Evaluation of IT modernisation in the NHS - NETSCC

Report to SDO for NCRS ProjectSupporting Literatureunpredictability that pre-empts the kind of standardisation and automation foundin other bureaucracies and industries. 23Hospital medicine has complexworkflows, job specialisation and a division of labour that creates knowledgeintensiveand diverse patterns of information use and record keeping. Yet, if IT isgoing to support the ‘core business process’ of health, record keeping routinesmust be standardised in the first instance. 23The difficulty of understanding and managing this organisational complexity,whilst implementing new levels of standardisation, is apparent when examiningthe spectacular IT failure that occurred in the public health system of New SouthWales (NSW), Australia. 9The essence of this case study concerns the mismatchbetween the facilities provided, i.e. the new IT system, and the social organisationit was supposed to support. 12In 1996, the NSW health care system embarked onan IT strategy to achieve better resource management. (The NSW health caresystem is large by world standards.) After a rigorous selection procedure, aPAS/clinical system was chosen that had been successfully implemented in over100 sites in the US, and a few sites across Europe. Despite careful systemselection, after a period of increasing staff dissent and protest, the system had tobe withdrawn. Losses were substantial and took several forms, includingconsiderable financial losses, the considerable distrust generated, and delays infuture strategic planning. To uncover what went wrong, a research teaminterviewed a total of 64 people across five implementation sites. Factors that ledto the failure were identified as organisational, cultural and technical. The systemdid not meet staff expectations in terms of ease of use, flexibility and the range ofservices offered, with staff roles and expectations being very different in NSWthan in the US. In sites that had a more developed IT infrastructure, manyclinicians found that they were actually losing important functionality. This factorgenerated considerable discontent. In addition, the programme was so novel thatnearly all the key decision-makers were well outside their area of expertise. 122.3. Organisational research examining EPR implementationIn attempting to unpack how IT can be successfully implemented, the scientificliterature spans a diverse range of disciplines and journals and covers a hugebreadth of issues. 13 Yet despite this wide interest, very little evidence on the16