A complexity inspired approach to co-evolutionary hospital management information systems development
Vincent Shaw - PhD thesis 2009
This thesis addresses the difficult task of developing sustainable and scalable hospital information systems in resource constrained (also commonly referred to as “developing country”) contexts. The thesis reflects on the authors’ experience working with public sector health and hospital information systems over 10 years in South Africa, Nigeria, Zambia, and Malawi. The research was conducted within the Health Information Systems Program which originated in 1994 through a partnership between NORAD and South African Universities and which is now established as an internationally acknowledged organization specializing in health information systems development in resource constrained contexts
The thesis provides rich insight into the context in which hospital management information systems design, development and implementation takes place in resource constrained settings. The context is described as exhibiting “extreme” heterogeneity because of the wide variety of possibilities that must be accommodated to successfully develop hospital information systems in resource constrained settings. For instance, if a computer is available, it will not function without electricity, and electricity supply may not be reliable. Even if there is electricity, and the computer is available, there may be insufficient staff to operate the computer, and if there are sufficient staff, there is no guarantee that the available staff will be computer literate. These characteristics have a compounding effect on one another, create imbalances and unexpected effects.
The contributions of the thesis can be briefly summarized as follows. An affordable and gradual approach to hospital information systems design and development is suggested based on developing local skills and systems using available resources and free and open source software. This approach contrasts the usual expensive, off-site development of hospital information systems that does not take into account the peculiarity of local circumstances. The technical design of hospital management information systems needs to incorporate flexibility into all components of the system. Typically for example, data reporting requirements change from year to year, or the data needs for managers at a national level differ from those at a facility level. The paper based tools for data collection and the software must be able to accommodate these changes over time. Flexibility is achieved by recognizing discrete components or modules within the information system. Modules can be easily replaced with newer versions, or modified to address local needs, without disrupting the entire system.
Flexibility is also built into the implementation process. Numerous approaches are described to encourage local innovation and development of the information system, and overcome skills shortages in the public sector. To counter these shortcomings, it is suggested that public sector organization (such as a hospital) and non-governmental organization specialising in health information systems design and development (such as HISP) can co-exist as synergistic partners. This is potentially a useful partnership because the organizations have complimentary skills, and organizational links with different domains of influence. An important outcome of this arrangement is the development of capacity within the public sector through the development of a new cadre of health information practitioners.
You can read all of the thesis on Vincent´s home page.