Doctoral Degrees (Industrial Engineering)

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Browsing Doctoral Degrees (Industrial Engineering) by browse.metadata.advisor "Bam, Wouter. G."

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    Evaluating the successful and sustainable implementation of evidence-based innovations in health systems in low- and middle-income countries: a maturity model approach
    (Stellenbosch : Stellenbosch University, 2023-03) Leonard, Elizabeth; de Kock, Imke. H.; Bam, Wouter. G.; Stellenbosch University. Faculty of Engineering. Dept. of Industrial Engineering.
    ENGLISH ABSTRACT: The unsuccessful and unsustainable implementation of evidence-based health innovations frequently occurs, leading to missed opportunities that could have improved various aspects of a health system. Understanding the facilitators and barriers to the implementation of innovations is especially important in the low- and middle-income country (LMIC) context, where unsuccessful implementation practices impede the progress and improvement of health systems. While high-income countries and LMICs experience many of the same implementation facilitators and barriers, LMICs must deal with additional health system complexities that impact implementation. Improving the success and sustainability of innovation implementation has become one of the most apparent promoters of LMIC health system improvements. However, existing approaches aimed at facilitating the innovation implementation process either do not consider a holistic health innovation landscape and thus overlook key concepts; or have not specifically been developed for the LMIC context and thus do not adequately capture the contextual specificities of LMICs. To address this gap, a novel solution is developed in this study – the LMIC Health Innovation Implementation Maturity Model (HII-MM). The research strategy followed in this study is based on the design science strategy. Design science can be divided into three overarching phases: Exploratory, Formative and Evaluative Phases. During the Exploratory Phase, the specific problem and resulting objectives are investigated through three sets of literature reviews: conceptual, systematic, and comparative literature reviews. During the Formative Phase, the solution to the identified problem is developed, namely the HII-MM. Lastly, during the Evaluative Phase, the developed solution is iteratively refined through theoretical and structural verification strategies, and the HII-MM's efficacy in solving the identified problem is validated. The HII-MM is a maturity assessment tool that facilitates the assessment of LMIC health innovation landscapes. It defines the system's current implementation maturity, identifies gaps hindering an innovation's successful and sustainable implementation, and provides potential maturation paths that can inform improvement initiatives. The HII-MM is made up of three dimensions: (i) implementation domains, which describe the concepts that act as either facilitators or barriers when implementing an evidence-based innovation within an LMIC health system, (ii) health system levels, which portray the health system that is being assessed, and (iii) maturity levels, which are statements that enable the understanding of the system's capability to implement an innovation. To verify the HII-MM subject matter expert (SME) interviews and a case study on a mHealth audiology device was leveraged. Then, to validate the HII-MM, additional SME interviews were conducted with expert representation from 25 unique LMICs and two case studies were carried out. The first case study is on the maternal health innovation MomConnect and the second is on the contact tracing innovation COVID Alert. These validated the transferability, flexibility, usefulness, and usability of the HII-MM. This study contributes to the growing literature that aims to inform health system stakeholders in LMICs on successfully and sustainably implementing evidence-based health innovations. The study promotes greater access to evidence-based health innovations to encourage health equity and improve the performance of LMIC health systems.