Change management in the implementation of electronic health records systems in public and private hospitals in the Ethekwini Municipality, Kwazulu-Natal, South Africa
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Date
2021
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University of Zululand
Abstract
The study examined change management practice in the implementation of electronic health records systems in public and private hospitals in the eThekwini area, Kwa-Zulu Natal Province, South Africa. The study is responding to the e-Health Strategy of South Africa set to provide road map for accomplishing well-functioning national health information systems to support delivery of health services. The study compared public and private hospitals in the development, execution and operation of electronic health records systems (EHR) systems. The study reviewed in-depth literature on the change management processes in the pre and post implementation of electronic health records systems, including user acceptance in the utilization of the system. The leading change model and technology acceptance model (TAM) model was utilized to evaluate changing behaviour of hospital employees towards tactical processes on their daily duties in the use of EHR systems. The study further assessed changes experienced by public and private hospitals due to EHR system implementation. It also evaluated the way hospitals monitor and measure success or failure of electronic health records systems.
The study adopted the pragmatic epistemology and pluralistic ontology to measures users’ attitude towards the operation of the EHR systems and evaluated change management in its execution. The study adopted the mixed methods research approach. The study targeted a sample of 215 participants in both public and private hospitals. Out of which, 187 responded representing a response rate of 87.76%. The questionnaires were used to collect data from nurses, doctors, filing or ward clerks, receptionist and patient administrators. Qualitative data was collected through interviews from the hospital management. Descriptive statistics were used to describe frequencies with data presentation in bar graphs and pie charts; while qualitative data was thematically categorised and presented narratively. The two sets of quantitative and qualitative data from both the public and private hospitals were compared and contrasted in order to produce a single interpretation, and draw appropriate conclusions.
The findings of the study established that ill-defined change management approach and unbalanced user acceptance dissuade EHR system effectiveness and set back visibility of execution progress. The study confirmed lack of standard guidelines for both public and private hospitals in the establishment of procedures and policies guiding change management in the implementation process. This study confirmed poor user involvement in the execution of EHR systems. Therefore, this results to imbalance in change management visibility in the implementation of EHR system as hospitals struggle to track effectiveness of the system and user acceptance. The study showed that there is a gap of change management directive in the eHealth Strategy of South Africa as there is no notable guidance in monitoring and evaluating the development and implementation of EHR systems.
In order to accomplish EHR system efficiency and meaningful use, the study recommends that official change management framework in the implementation of EHR systems should be developed. Similarly, the study recommends that standardised formal monitoring and evaluation processes need to be developed by the Department of Health in order to measure effectiveness and level of users’ acceptance from pre to post implementation of the EHR system. The study recommends the Department of Health to liaise with the National Archives of South Africa towards developing policy and procedure manuals that may guide hospitals in the implementation of EHR systems in their operations.
Description
Dissertation submitted to the Faculty of Arts in accordance with the requirements for the Masters Degree in Library and Information Science in the Department of Library and Information Studies, at the University of Zululand, 2020.