The dynamics of healthcare work practices : Implications for health management information systems design and implementation

Purpose – The purpose of this paper is to explore factors contributing to the dynamics in healthcare work practices and how health workers cope with the emerging dynamics. By focusing on these aspects, the study seeks to inform the design and implementation of health management information systems (HMIS). Design/methodology/approach – An ethnographic study of HMIS work practices in Tanzania was conducted. The collected data were analysed using concepts from Cultural Historical Activity Theory (CHAT). Findings – The complex and dynamic demands placed upon static healthcare information systems cause unregulated and inconsistent changes to off‐systems work practices. CHAT is a useful framework for identifying emerging gaps within existing information systems (IS). Practical implications – This study builds upon a research and development project known as the Health Information Systems Programme (HISP). HISP aims at addressing the problems of fragmentation, multiple data standards and lack of tools for data management in HMIS in low‐income countries. The findings from this study have practical implications for the design and implementation of IT‐based IS within the healthcare industry in general and within the HISP initiatives in particular. Originality/value – The paper offers a new perspective for conceptualizing the dynamics in healthcare work practices by looking at the means and solutions that health workers produce, not only as products of dynamics but as factors that inform and shape the design and implementation of new IT and IS.