made by the IT team. Except for holidays that fall on Mondays, CAB meetings are held once

each Monday. The cab meetings observed were held in January 2021. The specific CAB

meetings observed were held on Jan 5th, Jan 12th, and Jan 25th. The CAB meeting held on Jan

4th lasted for about 26 minutes; the CAB meeting held on Jan 12th lasted for about 32 minutes;

the CAB meeting held on Jan 25th lasted for about 23 minutes. Each CAB meeting discussed

65
changes scheduled for the week and the possible impact the IT changes on the network or IT

environment could have on the hospital. The searcher audio recorded the CAB Teams meetings

that were later transcribed using an online tool otter.ai. See appendix C for the protocol

document used to observe The Effect of IT Governance (ITG) on Hospital Network Operations.

Data Collection: Document review

The researcher conducted a document review from the IT service management web

portal, where all IT governance policy documents and processes are stored. Document review

was conducted as the last step in the data collection process to validate and collaborate some of

the perceived realities of IT governance by IT leaders and IT staff in the IT department at the

hospital. The researcher searched the hospital's IT service management page using keywords

such as IT governance, asset management, change process, and service management. The search

criteria yielded IT governance documents such as: (a)IT service management definitions; (b)

Change Management Process for Standard Change; (c) Change Management Process for Normal

Change; (d) Change Management Process for Emergency; (e) Change Management Policy; (f)

Release Management Process; (g) Release Management Policy; (h) Service Level Management

Policy; (i) Service level management process; (j) Incident management process; (k)

Configuration management polity (l) change management process; (m) Configuration

management process; (n) Asset Management Policy; and (o) Service Level Management Policy.

The document review process was conducted during February and March 2021. At the

conclusion of the data collection, the research started intensive data analysis discussed in the

section below.

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 Data Analysis

This section reviews how interview data were recorded, transcribed, and analyzed. This

section also examines how document and observation evidence was analyzed. Data from

interviews, observation, and document review was used to identify evidence that supports or

answers the research question and opposing views from the evidence collected (Yin, 2018).The

key to qualitative research analysis is mastering the art of reflexivity and data iteration as the

researcher reviews, analyzes, and revisits with analyzed data over and over to discover new and

emerging themes from the data and how those themes inform the researcher's research

phenomenon (Srivastava & Hopwood, 2009). Through constant comparison and iteration, the

researcher compared and revisited data from interview transcripts, observations and document

review to discover emerging themes about the perceived realities of hospital's IT employees

about the effects of IT governance on network operations. During the data analysis, 26 categories

emerged, and five major themes emerged from the 26 categories. The five major themes are

discussed in chapter 4.

The researcher followed a data analysis approach and framework consistent with

previous scholars. Many scholars recommend that data analysis start as soon as the first data

element is collected (Rowley, 2012). The data analysis process should then continue in an

iterative process, starting with organizing the data set, getting acquainted with the data,

classifying, coding, and interpreting the data see also (O’Kane et al., 2021; Rowley, 2012).

O’Kane et al. further suggested the data analysis process should be conducted in a reliable and

trustable manner to demonstrate transparency and trustworthiness. To increase the research

findings' trustworthiness, the researcher used constant comparison and triangulation as a strategy

67
to draw meaning from multiple sources by analyzing confirming or opposing themes from

interviews, document reviews, and observations (Yin, 2017; Yazan & De Vasconcelos, 2016).

In this case study, the researcher investigated evidence collected about IT governance

such as: (a) How IT governance delivers value to the Hospital; (b) How IT governance leads to

strategic alignment of IT network operations to the Hospital's goals and missions; (c) How IT

governance leads to performance management of network operations; (d) IT governance and IT

resource management; and (d); IT governance and risk management; and (6) What IT

governance means in an organizational context.

Based on a case study design suggested by Srivastava and Hopwood (2009), it is

recommended that data analysis should focus on three main questions, the questions are: (a) what

are the data telling me?; (b) what is it that I want to know from the data?; and (c) What are the

dialectical relationships between what the data is telling me with what I want to know? Lester et

al.(2020) suggested data analysis in qualitative case studies is used to develop a more profound

and nuanced phenomenon by pursuing a combination of procedures such as coding, memo

writing, creating categories, and themes. Therefore, data analysis is a meaning-making process

that at a minimum, consists of examining, categorizing, tabulating, testing, or recombining

qualitative and quantitative evidence to address the initial proposition of a study (Yazan & De

Vasconcelos, 2016). Yin (2017) further suggested that qualitative researchers can follow four

general strategies to analyze qualitative evidence. The general strategies are: (a) relying on the

theoretical proposition of the researcher, (b) working with data from the ground up following an

inductive approach, (c) developing a case description; and (d) examining plausible rival

explanations in the evidence.

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 Specifically, the researcher used two main approaches of data analysis. The first approach

was working data from the ground up, working the data from the ground up is an inductive

approach of data analysis that assigns codes to the data, and each code represents an abstraction

or concept of interest (Yin, 2018). The themes represent the researchers answers to the research

question, the research context, and theoretical framework (Roberts et al., 2019). The second

approach used is the constant comparative data analysis proposed initially by Glaser and Strauss

(Sharma et al., 2019, see also Gephart, 2003;), constant comparison can be used to discover

relationships among categories and themes (Sharma et al., 2019). In this case study, constant

comparison was used to compare data across interviews, document reviews and observations.

To start the analysis process, after interviews are conducted, interviews must be first

transcribed before the data can be analyzed (Nascimento & Steinbruch, 2019). Inappropriate or

inadequate preparation of transcripts from the audio to digital recordings can delay or negatively

affect the data analysis process (McLellan et al., 2003). Transcription is used in qualitative

research to show evidence about a certain phenomenon that constitutes a certain interest in a

study; the way transcription is conducted largely shaped by the researcher's institutional culture,

academic environment, and background (Nascimento & Steinbruch, 2019). In this study, the

researcher used data transcription technology otter.ai for voice recognition software (VRS) to

transcribe the interviews. Transcribing the interviews using otter.ai was a strategy used to ease

and increase the data transcription process's speed for audio recordings as recommended by

Matheson (2007). The transcripts from data recordings were later used for analysis by

categorizing and develop emerging themes from the data. The sections below illustrate how the

researcher conducted data analysis for interviews, observation, and document reviews

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Data Analysis: Interviews

In this research, the researcher transcribed the interview data using an online tool otter.ai,

the transcribed interviews were uploaded to MAXQDA Analytics Pro 2020 for Mac OS, release

20.3.0. The researcher used MAXQDA to generated codes, patterns, and themes from the

interview transcripts. O’Kane et al. (2021) suggested that although computer aided qualitative

analysis and design (CAQDAS) do not perform data analysis independent of the researcher,

CAQDAS tools play a significant role in supporting researcher efforts in analyzing and

presenting data analysis in a trustworthy manner. The researcher used MAXQDA as a qualitative

analysis tool to store, code, analyze and drive themes from the collected research data. Data in

MAXQDA constituted the research case record. The case record was organized into subfolders

such as interviews, document review and observation. Organizing the data in a structured

recorded enabled the researcher to easily access, review and analyze the data.

Because qualitative analysis is an inductive approach of understanding what is going on

within an inquiry through a process of continually hunting for themes and concepts that emerge

from the collected data (Srivastava & Hopwood, 2009; Yin, 2017). The researcher used a

ground-up strategy as suggested by Yin (2017), to allow themes to emerge from the data.

Patterns and themes were allowed to emerge from the data based on what the researcher wants to

know from the data guided by the researcher's theoretical framework; the researcher's subjective

perspective; and the researcher ontological and epistemological perspective (Srivastava &

Hopwood, 2009).

The researcher also focused on examining and categorizing data, the process of

examining and categorizing data is commonly referred to as qualitative data coding (Castleberry

& Nolen, 2018), a code in qualitative research is a word or short phrase that symbolizes salient,

70
essence-capturing, and or evocative attributes for a proposition of language-based or visual data;

coded data could consist of interview transcripts, observation notes, journal analysis, documents,

drawings, and artifacts, emails correspondences and much more. It is through the coding process

that raw data is converted into meaningful and usable data through the identification of themes,

concepts, and ideas that are related to each other (Castleberry & Nolen, 2018). Coding is not a

linear process but an iterative and reflective process (Srivastava & Hopwood, 2009). The

researcher used an interactive approach to code themes and sub-themes that emerged from the

data from the beginning of the interview data collection process to the end of the interview data

collection process. Interviews were analyzed for information about (a) How IT governance

delivers value to the Hospital; (b) How IT governance leads to strategic alignment of IT network

operations to the Hospital's goals and missions; (c) How IT governance leads to performance

management of network operations; (d) IT governance and IT resource management; and (e); IT

governance and risk management; (f) What IT governance means in an organizational context.

Five main themes emerged from the interview data analysis process. Details about the interview

findings and emerging themes are discussed in chapter 4.

Data Analysis: Observation

The researcher uploaded observation transcripts to MAXQDA for data categorization and

analysis for emerging themes. After interview transcripts had been analyzed, the researcher

analyzed observation data and document review. Observation is a data collection process

describing events, behaviors, and artifacts in a social setting study (Kawulich, 2005).

Observation allows the researcher to learn about participant's activities in a natural environment;

observations may be used to check the nonverbal expression of feeling and observe events that

participants may not be willing to share during an interview (Kawulich, 2005). The researcher

71
used a ground-up strategy suggested by Yin (2017) to analyze the data for categorizing and

themes that emerged from the data. The analysis process also used the constant comparison

process to compare and confirm categories and emergent themes from interview data and

document review. The CAB meetings findings were consistent with the IT policies and

processed defined by the hospital’s IT governance body. Observation transcripts were analyzed

for: (a) How IT governance delivers value to the Hospital; (b) How IT governance leads to

strategic alignment of IT network operations to the Hospital's goals and missions; (c) How IT

governance leads to performance management of network operations; (d) IT governance and IT

resource management; and (e); IT governance and risk management; (f) What IT governance

means in an organizational context. The main emerging themes from observation data analysis

are discussed in chapter 4.

Data Analysis: Document review

The researcher conducted document review analysis extracted from the IT service

management documents found on the Hospital’s IT service management portal in addition to

interview and observation data analysis. The researcher uploaded all collected data governance

documents such as: (a)IT service management definitions; (b) Change Management Process for

Standard Change; (c) Change Management Process for Normal Change; (d) Change

Management Process for Emergency; (e) Change Management Policy; (f) Release Management

Process; (g) Release Management Policy; (h) Service Level Management Policy; (i) Service

level management process; (j) Incident management process; (k) Configuration management

polity (l) change management process; (m) Configuration management process; (n) Asset

Management Policy; and (o) Service Level Management Policy to MAXQDA. The researcher

reviewed IT governance supporting documents for patterns and themes that emerged about how:

72
(a) How IT governance delivers value to the Hospital; (b) How IT governance leads to strategic

alignment of IT network operations to the Hospital's goals and missions; (c) How IT governance

leads to performance management of network operations; (d) IT governance and IT resource

management; and (e); IT governance and risk management; (f) What IT governance means in an

organizational context. The emerging themes from the document review were consistent with the

findings from interviews and observation. Details about the document review findings and

emerging themes are discussed in chapter 4.

Chapter Summary

This chapter has presented an exploratory case study as the data collection method that

was used to collect data using interviews, document review, and observation as the main

instruments of data collection. The case study approach was used because case studies are

commonly used to develop an understanding of organizations and organizational processes.

Chapter three also presented the main research question of the research "What is the relationship

between IT governance and hospital network operations" and sub research questions. A

purposeful sample of 11 IT employees and hospital administrators were used as the target sample

for interviews. All research participants were required to read and sign an informed consent

form that allowed the researcher to collect their data. Credibility and transferability were

established by triangulating data sources such as interviews, document review, and observation.

The data analysis process followed and an iterative process from the beginning of the data

collection process to the end of data collection and analysis process. The researcher developed a

coding system that was used to identify emerging themes from the data and how the emerging

themes address the research question. Chapter 4 discusses the analysis and results.

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 Chapter 4

Analysis and Results

This study was an exploratory qualitative single case study that sought to understand

essential network governance and network operations stakeholder’s perceptions of the use of IT

governance (ITG) and the relationship of ITG to critical health care infrastructures such as

hospital information technology network operations. The study also explored the IT

government's perceived effect on network operations at a Hospital in the Western United States

of America. This study contributes to the knowledge of IT managers, Network engineers,

Hospital administrators, and other hospital stakeholders about the significant contributions that

IT governance could have on hospital network operations. Additionally, the study contributes to

the understanding of IT professionals and hospital administrators about effectively implementing

IT governance to improve network operation's alignment with the hospital's strategic goals and

missions. This chapter describes the analysis process and the study results of this study using a

group up and constant comparison data analysis approach.

Research Questions

The main research question was, "What is the relationship between IT governance and

hospital network operations?" The researcher asked five sub-research questions to understand the

effects of ITG on network operations in a hospital in the Western United States of America.

Listed below is the list of five sub-questions used by the researcher to guide the research:

SQ 1: How is IT governance of network operations used to deliver value to the Hospital?

SQ 2: How is IT governance of network operations used for strategic alignment to the Hospital's

goal and mission?

SQ 3: How is IT governance of network operations used for performance management?

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SQ 4: How is IT governance of network operations at the Hospital used for resource

management?

SQ 5: How is IT governance of network operations at the Hospital used for risk management?

This chapter builds on the first three chapters, the introduction, literature review, and

research methodology to analyze and present the results of this study. Chapter 4 also serve as a

transitionary chapter to the findings and conclusions in chapter 5. This chapter presents an

inductive analytical process used to code, develop categories, and emerging themes from the

data. Furthermore, this chapter presents the data collection process with sections such as the

informed consent, discussion of the data analysis phases, research participant demographics, the

data analysis method used, and a presentation of the analysis results.

Data Collection

The sections below provide a detailed discussion of the informed consent and data

collection process used in this study. Additionally, this section reviews the actual data collection

process using interviews, observations, and document review.

Informed consent discussion

As suggested by Williams and Pigeot (2017), all research participants should read and

sign an informed consent form before participating in the data collection process. Moreover, all

researchers should ensure that they seek participant consent, ensure research participant's

confidentiality and privacy of personal protected information. Seeking participant consent

provides a level of accountability and responsibility throughout the research process. The

informed consent form was sent to the participants by email; the research participants signed the

informed consent form, scanned the form and sent back the form by email to the researcher.

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 The collected research data was kept secure by following the University of Phoenix and

Institutional Review Board research guidelines on confidentiality. The recorded research

participant interviews are stored on a locally encrypted and password-protect hard drive on the

researcher's computer. Both local copies and iCloud copies are encrypted, and the file transfer to

the researcher's iCloud account uses end-to-end encryption of local and in-transit data.

Redundant password-protected copies of interview transcripts will be kept on the researcher's

iCloud drive for at least three years after the interviews are collected. The protected files are

accessible to the researcher using two-fact authentication technology to ensure added security.

Personally identifiable research participant data is kept at a minimum. For example,

personally identifiable information has been removed from the transcripts and replaced with

participant pseudonyms. The participant pseudonyms were then assigned participant

identification numbers (ID) 1-11 for identifiers after interviews were transcribed and validated

by the research participants. The participant ID list is kept in a separate password-protected file.

Personally, identifiable information and raw data from interviews are stored in a different

password-protected file. The data will be kept for three (3) years. The research transcript data

will be destroyed by deleting the files from the researcher's local hard drive and redundant copies

from the researcher's iCloud account. Audio recordings from the interviews will be kept until the

interviews have been recorded and validated by the research participants within three to six

months. The audio recordings will be destroyed by file deletion. The researcher will destroy

interview hard copy field notes by shredding them after three years from the research date. Field

notes collected; and electronic copies will be destroyed by file deletion. The researcher obtained

data access and permission from the Hospital that granted the researcher permission to conduct

interviews, observations, and document reviews.

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The Data collection process

The data collection process was conducted using data triangulation from multiple sources

such as semi-structured interviews, document reviews, and observation. Data were primarily

collected using semi-structured interviews from a purposive sample of 11 interview participants.

The researcher used purposive sampling because purposive samples are intentionally used to

select participants and data that enrich the findings of a particular study (Marton, 2013). A

purposive sample is also known as judgment sampling where participants are deliberately chosen

due to their qualities and rich experiences (Etikan, 2016; Higginbottom, 2004). The purposive

sample, using a maximum variation sample (MVS) was used because, a purposive MVS allows

the researcher to select participants with a wide range of experience ( Etikan, 2016), using MVS

the researcher interviewed participants whose IT experiences ranged from 3 year in the company

to over thirty years in the organization. Research participants included IT service managers,

network engineers, firewall engineers, IT directors, and the Chief Technical Officer (CTO).

Using the MVS approach help the researcher gain greater insights into the research phenomenon.

The researcher worked with the Hospital's IT leadership to identify and handpick research

participants that were likely to contribute to the study's purpose. After the participants had been

identified, the researcher sent recruitment emails to the research participants. The recruitment

emails included a sample interview protocol and informed consent form attached in appendixes

A and B of this paper. After signing an informed consent form, the interviewees participated in a

30–45-minute interview. As per the university of phoenix IRB requirements, the researcher

obtained a signed Premises, Recruitment, and Name (PRN) use permission form document that

allowed the researcher to collect data at the Hospital's IT department in Western United States of

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America. The recruitment process, interview, and observation process spanned ten months (May

13, 2020, through February 28, 2021). The interviews and observations were all scheduled for

January 2021 based on the participant's availability. The collection of documents for document

review was conducted in the month of February and March 2021.

Although scheduled and conducted on separate days through January 2021, Interviews

and observations were conducted during the same period. The researcher reached a point of

saturation by the 9th interview participant. The researcher attended three IT CAB meetings to

observe the Hospital's governance body's IT governance process to approve and review network

operations-related changes made by the IT team. After the scheduled interviews and observation

sessions, the researcher performed a preliminary document review and downloaded documents

relevant to the research. Document collection was conducted as the last step in the data collection

process. The collected documents helped validate and collaborate interview participant's

perceptions of IT governance's effect on network operations. The sections below illustrate how

the researcher collected data using interviews, observation, and document reviews

Data collection process: Interviews

Data were primarily collected using semi-structured interviews from a purposive sample

of 11 interview participants. A purposive sample was used because purposive samples are

intentionally used to select participants and data that enrich the findings of a particular study

(Marton, 2013). Using MVS the researcher interviewed participants whose IT experiences

ranged from 3 years in the company to over thirty years in the organization, research participants

included service management managers, network engineers, firewall engineers, IT directors and

the CTO. Using the MVS approached help the researcher gain greater insights into the research

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phenomenon. Research participants included in this study were chosen because of their

experience with IT governance at the Hospital.

The researcher worked with the IT leadership at the hospital to identify and handpick

research participants that were likely to contribute to the study's purpose. After the participants

had been identified, the researcher sent recruitment emails to the chosen research participants;

the recruitment emails included a sample interview protocol and informed consent form attached

in appendix A and B of this paper. Each research participant was requested to sign the informed

consent form before participating in the 30-45 minutes interviews. All interviews were

conducted in January 2021. The researcher reached a point of saturation by the 9th interview

participant. Although scheduled and conducted on separate days through the month of January

2021, interviews and observations were conducted during the same period. The researcher also

used Microsoft Teams as the communication tool of chose by the hospital to schedule and

conduct interview meetings. Interview meetings were double recorded using the researcher’s

iPhone application Voice Recorder and a handheld audio recorder. Audio data were uploaded to

an online tool otter.ai for transcription.

Data collection process: Observation

Due to Covid-19 related restrictions and guidelines about social distancing, the researcher

conducted observations using Microsoft Teams. The researcher attended three IT CAB meetings

to observe the hospital's governance body responsible for approving and reviewing network

operations-related changes made by the IT team. The cab meetings observed were held in

January 2021. The specific CAB meetings observed were held on Jan 5th, Jan 12th, and Jan 25th.

The CAB meeting held on Jan 4th lasted for about 26 minutes; the CAB meeting held on Jan

12th lasted for about 32 minutes; the CAB meeting held on Jan 25th lasted for about 23 minutes.

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Each CAB meeting discussed changes scheduled for the week and the possible impact the IT

changes on the network or IT environment could have on the hospital. The searcher audio

recorded the CAB Teams meetings that were later transcribed using an online tool otter.ai

Data collection process: Document review

The researcher conducted document reviews from the IT service management web portal,

where all IT governance policy documents and processes are stored. Document reviews were

conducted to validate and collaborate findings from interviews and observations about IT

governance's perceived realities by IT leaders and IT staff in the hospital's IT department. The

researcher searched the hospital's IT service management page using keywords such as IT

governance, asset management, change process, and service management. The search criteria

yielded IT governance documents such as: (a) IT service management definitions; (b) Change

Management Process for Standard Change; (c) Change Management Process for Normal

Change; (d) Change Management Process for Emergency; (e) Change Management Policy; (f)

Release Management Process; (g) Release Management Policy; (h) Service Level Management

Policy; (i) Service level management process; (j) Incident management process; (k)

Configuration management polity (l) change management process; (m) Configuration

management process; (n) Asset Management Policy; and (o) Service Level Management Policy.

The document review process occurred during February and March 2021. The ITG related

documents were downloaded and saved as word files; the word files were uploaded to

MAXQDA for storage and analysis.

Demographics

The researcher interviewed 11 interview participants; except for one participant, all

research participants were white males over the age of 18, all interview participants voluntarily

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participated in the interview process. The study participants included IT service managers,

network engineers, firewall engineers, IT directors, and the CTO in charge of hospital network

operations. Table 4.1 below shows the participant's demographics. The participant's names have

been anonymized using participant ID 1-11 to maintain the participant's privacy and anonymity.

Using a purposeful sample selection as the research design method allowed the researcher to

select sample participants that would accurately represent and talk about IT governance

practices.

Table 4.1

Interview participant demographics

Participant Title Race Gender Dept Experience

ID(P) (yrs.)
P1 IT director White M IT 20-25
P2 Firewall White M IT 20-25
engineer
P3 Network White M IT -
Manager
P4 CTO White M IT 30-40
P5 Security White M IT -
engineer
P6 Network White M IT -
architect
P7 Network White M IT -
engineer
P8 Director White M IT 20-25
P9 IT manager White M IT 35-40
P10 Incident N/A M IT 10-15
response
team lead and
Associate
director

P11 IT manager White M IT -

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 From the Table 4.1 above, the majority of participants were all male and white. All

interview participants were full time employees of the Hospital. No contractors were included in

this study.

Pilot Study

The researcher did not conduct a pilot study due to Covid 19 related restrictions that led

to limited access to the site and research participants. The researcher also had to accommodate

that the IT team members to be interviewed were under pressure to build new Covid 19 testing

sites and other Covid 19 related projects. Additionally, the researcher was advised by

management at the Hospital that the research participants did not have ample time to engage in a

preliminary pilot study and then the actual research. Therefore, the researcher relied on the three

methods of data inquiry for triangulation to improve the study finding’s credibility. As

previously mentioned in chapter three, triangulation compares several data types and sources:

peer debriefing, negative case analysis. Member checking of data sources was also used to show

the research's content validity. The researcher used document triangulation using sources such as

document reviews, interviews, and observations.

Data Analysis

Intensive formal data analysis began after the researcher collected and uploaded all the

data from interview transcripts, observation field notes, and IT governance documents, into a

computer-aided design and analysis software (CADAS) MAXQDA Analytics Pro 2020 for Mac

OS, release 20.3.0. The research data was uploaded to MAXQDA to create a case record and

database that made it easy to search on keywords during the coding process. The researcher

started the analysis process of interview transcripts, observation field notes, and IT governance

documents by reviewing, reading, re-reading, coding the data, and engaging in a constant

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comparison process to generate categories and themes. The categories and themes generated

from the research data provided valuable insights and answers to the research questions.

Before uploading the transcripts to MAXQDA Analytics Pro 2020 for Mac OS, release

20.3.0, the researcher engaged in an audio transcription process. The researcher used an online

transcription software, otter.ai, to transcribe the interviews and observations from audio to text.

The research interview transcripts are only accessible to the researcher. After transcribing the

interviews and observation recordings, the researcher exported the transcribed text from otter.ai

to MAXQDA for coding and analysis. The researcher created a case study database of interview

transcripts, field notes recorded from observations, and IT governance documents. The records in

MAXQDA became the researcher's case record. The collected IT governance documents,

interviews, and observation transcripts were chronologically organized into folders to facilitate

easy access and retrieval. The researcher also uploaded the interview and observations audio

recordings to MAXQDA attached to the text transcripts to re-read during the coding and analysis

process. The following sub-sections illustrate the specific coding data analysis processes used for

each of the primary data collection instruments. In addition to the findings presented in Table

4.2, this section further illustrates the data analysis for the results collected from a sample of 11

IT employees using interviews, observation of change advisory meetings (CAB), and document

reviews. This section concludes with some of the research participants' rich descriptions from the

interviews, observations, and document reviews.

The Coding Processes

The researcher started the data analysis process by reviewing and re-reading the data,

coding the data, and engaging in constant comparison to generate codes, categories, and themes

from the data using MAXQDA. The researcher coded the data using several coding methods

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 such as open coding and NVivo coding methods, as shown in Table 4.2. The researcher used

first-level coding and the second-level coding technique to refine the raw first-level codes. The

researcher then used axial coding to correlate meaning from different principles. The researcher

coded keywords using temporary constructs. Finally, the researcher developed a list of the brief

first-order constructs and second-order constructs that summarized important categories into

emergent themes from the data.

Table 4.2

Second level codes, categories and emerging themes

Categories Emerging Themes

1. Visibility of network operations network ITG’s value creation

2. Provides stability and rigor to IT network operations process leads to IT agility

3. Enabling of IT processes

4. Prioritization of actives and funding of business operations across the

enterprise

5. IT agility

1. Prioritization of IT activities ITG is used for strategic

2. ITG bridges the gap between business operations and Technical operations alignment between the

interests ITG value creation

3. Direction, vision, communication, weathervane, accountability process leads to IT agility

4. Strong partnership between IT and business for the hospital’s IT

5. Provide standards and architecture network operations

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 Categories Emerging Themes

1. Measure SLA and OLA ITG is used for strategic

2. From-to-gap analysis alignment between the

3. Measure Customer satisfaction hospital’s governance

4. Monitoring project completion practices and IT Network

5. Monitoring project completion operations

1. Budgeting for IT operations IT governance is used as

2. CMDB is used for asset management a configuration

3. IT expenses budgeting management tool to

4. Capacity monitoring and performance manage IT assets

5. IT human resource management

1. CAB is used to regulate changes ITG is used for risk

2. Manage high risk changes management and risk

3. Vetting new network solutions mitigation for IT related

4. Makes sure changes do not pause any risk or harm to the patients risks

5. Follow best practices for security management

As illustrated in Table 4.2, the researcher determined how categories connect to the

themes using a constant comparison method. The coding, category generation, and theme

mapping process took several weeks using a combination of both MAXQDA Analytics Pro 2020

for Mac OS, release 20.3.0, and an online mind genius software to help with mapping and theme

virtualization. The researcher reviewed and compared interview findings, observations, and

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document reviews to identify emerging themes through data triangulation. The emergent themes

will be discussed in the results section of this chapter. Figure 4.1 is a word cloud that illustrates

the codes used, categories, and emergent themes from the study:

Figure 4.1. The codes, categories and emergent themes of the study.

After coding, constant comparison, and development of categories, 26 major categories,

and five major themes emerged from the study, as shown in table 4.2 and summarized in table

4.3. Out of 532 codes generated from the data using the MAXQDA auto coding feature, open

86
coding, and axial coding. The researcher used app.mindgenius.com to map all the generated

codes into categories, as illustrated in figure 4.2. Table 4.3 shows the emergent types from the

case study. Table 4.3 illustrates the emergent themes from interviews

Table 4.3

Emergent themes from the study

Theme ID Theme
The ITG value creation process leads to IT
1
agility for the Hospital’s IT network operations.
ITG is used for strategic alignment between the
2 Hospital’s governance practices and IT Network
operations.
IT governance is used to measure performance of
3
IT Network operations.
IT governance is used as a configuration
4
management tool to manage IT assets.
ITG is used for risk management and risk
5
mitigation for IT related risks.

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Figure 4.2. Showing a map of emergent categories and themes of the study

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 The visual map in figure 2 illustrates the final stages of data categorization and data

mapping process followed by the researcher to categorize the five emerging themes of IT

governance at the Hospital.

Data Analysis: Interviews

Data analysis started as soon as the first interview was collected; however, intense data

analysis was conducted in February 20201. The transcribed interviews were uploaded to

MAXQDA Analytics Pro 2020 for Mac OS, release 20.3.0. The researcher used MAXQDA as a

qualitative analysis tool to store, code, analyze, and drive themes from the collected research

data. Data in MAXQDA constituted the research case record. The case record was organized into

subfolders such as interviews, document review, and observation. Organizing the data in a

structured record enabled the researcher to access, review quickly, and analyze it.

The researcher used an inductive approach to understand the effects of IT governance at

the hospital through a process of continually hunting for themes and concepts that emerge from

the collected data. The researcher used a ground-up data analysis strategy to allow themes to

emerge from the data. Patterns and themes were allowed to emerge from the data guided by the

researcher's questions. The researcher also focused on examining and categorizing data. The

coded data consisted of interview transcripts. Through the coding process, raw data was

converted into meaningful and usable data by identifying themes, concepts, and ideas related to

each other. Because coding is a nonlinear, iterative, and reflective process, the researcher used an

interactive approach to code themes and sub-themes that emerged from the data from the

beginning of the interview data collection process to the end of the interview data collection

process. Interviews were analyzed for information about (a) How IT governance delivers value

to the Hospital; (b) How IT governance leads to strategic alignment of IT network operations to

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the Hospital's goals and missions; (c) How IT governance leads to performance management of

network operations; (d) IT governance and IT resource management; and (e); IT governance and

risk management; (f) What IT governance means in an organizational context. Five main themes

emerged from the interview data analysis process. Details about the interview findings and

emerging themes are discussed in chapter 4.

Data Analysis: Observation

The researcher uploaded observation transcripts to MAXQDA for data categorization and

analysis for emerging themes. The observation allowed the researcher to learn about participant's

IT governance activities using Microsoft team. Similar to the interview data analysis process, the

researcher used a ground-up strategy to analyze the data for categories and themes emerging

from the data. The analysis process also used the constant comparison process to compare and

confirm categories and emergent themes between interviews, document review, and observation

transcripts. The observation findings were consistent with the hospital’s IT governance body's IT

policies and processes. Observation transcripts were analyzed for: (a) How IT governance

delivers value to the Hospital; (b) How IT governance leads to strategic alignment of IT network

operations to the Hospital's goals and missions; (c) How IT governance leads to performance

management of network operations; (d) IT governance and IT resource management; and (e); IT

governance and risk management; (f) What IT governance means in an organizational context.

Intense data analysis was conducted in February 2021. The main emerging themes from

observation data analysis are discussed in chapter 4.

Data Analysis: Document review

Intense document reviews were conducted in February and March 2021. The researcher

conducted document review analysis extracted from the IT service management documents

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found on the Hospital’s IT service management portal in addition to interview and observation

data analysis. The researcher uploaded all collected data governance documents such as: (a) IT

service management definitions; (b) Change Management Process for Standard Change; (c)

Change Management Process for Normal Change; (d) Change Management Process for

Emergency; (e) Change Management Policy; (f) Release Management Process; (g) Release

Management Policy; (h) Service Level Management Policy; (i) Service level management

process; (j) Incident management process; (k) Configuration management polity (l) change

management process; (m) Configuration management process; (n) Asset Management Policy;

and (o) Service Level Management Policy to MAXQDA. The researcher reviewed IT

governance supporting documents for patterns and themes that emerged about how: (a) How IT

governance delivers value to the Hospital; (b) How IT governance leads to strategic alignment of

IT network operations to the Hospital's goals and missions; (c) How IT governance leads to

performance management of network operations; (d) IT governance and IT resource

management; and (e); IT governance and risk management; (f) What IT governance means in an

organizational context. The emerging themes from the document review were consistent with the

findings from interviews and observation. Details about the document review findings and

emerging themes are discussed in chapter 4.

Results

The interview questions asked allowed the participants to explain how they perceived the

phenomenon of IT governance at the Hospital in their own words. As illustrated in table 4.3, the

five major emerging themes were: (a) The ITG value creation process leads to IT agility for the

Hospital's IT network operations; (b) ITG is used for strategic alignment between the Hospital's

governance practices and IT Network operations; (c) IT governance is used to measure the

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performance of IT Network operations; (d) IT governance is used as a configuration

management tool to manage IT assets; (e) ITG is used for risk management and risk mitigation

for IT-related risks. The rest of this chapter delves into relevant interview participant findings,

observations, and document review. Figure 4.3 shows the emergent themes generated using

MAXQDA. The emergent themes generated from interviews, observations, and document

review analysis.

Figure 4.3 showing the emergent themes in MAXQDA

Relevant results from interviews, observation and document review.

This section shows the relevant results that emerged from interview participants,

document observations, and document reviews. The relevant results presented in this section

follow the structure of the research questions that guided the study.

SQ 1: How is IT governance of network operations used to deliver value to the Hospital?

SQ 1: Relevant results from interview data analysis.

This question was asked to elicit Network Operations engineer's and leaders' perceptions

about how ITG delivers value through the Hospital's network operations Team.

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 Although there were some opposing views about the effects of IT governance at the

Hospital, many interview participants seemed to suggest that IT governance provides room for

an effective response to business needs by enabling and supporting effective IT process, provide

network operations visibility to the business, provide stability and rigor to IT operations,

prioritization of actives and funding of business operations across the enterprise. Overall, IT

governance leads to stability. The participant responses below illustrate some of the opposing

views about IT governance expressed by the participants. Some of the opposing views came

from the same participants.

Participants 2 observed that some departments are very resistant to change. As a result,

the ITG change approval process sometimes impedes progress and leads to constant negotiation

with stakeholders before changes can be performed on the network. The ongoing negotiation is

usually because different departments experience different impacts depending on the magnitude

of the change; thus, some departments are more resistant to a network change than others.

Participant 9 seemed to agree with participant 2 by saying that some changes may need to be

scheduled for a later date depending on what is going on in the Hospital's critical units. The risk

benefits analysis drives the change approval process. Assessing all risks before network changes

are implemented is sometimes perceived as a roadblock to network changes.

Contrary to the views expressed by participants 2 and 9, that suggests that IT could

impede progress or become a roadblock to IT agility, participants 2,4, 9, and 10 argued that ITG

enables IT processes and clears roadblocks that prevent IT operations from being successful and

agile. Participant 4 emphatically stated that IT governance enables IT and could not think of a

situation where IT governance impeded IT network operations progress. Instead, IT governance

clears road blocks and provides finding needed to invest in the continuous improvement of IT

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services at the hospital. Participant 2 agreed with participant 4 by stating that IT governance

brings value to the hospital by vetting reviewing network changes that could negatively affect

patient care. The goal of network operations is to have constant uptime or near uptime.

Additionally, participant 9 suggested that IT governance helps the network team focus and

prioritize the most critical activities to meet the hospital's goals and mission. Furthermore,

participant 10 noted that the network team understands why there are strict guidelines for

network changes and that the network team feels supported by the IT governance and leadership

team.

Participant 1 noted that IT governance brings visibility to the change process. The change

process is used to track network changes to minimize downtime that could impact patient care.

Participants 1 and 6 further noted that the ITG process at the hospital provides stability and rigor

by regulating modifications on the network to reduce the impact on the Hospital. Participant 11's

observations helped to bridge the gap between the opposing and supporting views of IT

governance by suggesting that. Although IT governance seems bureaucratic, IT governance

helps network engineers to implement improved products and services. Participant 4 maintained

IT agility is still possible with the Hospital's current IT governance practices. IT agility is

achieved by understanding the Hospital's strategic needs and devising plans to implement the

Hospital's IT service needs in a timely but safe approach.

Participants 7, 8, and 9 made observations about the value of a service catalog in the ITG

process. All service in the IT service catalog depends on the network. Participants 7 and 8 noted

that service level agreements are used to make the customers happy. Participant 3 summed up the

role that ITG plays to deliver value by saying that the network team is the Internet Service

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Provider (ISP) of the Hospital and a partner in providing all critical network services needed for

the Hospital to function effectively.

As illustrated in this section, despite some opposing views about the effect IT

governance has on the Hospital, IT leadership and IT teams feel like the IT governance process

in place is a strong relationship with the Hospital's leadership, the strong IT governance

relationship with the Hospital allows the network operations team to operate effectively and

efficiently as observed by participants 4.

SQ 1: Relevant results from observations data analysis.

The interview participant responses about how ITG seeks to create value are consistent

with the researcher's findings in the CAB meetings attended by the researcher; many CAB

members asked questions that sought to understand the value that the network's changes were

adding to the business. As an example, in the CAB meeting conducted on Jan 25th, 2021. CAB

members discussed the value of upgrading network devices and applications to the latest

releases. The CAB's Vetting process is a value creation process that ensures that all changes add

value to the IT process and services to the hospital.

SQ 1: Relevant results from document review data analysis.

In addition to interviews and observation findings, document review findings revealed

that service level management policies are used to manage the quality of services offered by IT

network operations to the Hospital. For example, the service level management policy states that

"Service Level Management (SLM) establishes service targets, monitors to ensure targets are

met, and ensures that current and future IT services are delivered at agreed levels. (Service Level

Management Policy)". The change management process is used to ensure standard changes are

preapproved by the CAB; normal and emergency changes also require approval by the CAB. In

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addition to change management and service level management. ITG documents also illustrated

the service release management process followed by the hospital. IT service release management

is another value creation process played by ITG at the hospital2. The following section reviews

key results from Sub-Question 2:data analysis.

SQ 2: How is IT governance of network operations used for strategic alignment to the

Hospital's goal and mission?

SQ 2: Relevant results from interview data analysis.

Many of the interview participants suggested that ITG creates a strong link with the

Hospital through strategic alignment, stability, and rigor. The Hospital's IT network operations

are run with the Hospital's strategic goals and mission in mind. Participants also noted that ITG

is used to improve decision-making, defining the IT department's vision and defining the IT

strategy for all IT operations aligned with the Hospital's goals and interests. Participants 1, 4, 8,

10, and 11 noted that IT governance is credited for offering perspective, stability, rigor,

performance management, and risk management. Participant 9 indicated that ITG is used to

maintaining the stability of network operations. Participant 1 postulated that the Hospital's ITG

processes provide stability and rigor by regulating activities such as network changes to reduce

the Hospital's impact resulting from network change. Participant 11 attributed IT success to the

vision, strategy, and IT process, and best practices implemented to the network the IT

governance practices at the Hospital.

Participant 8 affirmed that having a strong governance group is critical for IT network

operations and business success. In addition to effective IT governance, as noted by participants

4, 5, 8, and 11, IGT leaders at the Hospital, such as the CTO provide an organizational structure

standard across IT organization consistent with the IT needs of the hospital. Participant 2 noted

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that IT governance is used to set out the ground rules for IT operations. As an example, it is

through ITG that changes on the network are approved. Such processes help to safeguard

patients who are a majority of end-users of IT services at the Hospital. The Hospital can deliver

the best possible product to the patients through IT governance.

Participant 4 further suggested that IT governance is used to create business value

through strategic planning and gap analysis. The IT department aligns with the Hospital's

strategic goals and missions by identifying the goals and objectives needed to achieve as an IT

group to meet the organizational strategy, goals, and objectives. After conducting a gap analysis

to determine the IT organization's current and future desired state. The IT department focuses on

what needs to be done through IT projects and tasks to attain the Hospital's future desired state.

Furthermore, IT governance creates a robust partnership between IT network operations

and the hospitals' leadership goals and missions. Such a relationship helps IT network operations

to understand the business goals of the Hospital. As suggested by participant 4, a stable

relationship between IT network operations and the hospital governance groups has led to a very

stable network that produces reliable IT services for the organization. The strong relationship

between IT and business is achieved by the right decision-making processes such as funding and

implementing reliable IT architecture to support the hospitals growing needs and changing

needs. Furthermore, as observed by participant 8, IT governance is used to "manage a very stable

network that produces great value for the organization." Participant 6 indicated that IT

governance is the tool that helps the network team, such as network engineers, to understand the

business needs of the Hospital.

Although some participants such as participant 3 suggested that Network operations are

removed from the direction and vision of the organization and that at operational level, they did

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not see any alignment between their daily operations and IT governance as network engineers.

Most participants believe that ITG strikes a pretty good balance between control and allowing

network engineer autonomy. As an example, participant 7 noted that they did not feel like IT

governance was overly restrictive. Instead, ITG was used at the Hospital for a known purpose.

As pointed out by participant 4 noted, the sole purpose of IT governance at the Hospital was to

enable IT and IT operations.

SQ 2: Relevant results from observation data analysis

One of the critical discussions observed was about the issue of license compliance. One

of the changes presented in CAB of Jan 12th, 2021, was removing some Java application

installations from the IT environment for compliance purposes. Here is what one CAB member

stated “So this is basically, as a result of Oracle's licensing. We need to remove all of our Java

instances from our environment so that we could be in compliance since we're not purchasing

your licensing. And if users need a Java solution, they can just go to our software portal to

download Amazon Zeto”. The ITG observation about release management of licenses is

consistent with the finding from interview participants about the hospital’s need to run IT

network operations with the hospital's strategic goals and mission in mind.

SQ 2: Relevant results from document review data analysis

The service management policy and change management policies state that compliance

with regulatory requirements should be followed when applicable, especially in instances that

include the Health Insurance Portability and Accountability Act (HIPAA). The service

management policy further states that “Audits should be conducted to assess whether SLAs and

OLAs have been created and are being maintained in compliance with policies and procedures

and ensure that relevant measuring and reporting are being provided to determine if agreed

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service levels are being met”. IT governance policies, therefore, seek to align IT activities with

federal regulations such as HIPAA. ITG policies such as the incident management policy are

used to record and manage incidents on the network. Incidents are managed with the goal of

minimizing the impact on the network and quickly restore services that the hospital depends on

for operations. The next section looks at performance measures as a tool for IT governance.

SQ 3: How is IT governance of network operations used for performance management?

SQ 3: Relevant results from interview data analysis

This question was asked to explore Network Operations engineers and IT leadership

perceptions about how ITG manages performance operations for IT network operations.

Performance measure at the Hospital is based on activities that have to take place

between the current and future states of the organization. The activities between the current and

future states have to demonstrate progress to the desired future state. Participant 4 noted that

performing a gap analysis also helps the organizations determine the organization's current state

and where the organization wants to be. Participant 4 further stated that it is through the gap

analysis process that the organization defines how the future desired state is to be achieved.

Performance measure demonstrates how progress is achieved along the path to the future state.

Additionally, participant 8 noted that the IT network operations team implements

performance management at the operational level using key performance indicators such as

network health. Network health is measure using tools and dashboards to report on the network's

activities. Participant 1 noted that other performance indicators include monitoring network

utilization statistics, incident ticket resolution times, and problem tickets. As part of a

performance measure, participant 8 observed that they measure such activities as incident

management, mean time to repair rate, customer satisfaction rates, and much more. The network

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operations team monitors network utilization on network links. Measuring network utilizations is

used to understand the utilization of the network environment better. Performance measures

such as network utilization statistics are used to inform IT decision-makers about where

additional investments need to be made to improve the Hospital's support. Additionally,

participant 1 noted that ongoing governance of (a) monitoring data, (b) logging data, (c)

monitoring trouble tickets, and (d) user performance concerns; through the ticketing system

provide performance data influential to spending decisions. Significant spending decisions may

be driven by changes such as network architecture changes.

A common observation noted by participants 1 and 8 is that knowing how the network is

used is one example that ITG uses to measure performance and determine architectural and

operational changes. Using data from the network, the IT team can quantify the increase in the

use of some core services and the need for additional resources such as hiring more full-time

network engineers to support the Hospital's growing needs.

Project management and asset management are also used as performance indicators.

Participant 9 noted that the project management team is used to manage and report on large

network projects. Project management reports such as project completion rates are used to

measure IT performance. For example, a high and successful project completion rate is viewed

as a good performance indicator. Another performance indicator used by the ITG at the Hospital

is asset management using the configuration management database (CMDB). Although there are

several CMDB used at the Hospital, participant 2 noted that asset management using the CMDB

is a tool used to manage assets for performance management,

Furthermore, as noted by participants 1, 10, and 11, service level management is also

used as a performance management tool. It was noted that the IT department has service level

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agreements (SLAs) with some departments that heavily depend on IT for business operations.

Participant 7 mentioned that service level agreements are used to make sure the customers are

happy.

SQ 3: Relevant results from observation data analysis

Although performance management is a key IT governance function. The change

advisory meetings attended by the researcher did not address IT governance performance

measures. Therefore, there are no key findings about IT performance that the researcher can

report on.

SQ 3: Relevant results from document review data analysis

As defined in the service management policy “Service Level Management (SLM)

establishes service targets, monitors to ensure targets are met, and ensures that current and future

IT services are delivered at agreed levels (Service Level Management Policy)”. The service

management process is also used to measure performance based on defined and existing Service

Levels Agreements (SLAs) and Operational Level Agreements (OLAs) agreements (SLA). All

network services have measurable service targets outlined in the SLA. All IT services including

network related services are audited annually for relevance. Services that do not meet agreed

upon SLA develop Service improvement Plans (SIP) with the customer. SIPs are used for

continued service improvement. The next section reviews IT governance as a tool for resource

management.

SQ 4: How is IT governance of network operations at the Hospital used for resource

management?

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SQ 4: Relevant results from interview data analysis

Participant 11 noted that asset management is used as a resource management tool to

determine why somebody has a device such as a laptop and know why somebody requested a

laptop and what kind of data resides on that laptop. Asset management is also used as an IT

governance tool to allocate IT assets in a way that is consistent with the Hospitals goals and

missions. Consistent with the responsibility of ITG, managing how resources are deployed and

why they are delayed, participant 11 further suggested that ITG also looks at the aspect of

translating the cost-effectiveness of IT services, such as making sure the organization has just the

right IT resources and solutions for the Hospital's needs. For example, participant 4 observed that

the ITG leadership team is constantly measuring how network resources such as bandwidth are

utilized and reviewing the network architecture to meet the Hospital's high-level needs.

Participants 1 and 11 noted that Asset Management is used for monitoring and managing

information about items that must be tracked because of financial or regulatory requirements.

Participant 1 further noted that the Hospital has an asset manager. The asset manager is

responsible for managing the asset management life cycle of all assets at the Hospital. However,

Participant 4 noted that assets or resource management is delegated to IT operations, and it is not

usually an aspect that IT governance is concerned with. Participant 4 further pointed out that the

only time ITG focuses on asset management is when there is a need for a significant strategic

change that could impact the organization. Asset management was generally viewed as an

operational issue as the ITG leadership team rarely discusses asset management issues. Effective

IT resource management starts with the vendor's adequate vetting to select the best and most

reliable solution. Selecting the most cost-effective and reliable solutions translates into an

excellent end-user experience at the Hospital; as noted by participant 2, the Hospital uses an RFP

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process to procure new IT services. Participant 2 further noted that the RFP process is utilized to

ensure that money is well spent and not wasted by getting the best IT services.

Finally, as observed by participant 3, good stewardship of IT resources requires good IT

asset management. Under the umbrella of ITG, IT leaders seek to establish a return on

investment for new deployments. Furthermore, participant 3 observed that asset management is

the tool used to keep information on purchase dates and replacement costs of assets. Effective

resource management helps the IT Network operations team to manage their asset's life cycle

effectively. The next results to be reviewed are about risk management.

SQ 4: Relevant results from observation data analysis

The hospital's IT CAB meetings confirmed interview participant's perceptions that the

change advisory body (CAB) is responsible for controlling changes that affect IT operations.

Therefore, the CAB provides an oversight role as stewards to changes made on all IT assets. The

role of controlling changes made on IT assets is a critical role for risk management further

discussed in the risk management section of data analysis.

SQ 4: Relevant results from document review data analysis

Document reviews revealed that the CMDB is used for both performance management

and asset management. Using a CMDB is one of the ways the hospital manages IT resources and

assets. The Configuration management process states that configuration management is used to

identify and manage information about configuration items or significant IT service items. In the

document review of the configuration management policy, the policy further states that "The

Hospital uses a Service Asset and configuration management (SACM) process to manage assets

configuration management is a sub-process of the service asset and configuration management

(SACM) process. Furthermore, the configuration management policy states that the CMDB's role

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is tracking information about items considered significant In-service delivery and may include

asset information. Participant views were consistent with the existing policy and processes about

asset management using the CMDB. The last and final section of this chapter is findings of how

IT governance is used for risk management at the hospital.

SQ 5: How is IT governance of network operations at the Hospital used for risk

management?

SQ 5: Relevant results from interview data analysis

Participant 7 noted that risk management is one of IT governance's core functions and

one function that IT governance does best. The sole purpose of IT governance at the Hospital is

to manage and mitigate network change-related risks that could negatively affect patient care.

Participant 7’s observation is consistent with the Hospital's change management policy that

states that change Management's objective is to control changes that affect the Hospital's

operations logically and methodically to reduce adverse risks and maintain a stable environment.

Participant 7 further noted that the higher the risk level paused by a proposed network change,

the higher the scrutiny and involvement of IT governance.

Participant 1 noted that all network improvement project initiatives must consider the

risks that network changes are likely to pause to patients. Participant 1 further stated that new IT

solutions are set to ensure that the defined IT security measures are followed. Participant 1 also

noted that when deploying critical hospital applications, the solution architects ensure

appropriate redundancy and disaster recovery is built into the new solutions.

Participant 11 observed that IT governance is used to vet new ideas and changes that

require changing the direction of services offered through architecture committees and the

change control process. New services are vetted to understand why a given solution needs to be

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implemented. Changes with significant impacts to the Hospital are evaluated against the overall

organizational strategy, such as network security. Participant 2 stressed that all new systems

undergo a comprehensive security review before implementation on the network. Participant 3

observed a risk group within the security team responsible for vetting all new systems' safety.

Furthermore, as suggested by participant 6, ITG encourages industry best practices such as ITIL

and enforcement of the security team's policies to mitigate and manage risks.

IT directors address risk management at the operational level. However, IT governance is

also responsible for Risk management at a strategic level. Participant 4 noted that risk

management is especially considered if there is a fundamental change in direction to change

strategy. Furthermore, participants 4 and 9 indicated that at the forefront of IT operations is

patient safety. IT practitioners at the Hospital seek to minimize IT operations' impact on patient

care, as was emphasized by participant 10. Participant 10 further noted. The whole objective of

the change advisory body is to manage or mitigate risks to hospital operations. Therefore, the

change advisory body (CAB) asked questions about the risk level or a specific change during

CAB meetings. The researcher validated the risk management and risk validation process during

the three CAB meetings observed during the data collection process.

Although there are strategic risks and compliance initiatives, as noted by participant 8,

the Hospital's IT department tends to be reactionary to security risks and events. Participant 8

further indicated that Hospital's IT governance and security management team should be

proactive in mitigating security events. Participant 8 also noted that one of the reasons why the

Hospital ends up in a reactionary mode is due to the funding model. Many strategic initiatives

already have funding allocated, whereas unplanned security does not have funds allocated.

However, Participant 4 noted that the hospital has a risk management insurance policy.

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SQ 5: Relevant results from observation data analysis

The researcher observed that risk management and risk mitigation is all that the change

advisory body (CAB) does. Risk management is performed by regulating preapproving standard

changes, reviewing, and approving normal and emergency changes. This observation is

consistent with the views of research participants about the hospital's risk management process.

Existing documents about the hospital's change management processes also confirm the role of

the change management process in managing risks at the hospital.

SQ 5: Relevant results from document review data analysis

All change management documents reviewed revealed that one of the change

management processes’ roles is to mitigate risks by providing oversight over network operations

changes. For example, the emergency change management policy states that the objective of

change management is to control changes that affect the hospital's operations. CAB follows

change and service management policies and processes to provides oversight for change

Management by reviewing and approving changes that could impact the health of the network

and patient care.

Chapter Summary

This Chapter explained the inductive analytical process used to code, develop categories,

and emerging themes. Furthermore, Chapter 4 presented the data collection process with sections

such as the informed consent, discussion of the data analysis phases, research participant

demographics. Chapter 4 presented a detailed data analysis method used to analyze data from

interviews, observation and document review. Finally, chapter 5 presented the results of the data

analysis process. Chapter 5 presents the Conclusions and Recommendations based on the five

emergent themes and research findings in chapter 4.

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 Chapter 5

Conclusions and Recommendations

Organizations can survive through the 21st century by adopting processes of constant

enhancement and effective application of information technology (Beaulieu-Brossard & Dufort,

2017). Research suggests that Information Technology Governance (ITG) ranks as one of the top

concerns of organizational leaders (Beaulieu-Brossard & Dufort, 2017; Falchi de Magalhães et

al., 2020). Just like good corporate governance leads to corporate success, so too good IT

governance leads to organizational success (Jeanne & Peter, 2004). Organizations that have

effective IT governance reported 20% more profitable bottom lines than organizations that do not

have IT governance (Weill & Ross, 2005). Organizations have an incentive to effectively run IT

operations because many organizations depend on IT for value creation and business success.

Decision-makers at the board level of an organization are faced with the need to make

sound IT-related decisions (Huygh & De Haes, 2019). Companies cannot remain innovative and

competitive without Information Technology (IT). Many organizations depend on IT for

innovation and for maintaining a competitive advantage. Organizational practices and skills are

needed to manage an organizations IT assets and operations. The achievement of business values

heavily depends on IT governance (Huygh & De Haes, 2019). Using corporate governance

bodies such as IT governance, effective IT operations can be well managed (Van Grembergen,

2007). IT governance is a branch of corporate governance used to institutionalize the

management and overseeing of IT assets by implementing processes, structures, and relational

mechanisms that enable IT and business to succeed (Huygh & De Haes, 2019). Caluwe and De

Haes (2019) further noted that IT governance is used for integrating IT strategy with an

organizational system to minimize enterprise IT-related risks and optimize IT investments. The

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ever-increasing dependence of hospitals on IT calls for the effective management of IT assets in

hospital environments IT governance is used in hospitals to cut costs and offer innovative

solutions to offer and improve patient care (Bradley et al., 2012).

This exploratory qualitative single case study sought to understand essential network

governance and network operations stakeholders' perceptions of IT governance's effects on

hospital network operations. The study also explored IT governance's perceived impact on

network operations at a Hospital in the Western United States of America. This study (a)

Contributes to the knowledge of professionals such as IT managers, Network engineers, hospital

administrators, and other hospital stakeholders about the significant contributions that IT

governance could have on hospital network operations. (b) The research findings also contribute

to the understanding of IT professionals and hospital administrators about how to effectively

implement IT governance as a way to improve the alignment of network operations with the

strategic, goals, and missions of the hospital. This chapter describes the analysis process and the

study results using a constant comparison data analysis approach.

Research Questions

The main research question was “What is the relationship between IT governance and

hospital network operations?” based on the literature review, five sub-research questions were

developed and asked to help the researcher understand the effects of ITG on network operations

at a hospital in the Western United States of America. The following sub-questions were used to

guide the research:

SQ 1: How is IT governance of network operations used to deliver value to the Hospital?

SQ 2: How is IT governance of network operations used for strategic alignment to the Hospital's

goal and mission?

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SQ 3: How is IT governance of network operations used for performance management?

SQ 4: How is IT governance of network operations at the Hospital used for resource

management?

SQ 5: How is IT governance of network operations at the Hospital used for risk management?

This chapter builds on the first three chapters, the introduction, literature review, and

methods used to collect the data to analyze and present the findings. Chapter 4 also serve as a

transitionary chapter to the findings and conclusions in chapter 5. This chapter presents an

inductive analytical process used to code, develop categories, and emerging themes.

Furthermore, this chapter presents the data collection process with sections such as the informed

consent, discussion of the data analysis phases, research participant demographics, the data

analysis method used, and a presentation of the analysis results.

Discussion of Findings

The findings in this section are drawn from the 11 reach participant responses,

observation of 3 change advisory board (CAB) meetings, and document review of documents

retrieved from the hospital's IT service management page. The findings illustrate the perceived

effect of IT governance of network operations at a hospital in the Western United States of

America. The interview participants were IT service management managers, network engineers,

firewall engineers, IT directors and the Chief Information Technology Officer (CTO). Semi-

structured interviews were used to collect participant responses. Additionally, the researcher

used document reviews and observation to validate the interview findings. Research participant

responses were recorded and transcribed using otter.ai.

The intense data analysis process started after the research data were uploaded to

MAXQDA Analytics Pro 2020 for Mac OS, release 20.3.0. Data was uploaded to MAXQDA to

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create a case record and database that made it easy to search on keywords during the coding

process. The researcher started the analysis process by reviewing, reading, re-reading, coding the

data, and engaging in a constant comparison process to generate categories and themes from

interview transcripts, observation transcripts, and IT governance process and policy documents.

The categories and themes generated from the research data provided valuable insights and

answers to the research question. The data findings in chapter 4 were used to draw conclusions

and recommendations by comparing and contrasting the study results to the existing literature.

Conclusions and recommendations will be drawn from the emerging five emerging themes of

this study. The five emerging themes were:

1. The ITG value creation process leads to IT agility for the hospital's IT network

operations.

2. ITG is used for strategic alignment between the hospital's governance practices and IT

Network operations.

3. IT governance is used to measure the performance of IT Network operations.

4. IT governance is used to manage IT assets using a configuration management tools.

5. ITG is used for risk management and risk mitigation for IT-related risks.

The next section presents the implications for each of the five-sub research question

asked and the emerging themes from each of five research questions from the 11 participants.

Table 5.1 shows the relationship between the five emerging research sub-questions and the

emerging themes from the study.

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 Table 5.1

Research questions and corresponding emergent themes

Research question Emergent theme.

R1. How is IT governance of network The ITG value creation process leads to

operations used to deliver value to the IT agility for the Hospital’s IT network

hospital? operations.

R2. How is IT governance of network ITG is used for strategic alignment

operations used for strategic alignment to between the Hospital’s governance

the Hospital's goal and mission? practices and IT Network operations.

R3. How is IT governance of network

operations used for performance IT governance is used to measure

management? performance of IT Network operations.

R4. How is IT governance of network

operations at the Hospital used for resource IT governance is used to manage IT assets

management? using a configuration management tools.

R5. How is IT governance of network

operations at the Hospital used for risk ITG is used for risk management and risk

management? mitigation for IT related risks.

Most findings in this study were consistent with the findings in the literature. The section

below will compare and contrast the study findings with existing current literature on the effects

of IT governance in organizations.

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Comparing and contrasting study findings with existing literature.

Theme 1. The ITG value creation process leads to IT agility for the hospital's IT network

operations. Most participants seemed to agree that IT governance creates value to the business

through the IT department's services. Vidmar et al. ( 2021) suggested that policymakers can use

IT to attain sustainable business objectives such as an organization's economic, social, and

environmental objectives. Sustainable business objectives can be achieved through IT

innovation. In most organizations, the IT department constitutes one of the most significant

portions of most firm investments. IT departments are increasingly the critical driver for strategic

initiatives in organizations. Therefore, there is a growing need for many businesses to see a

return on IT investments (Héroux & Fortin, 2018).

The value creation process is mainly attributable to best practices such as IT service

management (ITSM) as a tool to effectively deliver IT services (Winkler & Wulf, 2019).

Additionally, Zhen et al. (2021)) suggested that as organizations continuously rely on IT to

remain agile top management support of IT initiatives contributes to IT agility. IT governance

can be used to harmonize IT operations to achieve business agility by adopting governance

methods that use flattened organizational structures, smooth information flow, effective team

management for decision making, devolution of authority, and using participative management

styles, among others (Couto et al., 2015). The emergent findings from theme 1 about the role of

IT governance of network operations at the hospital in the value creation process are consistent

with current literature and industry best practices.

Theme 2. The IT governance process is used for strategic alignment between the

hospital's governance practices and IT Network operations. Many participants suggested that

there is a strong relationship between IT governance and the business. Research shows that IT

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alignment with business is critical for the decision-making process and the efficient

implementation of information technology in an organization (Couto et al., 2015).There is a

positive relationship between alignment and performance of proactive organizations. Therefore,

the IT organizations' alignment with the business leads to business success (Chau et al., 2020).

Patterson (2020) observed that it is almost impossible to separate business and IT strategies

because information technology is developing at an accelerated rate. Information technology can

only create value if aligned with the business strategy. New initiatives at the Hospital are

reviewed and approved by the ITG leadership team, as noted by research participant 1.

Participant 4 indicated that IT governance clears any roadblocks that may impede IT success. As

a foundation for IT architecture, the IT department at the hospital designs solutions that serve the

hospital's needs.

Theme 3. Information technology governance is used to measure the performance of IT

Network operations. Theme 3 is consistent with research findings that show that firms with

reliable IT capabilities lead to superior firm performance. A positive correlation between

effective IT project governance and project success or completion rate exists (Sirisomboonsuk et

al., 2018). Project completion rates are one of the key performance indicators of the efficient use

of IT resources. IT business value is measured based on improved productivity, improved

profitability, cost reduction, and the ability to enhance the organization's competitive advantage

(Pathak et al., 2019)

Additionally, enterprise IT architectures such as IT network designs should be designed in order

to optimize business workflows. Optimizing business work follows could result in maximizing

business benefits (Dumitriu & Popescu, 2020). Consequently, performance measures should be

integrated into the enterprise IT architecture design.

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 Theme 4. IT governance is used to manage IT assets using configuration management

tools. Many IT network operational failures are attributable to poor asset management; IT

failures that compromise IT assets' functional integrity and availability tend to be harmful to a

firm because such failures may compromise the confidentially of a firm's data assets (Langer,

2017). One of the relationships between IT governance and corporate governance is exercising

good stewardship through effective asset management (Juiz et al., 2015). Information technology

governance supports a business by identifying and managing strategic IT resources (Gërvalla et

al., 2018). Furthermore, IT resources at the hospital are managed using the configuration

management database. Consistent with the role of ITG in asset management as noted by

(Gërvalla et al., 2018; Langer, 2017; Juiz et al., 2015), several research participants pointed out

despite the existence of several configuration management data bases (CMDB), asset

management using CMDBs was a key component of IT service management at the Hospital.

Theme 5. Information technology governance is used for risk management and risk

mitigation for IT-related risks. Many participants suggested that risk management is the primary

goal of IT governance. Theme 5 is consistent with existing literature that suggests that IT

governance is used as a tool to manage both IT-related operational risks and business-related

risks as firms continue to face IT-related operational risks (Rubino et al., 2017). Additionally,

internal control of IT operations is the foundation of IT governance. Managers use ITG as a tool

to manage risks effectively and as a tool to manage internal business controls (Rubino et al.,

2017b). Heightened information technology-related security risks are a significant concern to

many organizations such as hospitals. Vincent et al. (2017) noted that IT risk management's

maturity is higher when the CIO reports to the CEO. Additionally, IT risk management practices

maturity mediates the relationship between IT governance and IT risk management practices

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(Edirisinghe Vincent & Pinsker, 2020). IT-related risks can be managed and mitigated by raising

awareness among IT managers about IT-related risks (Edirisinghe Vincent & Pinsker, 2020).

Limitations

The first limitation is that this study was a qualitative single case study and the findings

are limited to one major hospital in the Western United States of America. Generalizing the

conclusions from this study might be hard to apply in other hospital environments. The second

limitation was that study was conducted during the Covid 19 pandemic. Due to health experts

and government-mandated restrictions, the researcher could not interact with research

participants in a face-to-face interview process. The third limitations is that although most

research participants in the purposive sample were conversant with IT governance practices at

the hospital, some of the participants were not well-versed in how IT governance is implemented

and how their day-to-day efforts align with the Hospital's goals and missions through IT

governance. Participants that were not conversant with the IT governance practices could not

adequately speak to the effect of IT governance.

Recommendations to Leaders and Practitioners

This section includes recommendations for each of the five emerging themes.

Theme 1 recommendation. The ITG value creation process leads to IT agility for the

Hospital's IT network operations. Although most participants viewed IT governance as an

enabler of IT services and a strong partner with the business, a few participants suggested that

they sometimes viewed ITG as a roadblock that could impede the IT departments' agility or did

not see IT governance's role in their day-to-day operations. The recommendation is that CTO and

the IT governance group train or retrain the IT operations team about the benefits of IT

governance and how their roles contribute to the value creation and value delivery of IT services

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to the Hospital. IT leadership at the Hospital could provide all IT network operations employees

with IT best practice training such as Information Technology Infrastructure Library version 4

(ITILV4) and Control Objectives for Information and Related Technology version 5 (COBIT 5).

Such training would provide IT network operations employees with a holistic view of the role of

IT governance in the value creation process at the Hospital.

Theme 2 recommendation. Information technology governance is used for strategic

alignment between the hospital's governance practices and IT Network operations. Similar to the

observations made in theme 1, many employees expressed their appreciation for IT governance

and IT governance's role in aligning IT operations with the business. However, some employees

had a hard time seeing the alignment and benefits of aligning IT network operations to the

Hospital's strategic goals and missions. Similar to the recommendations noted in theme 1,

retaining the employees and constantly communicating with employees about the role and value

of network operations alignment to the organization's business goals will help improve the

perception of IT governance and IT governance at the Hospital.

Theme 3 recommendation. Information technology governance is used to measure the

performance of IT Network operations. Almost all participants did not seem to articulate how

ITG is used for performance management. The lack of clear performance measures may result in

poor execution of the IT delivery process. It could impact the quality of services delivered by the

network operations team to the Hospital. The researcher recommends that the hospital

implements performance measures such as using a balanced scorecard. A balanced scorecard is a

tool used to measure how the IT department aligns and focuses its people on the organizations'

strategic goals. The BSC helps an organization view the organization's performance from both a

financial and non-financial perspective (Lawrence & Gratton, 2016). The balanced scorecard can

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also be used to measure structure, cost, productivity, and quality of IT operations (Valchkov &

Valchkova, 2018).

Theme 4 recommendation. The IT governance is used to manage IT assets using

configuration management tools. Some key participants noted that assets or resource

management is delegated to IT operations, and it is not usually an aspect that IT governance is

concerned with. Some participants further noted that ITG is strictly focused on IT strategy.

However, the literature on IT governance suggests that One of the relationships between IT

governance and corporate governance is exercising good stewardship through effective asset

management (Juiz et al., 2015). IT governance supports a business by identifying and managing

strategic IT resources (Gërvalla et al., 2018). Consequently, the researcher's recommendation to

the IT governance team is that more time and resources are dedicated to the stewardship and

accountability of IT assets at the Hospital.

Theme 5 recommendation. Information technology governance is used for risk

management and risk mitigation for IT-related risks. Despite the existence of strategic risk and

compliance initiatives at the hospital, some participants noted that the hospital's IT department

tends to be reactionary to security risks and events. Yet, the hospital should be proactive when it

comes to mitigating security events. The hospital's reactionary stance on IT risks was attributed

to a lack of budget to deal with security events as they occur. As observed by Selig (2016), one

of the responsibilities is that ITG is responsible for managing risks and contingencies

proactively. Benz and Chatterjee (2020) recommended that IT practitioners proactively

implement cybersecurity measures such as identifying, detecting, responding, and recovering

from security incidents. The researcher recommends that the hospital's strategic leadership team

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ensures that cybersecurity efforts are well funded to respond to emerging information security

risks proactively. Table 5.2 presents a summary of the emerging themes and recommendations.

Table 5.2

Research emergent themes and recommendations

Emergent theme Recommendations

Training and retraining employees in IT

The ITG value creation process leads to IT
best practices such as COBIT 5 and ITIL
agility for the Hospital’s IT network
V5 to raise awareness about the ITG value
operations.
delivery process.

Constant communications about ITG,

training and retraining employees in IT

ITG is used for strategic alignment between
best practices such as COBIT 5 and ITIL
the Hospital’s governance practices and IT
V5 will help improve the perception of IT
Network operations.
governance and IT governance at the

Hospital.

IT governance is used to measure Implement a balanced score card (BSC) as

performance of IT Network operations. a performance management tool.

ITG should dedicate more time and

IT governance is used to manage IT assets
resources to the stewardship and
using a configuration management tools
accountability of IT assets at the Hospital.

ITG is used for risk management and risk The hospital's strategic leadership team

mitigation for IT related risks. ensures that cybersecurity efforts are well

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 funded to respond to emerging

information security risks proactively.

Recommendations for Future Research

Since this study was a single exploratory case study, future studies may conduct a multi

case study. A multi case study may be conducted to include other hospitals to help validate the

external validity of this research findings. The findings in this study may further be explored by

using other research methods such as:

1. A Multi case study with more than one hospital.

2. A quantitative research method to measure the impact of IT governance on hospital

network operations quantitatively.

3. An action research method to develop specific actions that should be implemented for

each of the issues noted in chapter 5.

4. A grounded theory to develop an emerging approach about the effects of IT governance

of hospital network operations.

Chapter Summary

Chapter five presented the study's conclusions and recommendations based on the

researcher's findings from chapter 5. The key conclusions based on the study's emergent themes

were: (a) The ITG value creation process leads to IT agility for the Hospital's IT network

operations; (b) ITG is used for strategic alignment between the Hospital's governance practices

and IT Network operations; (c) IT governance is used to measure the performance of IT Network

operations; (d) IT governance is used to manage IT assets using a configuration management

tools, and (c) ITG is used for risk management and risk mitigation for IT related risks. The five

119
key recommendations are: (a) Training and retraining employees in IT best practices such as

COBIT 5 and ITIL V5 to raise awareness about the ITG value delivery process; (b) Constant

communications about ITG, training and retraining employees in IT best practices such as

COBIT 5 and ITIL V5 will help improve the perception of IT governance and IT governance at

the Hospital; (c) Implement a balanced scorecard (BSC) as a performance management tool; (d)

ITG should dedicate more time and resources to the stewardship and accountability of IT assets

at the Hospital; and (e) The Hospital's strategic leadership team ensures that cybersecurity efforts

are well funded to respond to emerging information security risks proactively.

A previously noted, the findings in this study may further be explored by using other

research methods such as:

1. A Multi case study with more than one hospital.

2. A quantitative research method to measure the impact of IT governance on hospital

network operations quantitatively.

3. An action research method to develop specific actions that should be implemented for

each of the issues noted in chapter 5.

4. A grounded theory to develop an emerging approach about the effects of IT governance

of hospital network operations.

Further exploration could be dedicated to developing training modules that can help

improve IT governance alignment with the Hospital's goals and objectives. Additionally, further

research could be conducted using a mixed-method approach with multiple cases. The findings

for the study can help improve the applicability of the study findings to a larger environment.

The study contributed to the body of knowledge that effective IT governance leads to (a)

an improved ITG value creation process. An improved value creation process leads to IT agility

120
for the Hospital's IT network operations; (b) ITG plays a critical role in the strategic alignment

between the Hospital's governance practices and IT Network operations; (c) IT governance can

be used to measure the performance of IT Network operations; (d) IT governance is used to

manage IT assets using a configuration management tools, and (e) ITG is used for risk

management and risk mitigation for IT-related risks.

The practical application of IT governance best practices such as COBIT and ITIL will

enable the hospital's IT network operations to improve IT services continuously. The Hospital's

IT leadership team should constantly evaluate how IT governance enhances IT network

operations service delivery using a balanced scorecard. Additionally, the Hospital IT leadership

team will need to continually communicate what they are doing to the IT team to raise awareness

and alignment of IT network operations alignment with the hospital's goals and missions.

Finally, the researcher recommends that the hospital's IT department implement the COBIT

framework of IT governance and continually measure the IT department's maturity COBIT

maturity level.

121
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 Appendix A:

Informed Consent Form

Informed Consent: Participants 18 years of age and older

Greetings,

My name is Jackson Ivan Isiko and I am a student at the University of Phoenix working on a

Doctor of Management in Organizational Leadership with a specialization in Information

Systems and Technology. I am conducting a research study entitled The effect Of IT

Governance (ITG) On Hospital Network Operations.

This study will use an exploratory qualitative single case study to understand stakeholders'

perceptions on the use of ITG and the relationship of ITG to critical health care infrastructures

such as hospital network operations. The study will also seek to explore how the IT governance

body and IT governance practices implemented at a hospital in the Western United States of

America affect the efficiency of IT Network Operations at a hospital in the Western United

States of America. This study will: (1) Contribute to the knowledge of professionals such as IT

managers, Network engineers, Hospital administrators, and other hospital stakeholders about the

significant contributions that IT governance could have on hospital network operations; and (2)

The research findings will contribute to the understanding of IT professionals and hospital

administrators about how to effectively implement IT governance as a way to improve the

alignment of network operations the strategic, goals, and missions of the hospital. The findings

will be published in top information systems academic journals, such as : (1) Journal of the

Association for Information; (2) Journal of Information Technology; (3) Journal of Management

Information Systems; (4)Information Systems Research; (5) MIS Quarterly; (6)Information

150
Systems Journal; (7) Journal of Strategic Information Systems; (8) Journal of Management

Information Systems; and (9) European Journal of Information Systems.

Your participation will involve participation in interviews, observation and document review of

the exiting IT governance process by participating in:

1.One or two sessions of 45 minutes interview, research participants may also be involved in

a 1 hour’s session of document review and observation during the change advisory body

(CAB) meetings.

2. Interviews will be audio recorded and used to transcribe the interview session for each

participant.

3. If the researcher deems that the participants are not contributing to the research process,

the researcher may terminate the research participant from participation in the research

process without the research participant’s consent.

4. The participant will be part of the 10 to 20 research participants that will be part of the

study.

You can decide to be a part of this study or not. Once you start, you can withdraw from the

study at any time without any repercussions. The results of the research study may be published

but your identity will remain confidential or anonymous, and your name will not be made known

to any outside parties.

In this research, there are no foreseeable risks to you.

Although there may be no direct benefit to you, a possible benefit from your being part of this

study how the research findings will contribute to the understanding of IT professionals about

how to effectively implement IT governance as a way to improve their alignment to the strategic,

151
goals and mission of the of the hospital and the significant effects that IT governance could have

on hospital network operations.

If you have any questions about the research study, please call me at 801-791-3883 or email me

at isijackson@email.phoenix.edu. For questions about your rights as a study participant, or any

concerns or complaints, please contact the University of Phoenix Institutional Review Board at

IRB@phoenix.edu.

As a participant in this study, you should understand the following:

1. You may decide not to be part of this study or you may want to withdraw from the study

at any time. If you want to withdraw, please call me at 801-791-3883 or email me

isijackson@email.phoenix.edu

2. Your identity will be kept confidential or anonymous

3. Jackson Ivan Isiko the researcher, has fully explained the nature of the research study

and has answered all of your questions and concerns.

4. Before interviews are conducted, you must give permission for the researcher, Jackson

Ivan Isiko, to record them. The information from these recorded interviews will be

transcribed by Jackson Ivan Isiko, and the data will be coded to assure that your identity

is protected.

5. Data will be kept secure by following the University of Phoenix and institutional review

board research guidelines on confidentiality. The recorded research participant

interviews will be stored on a locally encrypted, and password-protect hard drive on the

researcher’s computer. Redundant password-protected copies of interview transcripts

will be kept on the researcher's iCloud drive for at least three years after the interviews

are collected. The protected files will only be accessible to the researcher. Personally,

152
 identifiable research participant data will be removed from the transcripts and replaced

with pseudonyms after interviews have been transcribed and validated by the research

participant. Personally, identifiable information and raw data from interviews will be

kept in different password protected files. The data will be kept for three (3) years. The

research transcript data will be destroyed by deleting the files from the researcher’s local

hard drive and redundant copies from the researcher's iCloud account. Audio recordings

from the interviews will be kept until the interviews have been recorded and validated by

the research participants within three to six months. That audio recording will be

destroyed by file deletion of the audio recording and destroying any media may that

contains the participant's audio record. The researcher’s interview field notes will be

destroyed by shredding after 3 years from the date of the research field notes collection.

Although not foreseen in this research, as a limit to your confidentiality, the researcher

may be compelled to release study data in response to legal action.

6. The results of this study may be published.

By signing this form, you agree that you understand the nature of the study, the possible risks

and benefits to you as a participant, and how your identity will be kept confidential or

anonymous. When you sign this form, this means that you are 18 years old or older and that you

give your permission to volunteer as a participant in the study that is described here.

( ) I accept the above terms. ( ) I do not accept the above terms. (CHECK

ONE)

153
Signature of the research participant ____________________________________ Date

_____________

Signature of the researcher _____________________________________ Date _____________

154
 Appendix B:

One-on-One IT governance Interview Protocol

Problem

The main problem is that poor information technology governance (ITG) has often led to

failed IT projects and implementation of effective IT operations in organizations that heavily rely

on IT for businesses operations(Ako-Nai & Singh, 2019). ITG governance is often found

lacking in critical healthcare IT infrastructures such as IT networks, poor IT governance could

impact the quality of IT services delivered by an IT department(Jairak & Praneetpolgrang, 2013)

Purpose

This study will use an exploratory qualitative single case study to understand stakeholders'

perceptions on the use of ITG and the relationship of ITG to critical health care infrastructures

such as hospital network operations. The study will also seek to explore how the IT governance

body and IT governance practices implemented at a hospital in the Western United States of

America affect the efficiency of IT Network Operations at a hospital in the Western United

States of America. This study will: 1) Contribute to the knowledge of professionals such as IT

managers, Network engineers, Hospital administrators, and other hospital stakeholders about the

significant contributions that IT governance could have on hospital network operations. 2) The

research findings will contribute to the understanding of IT professionals and hospital

administrators about how to effectively implement IT governance as a way to improve the

alignment of network operations the strategic, goals, and missions of the hospital.

Study: The effect of IT governance (ITG) on hospital network operations.

Pseudonym: _________________ Date: ______________________________

155
Time: ______________________ Location: ___________________________

Opening: Thank you for participating in the research study entitled, The effect IT governance

(ITG) has on hospital network operations, and for participating in this one-on-one interview. I

am dual audio recording this interview to have a back-up copy in case one of the recordings

should fail. Before we begin, for the purpose of confidential identification, please state the

pseudonym assigned to you.

1. Do you agree to the audio recording of this interview?

2. Do you willingly, of your own free choice, choose to participate in this interview?

3. Did you review the Preliminary Eligibility document?

4. Do you meet the eligibility criteria as outlined in the Preliminary Eligibility document?

5. Have you read the Informed Consent?

6. Do you understand the Informed Consent?

7. Have you signed the Informed Consent?

8. Are you aware that you are free to withdraw from participation at any time before, during,

or after this interview without penalty or repercussion?

Thank you.

Before we begin, do you have any questions?

156
I will be asking you a series of open-ended discussion questions that relate to the central research

question and sub-questions. Feel free to ask questions as they arise and to elaborate on your

responses. The more detail you can provide, the better. No right or wrong answers exist. This

interview will take no more than 90 minutes of your time.

The study will be guided by the following question and sub-questions.

Main research question.

What is the relationship between IT governance and hospital network operations?

The research will then be guided by the following sub-questions.

Sub research questions:

1. How is IT governance of network operations used to deliver value to the hospital?

2. How is IT governance of network operations used for strategic alignment to the hospital’s

goal and mission?

3. How is IT governance of network operations used for performance management?

4. How is IT governance of network operations at the hospital used for resource

management?

5. How is IT governance of network operations at the hospital used for risk management?

Close: Thank you for participating today. We will meet one more time after I transcribe

the interview to allow you to review, revise, and approve the transcription.

157
 Appendix C: The Effect of IT Governance (ITG) on Hospital Network Operations

Observational protocol

The researcher will be observing at 3 IT governance meetings, the researcher will observe IT

governance meeting participants for general information about what happens in IT governance

meetings without directly quoting or identifying any individuals or reporting any proprietary

company information.

Location of observation:
Date
Observed by:
Duration of observation: ___Start time_________ Finish time____ Session#_____
Topic / Category Descriptive notes Reflection
observed
How IT Governance of
network operations is
used to deliver value to
the Hospital.

How IT Governance of
network operations is
used for strategic
alignment to the
Hospital's goal and
mission.
How IT Governance of
network operations is
used for performance
management.

How IT Governance of
network operations at
the Hospital used for IT
resource management.

How IT Governance of
network operations at
the Hospital is used for
risk management.

158
How IT performance
measures are aligned
with the performance
measures used by the
organization

159
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