An institutional perspective on health information systems’ standardization: multiple case studies

This thesis aims to improve our understanding of standardization within the domain of health information systems (HISs) by studying how institutions enable, constrain and shape the process. It shifts the focus from actor (stakeholders) orientations of standardization studies to institutions. The study was conducted as multiple case studies in three research settings - Ethiopia, India and Tajikistan within the Health Information System Program (HISP). HISP is a professional network, which is engaged in health information systems strengthening activities in developing countries using open source software called District Health Information Software (DHIS). The study is a qualitative research following interpretive and elements of critical research traditions. It is interpretive in a sense that researchers did not go out to find out facts about standardization but to understand the situated meanings of stakeholders regarding the phenomena. The critical stance comes from the action research of HISP, in which researchers, in addition to understanding the phenomenon from the points of view of the stakeholders, attempt also to change the phenomenon. This action intervention helps researchers to identify historical and contextual factors that constrain and enable the interventionists’ efforts. Data was mainly collected through participant observations, interviews, and document reviews. The study was conducted in two phases from 2007 to 2009 that provided the main research findings and from January 2015 onwards. At the later phase, limited case revisits were conducted to understand what has happened to the cases since the first round of data collection. The main argument of the thesis is that network effects as standard diffusion mechanisms cannot fully explain standardization in public sectors. Network effects assume a bottom-up approach and increase in the installed base as a basis for standard formation, diffusion and institutionalization. However, in the public health sector of developing countries where decision-making is centralized and there is less competition for market share, institutional mechanisms are more prominent but not the only ones. Thus, concepts from neo institutional theory were used to explore how institutions constrain, enable and shape HIS standardization. The institutional analytical framework by Scott (2001) was used to examine the constraining and enabling role of institutions in the adoption of DHIS. The findings show that in addition to the regulative, normative and cultural-cognitive institutional pillars, technology as a fourth pillar plays an important role in standardization. Given these findings, the thesis argues that network effect is a complementary concept to institutional analysis of standardization. The other main argument is that when there are intermediary institutions such as HISP in standardization, the process is contingent upon the overlap between the institutional context of the intermediary unit and the institutional context of the health organization. When standardization involves technological solution, the process is also influenced by the nature of the technological solution that standardizes and facilitates the standardization of other types of standards. The findings of the study specifically show that institutions influence standardization process in three ways: 1. When informal constraints (i.e., norms, values, perceptions, shared assumptions) are not addressed, and the gap between the formal and informal institutions is not overlapped. 2. When competing and dominant institutional logics among stakeholders are not recognized and strategies are not devised to reconcile them in a mutual learning process. 3. When the standardization process cannot gain input legitimacy from relevant stakeholders, such as National Health Ministries, due to misalignment with the existing institutions such as the regulative, normative and cultural-cognitive institutions of the country. The study suggests the need to conceptualize standardization as institutional change, which is a broad two-staged process of de-institutionalization and re-institutionalization that is filled with small-scale transitions. Institutional change requires: 1. Strong management commitment that is aware and willing to overcome routine and resource constraints 2. Understanding and learning dominate heterogeneous logics in the standardization process. 3. Recognizing standardization not as a static and closed process but as an open, inclusive and continuous process that follows an adaptive approach. 4. Network building both from formal and informal relationships 5. Modularized and flexible standards for bringing institution-sensitive small-scale changes. The thesis provides theoretical and practical contributions. The first theoretical contribution is the conceptualization of standardization as institutional change. The other theoretical contribution extends the institutional analytical framework by Scott (2001) to also contain a technological element. It also adds upon the literature on information systems failure by looking at the temporality and multidimensionality of failure in standardization. Practically, it contributes to the future practices of standardization in health organization and to the future practices of the Health Information System Program (HISP)

Practicing Responsible Research and Innovation in a crowdsourcing project

Copyright remains with the authorsThe paper discusses the operationalization of responsible research and innovation (RRI), drawing on empirical materials from a research project that explored ICT-enabled tools and methods for crowdsourcing in urban environmental research and decision-making. An integrated model for RRI is developed from prior studies, in which socially responsible crowdsourcing is described as an iterative and recursive process of inclusion, anticipation, reflexivity and responsiveness on the purpose, process, product and people components of the crowdsourcing project. The paper outlines four important aspects that influence the practice of RRI: time, interdisciplinary skills and capacities, design flexibility of ICT tools and strategic alliances between researchers and public officials. Theoretically, the paper contributes with an integrated conceptual model that further extends the already existing RRI framework.publishedVersio

ADAPTIVE NETWORKED GOVERNANCE OF E-HEALTH STANDARDS: THE CASE OF A REGIONAL HEALTH INFORMATION INFRASTRUCTURE IN NORWAY

Due to local idiosyncrasies and professional variations in the capture and use of patient infor-mation, healthcare providers often struggle to facilitate smooth transfer of patients along with essential information about them. This puts pressure on national and regional authorities to consolidate e-health standards, but they often lack the legitimacy, capacity or mandate to im-plement significant changes. We have looked at the rather successful governance of e-health standards in one health region in Norway. Through the establishment of a coordinative network, health professionals share knowledge and continuously improve e-health standards across hos-pitals in the region. We conceptualize the phenomenon as an adaptive network-oriented stand-ards governance model for very large information infrastructures. For e-health standardization practitioners, we advise that the inherent consolidation problem in standards governance in healthcare may be mitigated through the establishment of profession-based network groups that can mediate between top-down and bottom-up standardization activities. Theoretically, we con-tribute with a fresh standards governance model, which takes into account the process, struc-ture and technical perspectives necessary to manage large-scale standardization efforts

Practicing Responsible Research and Innovation in a crowdsourcing project

The paper discusses the operationalization of responsible research and innovation (RRI), drawing on empirical materials from a research project that explored ICT-enabled tools and methods for crowdsourcing in urban environmental research and decision-making. An integrated model for RRI is developed from prior studies, in which socially responsible crowdsourcing is described as an iterative and recursive process of inclusion, anticipation, reflexivity and responsiveness on the purpose, process, product and people components of the crowdsourcing project. The paper outlines four important aspects that influence the practice of RRI: time, interdisciplinary skills and capacities, design flexibility of ICT tools and strategic alliances between researchers and public officials. Theoretically, the paper contributes with an integrated conceptual model that further extends the already existing RRI framework

Practicing Responsible Research and Innovation in a crowdsourcing project

The paper discusses the operationalization of responsible research and innovation (RRI), drawing on empirical materials from a research project that explored ICT-enabled tools and methods for crowdsourcing in urban environmental research and decision-making. An integrated model for RRI is developed from prior studies, in which socially responsible crowdsourcing is described as an iterative and recursive process of inclusion, anticipation, reflexivity and responsiveness on the purpose, process, product and people components of the crowdsourcing project. The paper outlines four important aspects that influence the practice of RRI: time, interdisciplinary skills and capacities, design flexibility of ICT tools and strategic alliances between researchers and public officials. Theoretically, the paper contributes with an integrated conceptual model that further extends the already existing RRI framework