A framework for the design, development and implementation of technology platforms in the South African health context

Herman, Hilde (2019-04)

Thesis (MEng)--Stellenbosch University, 2019.

Thesis

ENGLISH ABSTRACT: Healthcare in South Africa is in dire need of effective and sustainable solutions. Low life expectancy, high maternal and neonatal mortality, the impact of HIV and increasing non-communicable diseases are compounded by the limited availability of skilled healthcare professionals. Initiatives such as the Sustainable Development Goals aim to address these issues by working towards good health and wellbeing particularly in developing countries. Technology platforms can provide much-needed solutions to these above-mentioned issues. Ways in which such platforms can provide solutions include the ability to communicate information, remotely monitor patients, collect and analyse data and enable personalised medicine. Therefore, technology platforms could potentially be a valuable asset in the mission to improve healthcare in developing countries such as South Africa. However, the healthcare sector has been resistant to platform adoption due to characteristics such as sensitive data and high cost of failure. Research has confirmed the differences in platform implementation across countries, but a focus on implementation in the context of developing countries such as South Africa is limited. A framework for the design, development and implementation of technology platforms in the South African health context could therefore contribute to the gap in research as well as provide a practical tool that platform owners could use to potentially increase the adoption of platforms in this context. This study aimed to develop a framework that can be used in the design, development and implementation of technology platforms in the South African health context. In order develop the framework, the researcher developed eight research objectives that were grouped into two main phases. The first phase included the framework development, while the second comprised the framework evaluation, specifically within the South African health context. Subsequently, a suitable research design was developed and implemented that enabled the researcher to meet the project objectives. The research design for this study was based on the Grounded Theory Conceptual Framework Analysis process developed by Jabareen (2009). The process focused on mapping and investigating data sources, categorising and integrating concepts, synthesising these concepts into a framework and iteratively evaluating the framework. The research design comprised four overarching parts that aligned with the Conceptual Framework Analysis process. The first part of the research design aimed to establish the context and aims of the study. Thereafter the focus shifted to formulating the preliminary framework and its subsequent progressive evaluation process. The concluding part of the study presented and discussed the final framework and management tool. The first step in the research included a systematic literature review to develop an overall picture of the relevant research and identify possible gaps. This included identifying the key concepts related to technology platforms in innovation ecosystems as well as the multidisciplinary nature of this research. As a part of the systematic literature review results, the void of related research in Africa, challenges for platform owners, the three different platform ecosystem actors as well as several guiding principles were uncovered. Subsequently, a conceptual literature review was done to further investigate key concepts and ideas. This included an understanding of the ecosystem metaphor and thirteen fundamental characteristics of platforms and ecosystems. The context in which such a platform ecosystem would operate was investigated in terms of the ecosystem actors and the South African health context. The literature review also included the investigation and analysis of existing frameworks, models and tools (FMTs) related to platform design and platform and ecosystem management. The FMTs provided much-needed insight into the structure, use and layout of the proposed framework and highlighted gaps in these existing FMTs currently available to platform owners. The preliminary framework, constructed as a result of the systematic and conceptual literature reviews, had to be evaluated. The evaluation process comprised three components, namely a theoretical case study, semi-structured interviews and an industry-based case study. Subsequent to each of these components, the framework was modified and adapted. The components of the evaluation process also accounted for significant insights into the South African health context. As a result of the evaluation process, the final framework was developed. The final framework can be used by platform owners as a management tool. This tool comprises six canvasses: (1) Pre-use Canvas, (2) Overview Canvas, (3) Platform Owner Canvas, (4) Developer Canvas, (5) End-user Canvas and (6) Platform Development Canvas. These canvasses are divided into two dimensions, namely an ecosystem dimension and a platform development dimension. The ecosystem dimension includes a canvas for each of the three platform ecosystem actors. These ecosystem canvasses provide insights and questions regarding each of the ecosystem actors. The Platform Development Canvas aims to lead the platform owner into action and guides the platform development process. This Canvas comprises five parts, namely the platform core, the desired ecosystem and environment, the design of the platform and governance, the managing and operation and evolution of the platform and ecosystem. The framework and tool make a contribution to research. The framework was designed to be a practical tool with a user-centric focus. The framework therefore provides a platform owner with insight into the ecosystem actors and practical elements to design and manage the platform and ecosystem. The framework was also developed taking into account typical challenges that a platform owner would face. Another unique contribution is that the framework draws from two platform perspectives, namely the engineering and the economic perspectives. These perspectives are mostly viewed in isolation despite the fact that when combined, they provide a more holistic understanding of platforms. The final contribution is the tailoring of the framework for the South African health context. Particularly the End-user Ecosystem Canvas transformed significantly throughout the evaluation phases to suit the South African health context. The final framework and tool therefore met the project objectives. The framework should however continuously evolve to remain relevant and usable to platform owners and to sustain its use as a tool to facilitate the adoption of technology platforms in the South African health context.

AFRIKAANSE OPSOMMING: Gesondheidsorg in Suid-Afrika het 'n geweldige behoefte aan effektiewe en volhoubare oplossings. Lae lewensverwagting, hoë moeder- en neonatale sterftes, die impak van MIV en toenemende nieoordraagbare siektes word vererger deur die beperkte beskikbaarheid van geskoolde gesondheidswerkers. Inisiatiewe soos die ‘Sustainable Development Goals’ is daarop gemik om hierdie kwessies aan te spreek deur te werk aan goeie gesondheid en welsyn, veral in ontwikkelende lande. Tegnologieplatforms kan die nodige oplossings bied vir die bogenoemde kwessies. Maniere waarop sulke platforms oplossings kan bied, sluit in die vermoë om inligting te kommunikeer, pasiënte op afstand te monitor, data te versamel en te analiseer en persoonlike medisyne in staat te stel. Daarom kan tegnologieplatforms potensieel 'n waardevolle bate wees in die missie om gesondheidsorg in ontwikkelende lande soos Suid-Afrika te verbeter. Die gesondheidsorgsektor het egter weerstand teen platformaanneming, weens eienskappe soos sensitiewe data en die hoë koste van mislukking. Navorsing het die verskille in platform implementering regoor lande bevestig, maar 'n fokus op implementering in die konteks van ontwikkelende lande soos Suid-Afrika is beperk. 'n Raamwerk vir die ontwerp, ontwikkeling en implementering van tegnologieplatforms in die Suid-Afrikaanse gesondheidskonteks kan dus bydra tot die gaping in navorsing, asook 'n praktiese hulpmiddel bied wat platform eienaars kan gebruik om potensiële platforms in die konteks te verhoog. Hierdie studie het gemik om ‘n raamwerk te ontwikkel wat gebruik kan word in die ontwerp, ontwikkeling en implementering van tegnologie-platforms in die Suid-Afrikaanse gesondheidskonteks. Om hierdie raamwerk te ontwikkel, het die navorser agt navorsingsdoelwitte ontwikkel wat in twee hooffases gegroepeer is. Die eerste fase het die raamwerkontwikkeling ingesluit, en die tweede deel het die raamwerkevaluering ingesluit, spesifiek binne die Suid-Afrikaanse gesondheidskonteks. Vervolgens is 'n geskikte navorsingsontwerp ontwikkel en geïmplementeer wat die navorser in staat gestel het om die projekdoelwitte te bereik en die navorsingsvraag te beantwoord. Die navorsingsontwerp vir hierdie studie is baser op die Jabareen-ontwikkelingsproses (2009) wat gegrond is op die ‘Grounded Theory’ benadering. Die proses het gefokus op die soek en ondersoek van databronne, die kategorisering en integrasie van konsepte, die konsepte in 'n raamwerk te sintetiseer en die raamwerk iteratief te evalueer. Die navorsingsontwerp bestaan uit vier dele wat in lyn was met die konseptuele raamwerk ontwikkelings-proses. Die eerste deel van die navorsingsontwerp het ten doel om die konteks en doelstellings van die studie vas te stel. Daarna het die fokus verskuif na die formulering van die voorlopige raamwerk en die daaropvolgende progressiewe evalueringsproses. Die laaste gedeelte van die studie het die finale raamwerk en bestuursinstrument ingesluit en bespreek. Die eerste stap in die navorsing sluit 'n sistematiese literatuuroorsig in om 'n algehele prentjie van die relevante navorsing te ontwikkel en moontlike leemtes te identifiseer. Dit sluit in die identifisering van die sleutelkonsepte wat verband hou met tegnologie-platforms in innovasie-ekosisteme asook die multidissiplinêre aard van hierdie navorsing. As deel van die sistematiese literatuuroorsigresultate is die leemte van verwante navorsing in Afrika, uitdagings vir platform-eienaars, die drie verskillende platform-ekosisteem-akteurs en verskeie riglyne uitgelig. Daarna is 'n konseptuele literatuuroorsig gedoen om sleutelbegrippe en idees verder te ondersoek. Dit sluit in 'n begrip van die ekostelselmetafoor en dertien fundamentele eienskappe van platforms en ekosisteme. Die konteks waarin so 'n platform-ekosisteem sou funksioneer, is ondersoek in terme van die ekosisteem-akteurs en die Suid-Afrikaanse gesondheidskonteks. Nog 'n element in die literatuuroorsig was die ondersoek en analise van bestaande raamwerke, modelle en hulpmiddels (FMT's) wat verband hou met platformontwerp en platform- en ekosisteembestuur. Die FMT's het nodige insig gegee aan die struktuur, gebruik en uitleg van die voorgestelde raamwerk en gapings in die bestaande FMT's wat tans aan platform-eienaars beskikbaar is, uitgelig. Die voorlopige raamwerk, gebou as gevolg van die sistematiese en konseptuele literatuuroorsigte, moes geëvalueer word. Die evalueringsproses bestaan uit drie komponente, naamlik 'n teoretiese gevallestudie, semi-gestruktureerde onderhoude en 'n industrie-gebaseerde gevallestudie. Na aanleiding van elk van hierdie komponente is die raamwerk aangepas. Die komponente van die evalueringsproses het ook beduidende insigte in die Suid-Afrikaanse gesondheidskonteks verskaf. As gevolg van die evalueringsproses is die finale raamwerk ontwikkel. Die finale raamwerk kan potensieel deur platform-eienaars gebruik word as 'n bestuursinstrument. Hierdie instrument bestaan uit ses ‘canvasses’: (1) Pre-use Canvas, (2) Overview Canvas, (3) Platform Owner Canvas, (4) Developer Canvas, (5) End-user Canvas and (6) Platform Development Canvas. Die instrument het twee dimensies, naamlik 'n ekosisteemdimensie en 'n platformontwikkelingsdimensie. Die ekosisteemdimensie sluit 'n ‘Canvas’ in vir elk van die drie platform-ekosisteem-akteurs. Die ekosisteem-‘canvasses’ bied insigte en vrae in elk van die akteurs onderskeidelik, gebaseer op hul eienskappe en rolle in die ekosisteem. Die Platformontwikkelings ‘Canvas’ is daarop gemik om die eienaar van die platform in aksie te lei en begelei die platformontwikkelingsproses. Hierdie ‘canvas’ bestaan uit vyf dele, naamlik die vestiging van die platformkern, die verlangde ekosisteem en omgewing, die ontwerp van die platform en bestuursbenadering, die bestuur en werking van die platform en evolusie van die platform en ekosisteem. Die raamwerk en instrument maak 'n bydrae tot navorsing. Die raamwerk is ontwerp om 'n praktiese instrument met 'n gebruikersgesentreerde fokus te wees. Die raamwerk verskaf dus 'n platform eienaar met insigte oor die akteurs binne die ekosisteem en praktiese elemente om die platform en ekosisteem te ontwerp en te bestuur. Die raamwerk is ook ontwikkel met inagneming van tipiese uitdagings wat 'n platform-eienaar sou ondervind. Nog 'n unieke bydrae is dat die raamwerk uit twee platformperspektiewe, naamlik die ingenieurs- en die ekonomiese perspektiewe, saamgestel is. Hierdie perspektiewe word meestal in isolasie gesien, ondanks die feit dat hulle gekombineerd 'n meer holistiese begrip van platforms bied. Die finale bydrae is die aanpassing van die raamwerk vir die Suid- Afrikaanse gesondheidskonteks. Veral die Eindgebruiker-ekosisteem ‘Canvas’ het aansienlik deur die evalueringsfases getransformeer om by die Suid-Afrikaanse gesondheidskonteks te pas. Die finale raamwerk en hulpmiddel het dus die projekdoelwitte bereik. Die raamwerk moet egter voortdurend aangepas word om relevant en bruikbaar vir platform-eienaars te bly en om die gebruik daarvan as 'n instrument om die aanneming van tegnologie-platforms in die Suid-Afrikaanse gesondheidskonteks te bevorder.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105916
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