The Impact of Technology Insertion on Organisations
The Impact of Technology Insertion on Organisations
The Impact of Technology Insertion on Organisations
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HFIDTC/2/12.2.1/1<br />
Versi<strong>on</strong> 3 / 21 November 2007<br />
9.1.2.1 Findings<br />
9.2 Civil<br />
• <str<strong>on</strong>g>The</str<strong>on</strong>g>re was a lack <str<strong>on</strong>g>of</str<strong>on</strong>g> redundancy in the system. <str<strong>on</strong>g>The</str<strong>on</strong>g>re was no backup system in<br />
place and paper records were not kept;<br />
• <str<strong>on</strong>g>The</str<strong>on</strong>g>re was a lack <str<strong>on</strong>g>of</str<strong>on</strong>g> user feedback in the system. Errors were not apparent to the<br />
user until the entire system failed.<br />
9.2.1 <str<strong>on</strong>g>The</str<strong>on</strong>g> Regi<strong>on</strong>al Informati<strong>on</strong> Systems Plan<br />
<str<strong>on</strong>g>The</str<strong>on</strong>g> Wessex Regi<strong>on</strong>al Health Authority’s (WHRA) Regi<strong>on</strong>al Informati<strong>on</strong> Systems Plan<br />
(RISP), aimed to achieve integrati<strong>on</strong> across the health regi<strong>on</strong>, and began in the mid<br />
1980’s. <str<strong>on</strong>g>The</str<strong>on</strong>g> plan envisaged the development <str<strong>on</strong>g>of</str<strong>on</strong>g> five core computer systems covering<br />
hospital informati<strong>on</strong>, manpower estates, community care and accountancy, operating to<br />
comm<strong>on</strong> standards in every district regi<strong>on</strong>. Development was to be completed within five<br />
years at an estimated cost <str<strong>on</strong>g>of</str<strong>on</strong>g> £25.8 milli<strong>on</strong> (at 1984/1985 prices), with associated revenue<br />
costs over the five-year period <str<strong>on</strong>g>of</str<strong>on</strong>g> £17.5 milli<strong>on</strong>.<br />
In April 1990, when the project was <str<strong>on</strong>g>of</str<strong>on</strong>g>ficially aband<strong>on</strong>ed at least £43 milli<strong>on</strong> had been<br />
spent. Jeffcott and Johns<strong>on</strong> [58] analysed the organisati<strong>on</strong>al issues involved in the RISP<br />
case and identified the following factors that led to the system’s failure.<br />
9.2.1.1 Findings:<br />
• <str<strong>on</strong>g>The</str<strong>on</strong>g> NHS risk management strategy underestimated the risks involved in the<br />
adopti<strong>on</strong> and implementati<strong>on</strong> <str<strong>on</strong>g>of</str<strong>on</strong>g> new technologies. <str<strong>on</strong>g>The</str<strong>on</strong>g> risk management strategy<br />
was developed in resp<strong>on</strong>se to increasing financial pressures from litigati<strong>on</strong> for<br />
clinical negligence, but did not c<strong>on</strong>sider the risks involved in the introducti<strong>on</strong> <str<strong>on</strong>g>of</str<strong>on</strong>g><br />
new technologies;<br />
• <str<strong>on</strong>g>The</str<strong>on</strong>g> focus <strong>on</strong> risk assessment and avoidance <str<strong>on</strong>g>of</str<strong>on</strong>g> litigati<strong>on</strong> can be understood in<br />
historical and organisati<strong>on</strong>al terms. In 1975, the cost <str<strong>on</strong>g>of</str<strong>on</strong>g> clinical litigati<strong>on</strong> in the NHS<br />
in England al<strong>on</strong>e was around £1 milli<strong>on</strong>; by 1990, survey data suggests the cost had<br />
risen to around £50 milli<strong>on</strong>; in 1996 the costs were about £200 milli<strong>on</strong> [207], [208];<br />
• Risk assessment is a task that is not well understood in the NHS. <str<strong>on</strong>g>The</str<strong>on</strong>g> NHS<br />
Executive report that it is <strong>on</strong>ly carried out ‘because we have to include it in the<br />
business case’ rather than because it is recognised as a central task <str<strong>on</strong>g>of</str<strong>on</strong>g> successful<br />
project planning and management;<br />
• In terms <str<strong>on</strong>g>of</str<strong>on</strong>g> prior experience, the RISP was the first project <str<strong>on</strong>g>of</str<strong>on</strong>g> its kind in the WRHA;<br />
• At the time that RISP was c<strong>on</strong>ceived in 1982, there was no clear and agreed nati<strong>on</strong>al<br />
framework for informati<strong>on</strong> management. Until 1986 the Department <str<strong>on</strong>g>of</str<strong>on</strong>g> Health’s<br />
(DoH) IT policy allowed each regi<strong>on</strong>al health authority to develop its own IT<br />
services and decide what hardware and s<str<strong>on</strong>g>of</str<strong>on</strong>g>tware to buy, within the framework <str<strong>on</strong>g>of</str<strong>on</strong>g><br />
broad nati<strong>on</strong>al guidelines and internati<strong>on</strong>al rules;<br />
50