Information and Knowledge Management using ArcGIS ModelBuilder

Kate Dymoke-Bradshaw and Ann Brown
The problem that this paper addresses is how to implement a complex new large scale IS
successfully within an individual hospital. The approach taken has been to develop a reflective
framework to be used as a tool by the Project Manager of an IS implementation project. The
framework (A Reflective Framework for Successful IS Implementation) can be used to assess the
risks involved in the implementation and to identify the issues that look likely to be important for
successful exploitation. This should enable the Project Manager to better manage the risks, plan the
project steps and monitor progress. The framework is in the form of a set of questions for the Project
Manager to address. It draws on a number of theories including that of innovation diffusion (Cooper
and Zmud, 1990; Fichman, 1992; Rogers, 2003; Swanson and Ramiller, 2004), but owes much of its
final form to the pioneering work of Greenhalgh et al. (2008). The framework was developed as part of
research work carried out during the early stages of a project to introduce electronic prescribing and
medicines management into an NHS acute trust as part of the NHS Connecting for Health National
Programme for IT.
Section 2 of the paper introduces Greenhalgh’s model. Section 3 presents the framework together
with the reasoning on which it is based.
2. The contribution of the diffusion of innovation model by Greenhalgh et al.
This paper is concerned with complex IS innovation projects, new to the adopting organisation
(Rogers, 2003; Swanson and Ramiller, 2004) – the type of IS that will typically be implemented into
the core of the healthcare organisation’s operations and will have a direct impact on clinical care. Of
Fichman’s (1992) four different adoption contexts within his framework this is clearly a cell 4
application, i.e. adopted at the organisational level, imposing a heavy knowledge burden on adopters
and having a significant impact on business processes and workflows.
We took as the starting point for our reflective framework Greenhalgh et al.’s diffusion of innovation
(DoI) model for complex innovations in health services (Greenhalgh et al., 2008). This model, shown
in Table 1, is based on an extensive literature review (Greenhalgh et al., 2004) to address how
innovations in health service delivery and organisation can be spread and sustained and it identifies
nine interacting components that affect success in adopting complex innovations.
The model has a number of strengths that make its application valuable to IS innovation projects in
healthcare:
It provides a good, comprehensive framework and a multi-level approach to the analysis of
success factors for IS innovation projects, developed through a systematic review of
approximately 600 sources;
It was designed to be applied to a large NHS new technology project involving the implementation
of a complex healthcare information system (Fichman cell 4 type applications);
It takes into account the complexities of the healthcare environment; and
It provides a rationale for why various factors are important to success.
It was, however, designed for use in a different context to that which we are interested in and has
some different underlying assumptions.
It was designed to be applied to a case study which examined the diffusion process by which a fully
developed summary care record service (SCR) was adopted across a number of different
organisations, which included GP practices, out-of-hours clinics, walk-in centres and emergency
departments. We are interested in the innovation process within a single organisation.
Also, use of the SCR was optional: participation by GP sites in loading data into the SCR was
optional; patients could choose to opt out if they did not wish to have a record; and individual
clinicians working in emergency and unscheduled care situations were able to choose whether or not
to access the SCR on a patient by patient basis. We are interested in situations where use of the new
IS will usually be mandated.
Cooper and Zmud (1990) propose that IS implementation projects, once the adoption decision has
been taken, typically consist of four stages: adaptation, where the IS is adapted to meet the
organisation’s needs, organisational procedures are revised and developed incorporating its use, and
staff are trained both in the new procedures and the use of the system; acceptance, where the IS is
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