The Integration of e‐Health With e‐Governance: An ANT Translation of the Influencing Factors

BackgroundThe COVID-19 pandemic has been impacting the need, utilization, and delivery of mental health services with greater challenges being faced by clients and providers. With many clients facing reduced access to services and social isolation, a focus on suicide risk assessment and prevention is critical. Concern is particularly increased for clients with schizophrenia spectrum disorders given data show suicide rates are disproportionately high for those with psychosis in comparison to the general population. Provider perspectives of challenges in service delivery are needed to inform efforts to improve access, feasibility, and quality of mental health care throughout the evolving pandemic. This study explored mental health provider perspectives of client challenges in service utilization and provider challenges in service delivery, including remote engagement, suicide risk assessment, and treatment of psychosis.MethodsData were collected from social work mental health providers (n = 12) in United States community mental health setting. Providers consented to participate and responded to questions about service delivery experiences in late 2020 and in relation to COVID-19. Demographic and practice-related provider data were explored descriptively using SPSS and qualitative data using open coding and grounded theory methods in Dedoose.ResultsAmong the 9 providers who engaged in remote service delivery, 7 (77.8%) experienced challenges in remote engagement with clients and 8 (88.9%) experienced challenges in treatment of psychosis. Among the 7 providers who engaged in remote suicide assessment, 4(57%) experienced challenges. Qualitative themes emerged including logistic (e.g., technology access and use), engagement (e.g., virtual rapport-building and limited remote services), and clinical (e.g., difficulty assessing suicide risk, internal stimuli, abnormal involuntary movement, and affect) challenges in service delivery.ConclusionsProvider perspectives are essential to inform efforts to build resources and problem-solve challenges and barriers that both providers and clients face throughout various shifts in mental health service delivery. Findings emphasize the need to troubleshoot client access to technology, bolster support for providers to prevent burnout, and greater provider training to improve skills in remote engagement, assessment, and treatment, particularly in relation to psychosis and suicide prevention. Study implications are not only critical for the evolving COVID-19 pandemic, but also in preparation for ongoing shifts in service delivery as technology evolves.

In recent years, healthcare service providers have increasingly employed mobile systems in delivering services. However, the nature of the diversities in tribes and languages within many developing countries enhance the difficulty of delivering or receiving the services which are provided by many healthcare organisations. This is so because the English language is the primary medium of communication, although many healthcare recipients are not conversant in English as they cannot speak English fluently or understand it coherently. The objective of the study was to understand the impact which language barrier have on healthcare services. The interpretivist approach was employed. The case study approach was applied. Qualitative data were collected using semi-structured technique. The analysis of the data was guided by two theories, actor network theory and diffusion of innovation. From the findings, a framework was developed, which is intended to guide a solution that can be provided to address the barrier in the South African healthcare environment.

The basic values and principles of public administration guide the service delivery in the South African context. Despite the government's commitment to improve basic service delivery to the citizens in this era, the South African municipalities are still faced with serious challenges of service delivery and governance. This study discusses the basic values and principles governing public administration in the context of municipal service delivery. Thus, the purpose of this study is to unpack the implementation of the values and principles of public administration on service delivery as enshrined in the Constitution of the Republic of South Africa, 1996. Accountability, transparency, public participation, professional ethics, and access to information are some of the basic values and principles provided by section 195(1) of the Constitution. In this pandemic of COVID‐19, municipal officials in local government are expected to conduct their business in line with the values and principles as enshrined in the Constitution. Theoretically, this study relied on the theory of implementation sometimes referred to “Policy Implementation” by Pressman and Wildavsky (1973). Pressman and Wildavsky defined “implementation” as “to carry‐out, accomplish, fulfil, produce, complete.” Thus, this theory is relevant to this study as it discusses the implementation of the basic values and principles governing public administration. The study proposes how municipal officials should execute their duties within the Thuma Mina program which requires them to be at the forefront of service delivery. Furthermore, municipal officials should provide services within the parameters of basic values and principles of public administration.

Governments aim to digitalize public services. Whereas initially they worked in isolation, nowadays they increasingly link different building blocks together to realize integrated public services. This evolution poses challenges concerning the governance of public services. The purpose of this paper is to identify governance challenges in inter-organizational digital public service delivery. To do this, we investigated a case study that deals with the creation of digital invoicing services in Belgium. The findings show seven groups of governance challenges that incorporate technical, organizational and inter-organizational factors. Governance challenges can be external, related to the environment and the users, as well as internal, related to the digitalization objectives and governance dynamics. Moreover, as public services evolve over time, so do governance challenges, suggesting that governance regimes may have to evolve accordingly to maintain coordinated service delivery.

Enterprise Architecture (EA) is a strategy to attain alignment between an enterprise’s business and Information Technology (IT) to increase the competitiveness of an enterprise. In EA implementation, Critical Success Factors (CSFs) refer to factors that may facilitate the successful implementation of the EA. This research presents a CSF model based on an exhaustive literature review and empirical data from practitioners to identify rationalised CSFs. EA implementation projects that do not fully utilize the CSFs may result in inappropriate directions and dissatisfied EA project stakeholders. A quantitative research methodology is applied in this study using questionnaires to evaluate the proposed model. The respondents include enterprise architects, IT managers, and IT consultants with considerable knowledge of EA concepts. Statistical analysis is used to identify the relationships between the proposed CSFs and the success of EA implementation. From the results, the proposed CSF model is significantly related to EA implementation success. The highest-ranking CSF is governance, indicating the importance of governance in the success of EA implementation. Moreover, the proposed CSF model appears to facilitate achieving the desired architecture. By understanding the CSF model at the onset of a project, practitioners can better plan and focus on the CSFs to achieve the desired results.

Contemporary studies on public administration in Nigeria have revealed two dramatic findings. First, despite the moderate achievements in democratic governance and being rich in natural and human resources, there remain many politico-administrative challenges to be addressed in Nigeria. Second, ailing public administration has resulted in disturbing socio-economic indicators which are among the worst in the world. This paper examines the challenges of public administration for effective service delivery and good governance in Nigeria. The paper employs descriptive method of research and content analysis which is anchored on ‘efficiency theory' to examine the subject matter. Findings reveal that, notwithstanding the dramatic administrative reforms, citizen's confidence in government service is near an historic low because of poor service delivery and exclusionary policies. The paper submits that the label of poor performance and absence of excellence in the public service has the tendency to undermine development and good governance in Nigeria.

Enterprise architecture is a collection of artifacts describing various aspects of an organization from an integrated business and IT perspective. Practicing enterprise architecture in organizations implies using these artifacts to facilitate information systems planning and improve business and IT alignment. Despite its long history, the enterprise architecture discipline still remains largely atheoretical and lacks a solid theoretical basis. Based on our previous empirical studies of the practical usage of enterprise architecture artifacts in multiple organizations and broad literature analysis, this conceptual article identifies and discusses in detail 10 theories that can be considered key for understanding how an enterprise architecture practice works: actor-network theory, boundary objects theory, cognitive fit theory, communities of practice theory, decision-making theories, information processing theory, knowledge management theory, management fashion theory, media richness theory, and uncertainty principle. Taken together, these theories offer a comprehensive theoretical view of an enterprise architecture practice explaining the role of enterprise architecture artifacts, their usability, and participation of stakeholders and, therefore, may constitute a theoretical basis of the entire enterprise architecture discipline. Although this article does not elaborate on any of these theories, it brings these theories to light, establishes their critical importance for comprehending an enterprise architecture practice, and positions them as central to the enterprise architecture discourse. Each of these theories can be leveraged by enterprise architecture scholars in their future studies for analyzing enterprise architecture practices through respective theoretical lenses. This article intends to provide fresh theoretical insights on enterprise architecture, spark new waves of theoretical enterprise architecture research, and contribute to the development of a sound theoretical foundation for the enterprise architecture discipline.

A systematic literature review: Critical Success Factors to Implement Enterprise Architecture

Background: Many of the total quality management (TQM) implementation challenges substantiated in the literature seem oriented towards various facets, including organisation, management, or clients, casting doubts about the effectiveness of the concept in service delivery. The ever-increasing demand for quality services solicits more attention to the desired performance outcomes that define and reflect more of clients’ needs. Such demand presents quality management concerns for many healthcare organisations targeting service delivery.Aim: The TQM concept gets less logical given the increasing challenges in its implementation for service delivery. This research aimed to determine the significance of such challenges.Setting: Queen ‘Mamohato Memorial Hospital (QMMH), Lesotho.Methods: Based on a questionnaire survey of 297 participants, comprising 98 staff and 199 clients, the study obtains survey data from a 5-year result of TQM implementation attempts at Queen ‘Mamohato Memorial Hospital (QMMH), Lesotho.Results: TQM demonstrates great potential to support service delivery as a strategic approach. The study isolates the management-oriented facet of TQM implementation challenges and finds them considerably influenced by the various TQM components.Conclusion: This study establishes and classifies the TQM implementation challenges in QMMH, which are mostly organization, management, and client-oriented. It further addresses assumptions relating to their classifications. Overall, the result suggests that the significance of the underlying challenges in service delivery is more management-oriented.Contribution: The study provides directions that strengthen the effectiveness of the TQM concept and its implementation. It suggests the capacity-building of a hospital’s management team drives TQM implementation.

Aim/Purpose: The aim of this study is to identify Critical Success Factors (CSF) of Business Intelligence (BI) and provide a framework to classify CSF into layers or perspectives using an enterprise architecture approach, then rank CSF within each perspective and evaluate the importance of each perspective at different BI maturity levels as well. Background: Although the implementation of the BI project has a significant impact on creating analytical and competitive capabilities, the lack of evaluation of CSF holistically is still a challenge. Moreover, the BI maturity level of the organization has not been considered in the BI implementation project. Identifying BI critical success factors and their importance can help the project team to move to a higher maturity level in the organization. Methodology: First, a list of distinct CSF is identified through a literature review. Second, a framework is provided for categorizing these CSF using enterprise architecture. Interviewing is the research method used to evaluate the importance of CSF and framework layers with two questionnaires among experts. The first questionnaire was done by Analytical Hierarchy Process (AHP), a quantitative method of decision-making to calculate the weight of the CSF according to the importance of CSF in each of the framework layers. The second one was conducted to evaluate framework layers at different BI maturity levels using a Likert scale. Contribution: This paper contributes to the implementation of BI projects by identifying a comprehensive list of CSF in the form of a holistic multi-layered framework and ranking the importance of CSF and layers at BI maturity levels. Findings: The most important CSF in BI implementation projects include senior management support, process identification, data quality, analytics quality, hardware quality, security standards, scope management, documentation, project team skills, and customer needs transformation, which received the highest scores in framework layers. In addition, it was observed that as the organization moves to higher levels of maturity, the average importance of strategic business and security perspectives or layers increases. But the average importance of data, applications, infrastructure, and network, the project management layers in the proposed framework is the same regardless of the level of business intelligence maturity. Recommendations for Practitioners: The results of this paper can be used by academicians and practitioners to improve BI project implementation through understanding a comprehensive list of CSF and their importance. This awareness causes us to focus on the most important CSF and have better planning to reach higher levels of maturity according to the maturity level of the organization. Future Research: For future research, the interaction of critical success factors of business intelligence and framework layers can be examined with different methods.

There is growing interest among IT practitioners and academics in Enterprise Architecture (EA) as an effective response to increasingly rapid business, economic, and technological change. EA has been proposed as a path towards better achieving and sustaining stronger business-IT alignment and integration, cost reductions, greater agility, reduced time to market, and other important objectives. Yet there is little theoretical basis to explain how EA work can lead to such achievements; moreover, the creation of a holistic and resilient EA remains an elusive goal for most enterprises. In this paper we use concepts from Actor- Network Theory to highlight some important socio-political and socio-technical aspects of EA work in the context of complex organization situations. Specifically, we focus on such challenges as actor identification in EA negotiations, the importance of soft skills, integration and reconciliation of multiple EA representations, discovering hidden interests and reflecting them in EA representations, dealing with misalignments of interests, as well as creating an environment for continuous EA, and thereby enterprise, improvement.

Background: Substance abuse is recognised as a worldwide concern, contributing significantly to morbidity and mortality in South Africa. There is minimal research that has considered influences in mental health care service delivery in rural and disadvantaged communities in South Africa.
 
 Methods: A qualitative study with substance abuse service providers in uMkhanyakude rural district of KwaZulu-Natal was undertaken to gain insight into the experiences and challenges in service delivery. Focus groups and semi-structured interviews were conducted with various stakeholders (n = 29) in the rural district.
 
 Results: The findings of the study suggest that service providers experience challenges in service delivery in this rural area. The effects of culture (amarula festival and ancestral worship) exacerbate the use of substances; the high rate of unemployment and poverty lead to the produce of home-brewed substances for sustainable living; a lack of resources poses threats to service delivery; the poor prioritisation of mental health care services and a lack of monitoring and evaluation of services in the district were highlighted.
 
 Conclusions: Despite this being a single district study, findings reflect the need for a district, provincial and national standard for substance abuse rehabilitation services in addition to the improvement of monitoring and evaluation for quality improvement. There is also a need to respond to the gaps that exist in after-care and community-based or decentralised substance abuse services that are essential in such areas, which are under-resourced despite the high prevalence of substance users.
 
 (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1272232

Background: Substance abuse is recognised as a worldwide concern, contributing significantly to morbidity and mortality in South Africa. There is minimal research that has considered influences in mental health care service delivery in rural and disadvantaged communities in South Africa.Methods: A qualitative study with substance abuse service providers in uMkhanyakude rural district of KwaZulu-Natal was undertaken to gain insight into the experiences and challenges in service delivery. Focus groups and semi-structured interviews were conducted with various stakeholders (n = 29) in the rural district.Results: The findings of the study suggest that service providers experience challenges in service delivery in this rural area. The effects of culture (amarula festival and ancestral worship) exacerbate the use of substances; the high rate of unemployment and poverty lead to the produce of home-brewed substances for sustainable living; a lack of resources poses threats to service delivery; the poor prioritisa...

The EU directive on patients' rights and cross-border care is of particular interest to small states as it reinforces the concept of health system cooperation. An analysis of the challenges faced by small states, as well as a deep evaluation of their health system reform characteristics is timely and justified. This paper identifies areas in which EU level cooperation may bring added value to these countries' health systems. Literature search is based primarily on PUBMED and is limited to English-language papers published between January 2000 and September 2014. Results of 76 original research papers appearing in peer-reviewed journals are summarised in a literature map and narrative review. Primary care, health workforce and medicines emerge as the salient themes in the review. Lack of capacity and small market size are found to be the frequently encountered challenges in governance and delivery of services. These constraints appear to also impinge on the ability of small states to effectively implement health system reforms. The EU appears to play a marginal role in supporting small state health systems, albeit the stimulus for reform associated with EU accession. Small states face common health system challenges which could potentially be addressed through enhanced health system cooperation at EU level. The lessons learned from research on small states may be of relevance to health systems organized at regional level in larger European states.

Background: Despite the growing recognition of mental health as a critical component of overall well-being, mental health care services in public health facilities in Kiambu County, Kenya, remain under-researched and under-resourced. There is a lack of comprehensive data on the socio-demographic characteristics of healthcare workers, the availability of resources, and the challenges faced in delivering mental health services. This gap in knowledge hinders the development of effective policies and interventions to improve mental health care delivery and outcomes in the country. This study aimed to assess the state of mental health care and treatment services in public health facilities in Kiambu County, Kenya. Methods: This study employed a mixed-methods approach, collecting qualitative data through interviews and quantitative data via structured questionnaires from 165 healthcare professionals across 13 Kiambu County, Kenya public hospitals. Data analysis included descriptive statistics for quantitative data and thematic analysis for qualitative data. Results: The workforce is predominantly female (57.6%) and relatively young, with 40.6% aged 40-49. The majority hold degrees (65.5%) and have significant experience in mental health care, but there are gaps in specialized training and a shortage of psychiatrists (6.1%). Mental health care resources in Kiambu County are insufficient, with uneven staff distribution, a shortage of specialists, and limited training opportunities. Insufficient training opportunities, along with inadequate policy and funding support, further hinder service provision. Inadequate referral systems, a lack of essential equipment and medications, and poor budget allocation further strain service delivery. Conclusions: There are major gaps in specialized training, a shortage of psychiatrists, insufficient resources, and inadequate policy and funding support which significantly hinder effective mental healthcare service delivery.