Understanding the introduction and use of a mobile device-supported health information system in Nigeria

Copyright @ 2014 The Authors.This paper presents an in-depth analysis of efforts to introduce a mobile health information system in Nigeria as part of a development initiative aimed at improving maternal and child health. Specifically, it examines the use of mobile devices to facilitate maternal health information accessibility and exchange among health practitioners in order to reducing maternal, newborn and child mortality. Further, it also looks at the challenges raised while introducing mobile devices into work practices in the healthcare sector. The study adopts a case study approach, relying on semi-structured interviews and document analysis as its main methods for collecting data. The specific case examined is a mobile phone-based information system introduced to support a national government effort in Nigeria, known as the midwives service scheme. The findings of this study show that this integrated approach of using mobile phones to support (health) information systems has vast potential; for instance increasing the timeliness of (health) data available to stakeholders for monitoring and planning purposes. However, we also find that over time, attaining the potential of development efforts such as this remains difficult as initiatives involving the use of mobile devices is not just about getting the technical aspect right. It is equally dependent on deep seated social-cultural influences such as poor political and financial commitment. These two mutually reinforcing influences have been identified in this study as significant impediments to efforts of this kind. Therefore, this paper argues for, first a strong political commitment across all levels of government whereby their words are backed with action. Second it is important that the government maintains financial integrity by releasing the funds budgeted to support the smooth running of these efforts, for such initiatives to thrive and ultimately contribute to development

LESSONS IN EVALUATING COMMUNICATIONS CAMPAIGNS

Builds on the findings of the first and second papers. It examines specifically how campaigns with different purposes (individual behavior change and policy change) have been evaluated, and how evaluators have tackled some of the associated evaluation challenges that the first three papers raised as important to address. It features fi ve brief case studies in which the main unit of analysis is not the campaign, but the campaign's evaluation. The case studies provide a brief snapshot of the real experiences of campaign evaluations. The paper also features cross-case lessons that highlight important findings and themes

Achieving information fulfilment in the networked society: part 1: introducing new concepts

Purpose – The purpose of this paper is to introduce the idea of information fulfilment. The networked society provides many opportunities for information flow. However, information professionals readily accept that, although one is surrounded by information of many sorts, in many formats, what is important is whether users consider that they ever achieve what is known as “Information Fulfilment”. i.e. occurrences when there has been information which is accurate, timely, current and presented in an appropriate and useful format to allow (work) tasks to be completed. Design/methodology/approach – This first paper contains a literature review which informed the study. The study (which will be reported in detail in a later paper) was interpretive and used ethnography (through participant observation) as the research tool. The research deals with issues surrounding organisation structures and examines levels of information fulfilment in micro substantive settings. Findings – The paper serves to introduce background and cultural information from a small section of a larger European research project which involved five countries and was partially funded by TEMPUS and Leonardo da Vinci Socrates grants. Research limitations/implications – The paper introduces ideas concerning information fulfilment and addresses initial issues concerning a small section of results from a larger project. Phase 2 is now under way and more studies are planned. It is noted that organisation structures are only one variable that affects levels of information fulfilment and there are plans in the future to further extend the study. Originality/value – The research attempts to link the levels of information fulfilment with types of organisation structures. This paper introduces the concept and gives the rationale for the project

Creating Technology-enhanced Practice: A University-Home Care-Corporate Alliance

Insuring full benefit of consumer health informatics innovations requires integrating the technology into nursing practice, yet many valuable innovations are developed in research projects and never reach full integration. To avoid this outcome, a team of researchers partnered with a home care agency’s staff and patients and their corporate parent’s Information Systems and Research group to create a Technology-Enhanced Practice (TEP) designed to enhance care of home bound patients and their family care givers. The technology core of TEP, the HeartCare2 web site, was built in a collaborative process and deployed within the existing patient portal of the clinical partner. This paper describes the innovation and the experience of bringing it into full operation

Measuring quality in the therapeutic relationship-Part 2: subjective approaches

Publisher version: http://qualitysafety.bmj.com/content/19/6/479.ful

Biographical methods

The chapter reviews three different approaches to biographical methods, the biographical interpretive method, oral history and narrative analysis. Each is outlined in turn, looking at distinguishing characteristics. Each makes use of the interview to generate data and while each has unique strengths, the chapter concludes with a commitment to an oral history approach with its focus on the dynamics of the interview

Knowledge management and organizational culture

This paper explores the relationship between organisational knowledge, organisational culture, and Process Based Systems (PBS), in the U.K. National Health Service (NHS). Links between PBS and organisational culture have been observed before(Perry, 2003); the contribution made by PBS to organisational knowledge has also been suggested (Perry, 2004). However, links between organisational knowledge and organisational culture in the NHS have not been widely studied. A qualitative study of these links across clinical functions has been used in conjunction with a literature review to consider in particular the use of tacit knowledge and the role that might be played by PBS in mediating and sharing this "embedded" or experiential form of knowledge. While there may be some opportunity for "externalisation" (Nonaka, 1994) - the conversion of tacit to explicit knowledge, this paper argues that PBS may also contribute to "socialisation" - the direct generation of tacit knowledge by tacit knowledge.Process Based Systems, knowledge management, organisational culture

Electronic Health Records: Cure-all or Chronic Condition?

Computer-based information systems feature in almost every aspect of our lives, and yet most of us receive handwritten prescriptions when we visit our doctors and rely on paper-based medical records in our healthcare. Although electronic health record (EHR) systems have long been promoted as a cost-effective and efficient alternative to this situation, clear-cut evidence of their success has not been forthcoming. An examination of some of the underlying problems that prevent EHR systems from delivering the benefits that their proponents tout identifies four broad objectives - reducing cost, reducing errors, improving coordination and improving adherence to standards - and shows that they are not always met. The three possible causes for this failure to deliver involve problems with the codification of knowledge, group and tacit knowledge, and coordination and communication. There is, however, reason to be optimistic that EHR systems can fulfil a healthy part, if not all, of their potential

Bringing Anglo-governmentality into public management scholarship : the case of evidence-based medicine in UK health care

The field of public administration and management exhibits a limited number of favored themes and theories, including influential New Public Management and Network Governance accounts of contemporary government. Can additional social science–based perspectives enrich its theoretical base, in particular, analyzing a long-term shift to indirect governance evident in the field? We suggest that a variant of Foucauldian analysis is helpful, namely “Anglo-governmentality.” Having reviewed the literatures, we apply this Anglo-governmentality perspective to two case studies of “post hierarchical” UK health care settings: first, the National Institute for Health and Clinical Excellence (NICE), responsible for producing evidence-based guidelines nationally, and the second, a local network tasked with enacting such guidelines into practice. Compared with the Network Governance narrative, the Anglo-governmentality perspective distinctively highlights (a) a power–knowledge nexus giving strong technical advice; (b) pervasive grey sciences, which produce such evidence-based guidelines; (c) the “subjectification” of local governing agents, herein analyzed using Foucauldian concepts of the “technology of the self” and “pastoral power”; and (d) the continuing indirect steering role of the advanced neoliberal health care State. We add to Anglo-governmentality literature by highlighting hybrid “grey sciences,” which include clinical elements and energetic self-directed clinical–managerial hybrids as local governing agents. These findings suggest that the State and segments of the medical profession form a loose ensemble and that professionals retain scope for colonizing these new arenas. We finally suggest that Anglo-governmentality theory warrants further exploration within knowledge-based public organizations