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

Abstract

Health 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.

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