Interventions for information systems introduction in the NHS.
ABSTRACT This article provides a historical review of five long-term interventions which were undertaken within the NHS. The objective of the exercise was to examine how information systems (IS) were introduced into operational environments. The length of the interventions ranged from 9 months to almost 3 years. The five sites were all at different stages of system development and the research was carried out using a combination of participant observation and action research. The research question asks, 'How can organizations think about and hence go about their information provision in such a way that successful IS are introduced?'
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ABSTRACT: Purpose – The purpose of this paper is to examine the key practical factors that confront global businesses as they attempt to improve all aspects of their operations including emerging areas of the customer experience. The paper focuses on the way various organisational capabilities such as information systems/information technology have been adopted in order to provide an enhanced operational and strategic control over key areas of business. Design/methodology/approach – The paper adopts a case-based participation observation study which explores the global operations of a major restaurant brand. This approach enables it to explore several concepts which examine the behaviour of global operations at a time of major change. Findings – The paper has focused on the application of change principles in the restaurant and hospitality industry and its importance for business performance and marketing strategy. The paper shows how adapting business strategy to incorporate key cultural sensitivities can pay major dividends for organisations. This strategy appears to be contrary to the general approach of standardisation adopted by other franchises in this key market sector. Research limitations/implications – It will be necessary to increase the range of this research to ensure any real certainty regarding its implications. Originality/value – The paper identifies a number of interesting changes to preconceived ideas of standardising product portfolios in the restaurant sector. It shows the need for a balanced “mix” of menu products to satisfy local and national requirements.Business Process Management Journal 09/2009; 15(5):816-839.
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ABSTRACT: Purpose – Drawing on extant technology acceptance literature, the purpose of this paper is to critically examine the impact of mandatory enterprise technology adoption in Nigeria. Design/methodology/approach – Data were gathered from a survey of stockbrokers operating on the floor of the Nigerian Stock Exchange on two occasions over a four year period. Expert forecasting (TSModel) algorithms were employed to assess attitudinal changes of users on mandatory system adoption. Findings – The results suggest that over time, users (stockbrokers) developed an increasingly negative perception of the technology, thus emphasising the need for managers to focus on subjective imperatives that might impact the adoption of mandated technology. Practical implications – Africa remains neglected in relation to information systems/information technology (IS/IT) research. This has driven the authors’ interest in seeking to understand how contextual peculiarities specific to Africa could play a significant role in an understanding of well-established IS/IT models. Originality/value – To facilitate deeper explorations of the antecedents of user adoption of mandatory enterprise technology, the authors choose to lay the theoretical foundations of this study in social theories (specifically, voluntariness and subjective norm).Journal of Enterprise Information Management 07/2012; 25(4):373-391.
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ABSTRACT: Purpose – This paper aims to examine how project managers frame variability for categorised risk factors on enterprise resource planning (ERP) projects. Design/methodology/approach – Weighting and selection of the risk factors was undertaken based on an analysis of data (using PASW17), obtained from a random sample of 307 ERP project managers working in Thailand. Findings – The findings suggest that: framing of variability for categorised risk factors in ERP projects is not necessarily culturally bound; both “internal” and “external” risk factors did have a strong impact on ERP project success; and the impact of the degree of inter-relationships between critical risk and success factors may influence the success of a ERP project. Practical implications – The authors anticipate that the results will stimulate future research in this area as well as raise the profile of critical success factors for ERP implementation, particularly in developing countries. Originality/value – The study contributes to a better understanding of the viewpoint of consultants on critical success factors for ERP implementation in the context of a developing country.Industrial Management & Data Systems 04/2012; 112(4):600-618. · 1.67 Impact Factor
Interventions for information systems
introduction in the NHS
Stuart Maguire and Udechukwu Ojiako
This article provides a historical review of five long-term interventions which
were undertaken within the NHS. The objective of the exercise was to examine
how information systems (IS) were introduced into operational environments.
The length of the interventions ranged from 9 months to almost 3 years. The five
sites were all at different stages of system development and the research was
carried out using a combination of participant observation and action research. The
research question asks, ‘How can organizations think about and hence go about
their information provision in such a way that successful IS are introduced?’
informatics, methodologies, systems
This article examines, by intervention exercises carried out over a period of time, the introduction
of information systems (IS) in a large and complex organization. For this particular
work, the National Health Service (NHS), regarded as both a large and a complex organization
[1–3], is used as a case study for the interventions. The article, building on earlier work
by May et al. , aims to contribute towards a better understanding of the IS introduction
process from inception through to system evaluation and review. Five long-term interventions
were undertaken in a range of NHS sites, examining different aspects of IS introduction.
The output of the research is an identified set of factors that should be addressed when
introducing IS within large and complex organizations such as the NHS. The approach has
been reflective and has been directed at understanding the environment which has led to
repeated failures within the NHS’s £12.4 billion National Programme for IT (NPfIT), of which
parts have now been rebranded Connecting for Health. In particular, reports have been
published  which suggest that senior health managers within the NHS have lost faith
with the programme’s ability to advance the NHS IS implementation trajectory.
The research confronts the theory that identifies IS introduction as a predominantly
technical area. As a result, an agenda is put forward which suggests that IS introduction is
far from being a technical speciality; rather, successful introduction is seen to be dependent
on addressing softer issues. It is hoped that the outcome of the research will be a situation
in which effective IS are introduced while taking into account the behavioural, cultural, and
organizational issues that are so important within large and complex organizations.
This research is not specifically seeking to add to an accepted existing body of knowledge
but is rather of a preliminary reflective nature, seeking to reflect on the full complexity of
The IS projects in the NHS have to be desirable and feasible from several different perspectives.
There are multiple stakeholders with vested interests in the outcomes of these
projects. Failure to understand the complexity of this process may lead to future financial
and organizational problems. This article is intended to identify a range of specific areas
that need to be addressed in advance of any future IS project in the NHS .
In order to study IS introduction in large and complex organizations, five long-term
interventions were conducted across a range of NHS sites. Following recommendations by
Atkinson , the interventions were regarded as a means of ensuring that, when a suitable
approach to IS introduction is being developed, individual and social considerations are on
the agenda not merely as sources of information requirements or the needs of end users.
The length of the interventions ranged from 9 months to almost 3 years.
For nearly two decades, the NHS has absorbed a series of major changes. It is within this
strategy for meeting modernization objectives within the NHS that the NPfIT  is being
implemented. Although we are now more than halfway through the 10 year programme
of IS overhaul and upgrade which began with the NHS Plan in July 2000, the research was
initiated at a time of major change within the NHS.
The government intends that the NPfIT change programme will bring modern computer
systems into the NHS to improve patient care and services. Over the next decade, it
is expected to give patients and healthcare professionals access to their personal health
and care information, thus transforming the way the NHS works. To support this change,
effective and rigorous IS introduction structures and processes are being put into place
and developed. This process has been set up by the NHS and outside agencies to drive
and manage ambitious and challenging targets in terms of the purchase of systems and
services. It will also ensure that the resulting products and services will be implemented at a
local level and that the ultimate benefits to patients and the NHS will be delivered through
local ownership and changed working practices.
The NHS is a phenomenally large and complex organization [1, 2]. It has a budget of £96
billion for 2006–07  and employs over a million staff, making it the largest organization
in Europe and the third largest in the world . In terms of complexity, it provides around
2 million consultations and approximately 10 million clinical decisions each day.
The NHS has a complex structure. Responsibility in Scotland, Wales and Northern Ireland
belongs to the devolved administrations, while in England the government through the
Department of Health is politically responsible for NHS operations, which are run by the
Strategic Health Authorities (SHAs).
The NHS is characterized by constantly changing and evolving non-linear relationships,
structures and interfaces which are often difficult to determine. Central to this change
within the NHS is the softening of traditional professional boundaries and the increased
use of improved technology and service redesign, which will underpin its ability to share
high-quality information effectively between teams and organizations to provide safer
Based on this, it is safe to assume that change is not new to the service and a number
of major reorganizations have characterized it since its inception. Moreover, the pace
and intensity of the changes have left NHS managers with little time for consolidation or
To be able to operate in such a fluid and dynamic environment, the NHS requires accurate
information to carry out its functions. It is therefore essential that the NHS sees information
technology and systems (IS&T) as the key to support the provision of this information.
The general trend in such circumstances has always been to manage such complexity by
establishing a strong centralized organization which hopefully could lead to synergies and
opportunities for effective collaboration. It is interesting to note that Chapman , who
sees the NHS and other public service organizations as not just complex systems but essentially
complex adaptive systems interacting in a social system, suggests that the introduction
of learning processes rather than centralized policy initiatives is the key to allowing the NHS
to remain competitive and innovative in healthcare service delivery. It is also important to
note that this view is shared by the British Computer Society (BCS), which has backed calls
for a technical review of the NPfIT, while questioning whether the scheme’s centralized
approach will work in the complex structure of the NHS .
One problem which Chapman  identifies with such systems is an inevitable centralized
policy initiative aimed at trying to solve problems by isolating different parts of the system
rather than seeing the connections between them. A connections view would lead to the
introduction of learning processes rather than detailed targets, with the aim of providing
a minimum specification which allowed innovation and new solutions to emerge. He sees
centralization as characteristic of the way NHS reform has been approached, and points
to spending increases as an unintended consequence.
The value of IS and their introduction
As we enter the twenty-first century, we have witnessed the development of ever more
advanced information and communications technology (ICT). Due to increased commercial
and competitive demands, it is essential that the new technology and systems are introduced
effectively, in a way that enhances how business operates and competes.
IS serve as a core intellectual component of any organization’s resilient infrastructure. They
refer to the collection of resources from which organizations can draw business conclusions.
Their management represents a process of guidance and control through the introduction
and manipulation of scarce resources in order to enable their efficient use.
The effective introduction of IS as a shared and critical corporate resource will support
management making decisions, reducing costs, and meeting business, legal and accountability
requirements which ultimately will lead to the achievement of organizational objectives.
The result is the recognition that information as a resource must be managed just
like other vital organizational resources such as finance, manufacturing and personnel.
It should be noted that this research will concentrate on the introduction rather than the
implementation of IS within a large and complex organization.
IS introduction is about ensuring that new and changed systems are successfully introduced
into an existing technical space or environment using project management principles.
These have been recognized, for example through work done by Norris  and Bowns
et al. , as being a major value adding driver to healthcare information management
and systems. For this to be successful, it is essential that the stability of existing systems
is maintained and that there is minimal impact on the outputs of existing services. The
objective is to ensure that there is no disruption to the customer’s service. It also involves
ensuring that in-life support requirements are adequately addressed to support the new
and changed services.
To achieve this objective, it is the role of IS introduction to ensure that client concerns
about possible interference with service levels or an actual loss of service are addressed
prior to the new or upgraded system going live. The IS concept recognizes the fact that
prevailing conditions within organizations inherently mitigate against establishing an agile
and entrepreneurial IS culture. This culture is expected to deliver consistently high client
satisfaction, best-in-class cost leadership, and secure and resilient systems on demand.
The expectation is that this is fully addressed before, during and after the upgraded or
new systems are introduced. One such factor, identified by Atkinson , is the need to
ensure that introduction methodologies are not based on frozen-in-time user requirements.
Figure 1 shows a basic systems introduction framework.
What has to be noted is the fundamental difference between IS introduction and deployment.
IS deployment is concerned with technical implementation and with ensuring that new or upgraded
systems are able to be integrated within the infrastructure space with minimal problems. On the other
hand, systems and technology introduction primarily focuses on the user’s and customer’s experience
at the point that the new systems or technology are being adopted within the organization.
The research findings will show that there is a need for more explicit recognition of the
inherent organizational characteristics that influence the introduction of new systems.
The research approach
The problems associated with introducing agile, best-in-class, secure and resilient IS into
the NHS has been made more difficult because the NHS has continued to operate in a
rapidly changing environment . This has resulted in a need to identify frameworks that
encompass important issues such as risk so as to ameliorate the success rates of future
implications. From the research approaches perspective, this means that we have to identify
a research methodology that will maximize learning in a dynamic and multifaceted area.
The research was undertaken in a way that conforms to participatory observation/
action research (PAR) which involves practitioners as both subjects and co-researchers,
based on the proposition that causal inferences about the behaviour of human beings are
more likely to be valid and enactable when the human beings in question participate in
the building and testing process . In such a research approach, the researcher becomes
part of the arena being studied, with an explicit concern for developing findings that can
be applied in the organization .
The research approach which was adopted was participant intensive, leading to what
we have referred to as an intervention. Papworth and Crosland , who have identified
various characteristics of whole systems interventions such as their temporal nature and
short life spans, point out that these research approaches (which emerged from the 1950s
and 1960s) are increasingly being used in the NHS.
We however did not adopt the whole systems intervention approach they proposed.
We felt that viewing entire organizations as whole systems, and hence ignoring local environmental
and operational conditions, was not appropriate for the work we intended to
carry out, especially considering the size and organizational complexity of the NHS.
The participant observation/action research methodology as applied to this particular
study is based on work done by Checkland and Holwell . In Figure 3 we diagrammatically
represent the reason that such soft systems methodology (SSM) has been identified
as the most appropriate for this research. We particularly note that if the research into
IS development had been viewed as concentrating on the issues shown in Figure 2, i.e. in
the areas of hardware theory etc., a positivistic approach may have been seen as the most
The overlap in the research at the various sites in principle allowed for interaction between
various NHS organizations. This interaction between the various research sites is
reflected in Figure 3.
The various project timeframes overlap. Learning from one research site can be fed back
into the others. The sites are also at different stages of understanding about these complex
issues. This is expressed in Figure 4. The process shown allows a comparison of the theory
and practice of information system introduction. It makes it possible, in principle, to produce
materials that will support the introduction of IS into the NHS. The research area reveals
a large number of very different systems issues relevant in trying to improve the effective
introduction of information into the NHS.
The timing of this work is apposite. It is expected that the total NHS spend on IS could well
reach £40 billion over the next decade . This has coincided with a growing concern that
there is a widespread failure to deliver benefits on the part of IT-based IS via the NPfIT.