Abstract
The adoption of packaged software solutions like Electronic Health Record- and Health Management Information Systems are argued to bring benefits to the provision of healthcare through increased efficiency, effectiveness, and safety. Despite the promises of software solutions, research document health software that is difficult to use and bring limited value to the end-users. The socio-technical tradition and the information systems field have shown how a symbiotic interplay between the technology and their human counterparts is essential in the pursuit of the intended outcomes of digitization. In healthcare, the implemented systems must be perceived as usable and provide value to the end-users. This trait combination can be summarised as usability and is highly desirable in software. Academic literature and publications from practitioner communities alike outline a wealth of methods and methodologies that aid in the design and development of usable software - I collectively refer to these approaches to design as usability design. Despite the consistent promotion of these approaches, we still too little about how to design for usability and the related challenges faced during HIS implementation. In this thesis, I report from a health implementation project where I collaborated with a team of local practitioners. We tried to straighten the usability of health software following principles of usability design. During the process, we learned that taking these principles to practice was a difficult task. Based on this experience, I become motivated to understand the obstacles we encountered. I subsequently ask; What are key obstacles constraining usability design when implementing health management software in the public health sector in India? Based on my experiences, this case study proposes a conceptual framework for usability design obstacles. I divide the obstacles to usability design into three categories. The two first categories, acquiring knowledge and realizing insight, are discussed in existing literature. However, my empirical experiences and discussions with the practitioners bring insight to a new set of obstacles. I argue that the lack of perceived value, excessive managerial orientation, and our sub-par project handling in combination with unforeseen challenges produced an infertile environment - making facilitating the process a third category and a fundamental obstacle to usability design. By leveraging the insight from the framework and our empirical experiences, I propose five practical recommendations to help future implementation projects achieve a more viable environment for usability design. The conceptual framework and the practical recommendations can prove useful by preparing scholars and practitioners aiming to create more locally relevant, meaningful, and successful implementations of health software for the future.