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. 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: 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.

‘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.

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.

Organizing migrant workers

2005 ◽  
Vol 19 (3) ◽  
pp. 463-480 ◽  
Author(s):  
Jane Holgate
Keyword(s):  
Labour Market ◽  
Migrant Workers ◽  
Large Scale ◽  
Case Study Approach ◽  
Study Approach ◽  
Post War ◽  
The Uk ◽  
White Workers ◽  
Minority Ethnic

The structural position of black and minority ethnic workers (BME) and migrant workers in the UK labour market is relatively well known. Many workers in these groups find themselves in low-paid, low-skilled jobs primarily because of their ethnicity and regardless of their skills. This racialization of the labour market has been well documented - particularly since the ‘large-scale’ BME immigration in the post-war period. What is less well known is what it is like to work in these increasingly segmented sections of the economy where white workers have abandoned jobs in favour of (slightly) more lucrative work. Adopting a case-study approach, this article follows a trade union’s attempt to organize a sandwich factory of 500 workers, where most of the workforce was made up of BME migrant workers.

ENTREPRENEURIAL LEADERS IN FAMILY BUSINESS ORGANISATIONS

2004 ◽  
Vol 12 (01) ◽  
pp. 1-34 ◽  
Author(s):  
SEOW WAH SHEH
Keyword(s):  
Family Business ◽  
Large Scale ◽  
Transformation Process ◽  
Transformational Leader ◽  
Case Study Approach ◽  
Chief Executives ◽  
Qualitative And Quantitative ◽  
Study Approach ◽  
Primary Instrument

This research reports the findings of an empirical study into the behavioural attributes of the Chinese transformational leader in Singapore. The literature review reveals that the current research on transformational leadership only focuses on Western organisations. This research design used both qualitative and quantitative approaches. The qualitative research used the case study strategy as a primary instrument. This case study approach was to search for new themes and patterns across eight Chinese Chief Executives of medium to large-scale business enterprises. In the quantitative part of the research, the subordinates of the selected leader were identified to participate in the questionnaire survey – to rate their leaders' based on the presence and intensity of practice of the identified behavioural attributes. The six factors rotated uncovered a common list of behavioural attributes of the Chinese transformational leader that will facilitate the transformation process. Implications of the findings are discussed.

Social Insurance, Distributive Criteria and the Welfare Backlash: A Comparative Analysis

1982 ◽  
Vol 12 (4) ◽  
pp. 421-447 ◽  
Author(s):  
Sara A. Rosenberry
Keyword(s):  
Welfare State ◽  
Case Studies ◽  
Policy Development ◽  
Comparative Research ◽  
Social Insurance ◽  
Large Scale ◽  
Study Approach ◽  
Policy Development Process ◽  
The Welfare State

With some notable exceptions, comparative research on the welfare state falls generally into one of two categories: qualitative and generally descriptive case studies and large-scale quantitative efforts at explanation. Case studies have progressed past the point of being essentially journalistic descriptions of the peculiarities of the policy development process or the policies of a particular society. It is nevertheless true that there has been little progress in moving beyond the case study approach towards building a theory about how and why societies make particular decisions about the priorities and organization of their social welfare efforts. On the other hand, while large-scale aggregate analysis yields theoretical statements about the character of ‘the welfare state’, those conclusions are often so general as to be ‘difficult to relate to… how particular substantive problems have been [and might be] handled.’

scholarly journals RAGAM HIAS MOTIF BATIK MELALUI RELIEF FLORA CANDI BOROBUDUR PADA MAHASISWA PGSD FKIP UAD

2021 ◽  
Vol 11 (4) ◽  
pp. 385-390
Author(s):  
Fery Setyaningrum ◽  
◽  
Heni Siswantari ◽  
Keyword(s):  
Data Analysis ◽  
Research Method ◽  
Case Study Approach ◽  
Data Presentation ◽  
Analysis Techniques ◽  
Study Approach ◽  
Irregular Shapes ◽  
Decorative Motifs ◽  
Document Review

His study aims to describe the implementation of the decorative reliefs of the Borobudur temple flora on the batik motifs of PGSD FKIP UAD students. The research method that will be used is qualitative with a case study approach. Data collection techniques were carried out by interview, observation, and document review. Data analysis techniques that will be used in the form of data reduction, data presentation and drawing conclusions. The results of the study were the implementation of various relief batik motifs through the reliefs of the flora of the Borobudur temple on the work of PGSD UAD students. The motifs that appear in the decorative motifs made by students are geometric and non-gemetric batik motifs combined with flora reliefs in the form of frangipani trees, lotus trees, banana trees and lotus trees. Student works are in the form of 2-dimensional works with the identification of elements of straight, curved, zigzag and irregular lines, geometric expressions, organic expressions, multi-angled faces, and irregular shapes. and tertiary, playing dark and light, applying the principles of composition work. Keywords: Decorative Variety, Batik Motif, Relief

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