Improvisation during implementation of health information systems

Extant research on the implementation of health information systems (HIS) provides guidance on how to implement future HIS and little guidance on how to steer a current HIS implementation towards specified outcomes. We contribute to this gap by providing theoretical clarity on stakeholder responses to change brought about by HIS implementation, and how such responses may impact HIS implementation outcomes. Building on Heeks' view [27] that stakeholders engage in improvisation to bridge design-reality gaps during HIS implementation, we elaborate on improvisation, and distinguish it from adaptation. We then establish the link between improvisation and HIS implementation outcomes by adopting Vera's revised model [44] to propose that improvisation will have a positive impact on HIS implementation outcomes when stakeholders have higher levels of expertise and teamwork skills, and where the healthcare institution adopts an experimental culture characterized by higher levels of real-time information & communication. There is however a need to balance the effects of organizational memory. A key limitation in our present contribution is its theoretical nature.