Identifying micro-level generative mechanisms of ICT-enabled performance improvement in resource-constrained healthcare organisations: a critical realist perspective

Healthcare studies in the information and communication technology for development (ICT4D) domain have attempted to understand how technology can be used to support healthcare organisations in developing countries; organisations whose performance is negatively impacted by resource constraints. Current studies, predominantly informed by positivist and interpretivist paradigms - produce analyses and prescriptions designed without an in-depth understanding of the underlying mechanisms influencing performance. The result is limited ability to explain how organisational performance is enabled by ICT. Critical realism as a philosophy of science provides a deeper ontological and broader epistemological approach that makes it possible to theorise the micro-level mechanisms that hold potential for explaining observed outcomes. The study reported here, informed by the critical realism paradigm, uses interviews, observation and organisational data collected from a single case study to identify the resource optimisation micro-level generative mechanisms that have improved emergency medical services. The study integrates the technological affordances lens to explain ICT-enabled organisational performance. Additionally, the paper proposes and tests an understanding of the Bygstad, Munkvold, and Volkoff stepwise framework as a methodology for doing critical realist research using affordances.