scholarly journals The complexity of scaling up an mHealth intervention. SMS for Life: A Case Study from a Health Systems Integration Perspective

2020 ◽  
Author(s):  
Carmen Sant Fruchtman ◽  
Selemani Mbuyita ◽  
Mary Mwanyika-Sando ◽  
Marcel Braun ◽  
Don de Savigny ◽  
...  
Keyword(s):  
Health System ◽  
Large Scale ◽  
Scaling Up ◽  
Stock Management ◽  
Study Approach ◽  
Mhealth Intervention ◽  
Key Stakeholders ◽  
Key Events ◽  
Document Review

Abstract Background The objective of this study was to apply systems thinking to examine the opportunities and challenges of scaling up and integrating a new electronic health technology into a complex health system. We used the implementation cycle of the supply chain management solution (SMS for Life 1.0) in Tanzania as a case study. SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. It aimed to bring visibility to antimalarial stock-outs through the use of SMS technology.Methods A qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework, we carried out a joint thematic analysis and identified the key reasons for the discontinuation of the programme.Results SMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after four years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers.

scholarly journals The Complexity of Scaling Up an mHealth Intervention. SMS for Life: A Case Study from a Health Systems Integration Perspective

2020 ◽  
Author(s):  
Carmen Sant Fruchtman ◽  
Selemani Mbuyita ◽  
Mary Mwanyika-Sando ◽  
Marcel Braun ◽  
Don de Savigny ◽  
...  
Keyword(s):  
Health System ◽  
Large Scale ◽  
Digital Health ◽  
Scaling Up ◽  
Stock Management ◽  
Study Approach ◽  
Mhealth Intervention ◽  
Future Technologies ◽  
Document Review

Abstract BackgroundThe objective of this study was to apply systems thinking to examine the opportunities and challenges of scaling up and integrating a new electronic health technology into a complex health system. We used the implementation cycle of the supply chain management solution (SMS for Life 1.0) in Tanzania as a case study. SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. It aimed to bring visibility to antimalarial stock-outs through the use of SMS technology.MethodsA qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework, we carried out a joint thematic analysis and identified the key reasons for the discontinuation of the programme.ResultsSMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after four years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers.Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system.ConclusionThis study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.

scholarly journals The complexity of scaling up an mHealth intervention: the case of SMS for Life in Tanzania from a health systems integration perspective

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carmen Sant Fruchtman ◽  
Selemani Mbuyita ◽  
Mary Mwanyika-Sando ◽  
Marcel Braun ◽  
Don de Savigny ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Large Scale ◽  
Digital Health ◽  
Health Sector ◽  
Building Blocks ◽  
Scaling Up ◽  
Stock Management ◽  
Study Approach

Abstract Background SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. Its goal was to increase visibility to antimalarial stock-outs through the use of SMS technology. The objective of this case study was to show the multiple innovations that SMS for Life brought to the Tanzanian public health sector and to discuss the challenges of scaling up that led to its discontinuation from a health systems perspective. Methods A qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Data collection was informed by the health system building blocks. We then carried out a thematic analysis using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework. This served to identify the key reasons for the discontinuation of the programme. Results SMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after 4 years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers. Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system. Conclusion This study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.

Overcoming the Challenges of Experimental Research: Lessons From a Criminal Justice Case Study Involving TASER Exposure

2018 ◽  
Vol 42 (3) ◽  
pp. 358-385 ◽  
Author(s):  
Natalie Todak ◽  
Michael D. White ◽  
Lisa M. Dario ◽  
Andrea R. Borrego
Keyword(s):  
Criminal Justice ◽  
Large Scale ◽  
Human Subjects ◽  
Controlled Trial ◽  
Human Subjects Research ◽  
Case Study Approach ◽  
Study Approach ◽  
Randomized Controlled ◽  
The Impact

Objective: To provide guidance to criminologists for conducting experiments in light of two common discouraging factors: the belief that they are overly time-consuming and the belief that they can compromise the ethical principles of human subjects’ research. Method: A case study approach is used, based on a large-scale randomized controlled trial experiment in which we exposed participants to a 5-s TASER shock, to describe how the authors overcame ethical, methodological, and logistical difficulties. Results: We derive four pieces of advice from our experiences carrying out this experimental trial: (1) know your limitations, (2) employ pilot testing, (3) remain flexible and patient, and (4) “hold the line” to maintain the integrity of the research and the safety of human subjects. Conclusions: Criminologists have an obligation to provide the best possible evidence regarding the impact and consequences of criminal justice practices and programs. Experiments, considered by many to be the gold standard of empirical research methodologies, should be used whenever possible in order to fulfill this obligation.

scholarly journals Is Long-Term Care Person Centred? A Case Study

2021 ◽  
Author(s):  
Katarina Young
Keyword(s):  
Long Term Care ◽  
Direct Care ◽  
Care Providers ◽  
Term Care ◽  
Study Approach ◽  
Key Stakeholders ◽  
Direct Care Providers ◽  
Government Legislation

In Ontario long-term care (LTC) settings, person-centred care (PCC) is promoted by government legislation, accreditation organizations and professional practice guidelines aiming to integrate this approach. However, there is currently no standardized approach to providing PCC in LTC. The purpose of this study was to examine public policies on PCC in Ontario and explore how they are interpreted and translated into practice in LTC. A qualitative case study approach was used to examine the perspectives of key stakeholders at one LTC facility in Ontario. Focus groups were conducted with residents, family members, direct care providers and managers. Through content analysis, findings were organized into four categories showcasing both overlapping and differential understandings of PCC in practice: 1) conceptualization, 2) barriers, 3) facilitators, and 4) evaluation. Identified tensions between policy and the delivery of PCC highlight systemic issues that must be addressed to enable equitable person-centred LTC rooted in resident-identified priorities.

Architecture of an Integrated Collaboration Portal for Clinical Trial

2015 ◽  
pp. 127-162
Author(s):  
Partha Chakraborty
Keyword(s):  
Clinical Trial ◽  
Development Cost ◽  
Training Activities ◽  
The Cost ◽  
Key Events ◽  
Document Review ◽  
Patient Enrollment ◽  
And Training ◽  
Clinical Trial Activity

Collaboration is defined as the actions for individuals and teams to work together for a common goal. There are several bottlenecks to an efficient and effective collaborative model of clinical trial including: the lack of a centralized, consistent, globally accessible platform to manage and store essential study related documentation; inconsistent or incomplete work assignments; inefficient notification of key events requiring follow-on action; and incomplete, missing, expired, or redundant documentation and training activities and need to maintain multiple credential to access various system, Removing these barriers is an important part of establishing an environment that fosters collaboration among all constituencies involved in managing clinical trial keeping them connected, informed, and on task by providing access to everyone at any time, from anywhere.The case study below introduces need of an integrated clinical collaboration platform, addressing key functionality of such an platform and describes the architecture & design consideration to industrialize such a platform. The intended audience of this case study is the architects & designers of similar systems. The clinical trial activity for a drug in research is approximately 70% of the overall drug development cost. It is estimated that 4% of the cost of a trial is in 'rework' involving communication, regulatory issues, patient enrollment, document review and replacement of patients. The integrated clinical collaboration platform has potential to eliminate significant amount of cost of re-work, which is in order of $3.5M per trial.

Cathay & Southwest: flying the flag of good practice in airline mergers

2015 ◽  
Vol 31 (8) ◽  
pp. 20-22 ◽  
Author(s):  
Reetesh Sharma ◽  
Mark Thomas
Keyword(s):  
Airline Industry ◽  
Large Scale ◽  
Good Practice ◽  
Aviation Industry ◽  
Content Type ◽  
Key Stakeholders ◽  
The Usa ◽  
Airline Mergers ◽  
Southwest Airlines

Purpose – This article highlights the essential factors to be considered for successful mergers and acquisitions (M & As) in the aviation industry. The article draws insights from the successful deals between Morris and Southwest Airlines as well as Cathay Pacific and Dragonair. Design/methodology/approach – The article is a case study of two successful mergers in the airline industry, one in the USA and one in Asia. Findings – M & As in the airline industry are loaded with difficulties. These include problems of brand identification, opposition from key stakeholders and the need of forming one coherent organisational culture. However, this does not mean that they are impossible. Two large-scale mergers have shown that successful mergers can occur in the industry. Originality/value – This article gives examples of two successful M & A deals from the aviation industry and shows the important factors to achieve this.

‘The Color of Heart is More Important’: Korean Kindergarteners Exploring Racial Diversity through Poem Writing

2017 ◽  
Vol 42 (1) ◽  
pp. 60-69
Author(s):  
So Jung Kim ◽  
Su-Jeong Wee ◽  
Youngmi Lee
Keyword(s):  
Multicultural Education ◽  
Large Scale ◽  
Racial Diversity ◽  
Kindergarten Children ◽  
Early Childhood Classroom ◽  
Study Approach ◽  
Poetry Writing ◽  
Current Article ◽  
Written Materials

ALTHOUGH THE BENEFITS OF poem writing have been emphasised in a variety of contexts, there has been an understandable lack of knowledge about how to promote young children's multicultural/multiracial awareness using poetry writing. Adopting a qualitative case study approach, the current article explores how poem writing after reading and discussing multicultural picture books helps Korean kindergarten children develop an understanding of racial diversity and equality. As part of a large-scale research project on multicultural education in South Korea, this study focuses on data collected over a five-month period including participatory observations, in-depth interviews and written materials. Findings suggest that writing poetry can function as a means to foster children's critical awareness of racial diversity and equality and can help them find their own identities. How to make poetry-writing activities more meaningful and effective in the early childhood classroom is discussed.

Creation of firm performance through resource orchestration: the case of ÜLKER

2015 ◽  
Vol 25 (2) ◽  
pp. 179-204 ◽  
Author(s):  
Rifat Kamasak
Keyword(s):  
Firm Performance ◽  
Large Scale ◽  
Quantitative Methods ◽  
Business Processes ◽  
Empirical Studies ◽  
Complex Nature ◽  
Content Type ◽  
Study Approach ◽  
Multiple Data

Purpose – This study aims to investigate the complex interaction of different resource sets and capabilities in the process of performance creation within the context of resource-based theory. Design/methodology/approach – An inductive case study approach that included multiple data collection methods such as in-depth interviews, observation and documentation was utilized. Findings – Organizational culture, reputational assets, human capital, business processes and networking capabilities were found as the most important determinants of firm performance within the context of Ülker case study. Originality/value – Although large-scale empirical studies can be used to explore the direct resource–performance relationship, these quantitative methods bypass the complex and embedded nature of intangibles and provide only a limited understanding of why some resources are identified as strategic but others are not, what their roles are, and how these resources are converted into positions of competitive advantage. However, understanding of complex nature of resources that are embedded in organizations designates the need for more fieldwork-based qualitative studies. This study aims to address this gap by providing a thorough understanding about the managerial and organizational processes through which the resources become valuable.

scholarly journals Integration and Synergy Generation in Cross Border Acquisitions: A Case Study of Business Failure and Success ‘Made in Japan’

2017 ◽  
Vol 10 (9) ◽  
pp. 122
Author(s):  
Shigeru Matsumoto ◽  
Keith Jackson
Keyword(s):  
Business Performance ◽  
Business Failure ◽  
Senior Managers ◽  
Strategic Integration ◽  
Study Approach ◽  
Cross Border ◽  
Key Stakeholders ◽  
Study Methodology ◽  
Measure Of Performance

This article seeks to advance international business researcher and practitioner insights into processes of cross-border mergers and acquisitions. Specifically, this article highlights the extent to which processes of strategic integration might impact positively and / or negatively on the long term business performance of the newly formed firm during the post-acquisition period – a measure of performance we refer to here as ‘synergy’. In methodological terms, this article develops a mixed-method case study approach, generating, analysing and interpreting empirical data designed to illustrate processes of strategic integration implemented by senior managers at a Japanese firm, Nippon Sheet Glass (NSG), after its acquisition of a UK firm, Pilkington. The case study is longitudinal, drawing on quantitative and qualitative data gathered and analysed between 2006 and 2017. Applying a combination of event study methodology to an iterative analysis of business performance data along with coded analysis of data from in-depth interviews with key stakeholders, this article explores the extent to which strategic integration can both ‘fail’ in terms of achieving synergy and - for a number of generalizable reasons proposed in this article - ultimately ‘succeed’: for example, in cases where the acquiring and acquired firms attempt to integrate their human resource management systems while benefitting from investments of ‘patient’ capital, which (we propose) might be a distinctive feature of cross-border acquisitions sourced in Japan. 

Using systems thinking to support clinical system transformation

2016 ◽  
Vol 30 (3) ◽  
pp. 302-323 ◽  
Author(s):  
Allan Best ◽  
Alex Berland ◽  
Carol Herbert ◽  
Jennifer Bitz ◽  
Marlies W van Dijk ◽  
...  
Keyword(s):  
Health System ◽  
Complex Adaptive Systems ◽  
Clinical Guidelines ◽  
Large Scale ◽  
Guideline Implementation ◽  
Clear Understanding ◽  
Care Providers ◽  
System Transformation ◽  
Content Type

Purpose – The British Columbia Ministry of Health’s Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC’s health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings. Design/methodology/approach – Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey. Findings – The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system. Research limitations/implications – The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels – policy, management and practice – about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue. Practical implications – Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues. Originality/value – Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.

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