Design-Reality Gap Analysis of Health Information Systems Failure

Abstract: This study investigates the factors contributing to the failure of Health Information Systems (HIS) in a public hospital in South Africa. While HIS have the potential to improve healthcare delivery by integrating services and enhancing effectiveness, failures can lead to service interruptions, revenue loss, data loss, administrative difficulties, and reputational damage. Using semi-structured interviews with key stakeholders, we employed a hybrid data analysis approach combining deductive analysis based on the Design- Reality Gap Model and inductive thematic analysis. Our findings highlight several factors contributing to HIS failures, including system capacity constraints, inadequate IT risk management, and critical skills gaps. Despite these challenges, end users perceive HIS positively and recommend its implementation for streamlining daily processes. This study underscores the importance of addressing design-reality gaps to improve HIS outcomes in public healthcare settings.