A Realist Evaluation of the Sustainability of Disease Surveillance Intervention Outcomes in Sub-Saharan Africa

In recent years, the use of Information and Communication Technologies (ICTs) and to improve disease surveillance has been on the increase. This is in line with the notion that ICTs improve timeliness, availability and quality of public health data. Sub-Saharan Africa (SSA) is burdened with increasing health challenges and poor health infrastructure. Thus, an explosion of ICT-based health surveillance interventions to curb these challenges. However, despite the implementation of these interventions, important questions around the effectiveness and sustainability still remain. This study proposes a realist evaluation of disease surveillance intervention outcomes from a sustainability perspective to uncover what works, for whom, under what conditions and why? We also discuss how the complex adaptive systems theory and affordance theory provide a lens for investigating this phenomenon. The results of this study will contribute to the evidence based movement for Information Systems (IS) research and practice in SSA

Pharmacy Manager Strategies for Reducing Financial Losses From Adverse Drug Events by Polypharmacy Patients

Every year over 100,000 deaths occur in the U.S. from adverse drug events derived from medication errors. Medication errors account for an annual cost of $100 to$200 billion. Healthcare pharmacists lack strategies to reduce adverse drug events and medication errors from taking place. Grounded in complex adaptive system theory, the purpose of this qualitative multiple case study was to explore strategies to reduce advere drug events and medication errors. The participants were 5 pharmacist managers in a county in central Florida. These pharmacists were from different community pharmacies, and each had a minimum of 5 years’ experience in the field. The participants all responded to the same set of open-ended questions during semistructured interviews. Additional data sources for this study were field notes, business prescription literature, and analyzing observations of the participants. Data were analyzed using Yin’s 5 analytic techniques. Themes identified included: polypharmacy and the unknown, HIPAA and legal constraints, and CAS, the edge of chaos and clarity. The findings from this study may enable pharmacy managers to increase patient counseling time, encourage patient medication adherence; thereby, decreasing liability costs and additional medical expenses for polypharmacy patients. Social changes that may occur as a result of this study include a decrease in adverse events for polypharmacy patients and an increase in the quality of life for these patients

What is the extent of research on the characteristics, behaviors, and impacts of health information technology champions? A scoping review

Abstract Background Although champions are commonly employed in health information technology (HIT) implementations, the state of empirical literature on HIT champions’ is unclear. The purpose of our review was to synthesize quantitative and qualitative studies to identify the extent of research on the characteristics, behaviors, and impacts of HIT champions. Ultimately, our goal was to identify gaps in the literature and inform implementation science. Methods Our review employed a broad search strategy using multiple databases—Embase, Pubmed, Cinahl, PsychInfo, Web of Science, and the Cochrane library. We identified 1728 candidate articles, of which 42 were retained for full-text review. Results Of the 42 studies included, fourteen studies employed a multiple-case study design (33 %), 12 additional articles employed a single-case study design (29 %), five used quantitative methods (12 %), two used mixed-methods (5 %), and one used a Delphi methodology (2 %). Our review revealed multiple categories and characteristics of champions as well as influence tactics they used to promote an HIT project. Furthermore, studies have assessed three general types of HIT champion impacts: (1) impacts on the implementation process of a specific HIT; (2) impacts on usage behavior or overall success of a specific HIT; and (3) impacts on general organizational-level innovativeness. However the extent to which HIT projects fail even with a champion and why such failures occur is not clear. Also unclear is whether all organizations require a champion for successful HIT project implementation. In other words, we currently do not know enough about the conditions under which (1) a health IT champion is needed, (2) multiple champions are needed, and (3) an appointed champion—as opposed to an emergent champion—can be successful. Conclusions Although champions appear to have contributed to successful implementation of HIT projects, simply measuring the presence or absence of a champion is not sufficient for assessing impacts. Future research should aim for answers to questions about who champions should be, when they should be engaged, what they should do, how management can support their efforts, and what their impact is given the organizational context

Health Information Technology Implementation Strategies in Zimbabwe

The adoption rate of health information technology (HIT) remains low in developing countries, where healthcare institutions experience high operating costs and loss of revenue, which are related to systems and processes inefficiency. The purpose of this case study was to explore strategies leaders in Zimbabwe used to implement HIT. The conceptual framework of the study was Davis\u27s technology acceptance model (TAM). Data were gathered through observations, review of organizational documents (i.e., policies, procedures, and guidelines), and in-depth interviews with a purposive sample of 10 healthcare leaders and end-users from hospitals in Zimbabwe who had successfully implemented HIT. Transcribed interview data were coded and analyzed for emerging themes. Implementation strategies, overcoming barriers to adoption, and user acceptance emerged as the themes most healthcare leaders associated with successful HIT projects. Several subthemes also emerged, including: (a) the importance of stakeholder involvement, (b) the importance of management buy-in, and (c) the low level of IT literacy among healthcare workers. The strategies identified in this study may provide a foundation on which healthcare leaders in developing countries can successfully adopt and implement HIT. The recommendations from this study could lead to positive social change by providing leaders with knowledge and skills to use information technology strategies to deliver better healthcare at lower costs while creating employment for local communities