Postgraduate Program in Administration, University of Southern Santa Catarina, Palhoça 88137-270, Brazil.
Postgraduate Center in Administration, Federal University of Bahia, Salvador 40110-903, Brazil.
Int J Environ Res Public Health. 2023 Oct 25;20(21):6971. doi: 10.3390/ijerph20216971.
Governments around the globe are paving the way for healthcare services that can have a profound impact on the overall well-being and development of their nations. However, government programs to implement health information technologies on a large-scale are challenging, especially in developing countries. In this article, the process and outcomes of the large-scale implementation of a hospital information system for the management of Brazilian university hospitals are analyzed. Based on a qualitative approach, this research involved 21 hospitals and comprised a documentary search, interviews with 24 hospital managers and two system user focus groups, and a questionnaire of 736 respondents. Generally, we observed that aspects relating to the wider context of system implementation (macro level), the managerial structure, cultural nuances, and political dynamics within each hospital (meso level), as well as the technology, work activities, and individuals themselves (micro level) acted as facilitators and/or obstacles to the implementation process. The dynamics and complex interactions established between these aspects had repercussions on the process, including the extended time necessary to implement the national program and the somewhat mixed outcomes obtained by hospitals in the national network. Mostly positive, these outcomes were linked to the eight emerging dimensions of practices and work processes; planning, control, and decision making; transparency and accountability; optimization in the use of resources; productivity of professionals; patient information security; safety and quality of care; and improvement in teaching and research. We argued here that to maximize the potential of information technology in healthcare on a large-scale, an integrative and cooperative vision is required, along with a high capacity for change management, considering the different regional, local, and institutional contexts.
全球各国政府正在为医疗保健服务铺平道路，这些服务将对国家的整体福祉和发展产生深远影响。然而，政府大规模实施卫生信息技术的计划具有挑战性，尤其是在发展中国家。本文分析了在巴西大学医院管理中大规模实施医院信息系统的过程和结果。本研究采用定性方法，涉及 21 家医院，包括文献检索、对 24 名医院管理人员和两个系统用户焦点小组的访谈，以及对 736 名受访者的问卷调查。总的来说，我们观察到与系统实施的更广泛背景（宏观层面）、管理结构、文化细微差别以及每个医院内部的政治动态（中观层面）以及技术、工作活动和个人本身（微观层面）相关的方面，促进了或阻碍了实施过程。这些方面之间的动态和复杂相互作用对过程产生了影响，包括实施国家计划所需的时间延长以及国家网络中医院取得的结果喜忧参半。这些结果主要是积极的，与实践和工作流程的八个新兴维度有关；规划、控制和决策；透明度和问责制；资源利用的优化；专业人员的生产力；患者信息安全；护理质量和安全性；以及教学和研究的改进。在这里，我们认为，为了在大规模上最大限度地发挥信息技术在医疗保健中的潜力，需要具有综合和合作的愿景，以及强大的变革管理能力，同时考虑到不同的区域、地方和机构背景。
