A manifesto for a socio-technical approach to NHS and social care IT-enabled business change - to deliver effective high quality health and social care for all

80% of IT projects are known to fail. Adopting a socio-technical approach will help them to succeed in the future. The socio-technical proposition is simply that any work system comprises both a social system (including the staff, their working practices, job roles, culture and goals) and a technical system (the tools and technologies that support and enable work processes). These elements together form a single system comprising interacting parts. The technical and the social elements need to be jointly designed (or redesigned) so that they are congruent and support one another in delivering a better service. Focusing on one aspect alone is likely to be sub-optimal and wastes money (Clegg, 2008). Thus projects that just focus on the IT will almost always fail to deliver the full benefits

Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

A quantitative analysis of the impact of a computerised information system on nurses' clinical practice using a realistic evaluation framework

Objective: To explore nurses' perceptions of the impact on clinical practice of the use of a computerised hospital information system. Design: A realistic evaluation design based on Pawson and Tilley's work has been used across all the phases of the study. This is a theory-driven approach and focuses evaluation on the study of what works, for whom and in what circumstances. These relationships are constructed as context-mechanisms-outcomes (CMO) configurations. Measurements: A questionnaire was distributed to all nurses working in in-patient units of a university hospital in Spain (n = 227). Quantitative data were analysed using SPSS 13.0. Descriptive statistics were used for an overall overview of nurses' perception. Inferential analysis, including both bivariate and multivariate methods (path analysis), was used for cross-tabulation of variables searching for CMO relationships. Results: Nurses (n = 179) participated in the study (78.8% response rate). Overall satisfaction with the IT system was positive. Comparisons with context variables show how nursing units' context had greater influence on perceptions than users' characteristics. Path analysis illustrated that the influence of unit context variables are on outcomes and not on mechanisms. Conclusion: Results from the study looking at subtle variations in users and units provide insight into how important professional culture and working practices could be in IT (information technology) implementation. The socio-technical approach on IT systems evaluation suggested in the recent literature appears to be an adequate theoretical underpinning for IT evaluation research. Realistic evaluation has proven to be an adequate method for IT evaluation. (C) 2009 Elsevier Ireland Ltd. All rights reserved

Summary care record early adopter programme: an independent evaluation by University College London.

Benefits The main potential benefit of the SCR is considered to be in emergency and unscheduled care settings, especially for people who are unconscious, confused, unsure of their medical details, or unable to communicate effectively in English. Other benefits may include improved efficiency of care and avoidance of hospital admission, but it is too early for potential benefits to be verified or quantified. Progress As of end April 2008, the SCR of 153,188 patients in the first two Early Adopter sites (Bolton and Bury) had been created. A total of 614,052 patients in four Early Adopter sites had been sent a letter informing them of the programme and their choices for opting out of having a SCR. Staff attitudes and usage The evaluation found that many NHS staff in Early Adopter sites (which had been selected partly for their keenness to innovate in ICT) were enthusiastic about the SCR and keen to see it up and running, but a significant minority of GPs had chosen not to participate in the programme and others had deferred participation until data quality improvement work was completed. Whilst 80 per cent of patients interviewed were either positive about the idea of having a SCR or ?did not mind?, others were strongly opposed ?on principle?. Staff who had attempted to use the SCR when caring for patients felt that the current version was technically immature (describing it as ?clunky? and ?complicated?), and were looking forward to a more definitive version of the technology. A comparable technology (the Emergency Care Summary) introduced in Scotland two years ago is now working well, and over a million records have been accessed in emergency and out-of-hours care. Patient attitudes and awareness Having a SCR is optional (people may opt out if they wish, though fewer than one per cent of people in Early Adopter sites have done so) and technical security is said to be high via a system of password protection and strict access controls. Nevertheless, the evaluation showed that recent stories about data loss by government and NHS organisations had raised concerns amongst both staff and patients that human fallibility could potentially jeopardise the operational security of the system. Despite an extensive information programme to inform the public in Early Adopter sites about the SCR, many patients interviewed by the UCL team were not aware of the programme at all. This raises important questions about the ethics of an ?implied consent? model for creating the SCR. The evaluation recommended that the developers of the SCR should consider a model in which the patient is asked for ?consent to view? whenever a member of staff wishes to access their record. Not a single patient interviewed in the evaluation was confident that the SCR would be 100 per cent secure, but they were philosophical about the risks of security breaches. Typically, people said that the potential benefit of a doctor having access to key medical details in an emergency outweighed the small but real risk of data loss due to human or technical error. Even patients whose medical record contained potentially sensitive data such as mental health problems, HIV or drug use were often (though not always) keen to have a SCR and generally trusted NHS staff to treat sensitive data appropriately. However, they and many other NHS patients wanted to be able to control which staff members were allowed to access their record at the point of care. Some doctors, nurses and receptionists, it seems, are trusted to view a person?s SCR, whereas others are not, and this is a decision which patients would like to make in real time

The fundamental challenge: human and organisational factors in an ERP implementation

Organisations encounter obstacles when implementing ERP systems. This paper intends to explore some of the problems that occur throughout the implementation of an ERP system. Using a combination of the work of Markus et al (2001) and Kim et al (2005), a framework is constructed of Human and Organisational and Technical problems in ERP Implementations during the project phase. Drawing on empirical evidences from a UK furniture manufacturer, this study then discusses and analyses each problem identified in the framework and its affect on the implementation of their ERP system. The findings of this paper reveal that the fundamental challenge of ERP implementation is not technology but organisational and human problems, which, if not properly comprehended and addressed, can lead to ERP failure. Understanding that organisational and human issues are extremely important will encourage practitioners to address these problems and succeed in their ERP system implementations

Data and Predictive Analytics Use for Logistics and Supply Chain Management

Purpose The purpose of this paper is to explore the social process of Big Data and predictive analytics (BDPA) use for logistics and supply chain management (LSCM), focusing on interactions among technology, human behavior and organizational context that occur at the technology’s post-adoption phases in retail supply chain (RSC) organizations. Design/methodology/approach The authors follow a grounded theory approach for theory building based on interviews with senior managers of 15 organizations positioned across multiple echelons in the RSC. Findings Findings reveal how user involvement shapes BDPA to fit organizational structures and how changes made to the technology retroactively affect its design and institutional properties. Findings also reveal previously unreported aspects of BDPA use for LSCM. These include the presence of temporal and spatial discontinuities in the technology use across RSC organizations. Practical implications This study unveils that it is impossible to design a BDPA technology ready for immediate use. The emergent process framework shows that institutional and social factors require BDPA use specific to the organization, as the technology comes to reflect the properties of the organization and the wider social environment for which its designers originally intended. BDPA is, thus, not easily transferrable among collaborating RSC organizations and requires managerial attention to the institutional context within which its usage takes place. Originality/value The literature describes why organizations will use BDPA but fails to provide adequate insight into how BDPA use occurs. The authors address the “how” and bring a social perspective into a technology-centric area

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