‘A Complexity Inspired Approach to CoEvolutionary Hospital Management Information
Systems Development’
Judge Business School
by Vincent Shaw
Geoff Walsham – First Opponent
Strengths of the thesis
Valuable exploration of hospital MIS in resource constrained
environments
Based on rich field data from a variety of African countries
Adopts an interesting theoretical stance of a complex adaptive systems
(CAS) perspective
Seven papers of good quality, becoming more sophisticated over time
Page 2
Some broad contributions
Context is one of ‘extreme’ heterogeneity
Need for flexibility in both technical design and the implementation
process
Technical: flexible components, modular design
Implementation: self-organising groups which cross boundaries;
synergistic partnerships between public sector organisations (e.g.
hospitals) and NGOs (e.g. HISP-SA)
Page 3
More specific contributions
Process of co-evolutionary development whereby agents (human and
non-human) change and adapt together ‘at the edge of chaos’
PAN model - Process of Accommodating Non-Linearity: data
management; technical resources; human resources
Mindful innovation: preoccupation with the possibility of failure,
commitment to resilience, sensitivity to operations
Flexible standards, sustainability, scalability, gateways, attractors …
Hard sometimes to see the wood for the trees and a bit repetitive at
times
Page 4
My questions
Choice of CAS as a theoretical framework
Methodological issues
Culture, power and politics
Human capacity development
Reflexivity?
Page 5
Choice of CAS as a theoretical framework
Why choose CAS rather than ANT for example?
Weaknesses of CAS?
Page 6
Methodological issues
You claim to be using an interpretive stance but ….
‘Data and interpretations have been triangulated by moving between the
micro- and macro-levels …’ (p85 – italics added)
And ‘in order to ensure my interpretations are valid …’ (p85 – italics
added)
Page 7
Culture, power and politics
They often seem absent. Why?
e.g. ‘We need to move away from a culture of reporting to a culture of
using the data for ourselves’ (Byskov and Olsen in response to Paper 2,
p639)
How do we do this? How does complexity theory help? Is ‘training’
adequate?
Page 8
Power and politics - example
e.g. ‘a co-evolutionary process between an NGO and a public sector
organisation is potentially a relationship which allows the strengths of
each organisation to complement one another’ (pp137-8)
Possibly!
What about tension, disagreement, conflict ….?
Page 9
Human capacity development
I agree it is crucial but it seems to arrive relatively ‘late in the day’. Why?
Health information practitioner (HIP) – interesting concept but not welldeveloped: recruitment, incentives, career structure …
And only one element in efforts to shift towards a culture of ‘information
for action’
How do we shift the attitudes and capabilities of all the stakeholder
groups: doctors, nurses, other health workers, managers …?
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Reflexivity
‘I conclude with a quote from Suchman (1987, p. v11) on plans and
situated action which, in my view, provides an invaluable insight into the
approach which is necessary for sustainable HospMISD in resource
constrained settings: (italics added)
“The Trukese navigator begins with an objective rather than a plan. He
sets off toward the objective and responds to conditions as they arise in
an ad hoc fashion. He utilizes information provided by the wind, the
waves, the tide and current, the fauna, the stars, the clouds, the sound of
water on the side of the boat, and he steers accordingly. His effort is
directed to doing whatever is necessary to reach the objective. If asked,
he can point to his objective at any moment, but he cannot describe the
course.” (p161)
Or a description of yourself and your PhD journey?
Page 11