Open Access
Becker, Jonathan David
Graduate Program:
Information Sciences and Technology
Doctor of Philosophy
Document Type:
Date of Defense:
May 24, 2016
Committee Members:
  • Carleen Frances Maitland, Dissertation Advisor
  • Carleen Frances Maitland, Committee Chair
  • Irene Petrick, Committee Member
  • Rosalie Ocker, Committee Member
  • Shawn Mitchell Clark, Outside Member
  • Resource Dependence Theory
  • Organizational Theory
  • Health Information Exchanges
  • State Health Information Exchange Cooperative Agreement Program
  • HIE
  • RHIO
  • Regional Health Information Organizations
  • Board of Directors
  • Strategy
  • Organizational Performance
  • Information systems
In 2009, $550 Million was disbursed through a Federal program, the State Health Information Exchange Cooperative Agreement Program (SHIECAP), to facilitate and expand the exchange of patient health data among healthcare organizations. This program created concurrent efforts in each state that recruited leadership and drafted strategy to surmount the sociotechnical barriers to offering patient data exchange. SHIECAP aimed to alleviate these barriers through a combination of funding and guidance. As of 2016, there has been growing interest in the local counterparts of SHIECAP, the Health Information Exchanges (HIEs), but there has been little research on the performance of the statewide SHIECAP organizations. This investigation applies Resource Dependence Theory to fill this gap, focusing on the relationship between the boards of directors and strategy of these organizations as they influence performance. Resource Dependence Theory argues that organizations recruit directors to their boards to gain access to critical resources necessary for their strategy. As resources required and strategies employed vary across contexts so do their boards. To study these boards within this data exchange context, this study uses mixed methods within an embedded case research design. In this design, quantitative analyses of 44 SHIECAP organizations provide evidence to test the predicted relationships between boards, strategy and performance. An in-depth qualitative investigation of North Carolina is used to augment this analysis by capturing the mechanisms driving these predicted relationships. This work finds a strong relationship of board size and composition predicting performance of SHIECAP Organizations, but does not find a similar relationship between strategy and performance, though this is partially expected due to the lack of alignment between boards and strategy in this context. The North Carolina Case offers further explanation of these results showing (1) performance is mediated by the actions of several organizations, (2) a weakness in the SHIECAP Strategy labels applied by ONC, and (3) the mechanism that drives performance of these organizations. This melded approach provides three main contributions to Resource Dependence Theory. These are (1) a conceptual understanding of how boards and strategy relate to performance within the context of data exchange organizations, (2) a demonstration of a link between boards of directors and exchange use, and (3) an approach to categorizing compositions of board members in data exchange organizations.