Information and Knowledge Management using ArcGIS ModelBuilder

Kate Dymoke-Bradshaw and Ann Brown
In consequence, some components of the DoI model do not go into the detail needed in addressing
how to implement a complex new IS successfully within an individual health care organisation such as
a hospital, or are based on assumptions that are not fully valid in the situations that we are interested
in.
The IS innovation and implementation literature has a number of useful concepts and theories that do
apply to these situations, in particular those based on research into the implementation of enterprise
resource planning (ERP) systems. Although commercially available healthcare records systems, such
as the CRS, and ERP systems are targeted at very different markets, there are a number of
similarities which make the findings from ERP applicable to healthcare records systems:
Both are complex packaged solutions
Both require the organisation to change and integrate its processes to fit the software
Both produce and access information in a real-time environment
Both have proved challenging to implement successfully in practice (Berg, 2001; Car et al., 2008;
Coiera, 2003; Nah et al., 2001; Robey et al., 2002)
We have therefore adapted the model and supplemented it with a number of additional theories to
form our reflective framework. Specific areas we have drawn on include mindful innovation (Swanson
and Ramiller, 2004), commitment to the project (Kim and Kankanhalli, 2009; Nah et al., 2001), user
involvement and participation (Robey et al., 2002; Vaughan, 2001), managing resistance (Kim and
Kankanhalli, 2009; Vaughan, 2001) and building clinical engagement (Kaplan and Harris-Salamone,
2009; NHS Institute for Innovation and Improvement, 2008; Siriwardena, 2009), overcoming
knowledge barriers (Robey et al., 2002), managing change (Nah et al., 2001), minimising
customisation (Nah et al., 2001), and managing process redesign (Berg, 2001; Heeks, 2006).
3. A reflective framework for successful IS implementation
The framework is organised into ten components, nine of which are exactly the same as those that
Greenhalgh identified. We have added one key additional component (item 3.7 below) – the
adaptation process by which a good fit is developed between the information system and the
organisation that will use it. The framework takes the form of a series of questions that the Project
Manager needs to address.
The numbering does not denote an ordering of the components. Although some components need to
be settled early in the project life cycle (for example 3.1 Material properties of the technology and 3.9
Linkage), most components need to be addressed in parallel from the beginning of the project. Indeed
many of the components raise issues that need active managing long after the initial successful
installation if the hospital is to reap the full benefit of the new IS and reach Cooper and Zmud’s (1990)
final stage of infusion.
Mindful innovation (Swanson and Ramiller, 2004) can be thought of as an overarching principle for
the successful implementation of IS innovations in healthcare and is a fundamental concept
underpinning many of the components of the framework. Successful implementation cannot be
achieved without careful reflection on what is appropriate in a given situation. A mindful approach
takes account of the specifics of the complex healthcare environment with its many relationships and
interactions and with the need to respond to unexpected events. It investigates and addresses
problems and risks, recognising different perspectives and conflicting needs, and it is flexible in
situations that may be inherently uncertain and subject to crisis.
The key aspects of each component are presented and explained below.
3.1 Material properties of the technology
Are the key functional requirements well understood? How have they been / will they be documented?
What are the key use cases? How well are they understood / defined?
Which functional requirements cannot be fully met by the system? Where are the most serious gaps? How can
these be worked around?
Are non-functional requirements (e.g. system capacity, performance, access and security, availability, backup
operation in the event of outages) well understood?
What additional hardware/networking will be required to support use of the system?
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