The role of communication practices in the strengthening of counter networks: Case experiences from the health care sector of Mozambique

In this article we provide a theoretically informed empirical analysis of the introduction and use of information and communication technology (ICT) within the primary health care (PHC) sector of Mozambique. The theoretical lens for this analysis is developed from Manuel Castells' (1996, 1997, 2001) ideas on the network society and counter domination. These ideas help us to conceptualize the communicative action required to strengthen the PHC sector as a “counter network,” which has the normative aim to strengthen the health information system (HIS) as a key strategy to improve health care delivery. Taking an informational perspective, the role of communication is highlighted as playing an important constitutive basis in the strengthening of this network. These conceptual ideas are applied to the empirical analysis of an ongoing project (the Health Information Systems Programme or HISP), and to analyze some key constraints and strategies for strengthening these networks. This study makes key contributions to both the theoretical and practical domains of HIS in developing countries. © 2005 Wiley Periodicals, Inc.     

Analyzing the problem of unsustainable health information systems in less-developed economies: Case studies from Tanzania and Mozambique

Most of donor-supported information technology (IT)–based projects developed or implemented in less-developed economies (LDEs) end up as complete or partial failures or unsustainable. Notably, a number of intra-organizational and external factors are associated with this problem, including inadequate infrastructure and human resource capacity, fragmented donor policy, and lack of policies to manage the sustainability problem. Accordingly, IT initiatives are often donor-driven, top-down, and hijacked by top managers who (normally) do not have adequate skills, but have enormous power to enforce such initiatives across organizational hierarchies.

In analyzing the concepts from sustainability and institutionalization, key insights towards a better understanding of the problem of unsustainability are developed. It is argued that health information systems (HISs) become sustainable if they are institutionalized in the sense of being integrated into the everyday routine of the user organization. However, a sustainable HIS should also be flexible enough to allow changes as the user needs change. Moreover, introduction of a new HIS is not only a technical change, but requires the cultivation and institutionalization of a new kind of culture.

Through a comparative case analysis of the HIS development and implementation processes in Tanzania and Mozambique, we have identified two sets of relationships, between the Ministry of Health (MoH) and donor agencies and between the MoH and software development agencies as critical and contributing factors to the unsustainability of a HIS. Given this setting, we highlight three key strategies for dealing with the problem of unsustainability in LDEs: (a) integration of a HIS, (b) local shaping of new cultures, and (c) cultivation approach to systems development. © 2005 Wiley Periodicals, Inc.     

Iterative development of information systems: A case study

This paper makes some observations about the applicability of iterative development for system implementation. After a general discussion of the software process, the types of projects suitable for this approach are identified. A system designed to support the iterative development method is then briefly examined, and a case study of its use is presented. Conclusions about the process are drawn, and some research issues regarding productivity are defined.     

Towards client-led development of information systems

Abstract. With the incorporation of Information Technology into most areas of modern life, the methods used by the Computer System Analyst (CSA) needs to be reconsidered. To suppose Systems Analysis to be concerned solely with computing is to minimize the task as an information system is greater than a computer system. As such, the information system designer needs to be able to 'appreciate' the wider implications of a clients information needs. An argument is put forward that Information System Design should be undertaken by the client with the CSA acting as facilitator. This paper attempts to provide a re-appraisal of the CSA and arising from this re-appraisal, suggest that ideas originating from organizational analysis could be usefully embodied in the design process for Information Systems.     

Action research in information systems development

Abstract. Action research is located within a spectrum of problem-solving activity that ranges from pure basic scientific research, the purpose of which is to add to knowledge, to human action designed to achieve a purpose without thought of contributing to knowledge. Action research both adds to knowledge and applies it in practice. Action research is particularly appropriate information systems development. A number of alternative methodologies for action research exist that make differing philosophical assumptions. A body of theory exists that enables a choice to be made among methodologies. This theory is useful in analysing information system problems.     

Rapid adoption of information systems in an organization with poor management: the case of fund-holding in UK primary health care

Abstract. Reorganization of the UK primary health care system to create an internal market for health services depends upon local family doctors (general practitioners) taking on budgetary responsibilities and purchasing services from hospitals. These budgets will be monitored by local committees. The success of the internal market is heavily dependent upon computerized management information systems. This paper investigates the introduction of information systems into an organization that is ill prepared for change.     

Linking soft systems methodology with data-focused information systems development

Abstract. Where the soft systems methodology (SSM) is used in the development of organizational information systems a clear division exists between the use of SSM to identify what information systems are required and conventional development activities in which it is decided how those information systems will be supplied. Discussion of how SSM might be more closely linked to conventional information systems development methodologies has been concentrated upon process-focused approaches to information systems development. This has been partly due to a perceived mismatch between the underlying philosophies of SSM and the alternative data-focused development methodologies. This paper argues that this perception may be mistaken; not only do the existing forms of data analysis have a large though unacknowledged subjective component but the SSM concept of appreciation may provide a model of human sense-making that the data-focused approaches currently lack and from which they may benefit. The idea of appreciation also allows that an alternative, interpretative form of data analysis might be used within SSM. It is therefore the conclusion of this paper that some closer integration of SSM with data-focused approaches to information systems development is theoretically feasible and may be practically desirable. A number of possible advantages of such integration are described.     

Lessons learned from three interorganizational health care information systems

The airline, financial, retail, consumer goods and cotton industries are not alone in their increased use of interorganizational information systems (IOSs). Health care organizations are investing and participating in a growing number of IOSs, such as community health information networks (CHINs) and integrated delivery systems (IDS). This paper examines the experiences of three CHIN systems located in the US — Midwest. Multiple data sources, including executive interviews, memoranda, internal documentation and system demonstrations, provided data for this research. The history of each case provides a better understanding of systems implementation and the underlying determinants that emerged as having significant impact. Not only do these findings provide guidelines and learning tools for practitioners, but they also hold implications to the field and its current position on bipolar streams in the literature. Lastly, our findings suggest that large health care infrastructures will continue to be confronted by the presence of the World Wide Web and electronic commerce.     

Women's voice: The case of nursing information systems

This paper looks at the cultural transformation of nursing. It argues that introducing computers in a female occupation is not simply a case of imposing male technology on female care-oriented practices and values. In order to understand current changes of nursing practice, three points of view have to be simultaneously kept in focus: 1) the differences between women's interests and ambitions; 2) the readings of a technology that have already been established through previous examples of design and use (in hospitals up to date primarily for the purpose of establishing discipline and management control); and 3) the social practices that dominate a field of work (in the case of health work the already technology-driven cure aspect).     

Soft systems and systems engineering: on the use of conceptual models in information system development

Abstract. Many recent studies have shown that computer-based systems continue to ‘fail’ at a number of different levels (Romtec, 1988; KPMG, 1990) and it is increasingly apparent (Maclaren et al., 1991) that the most serious failures of information technology (IT) lie in the continuing inability to address those concerns which are central to the successful achievement of individual, organizational and social goals. It is the contention of this paper that this failing is precisely because these are the areas which are ignored or inadequately treated by conventional system development methods. There is, of course, a vast body of literature concerned with the understanding of complex human activity systems. This literature often reflects a mass of contradictions at the epistemological and the ontological level about the behaviour of such systems and has also spawned numerous methods (and methodologies) which seek to guide the individual in making successful interventions into organizational situations (Rosenhead, 1989). Despite this multiplicity of viewpoints many writers have posited a dichotomy between so-called 'soft and ‘hard’ approaches to problem situations and use this dichotomy to inform the choice of an appropriate problem-solving methodology (Checkland, 1985). In this paper we characterize these two approaches as being concerned with either the purpose(s) of the human activity system (i.e. ‘doing the right thing’) or with the design of the efficient means of achieving such purpose(s) (i.e. ‘doing the thing right’). It is our belief that much of the literature and work in either area has not concerned itself with the issues of the other. Writers on ‘hard’ engineering methods often assume the question of purpose to be either straightforward (e.g. given in the project brief) or, paradoxically, too difficult (e.g. it is not our concern as mere systems analysts). Writers on ‘soft’ methods on the other hand rarely have anything to say about the design and implementation of well-engineered computer-based systems, giving the impression that this is a somewhat mundane activity better left to technical experts. This paper, therefore, attempts to set out a rationale for the bringing together of principles from both ‘hard’ engineering and ‘soft’ inquiry methods without doing epistemological damage to either. To illustrate our argument we concentrate on JSD (Jackson system development) as an example of system engineering (Cameron, 1983) and SSM (soft systems methodology) as an example of system inquiry (Checkland, 1981; Checkland & Scholes, 1990). Our general thesis, however, does not depend upon either of these two approaches per se but applies to the overall issue of bringing together insights from two apparently opposed epistemological positions in an effort better to harness the power of IT in pursuit of purposeful human activity.     

Creation of environmental health information system for public health service: A pilot study

Despite more than a decade of research on medical information systems, deficiencies exist in our capability of establishing an effective environmental health information infrastructure. In this research, we present a pilot study on creating a feasible environmental health information infrastructure. The newly-developed environmental health information system is a web-based platform that integrates databases, decision-making tools, geographic information systems for supporting public health service and policy making. The study, which is a part of a comprehensive effort known as Environmental Public Health Tracking proposed by the Center for Disease Control and Prevention, opens the door for future research on a large scale nation-wide healthcare information infrastructure.

Outlier detection in relational data: A case study in geographical information systems

Geographical information systems are commonly used for a variety of purposes. Many of them make use of a large database of geographical data, the correctness of which strongly influences the reliability of the system. In this paper, we present an approach to quality maintenance that is based on automatic discovery of non-perfect regularities in the data. The underlying idea is that exceptions to these regularities (‘outliers’) are considered probable errors in the data, to be investigated by a human expert. A case study shows how the tool can be used for extracting valuable knowledge about outliers in real-world geographical data, in an adaptive manner to the evolving data model supporting it. While the tool aims specifically at geographical information systems, the underlying approach is more broadly applicable for quality maintenance in data-rich intelligent systems.     

The strategic dimension of transactional information systems: some organizational implications

Abstract. Often information systems (IS) are classified in three groups: (a) transactional, used mainly for co-ordination and resource allocation purposes at the operational level of a company; (b) tactical, often employed to support the resource procurement activities typical of middle management; and (c) information systems for strategic decision making, designed to help in the planning and strategy design processes which are the direct responsibility of top management. In general, the amount of care and management attention that companies give to these different types of systems is proportional to their position in this hierarchy: little attention is devoted to the mundane transaction-pushing systems and exquisite care is put into developing the sophisticated decision making aid for the CEO and his/her staff.
The IS/IT literature has been reporting quite commonly cases in which companies have attained or lost great competitive advantages by way of their transactional information systems [for example, Emery Worldwide, Baxter Healthcare ASAP system, and Frontier Airlines]. The aim of this paper is to identify actions that companies can take to realize potential benefits of their IS, in particular from their low-level, transactional IS.
Among other actions, we will conclude that companies would be better off if they: (a) have the IS department at the right place in the organization, staffed with people knowledgeable about the basic nature of the business in which the company is engaged; (b) are sensible to what can be called 'strategic maintenance' of systems, (c) set up a formal procedure for IS planning to ensure coherence between IS plans and business plans, derived, in turn, from business strategy, and (d) keep abreast of the relevant technology.
Several examples taken from European companies are used to illustrate these conclusions.     

Individual attitude toward improvisation in information systems development

In the area of information systems development (ISD) the traditional approaches to developing innovative projects, which are historically characterised by top-down, meticulously planned procedures, may not allow the effective handling of the emergent and continuously evolving needs of users. This article investigates the role of improvisation in addressing the shortcomings of traditional approaches to ISD in the fulfilment of the user's need for the maximisation of IS effectiveness. Prior research on software engineering and human–computer interaction (HCI) has focused considerable attention on the need for a shift in the developer's attitude in dealing with contingencies departing from the original plan, while less emphasis has been placed on the factors that may augment the incidence of the attitude towards extemporaneous action (i.e. improvisation). In an attempt to fill this gap, we theoretically analyse the antecedents of individual attitude toward improvisation, grounding our theoretical framework on the ISD domain.     

Executive information systems development in an emerging economy

This paper addresses executive information systems (EIS) development in an emerging economy. In particular, it examines EIS development in Thailand, a nation that is more representative of the majority of emerging economies in the South East Asian region than the four Asian Tigers (Singapore, Hong Kong, Taiwan and South Korea). Case studies of the development of four systems in large Thai organizations are presented. The analysis of the cases and their comparison to a benchmark study gives rise to the concept of EIS cultural fit, a concept that adds to our understanding of the reasons for the success and failure of EIS projects in emerging economies. The cases also raise questions about using outsourcing as a development strategy for EIS in emerging economies.     

Issues in information systems planning

Numerous difficulties face information systems managers as they develop IS plans. Three nominal group technique sessions used IS practitioners from different levels of management to identify specific difficulties. The findings indicate a wide variety of problems faced by these managers. Top IS managers were concerned most with learning the objectives of top general management. Middle IS managers were concerned most with adopting a methodology for planning. Operating IS managers were concerned most with understanding the perceived needs of the user. These results suggest the need for more sophisticated management techniques (or the better use of existing techniques) and the need for research to address the development, utilization and evaluation of such techniques.     

On the discipline of information systems

Abstract. Although information systems is growing rapidly, it has little theoretical clarity. An article in the Times Higher Education Supplement of March 1989 by Liebenau and Backhouse sparked a debate on the character of information systems as a discipline. This paper reviews that debate, bringing out the main points of many of the discussants, and presents an analysis which is intended to carry the discussion further in order to help clarify and to galvanize opinion.     

Integration issues elucidated in large-scale information systems development

This article explores some basic issues in system integration by examining the integration process with information systems. The article begins with a discussion of the domain of interest. Terms are defined, the software process is reviewed, and two system categories are established. It is shown that software is materially different from hardware. Moreover, these differences present opportunities for reducing the integration effort. Several methods that take advantage of software's special characteristics are identified, and a case study of one environment provides some empirical evidence that reveal the benefits that may follow. The article concludes with some observations regarding the transfer of the lessons learned with information systems to other application domains-both hardware and software.This work was supported in part by the U.S. Navy, Space and Naval Warfare Systems Command (SPAWAR) under contract N00039-89-C-001, task VMAR9 with the Office of Naval Research (ONR).     

The effectiveness of office information systems: a social action perspective

Abstract. The purpose of this paper is to show that a number of basic issues have not been adequately addressed in existing office information systems research. Prominent among these are the nature and role of offices, the goals of office information systems development, and the nature of its organizational and managerial consequences. It is proposed that office information systems should be analysed as social action systems the behaviour of which is strongly affected by socially determined forces and constraints such as the behaviour-channelling influences of authority, norms, customs, habits and precedence. Four types of social action are discussed: instrumental, strategic, communicative and discursive. Three contexts for perceiving and analysing the effects of social action in offices are introduced: technology, language and organization. Office information systems changes affect elements and relationships in these three contexts in different ways. By cross-relating social action types and contexts, nine classes of object systems are identified. Each object system class implies a different category of effectiveness concerns which in turn implies different office information system design requirements. The paper notes that the existing research literature has primarily been concerned with only three of the nine object systems. For more effective office information systems development, however, the other systems also need to be considered. The paper concludes by exploring how this may be done.