Strategy and practices A qualitative study of a Brazilian public healthcare system of telemedicine

摘要

Purpose - In analyzing the field of strategic management in public organizations, scholars have noted a lack of studies that investigate how public organizations actually apply strategic management tools (Hansen, 2011) as well as studies that investigate how strategic knowledge is developed and used in practice in public organizations (Bryson et al, 2010). Voicing similar concerns, the 2013 World Health Report pointed out the challenges facing many governments in providing universal health coverage and the importance of conducting new studies that focus on practical approaches using the existing knowledge rather than only investing in research related to new technologies. The purpose of this paper is to analyze how Telemedicine System of Santa Catarina (TSSC)'s strategy has resulted in significant improvements as seen through the lens of structuration theory (ST). Design/methodology/approach - The authors support the analysis using the strategy as practice (SAP) framework of practice, praxis and practitioners and the ST of Giddens (1984), using Orlikowski's (2000) technology in practice framework. The authors have applied a qualitative methodology using a single case study which analyzes a healthcare system that has resulted from a successful cooperation agreement between two public organizations in Brazil. This research is based on the analysis and identification of the structural aspects (interpretative schemes, facilities, norms and stock of knowledge) that are enacted by the practitioners through their practices and praxis. Findings - The authors have identified five strategic practitioners that perform six strategic practices and praxis, and have analyzed the structures they enact during their praxis. The authors have also identified the interpretative schemes, norms and facilities that motivate these social practices and how they influence the results of the TSSC. Research limitations/implications - As limitations of this study, the authors highlight the focus given to the service provider practitioners, leaving aside the political practitioners and patients. The researcher perception and possible biases must be considered also as a limitation, despite of the efforts to minimize them with the rigor of the methodology and the use of mixed data collection techniques to enable data triangulation. Practical implications - This research contributes to a better understanding of the benefits that the practice perspective offers and provides insights into the possible management cooperation between institutions. It also provides substantial evidence of the relationship between SAP and ST as it contributes to the reinforcement of empirical studies using ST. In addition to academic advances, this study contributes to the field by highlighting how the relationship between practices, praxis, practitioners and the existing structures has positively influenced the results of a public healthcare system and by presenting a successful initiative that has helped to improve the public healthcare system. Originality/value - The authors believe that this paper will contribute to the field by highlighting how the relationship between practices, praxis, practitioners and existing structures has positively influenced the results of a public healthcare system and the roles played by the human agents involved.