Health Information Management: Integrating Information Technology ...

128 STRATEGY, IMPLEMENTATION AND EVALUATION
requires a sometimes dramatic redefinition of roles, responsibilities and
positions.
If health care organizations were hierarchically structured like ‘ordinary’
companies, the professionals’ worries may be overcome through enforcing the
required organizational change (although in such ‘ordinary’ environments this is
by no means easy either). In professional bureaucracies like hospitals, there is no
simple hierarchical line of command between the hospital directors and the
medical staff. ‘Resistances’ of the staff (one of the most frequent reasons for
PCIS implementation failure) have to be overcome through argument, through
emphasizing benefits and a host of other such instruments.
In this environment, the development of a framework to build strategies
certainly is no easy task. Implementing the strategy and achieving alignment (fit)
may be even more difficult. Therefore, we will now turn to the question of IT
strategy in hospitals and health care.
CASE STUDY
Case II: on strategy implementation: the UK—NHS experience
The NHS has a long history of ambitious IT strategies. Equally,
however, it has a long history of disappointments in meeting the targets set
out in the strategies. Even if alignment is produced on paper (see the
previous Case Study Box), in practice the NHS IT strategy has generally
favoured a technology-driven approach over an organization-driven
approach. In doing so, it has similarly massively underestimated the
complexities of providing IT that provide ‘solutions’ for problems that
practitioners actually have (see also Chapter 2). One can plead for an
‘integrated record’ including NHS organizations and private nursing
homes, for example, but this is hardly a technical problem: this is first and
foremost about ensuring cooperation between NHS sites and private
nursing homes. Thinking about how that cooperation should look, who
should initiate it, who should bear what costs cannot be second thoughts to
a technology-driven ‘solution’. All this, two observers argued in 2001, is ‘a
massive organizational development project involving the whole NHS.
That beige box on your desk is the agent of fundamental changes in
clinical work, whose implications have not yet been established’ (Wyatt
and Keen 2001).
IT STRATEGY IN HEALTH CARE ORGANIZATIONS
General criteria for strategy formation
In Part I of this book, the practice of IT development in health care has been
discussed. For the purpose of this chapter, searching for strategy tools to support