Sense-able process innovation in digital health infrastructures

In this paper, we examine the role of IT in enabling and supporting process innovation at a general hospital in Norway. The motivation for our study is that fragmented and heterogeneous components of digital infrastructure in complex organisational settings hamper the ability to monitor and improve organisational performance through process innovation. Prior research indicates that loose couplings between traditional ‘heavyweight IT’ (resilient, secure, and stable) and ‘lightweight IT’ (consumer-oriented, context-aware and flexible) can support innovation. These principles have not been applied to process innovation. Our research question is, how can lightweight IT extend digital infrastructure to support process innovation, in hospital coordinative practices? We use the sense and respond framework from Overby et al. (2006) to analyze our case findings and derive a model for sense-able process innovation with lightweight IT. The model outlines how lightweight IT extends digital (health) infrastructure and affords an organisational ability to continuously sense and respond to the effects of process innovatio

Grafting: Balancing Control and Cultivation in Information Infrastructure Innovation

This paper proposes grafting as a new perspective on information infrastructure (II) innovation. We introduce the organic notion of grafting to help explore innovation processes in settings where control is distributed and episodic. Our case study follows the implementation of mobile phone-based reporting of routine data from sub-district health facilities in Malawi. Initial grafting work entails the careful alignment of available resources, capacities, and interests through the proposition of an information system (IS) innovation (e.g., mobile phone-based reporting). The nurturing of the implementation involves collaborative efforts spanning technological, professional, geographical, and organizational boundaries. This work is taken forward by the identification of opportunities for merging an innovation with existing socio-technical arrangements (e.g., health management information systems in Malawi) in such a way that the parts continue to grow

Standardising Through Software

Since its inception in 1948, the World Health Organization (WHO) has been instrumental in setting standards for monitoring and evaluation of public health interventions and health service delivery. This paper focuses on the way in which these standards are operationalized through health indicators and analytical tools. We describe and discuss a concrete attempt by WHO to achieve this by embedding indicators and analytical outputs in a health information software that is used in a majority of the world’s least developed nations. We analyse this phenomenon by using a concept of fluid standards, and challenge the ‘conventional’ perspective on standards as fully specified and unequivocal outputs of formal standardisation processes

Cultivating the Norwegian Mobile Internet : A critical inquiry into high level services based on mobile telecommunication technologies

In this thesis the Norwegian Mobile Internet (NMI) is investigated. The critical approach, to my research, stems from a Habermasian concern for collective liberation through the cultivation of a (networked) public sphere, as well as a Foucauldinian concern for individual self liberation. The investigation draws upon two conceptual frameworks, namely, Actor-Network Theory and generativity. Here, the concept of generativity lends special attention to how well the presence of current mobile telecommunication technologies and services, allow for the innovation, development and adoption of new high level services. Through the application of the two conceptual frameworks, the thesis seeks to investigate the NMI’s generative capacity as well as its emancipatory potential. My findings suggest that the somewhat obscure pricing schemes on mobile data traffic, in conjunction with the lack of a strong de facto* standard for publishing and retrieving mobile browser content, is generally hampering the emancipatory potential of the NMI. In addition, I suggest that the mobile telecom operators also being directly involved in mobile content provision (e.g. CPA-platform), is keeping a lid on innovation. The main reason for this is the increased incentives for mobile telecom operators to control both content providers’ and end users’ interests towards the NMI

Grafting Information Infrastructure: Mobile Phone‐based Health Information System Implementations in India and Malawi

In the wake of ‘the mobile revolution’ there has been an immense upsurge in mobile phone based health innovations, or mHealth for short. Expected efficiency gains and health benefits with such innovations, however, have been notoriously difficult to realize in the resource sparse settings of less developed economies. Scholars and industry specialists have found the implementation of a large portion of mobile phone-based innovations unsustainable beyond short term pilot projects. This dissertation is positioned within the information systems (IS) research tradition and develops a nuanced understanding of so called mHealth sustainability challenges through two qualitative and exploratory interpretive case studies, one in India and one in Malawi. Both mobile phonebased implementations under study were commissioned by health authorities to strengthen routine reporting of public health data. A ‘big-bang’ roll-out to 5000 community-based health workers was initiated in India while incremental ‘baby-steps’ were favored in Malawi. The two empirical cases highlight different technical, infrastructural, socio-political, and institutional hurdles. The dissertation draws theoretical inferences from both cases through the proposition of information infrastructure grafting, whereby complex and fragile multi-stakeholder ICT implementation processes are conceptualized analogously with horticultural grafting (read: gardening). There is one simple maxim to plant grafting – the grafted branch or shoot has to take hold before it can grow. The merge between congenial plant parts can be assisted, but not asserted, by a gardener’s careful application of appropriate grafting techniques. The grafting metaphor foregrounds the need for care and tenderness in information infrastructure development, particularly in resource sparse settings. Information infrastructure grafting, then, is a fragile process whereby innovative ICT capabilities merge and coevolve with extant technologies, work practices, physical and digital infrastructure, and social institutions. This dissertation explores how congeniality between innovative ICT capabilities and extant socio-technical arrangements, and not merely ‘technology fit’ or ‘organizational readiness’, paves the road towards more sustainable implementations. This has practical implications for health information system policy makers and strategists, international funding agencies, ICT project managers and mHealth practitioners. Based on empirical investigations and an ecological conceptualization of socio digital change, this dissertation engages constructively with the discourse on sustainable development as it pertains to ICT based implementations in general and mHealth research and practice in particular

Enabling responsive hospital housekeeping with workflow IT

Workflow oriented use of IT in hospitals can increase resource utilization, patient satisfaction and patient throughput, by integrating and aligning work processes. However, the role of hospital support staff, such as porters and housekeepers in interdepartmental workflow coordination has received scant attention. With digitally integrated workflows, the influence of support services on patient flow becomes visible and open to scrutiny and explication. Empirically, we follow efforts to leverage IT to improve workflow coordination at Kalnes general hospital in Norway. Specifically, we employ the Theory of Swift and Even Flow to examine the influence workflow oriented use of IT has on housekeeping responsiveness to patient flow variability and temporary patient flow bottlenecks. We find that efforts to improve workflow coordination introduces novel ramifications for hospital housekeeping and that IT serves both as a real time coordinative tool and as a source for post hoc data analysis and process streamlining. In particular, we identify and discuss three maturity levels of IT mediated workflow coordination, which we refer to as workflow transparency, synchronization and responsiveness. We find that workflow oriented use of IT can raise the responsiveness of hospital support services through a combination of interdepartmental transparency and improved synchronization. Importantly, workflow integration can reveal interdependencies that impinge on the productivity of support staff but are beyond their immediate influence. Consequently, it is important to involve often-overlooked hospital support services directly in the planning and evaluation of workflow-oriented use of IT

A Post-development Perspective on mHealth -- An Implementation Initiative in Malawi

While the sheer number of mHealth implementations around the world have been increasing dramatically, authoritative voices on global health have tried to put the focus on quantifiable evaluations and comparisons of these projects (e.g. health outcomes, cost savings, efficiency) in order to channel donor funds and investments into proven and scalable solutions. Drawing on empirical data from an mHealth implementation in Malawi we argue that quantitative evaluation of health interventions often assumes a top-down and limited view on the developmental impact of mHealth. Through our action-research involvement with facility-based reporting of routine health data through mobile phones, we conclude that developmental impacts of mHealth are local and each locale experience a different developmental impact depending on the context of use and available resources. The paper contrasts global concerns for quantifiable development with local priorities with respect to mHealth projects and information system (IS) interventions in health more broadly

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

P for Platform. Architectures of large-scale participatory design

Participatory Design (PD) has traditionally been committed to extensive interaction between developers and situated users to mitigate the disempowering consequences of computerization, such as the deskilling of labour workers. However, the widespread adoption of off-the-shelf software and the emergence of complex information system architectures with interdependencies across user groups and organizations challenge the applicability of traditional custom PD. Pressure is put on PD to scale with initiatives that span an increasing number and distribution of heterogeneous settings, developers, users and uses over time. In this article, we follow a PD project that started out in post-apartheid South Africa more than two decades ago. The project, which centres on the development of a software product for decentralised public health care management, has since grown into a venture with a significant footprint in the Global South. In order to problematise the scaling of key aspects of PD, such as the politics of design, the nature of participation and participatory design techniques, we first review extant literature and develop a classification of four different types of PD with respect to scale. We then apply the typology to our empirical case to discuss PD in relation to architectural traits at different stages of project scale. We contribute to PD literature by addressing the exploratory research question: What role does architecture play in large scale PD? Specifically, the study highlights how an emergent platform architecture and its surrounding ecosystem co-constitute a platform for participation in design