Niveles de desempeño y Marco de Referencia Europeo

In this section, the researcher wanted to know the limitations that influence the acceptance and use of e-Health IS by clinical staff in the public healthcare institutions where this study was conducted. In this study, the term ‘Limitation’ was conceptualized and defined as a restricting condition that hinders an intended act. In the context of this study, ‘Limitation’ was determined by variables such as inadequacies and technical difficulty. Inadequacies in facilitating conditions serve as a limitation such that if users lack essential resources

99

(software, hardware, IT support and training) and knowledge (skills) required to use a technology, they may develop negative perceptions which either result in selective usage or discarding of a new technology innovation (Alwahaishi & Snásel, 2013). Hence, this section presents the findings on user experiences concerning use challenges and the impact of use challenges on clinical care processes. The researcher searched through the transcripts for the attributes of inadequacies with respect to words (or phrases) that indicate actions that impede the acceptance and use of e-Health IS by clinical staff. In addition, the researcher identified words (or phrases) that imply glitches associated with the use of e-Health IS.

When asked to reflect on the factors that inhibit the use of e-Health information systems, all 7 (100%) respondents reported various inadequacies and technical faults.

5.3.4.1 Inadequacies of e-Health IS use in the public hospitals

Under this section, the researcher wanted to explore and understand the deficiencies in the use of e-Health IS as experienced by clinical staff. The extent to which adequate facilitating conditions are provided, partly influences the perceptions of individuals to use of a new technology (Karuri et al., 2013). In other words, the perception that the facilitating conditions are deficient or less than adequate, would likely influence the use of a new technology and ultimately the efficiencies of quality clinical care services delivery (Li et al., 2013).

The findings show that insufficient ICT systems, financial, socio-political constraints, busy schedule, resistance and non-flexibility are factors that impede the use of e-Health IS by the clinical staff in the public hospitals in this study (AC- H1-R32; GP-H2-R26; SR-H2-R15).

There seems to be less than sufficient ICT systems for clinical care as a clinician respondent disclosed that they “…don’t have ICT…” systems (AC- H1-R32). Respondents further disclosed that lack of adequate hardware is due to financial restrictions in public hospitals on the part on the government. It was described that the e-Health IS are “…a little bit slower…”

especially because “…most of the computers are older than 3 years…” (SR-H2-R15) and even the present backup systems for the workstations “…are very old…” (FDT- H1-R29).

The respondents clarified that the backup systems are overly due for replacement but

“…there’s not always finances…” (SR-H2-R15). This was regarded as a major challenge

“…within the government” (SR-H2-R15), as “…doctors are ruled…by various people (AC- H1-R38), who are accustomed to traditional methods and not willing to compromise. It is clear from the findings that the implementation of e-Health IS are less than adequate, to the extent that there is insufficient budget and the clinical staff feel it is expected that a higher authority should naturally facilitate the implementation of the e-Health IS.

It is evident from the findings that the resistance to use e-Health systems is peculiar to the older generation of clinical staff who “…aren’t familiar with technology…” (JM-H2-R10),

100

because they perceive “…computers… as a challenge...” resulting in the selective use of the system. In addition, the hospital management “…still don’t have very good buy-in …” (FDT- H1-R21) from clinical staff. For instance, the CLINICOM system enables clinical staff “…to put in information…” (FDT- H1-R30) such as the clinical notes, but that function is never optimized. With respect to some implemented e-Health IS, respondents complained that features were “…problematic…” (GP-H2-R31) and lacks the “…ability to enter clinical notes…” (SG-H2-R1) and capture “…patient held records…” (SG-H2-R15).

The findings also indicated constraint of e-Health IS mobility in terms of flexibility to work at any place and any time, inhibits use. A respondent disclosed that “…there are two challenges…” (GP-H2-R26) associated with the clinical note system. The respondent further stated that “…it’s not mobile…” and secondly, “…you can’t enter data directly...” on to the system. In essence, the system basically stored “…pieces of paper that have been scanned in their thousands or their tens of thousands…” (GP-H2-R19). The respondent claimed shortcomings are experienced ultimately “…when the processes are slow…” and “…when a user isn’t adequately trained…” (FDT- H1-R30). It is clear from the findings that some of the implemented e-Health IS were not pragmatically designed to be used effortlessly, while training the clinical staff to use the systems appears to be a necessity.

The findings show that facilitating conditions are less than adequate. For instance, training to acquire the required skills to facilitate the use of e-Health IS are put in place by the hospital management but it is either not adequate or the individual capabilities ultimately determine whether the systems would be used (or not used).

Moreover, certain e-Health IS are non-compatible with the preference of clinical staff as they lack complete electronic features that restrict the work-flow of clinical staff and also slow down their work processes. In essence, e-Health IS that are suitable and offer consistency with the needs lacking in existing work processes influence positive perceptions; otherwise, non-compatibility and difficulty negatively influences the acceptance and use of e-Health IS.

Explanations to these findings are presented in section 5.4.

5.3.4.2 Technical difficulties of e-Health IS use in the public hospitals In this section, the researcher wanted to know the circumstances that hinder the use of e-Health information systems by the clinical staff. Despite the provision of facilitating conditions by the hospital management to enable a smooth adoption process, the findings indicate that the clinical staff experience technical difficulties using implemented e-Health IS for their work activities in the public healthcare institutions. When asked questions related to use and use challenges, 5 (71%) of the 7 respondents reported that technical difficulties mainly include downtime and slowness of the systems (AC- H1-R16; FDT- H1-R28 & JM-H2-R15)

101

The NHLS is reported to have a regular downtime. Respondents disclosed that the NHLS is frequently down “…on a daily basis…” (AC- H1-R16), and as a result, it is difficult to gain

“…access…through the system”. It would seem like systems slowness and downtime are co-related; they are prominently mentioned as the biggest technical difficulties that impede the clinical care processes (SG-H2-17). A respondent expressed concerns that slowness is

“…the biggest problem…” (FDT- H1-R28) as a result of power outages, and it “…affects the medical staff in particular…”.

Further, downtime is experienced “…when systems need to be upgraded…” (JM-H2-R15); it, ultimately, creates a constant back-log in the work-flow such that users “…can’t verify…”

information (FDT- H1-R18). In this instance, lack of adequate enabling environment ensues in slowness and downtime of implemented e-Health IS and the work processes. In line with the unified acceptance and use of technology (UTAUT), less than adequate facilitating conditions ultimately have adverse effects on user perceptions on system usage. In section 5.4, a discussion of the findings is presented with causal explanations and its implication on the use of e-Health IS in this investigation.

Thus far, some of the peculiar challenges of implementation and use observed in the context of low-medium (LMI) countries (section 2.5.2.2) are being experienced in the public hospitals of the Western Cape Province where this investigation was conducted. These challenges include a lack of adequate infrastructure, insufficient financial resources, a lack of proficiency in ICT and even political influence.

The research objective was to understand the reasons for low use (or non-use) of e-Health IS by clinical staff, and clarify reasons for the limitations in clinical support of the systems in the public healthcare institutions of the Western Cape Province. To achieve this objective, an interpretive discussion explaining the findings and a critique is presented in section 5.4.