WhatsApp as an improvisation of health information systems in Southern African public hospitals: A socio-technical perspective
🤖 AI Summary
This study investigates the phenomenon of improvisational use of health information systems (HIS) in public hospitals in South Africa and Namibia, driven by a “design–reality gap.” Specifically, it examines how healthcare workers spontaneously adopt informal digital tools—particularly WhatsApp—to optimize referral workflows. Drawing on a sociotechnical perspective, the research employs qualitative analysis of 31 semi-structured interviews with clinicians and nurses, integrating the Design–Reality Gap Framework and the Improvisation Process Framework. It introduces the novel concept of “institutionalized improvisation,” demonstrating how WhatsApp functions as a de facto compensatory mechanism that mitigates structural misalignments in HIS. Findings confirm significant improvements in referral efficiency and interprofessional collaboration. The study identifies three root causes of the design–reality gap: managerial oversight deficits, insufficient end-user involvement in system design, and inadequate HIS functionality. These insights offer empirically grounded recommendations for adaptive HIS design and digital health governance in low-resource settings.
Application Category
📝 Abstract
Digital health interventions, particularly electronic referrals (e-referrals) and health information systems, have revolutionised clinical workflows in public hospitals by automating processes. However, the utilization of e-referrals has yielded mixed outcomes, with varying levels of success in organisational processes.This paper explores improvisation of health information systems in Southern African public hospitals from a socio-technical perspective. In particular the paper explains the design-reality gaps giving rise to improvisations of mandated health information systems in order to understand their occurrence and impact on referral outcomes. We employed the design-reality framework and the Process framework for Healthcare Information System Workarounds and Impacts to explain the socio-technical issues related to the phenomenon of interest.We conducted semi-interviews with 31 respondents from health organisations as case studies.Respondents from two public hospitals in South Africa and two in Namibia were interviewed to examine how they devised improvisations to various health information systems in each setting.The findings showed that using WhatsApp or improvising existing health information systems (HIS) improved efficiency and productivity of healthcare practitioners (HCPs) referral activities. Additionally, HCPs reported positive outcomes related to continual professional development in the given settings.The findings further show a relationship between design-reality gaps and improvisations enacted by HCPs.The observed gaps are related to poor management systems and structures lack of HCPs' involvement in the roll-out of HIS and inadequacies of existing HIS to support referral tasks.These study findings can be insightful and useful to system developers and other stakeholders for devising measures to address the gaps.
Problem
Research questions and friction points this paper is trying to address.
WhatsApp improves health information systems efficiency
Design-reality gaps cause HIS improvisations in hospitals
HCPs' involvement enhances referral outcomes in Africa
Innovation
Methods, ideas, or system contributions that make the work stand out.
WhatsApp improves healthcare efficiency
Design-reality gaps prompt HIS improvisations
Semi-interviews reveal healthcare system improvisations
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