Thematic analysis of a qualitative interview

1. Laboratory

B: Good morning, my name is B chin and I’m a DBA student from the university of wales trinity St David London campus.

Participant: Please excuse me are we going to speak in English or French…?

B: Oh no just an introduction then I speak in French, but do you prefer speaking in English or French.?

Participant: No, I will speak in French (Laughs)

B: (Laughing.) you can speak in French and in some cases when you’re explaining you can speak in English if you like will be helpful

Participant: If you want... I will speak in French and try in English

B: okay My first question is, I’ll put the questions here so you can see and read when my pronunciations is not clear

Participant: Okay

B: My first question is, what do you understand by health information systems in patients care?

Participants: They are making too much noise (colleagues), I think it’s better we change location

B: Yeah, where? outside? (change location)

B: so, what do you understand by health information systems in patients care?

Participants: (Repeat’s question) what do you understand by health information systems in patients care? Ok I think that when they talk of health information systems, it relates to a certain number of relative information used in patients care. Now this information depends on different services because patients care involves different number of services as there exist different services in the health department and structure for example there are laboratory services, patient’s consultation sector, you also have treatment rooms, reanimation ward and many other services. So, you have all these services but then, all these services constitute a narrower system through the information that each service brings. These information’s will be computerised meaning we will work in a platform in a way to have a set of computerised data or information to facilitate patients care while keeping the cohesion on the course and the procedure that consist of the entry and exit of patients.

B: OK. Thank you very much for the answer.  And why did the clinic adopt a health information system.

Participant: (Breaths heavily) so as I was already saying, if we decided to adopt this System of health information its already because, through computerization, since today with modernization, I believe it is important to follow the rhythm if people are advancing you should advance with them. We cannot stay in one place and continue to follow same routine. This means that there would be need for example for a patient taken from somewhere else in our side, if the system isn’t the same patients care will be a little complex for example looking or searching for the patient’s information or data. Whereas if you have an advanced performing system for example if I have to look up for the information of a patients we are receiving today, but had been here three to four years before, it will be very easy to rapidly access their data without having to go back looking for medical files as it used to be before. With HIS it is much easier with just one punch to directly see the health history of this patient and facilitate the care given to this patient by using internal data. That is why if we decided to adopt HIS if also to ameliorate this section, reduce paperwork because when computerization comes in paper works reduces which gives more work so this is also very easy in this level. So, this are some of the reasons we adopted HIS. 

B: Do You Have a HIS and Which Ones are presently Being Used. 

Participant: For the moment, the HIS we use a logistician called IPLAN on which we use the platform that has this advantage if we have to say it has an interesting advantage cause you can easily follow up a patient while in your office  and through this HIS any medical doctor and come at any time and easily see the progress or journey since the entry of a patient what has been done, what is being done, the results of the patient are can also be instantly seen because the doctors can prescribes that results be available in two or three while he is following up the patient and before the results comes out he already has the data  which facilitate patients care and services offered.

B: From your experience how easy is it to use this HIS? Is the IPLAN easy for you to use and was it easy to use at the beginning when it was introduced. 

Participant: ermmm today I think the transition introducing a new system is never easy at the start. Integrating a new system is never easy at the start whatever it may be. It a new element and had to be adapted but once adapted and integrated, people tend to understand that it is way easier than they thought it would be.

B: This question might sound repetitive cause I think you answered it under another, but I’ll just ask again. How do you think the adopting HIS has change the functioning of the clinic?

Participant: As I was saying, we do not work a lot with physical files of patients it facilitates work. Also, in the level of patients results, as test are done, results are already available we don’t more wait till the end to get the results. They can ask for 1,2,3, to 4 tests while your hospitalized once the 1st and 2nd are taken, we have already sent it the results through the information system which means it’s possible to see what has been done and what is left to be done and with what is already available, doctors can start administering patients care to patients while before, we had to wait for the end of all 4 test before seeing results. Also, if So, this is one very big advantage of HIS. To add more, if there were already patients being hospitalized, and your being asked for a malaria test, typhoid, while being hospitalized it can be remarked that you have these symptoms that require that we do another test that was maybe not asked in the beginning of your treatment at time the nurses call the laboratory, some nurses even forget until they are doing rounds that they remember that they had to request for more medical test for that patient whereas with this system, when doing morning rounds, they just send the notification straight to the laboratory of what has to be done through this platform. So even this has been corrected and forgetfulness is avoided. So, this is another change that HIS has brought and its advantage.

B: Oh, wow that is impressive. Okay In your point of view, do you there exist a difference between the use HIS and the effective use of HIS?

Participant: Rereads the question; In your point of view, do you there exist a difference between the use HIS and the effective use of HIS? (sound a little confused)

B: (Trying to break down the question for better understanding) so, what I’m asking is... it is true that the clinic has adopted in HIS, but do you think you and your colleagues are effectively using it, is it perfectly functioning or implemented, are there any problems encountered while using the HIS and all that? 

Participant: Oh, okay I understand now, well when it’s said to be effective it means it works exactly as it was said it would from the beginning.

B: exactly

Participant: Because when they present a system to us, they show us all its advantages when we start using it. But when you start using it’s not always that at the start cause you encounter little issue and now, I will take two strands. The first strand is that a HIS can be put in place to be used in a health center that when you come Polyclinic to use adaptation is very difficult because the work system in a policlinic is much more complex. The work volume is not the same as you have many services in a policlinic whereas in a small center there is nothing much to do. This means that when you take this logistician and integrate, I’m saying cause it’s our case there are clinic that use our type of system and have no problems but there are the same IT Engineers that implemented our own and have problems with us because it is very complex which make it okay to say we have general internet problems. It crashes, it is not rapid, and we are told it’s because there are many services and department, so you see it is not the same situation with someone who has a small center using same system. So, it blocks and there are things in the systems that gave to be modified to suit and adapt to our system out and our workload. That is one of the problems we had at the start and was not really easy cause there were a lot of things not included in the system and it had to be us to tell them what to add and what to subtract because f doesn’t add it instead distract us. If it’s not helpful, then it’s not effective. So, when a system is integrated is to improve what used to be. But if we see that it is not progressing it means it’s not effective.

B: Do you think there are ways to ameliorate these barriers or problems you encounter using HIS (IPLAN). And how do you think employees can contribute to this amelioration. 

Participant: Rereads question more fluently. Do you think there are ways to ameliorate these barriers or problems you encounter using HIS (IPLAN)? And how do you think employees can contribute to this amelioration. So, you mean with the problems encountered how can it be ameliorated. Ok so firstly; the employees themselves don’t forget that when something new is introduced you have people that are resistant to change. Don’t even pay much attention to the logisticians but the users. The people that will say “it will give us too much work” because they don’t yet understand how it works, you’ll have those that are maybe not used to and will say “it’s just surplus work they are giving us” so this means that on the employee’s level, they should be receptive and have a positive mind and say “this is something new ill accept it and learn” because this is where it first starts. You can explain something to someone and if in their heads they don’t wat to learn it will not progress and we will still think there is a problem whereas it is just them not wanting to correct little things they themselves can. So, its first of all starts with the employees and when the employees have released their prejudgment and that the zeal to learn it means information can be gathered and used but must also be capable to make suggestion so ameliorations can be made. I can have no zeal to learn but u make want to. This also mean that I should be capable to tell you there is this and that problem so you can be able to ameliorate because if I don’t voice it out and leave it unattended to then it means sill call you every day to ask u what this your system is doing, and we have the impression that it’s not working. I can have the will to tell you that for example here can you do this or that I’ll take my case for example, the report design, I am the one that gave the report design model for the laboratory whereas there were already models, but I made suggestions to ameliorate the model they have. Their model can be okay for other centers because there can be test that they don’t do there, but we do them. So, it says one: they users should have the will to learn and accept, two they should have the capacity to collaborate with those implementing the System. We can want to work but don’t want to collaborate. There are people like that…. (laughs together with B).

B: Does the clinic have the required capacity for example cost, leadership, infrastructure, HR and so on. Do they have the required capacity to carry out these amendments such as the internet problems, worn out computers how do they see it?

Participant: To be sincere yes; the clinic has this capacity. Those that bring the logisticians tell us that we need to change our computer capacity and machines and yes, the clinic has the capacity to do it and when we are being told this it means the problem can be in our level. So, we have to correct it. Sometimes the clinic tells us Non “we are sorry for the materials we provide we will change them for much better ones because we can see the capacity of work that has to be done”. So, I can say it in both sides, but the clinic has the means. But why does the clinic ask “what more do need to work better, tell us” if we say it’s the machines, they will do everything to change them because they have the means to cause no matter what we the ones still benefitting from it. When the work is well done it’s our image that is positively seen it not the company implementing the system.

B: And from your [personal experience, does the usage of HIS play any role in the general performance of the clinic? Does it impact the overall performance of the clinic? 

Participant: As I was saying earlier, the usage of HIS today has impacted the organization so much because when we speak of organization it means through this system, everyone knows what they have to do as it is a system where everyone has to feel concerned. Still through this system, it really subdivided and really permit everyone to understand their job for example I’ll take the case of the nurses. The nurses there are some in charge to give medication to patients, there are others to offer treatments and all that but in the role of everyone, they all understand the space left only for the doctors to fill whereas before there were medical files, the nurse will sit and instead of writing just she’s meant to write she will write everything including the doctors’ part. (B laughs) ... but with this system, everyone knows where their role ends and where the others come i. so when it concerns the role, it automatically adjusts and fix it. There are some paper files where the doctor can make mistakes and write with the hand and when there is a problem the doctor can deny writing it but with HIS there is a zone liable to doctors so everyone take responsibility of their actions without denial or lying cause before writing anything in the system you sign in with your name. 

B: Okay thanks so much for granting this interview. Since I started you have been the must open and I have better understanding about everything and this is why I want to add a last question I didn’t not include in my questions here. Apart from the HIS I was told of a chatroom for you employees a little bit similar to WhatsApp but easier for your internal communication.

Participant: ohhh yeah, the LAN I don’t really use that LAN. It’s like intranet but I don’t communicate a lot with people I have no time (laughs) I’m very busy and no time. 

B: I understand (laugh) because since I came, I’ve been seeing you up and down and today I said I have to get your time and really do not regret it. Thanks a lot for your time I really do appreciate. I know I took a little bit more of time but thanks for being open and for answering to all my questions.

Participant: your welcome I’m glad I could help and contribute

ENNNDDD.