Abstract
BackgroundThe deployment of digital health systems may be impeded by barriers that are, or are linked to underlying enduring institutions. Attempting to challenge the barriers without addressing the underpinning institution may be ineffective. This study reflects on ways actors may surmount institutionalised barriers to the uptake of digital tools in health systems.MethodsI applied Institutional theory concepts to an autoethnographic case study of efforts to introduce a digital tool to provide citizens with medicines information.ResultsThe tool’s uptake was impeded because of state regulators’ institutionalised interpretation of pharmaceutical advertising laws, which rendered the tool illegal. I, along with allies beyond the health sector, successfully challenged the regulators’ institutionalised interpretation of pharmaceutical advertising laws through various actions. These actions included: framing the tool as legal and constitutional, litigation, and redefining these concepts: ‘advertising’, ‘health institution’, and the role of regulatory bodies vis a vis innovation.ConclusionAfter identifying a barrier as being institutionalised or linked to an institution, actors might challenge such barriers by engaging in institutional work; i.e. deliberate efforts to challenge the relevant institution (e.g. a law, norm or shared belief). Institutional work may require the actions of multiple actors within and beyond the health sector, including judicial actors. Such cross-sectoral alliances are efficacious because they provide institutional workers with a broader range of strategies, framings, concepts and forums with which to challenge institutionalised barriers. However, actors beyond the health system (e.g. the judiciary) must be inquisitive about the potential implications of the digital health interventions they champion. This case justifies recent calls for more deliberate explorations within global health scholarships and practice, of synergies between law and health.
Highlights
The deployment of digital health systems may be impeded by barriers that are, or are linked to underlying enduring institutions
I solidify the assertion that the interpretation of advertising rules that rendered the Medical Information Service’ (MIS) unacceptable to regulators was an institution
Having identified problematic institutions, is worthwhile for practitioners to familiarise themselves with the forms of institutional work that are at their disposal, such as institutional logics in a given context, in order to effectively surmount institutionalised barriers
Summary
The deployment of digital health systems may be impeded by barriers that are, or are linked to underlying enduring institutions. Digital systems hold promise for healthcare delivery and attract billions in investment worldwide [1] Their deployment is complex and vulnerable to barriers [2, 3]. (Institutions being practices, customs, ideas, beliefs, shared understandings, objects etc., that shape social interactions, have attained the status of ‘taken-for-granted facts’ [4], tend to be invisible [5] and resistant to change [6]. This premise is the basis for this paper, which considers institutionalised barriers to the deployment of digital health systems and some of the ways those barriers can be overcome. It was the impeding institution that more readily recommended itself to empirical study because of its conspicuousness
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