Capturing implementation knowledge: applying focused ethnography to study how implementers generate and manage...

Area of Science:

• Public Health Informatics
• Implementation Science
• Health Services Research

Background:

• Electronic information management systems (EIMS) are vital for large-scale population health program delivery, tracking progress and coordinating activities.
• Many EIMS face abandonment or integration failures, hindering program success.
• This study examines a successful, long-standing EIMS supporting childhood obesity prevention programs for over five years.

Purpose of the Study:

• To investigate the factors contributing to the sustained use and success of an electronic information management system in public health program implementation.
• To understand how EIMS interact with local practices and relationships in achieving program targets.
• To identify key functions of information management systems in supporting evidence-based program delivery at scale.

Main Methods:

• Co-designed partnership research involving policymakers, practitioners, and IT designers.
• A 12-month multisite ethnography of 14 implementation teams using the Population Health Information Management System (PHIMS).
• Analysis of how teams utilized PHIMS and complementary informal tools and technologies.

Main Results:

• All teams used PHIMS, supplemented by informal tools for relationship management, progress monitoring, troubleshooting, teamwork, evaluation, and recording extra work.
• Informal tools facilitated the creation of locally derived implementation knowledge, bridging knowledge generation and PHIMS entry.
• Practitioners leveraged informal tools to manage local contexts and relationships, enhancing implementation efforts.

Conclusions:

• Successful large-scale implementation requires both standardized systems like PHIMS and adaptive informal tools to capture and utilize local implementation knowledge.
• Understanding and harnessing practitioners' tacit knowledge is crucial for effective program scaling.
• Flexible systems that incorporate informal knowledge management are essential for sustained program delivery and achieving targets.