The Interplay between Transformation in Everyday Work Practices and IS Design and Implementation Processes
- Empirical Experiences From the Health Information Systems in Tanzania
Faraja T. Igira - PhD thesis 2008
Studies recognizing that practices always contain an element of transformation are limited, not even in the integration of work practices and systems design. To address this shortcoming this thesis focuses on exploring the interplay between transformation in everyday work practices and information systems (IS) design and implementation processes. It is an interpretive and critical study initially informed by perspectives from Cultural Historical Activity Theory (CHAT) and Developmental Work Research (DWR). It builds on four papers based on a study in two health care organizations in Tanzania Mainland and Zanzibar during the period of January 2005- January 2007. It involves a study of everyday health workers’ work practices as well as the health information systems (HIS) developmental trajectory under the Health Information Systems Programme (HISP)’s initiatives. The study is an analysis of transformation in work practices that occur without and due to the effects from the IS design and implementation process, and how they impact each other. The aim is to contribute to a firmer and broader understanding of IS design and implementation processes within health care organizations and how to improve these processes.
The thesis focuses on two main questions: (1) What are the tensions that characterize transformation in everyday work practices of health workers and how do these tensions influence the design and implementation of IS?, and (2) What were the significant influence on transformation of work practices during the IS design and implementation process?
Data collection was qualitative based on ethnographic methods: a combination of formal semi- structured interviews, informal interviews and discussions (during workshops and trainings), participant observation (during formal and informal interviews, workshops and trainings), and documents analysis. Data analysis was interpretive basing on my capacity to conceptualize the gathered data in relation to the research objectives and questions. Data collection and analysis were intertwined such that analysis occurred as the data was collected leading to further data collection and analysis. I initially used theoretical perspectives from CHAT as my primary analytical tool through which themes were created. However, the data collection and analysis involved openness and sensitivity to data and unexpected elements that became known as the study progressed. In this regard, I used additional theoretical perspectives from situated action, the temporal theory of agency and information infrastructure studies to complement my analysis of the empirical data in a CHAT sense.
The findings of the study are discussed into four main aspects: (1) tensions and transformation in work practices, (2) the interplay between technology materiality, context and the temporal view of human agency, (3) participation and how to participate in the IS design and implementation processes, and (4) improving HIS design and implementation processes.
The thesis draws both theoretical and practical contribution to the IS field in general and the HIS design and implementation processes in particular. The basis for the theoretical contribution is a diversity of the theoretical perspectives and their combination in analysing the empirical material. In this regard, the thesis contributes to existing activity theoretical approaches to the study of work practices in IS research by emphasizing the following: (1) situatedness of work practices as a way to understand the tensions between the needs of an individual as part of different collective activity systems, (2) considering the practical contingencies affecting action in the present, and (3) conceptualization of aspects of work practices that are taken from one activity system to another during its expansive development. Practical contributions include: (1) studying current work practices with change thinking, and (2) contextualization of participatory design approaches in non western countries. While the practical contributions are more relevant for health care settings, which are characterized by dynamics in work practices, I do see the potential of their applicability also in other settings where work practices in based on commonly shared routines and procedures involving practices that are not easily made visible.