Legitimacy Maintenance for Data Quality Management Practices: A Case of Health Management Information Systems

Abstract

This study answers the broad question of how institutional changes in Health Management Information Systems (HMIS) affect the legitimacy of institutionalized data quality management practices. We premise the study on the general assumption that institutional changes erode legitimacy objects' legitimacy. We used Scott's conceptualization of legitimacy as having three states: normal state, unstable state, and renormalized state, to understand how institutional changes affect the legitimacy of the institutionalized data quality management practices (DQMP) in HMIS. Our theoretical framework from the literature is based on (i) two pillars of institutional theory: institutionalization and legitimation, and (ii) two constructs from Lewin's Field Force Analysis model: the driving and resisting forces. The study adopted interpretive case study methods using the case of Malawi's HMIS. We designed participants' observations, semi-structured interviews, and reviewed strategic documents to collect data. It engaged 51 participants from the three levels of HMIS in Malawi. Data were analyzed using thematic content analysis. Our key findings are that technology and operational structure changes erode the legitimacy of DQMP in HMIS. The study posits two contributions to information system research and practice: Extending the Legitimation Activity Model to enhance the maintenance concept befitting the HMIS and developing a legitimacy maintenance framework for HMIS, respectively.