Dynamic Ambidexterity for Balancing Standardization and Evolve-Ability in Information System Implementation in the Resource-Constrained Setting: the Case of DHIS2 Implementation in Public Health Care in Ethiopia
| dc.contributor.advisor | Mark Gaynor (Professor) | |
| dc.contributor.author | Birkinesh W/Yohannes | |
| dc.date.accessioned | 2025-08-05T00:55:03Z | |
| dc.date.available | 2025-08-05T00:55:03Z | |
| dc.date.issued | 2023-06-26 | |
| dc.description.abstract | Health Information System (HIS) implementation involves inherently contradictory issues, standardization, and evolve-ability, that require different sets of information technology solutions and governance mechanisms (i.e. centralized/decentralized structure, controlled/autonomous process, top-down/bottom-up communication) which is difficult to materialize in practice. Contemporary studies indicate that organizations are shifting away from either/or strategies toward balancing that favors simultaneously achieving contradictory activities. However, theoretical and empirical research guiding how to organize and implement a balancing of standardization and evolve-ability is lacking. Furthermore, research has paid little attention to resource-constrained settings where sources of contradiction are immense due to a lack of technical and financial resources needed for HIS implementation. To address this shortcoming, this study seeks to study HIS implementation in the public healthcare sector of Ethiopia aiming to contribute to the development of an IT governance framework for understanding and addressing contradictory issues in the resource-constraining setting. Following an interpretive approach, the implementation of DHIS2, an open-source software developed at the University of Oslo, in the Ethiopian public health care setting was used as a case to explore the underlying logic of IT governance and IS implementation and its impacts. Managers, health, and IT professionals who were involved in the implementation were chosen as informants for this study to provide a deeper understanding of the IT governance mechanisms and their impact on the implementation. Institutional logic served as the primary analytical tool for this study and was used to identify common themes for stakeholders. Dynamic ambidexterity and boundary resource concepts became parts of analytical tools to explore the process of IS implementation at organizational and project levels as the study progressed from data collection, analysis, and the development of theoretical inferences. This study proposed an integrated ambidextrous implementation governance framework, drawn from institutional logics; dynamic ambidexterity, and boundary resource model; to complement the resource-chasing collaboration with major logics-collaboration, uncontrolled and controlled processes. This framework can be considered a major theoretical contribution that requires the central actor’s institutional distance to accommodate major collaboration with diverse underlying logic. This required enabling common visions, strategies, and mechanisms for sensing, seizing, and reconfiguring the emergent heterogeneous system implementation initiatives that lead to continuously and simultaneously achieving standardization and evolve-ability. This study is limited by data from one region and a specific system which might not adequately describe the complexity of a national HIS implementation. Furthermore, the researcher's role as an external participant would miss important events such as internal meetings where technical decision and discussion was made which should have been ideal to get rich information. Furthermore, the research indicates the importance of technological features to shape governance mechanisms. Hence further research can investigate the interrelationship between IT governance and the technology feature. Further research is needed to extend the scope of this study to multiple regions, and systems for a longer time to highlight new insights and to highlight the differences across regions and systems. These are limitations and potential areas for further research. | |
| dc.identifier.uri | https://etd.aau.edu.et/handle/123456789/6049 | |
| dc.language.iso | en_US | |
| dc.publisher | Addis Ababa University | |
| dc.subject | Standardization | |
| dc.subject | Evolve-ability | |
| dc.subject | Health Information System | |
| dc.subject | Implementation | |
| dc.subject | Institutional Logic | |
| dc.subject | Ambidexterity | |
| dc.title | Dynamic Ambidexterity for Balancing Standardization and Evolve-Ability in Information System Implementation in the Resource-Constrained Setting: the Case of DHIS2 Implementation in Public Health Care in Ethiopia | |
| dc.type | Thesis |