Contributions to the design of digital technologies supportive of resilient performance in health services

Abstract

Digital technologies (DT) help complex sociotechnical systems cope with disruptive events small and large and, consequently, might boost the resilience of healthcare supply chains (HSC). However, previous studies on HSC did not take a holistic perspective of resilience considering both its proactive and reactive dimensions. The design of DT supportive of RP depends on the accurate identification of requirements. However, the requirements elicitation process is often ineffective, partly because it is based on oversimplified assumptions of stability in healthcare systems and the consequent neglect of the need for RP. This drawback results in a mismatch between the technology’s functionalities and the user's requirements, affecting efficiency and patient safety. Thus, little is known on how to deliberately design resilient and digital HSC. This thesis explores these gaps in the context of HSC with emphasis in blood supply chains (BSC). Data collected from eight healthcare organizations based on semistructured interviews were articulated in a framework that describes what and how technology adoption improves HSC resilience. These findings, which allowed an exploratory understanding of the research topic, were followed by the development of a prescriptive framework for designing resilient and digital hospital internal logistics (RDHealth). The framework was developed, tested, and evaluated through Design Science Research (DSR) in a blood transfusion process of a large tertiary public hospital in Brazil. The framework is anchored on the principles of Designing for Resilient Performance (DfRP) developed in prior studies. Data collection for this test included participant and non-participant observations, interviews, and documentary analysis. Results shed light on the framework’s utility and ease of use, also giving rise to propositions that were reframed as six generic requirements of DTs supportive of RC in HSC. These requirements were used as a starting point for data analysis of a systematic literature review of 34 articles on DTs in BSC. Results pointed out 14 DTs employed in the BSC and six new resilience requirements specific for BSC. The adopted analytical procedure was articulated in a framework that describes a workflow for identifying specific requirements of DTs supportive of RP in particular health contexts. The framework can be replicable to identify requirements specific to health services other than BSC.