BMC Med Inform Decis Mak - Tool, weapon, or white elephant? A realist analysis of the five phases of a twenty-year programme of occupational health information system implementation in the health sector.

Tópicos

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{ general(901) number(790) one(736) }
{ implement(1333) system(1263) develop(1122) }
{ data(3008) multipl(1320) sourc(1022) }
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Resumo

CKGROUND: Although information systems (IS) have been extensively applied in the health sector worldwide, few initiatives have addressed the health and safety of health workers, a group acknowledged to be at high risk of injury and illness, as well as in great shortage globally, particularly in low and middle-income countries.METHODS: Adapting a context-mechanism-outcome case study design, we analyze our team's own experience over two decades to address this gap: in two different Canadian provinces; and two distinct South African settings. Applying a realist analysis within an adapted structuration theory framing sensitive to power relations, we explore contextual (socio-political and technological) characteristics and mechanisms affecting outcomes at micro, meso and macro levels.RESULTS: Technological limitations hindered IS usefulness in the initial Canadian locale, while staffing inadequacies amid pronounced power imbalances affecting governance restricted IS usefulness in the subsequent Canadian application. Implementation in South Africa highlighted the special care needed to address power dynamics regarding both worker-employer relations (relevant to all occupational health settings) and North-south imbalances (common to all international interactions). Researchers, managers and front-line workers all view IS implementation differently; relationships amongst the workplace parties and between community and academic partners have been pivotal in determining outcome in all circumstances. Capacity building and applying creative commons and open source solutions are showing promise, as is international collaboration.CONCLUSIONS: There is worldwide consensus on the need for IS use to protect the health workforce. However, IS implementation is a resource-intensive undertaking; regardless of how carefully designed the software, contextual factors and the mechanisms adopted to address these are critical to mitigate threats and achieve outcomes of interest to all parties. Issues specific to IS development, including technological support and software licensing models, can also affect outcome and sustainability - especially in the North-south context. Careful attention must be given to power relations between the various stakeholders at macro, meso and micro levels when implementing IS. North-South-South collaborations should be encouraged. Governance as well as technological issues are crucial determinants of IS application, and ultimately whether the system is seen as a tool, weapon, or white elephant by the various involved parties."You may call me a fool, But was there a rule The weapon should be turned into a tool? And what do we see? The first tool I step on Turned into a weapon. - Robert Frost"White (albino) elephants were regarded as holy in ancient times in Thailand and other Asian countries. Keeping a white elephant was a very expensive undertaking, since the owner had to provide the elephant with special food and provide access for people who wanted to worship it. If a Thai King became dissatisfied with a subordinate, he would give him a white elephant. The gift would, in most cases, ruin the recipient. - The Phrase Finder"

Resumo Limpo

ckground although inform system extens appli health sector worldwid initi address health safeti health worker group acknowledg high risk injuri ill well great shortag global particular low middleincom countriesmethod adapt contextmechanismoutcom case studi design analyz team experi two decad address gap two differ canadian provinc two distinct south african set appli realist analysi within adapt structur theori frame sensit power relat explor contextu sociopolit technolog characterist mechan affect outcom micro meso macro levelsresult technolog limit hinder use initi canadian local staf inadequaci amid pronounc power imbal affect govern restrict use subsequ canadian applic implement south africa highlight special care need address power dynam regard workeremploy relat relev occup health set northsouth imbal common intern interact research manag frontlin worker view implement differ relationship amongst workplac parti communiti academ partner pivot determin outcom circumst capac build appli creativ common open sourc solut show promis intern collaborationconclus worldwid consensus need use protect health workforc howev implement resourceintens undertak regardless care design softwar contextu factor mechan adopt address critic mitig threat achiev outcom interest parti issu specif develop includ technolog support softwar licens model can also affect outcom sustain especi northsouth context care attent must given power relat various stakehold macro meso micro level implement northsouthsouth collabor encourag govern well technolog issu crucial determin applic ultim whether system seen tool weapon white eleph various involv partiesyou may call fool rule weapon turn tool see first tool step turn weapon robert frostwhit albino eleph regard holi ancient time thailand asian countri keep white eleph expens undertak sinc owner provid eleph special food provid access peopl want worship thai king becam dissatisfi subordin give white eleph gift case ruin recipi phrase finder

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