Looking beneath the Statistics in Healthcare Transformation: Linking Macro-Level Goals to Micro-Level Routines

Abstract

Information and Communication Technologies are known to play a central role in the enhancement of healthcare management capabilities in developing countries. Turkey, a developing country, has been undergoing a major healthcare transformation, including the redesign of primary care service delivery under a family medicine scheme. Statistics show substantial improvements in developmental health indicators, such as increases in immunization coverage and decrease in infant and maternal mortality rates. However, field studies highlight concerns about patient-based primary care outcomes. The engine of the redesign is an electronic health records system that determines the structural and institutional features of the whole scheme. We argue that to better understand a macro-level transformation, we need to look beneath the statistics and analyze the changes in micro-level care delivery practices through implementation of meso-level structures and systems; hence, we center our research on system use. Drawing on information systems, information and communication technologies for development, and health informatics literature, and adopting the affordances concept as the theoretical lens, our study sheds light on when and how system use enables or constrains family medicine practitioners’ care delivery practices. Our findings highlight the importance of goal alignment between the Ministry of Health, materialized through the meso-level system design, and the clinicians. When the goals are aligned, system usage behaviors and healthcare delivery routines converge and system affordances are actualized. On the contrary, goal misalignment leads to divergent system usage behaviors, and in some cases goal abandonment.

Keywords: ICT-Enabled Healthcare Transformation, Primary Care, Developing Countries, Affordances, ICT4D