On Quality and Communication: The Relevance of Critical Theory to Health Informatics

Abstract

Special IssueHealth information systems require long-term investment before they provide a socio-economic return, yet their implementation remains problematic, possibly because the claims made about them appear not to sit well with healthcare professionals' practice. Health informatics should address these issues from a sound conceptual base, such as might be provided by critical theory, which seeks to identify hidden assumptions and ideologies. This discipline can provide a better understanding of the inner workings of socio-technical systems, with a view to improving them through the promotion of emancipation (allowing people to fulfill their potential). Critical theory can also shed light on the problems with health information systems and offer insight into remedies, for example, by relating Habermas' theories about communication to feedback, a concept central to quality assurance (QA). Such analysis finds that QA's principal practices can be interpreted as emancipatory but requires organizations to substantially change their behavior. An alternate approach is to install health information systems designed to support QA. Applying critical theory to these systems shows that they could become an active part of service delivery rather than static repositories of data, because they may encourage standardized conversations between all stakeholders about the important features of health care. Success will depend on access for all participants to data entry and analysis tools, integration with work practice, and use by staff and management in QA. These ideas offer new directions for research into and the development of health information systems. The next step will be to implement them and observe their technical and emancipatory properties.

Symbolic Action Research in Information Systems: Introduction to the Special Issue

“…decision making (Shaw and Stahl 2011;Vieira da Cunha 2013), and the behavior of firms (Vannoy and Salam 2010). Six of these articles brought a symbolic action motivated research approach to other types of information system theory, such as, Gasson's (2006) qualitative-interpretive investigation of boundary spanning during information systems design that engaged with Checkland's theory of systems design (Checkland 1994;Checkland and Holwell 1998).…”

Emancipation Research in Information Systems: Integrating Agency, Dialogue, Inclusion, and Rationality Research

“…As technologies become more autonomous, practitioners and scholars warn of increasing threats to users' autonomy and agency. A dominant theme in this stream of emancipation research relates to when and how IS design affects users' abilities to exert agency and accomplish their goals [25,27,28,55,85]. Another theme relates to IS use for domination of workers through surveillance-enforced punishment systems and other forms of computer-mediated control [45,67,70,76].…”

“…[24] Progressive emancipation, recovery of integrative values, reformation of social order and the claiming of space for lost voices are possible outcomes of the four scientific discourses. [25] Emancipation entails "allowing people to fulfill their potential" (p. 255). [26] Open communication "is the first step toward emancipation" (p. 172).…”

In search of development in a national ICT policy

“…Rationalisation is an integral part of communicative action and can only be realised once systematically distorted communication, which comes from the use of coercion and force, has been overcome [9]. To promote a free and equal communication, Habermas called for communication to be done in what he called an ideal speech situation -which is a set of conditions that allows communication to be structured in such a way that it gives acceptable outcomes [40]. Habermas stated that anyone who engages in a discourse without accepting the principles of an ideal speech situation is behaving either deceptively or hypocritically.…”