From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument

<b>Background</b> Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field.<p></p> <b>Methods</b> A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals.<p></p> <b>Results</b> The developed instrument was pre-tested in two professional samples (N = 46; N = 231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.<p></p> <b>Conclusions</b> To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study

Mapping knowledge management and organizational learning in support of organizational memory

The normative literature within the field of Knowledge Management has concentrated on techniques and methodologies for allowing knowledge to be codified and made available to individuals and groups within organizations. The literature on Organizational Learning however, has tended to focus on aspects of knowledge that are pertinent at the macro-organizational level (i.e. the overall business). The authors attempt in this paper to address a relative void in the literature, aiming to demonstrate the inter-locking factors within an enterprise information system that relate knowledge management and organizational learning, via a model that highlights key factors within such an inter-relationship. This is achieved by extrapolating data from a manufacturing organization using a case study, with these data then modeled using a cognitive mapping technique (Fuzzy Cognitive Mapping, FCM). The empirical enquiry explores an interpretivist view of knowledge, within an Information Systems Evaluation (ISE) process, through the associated classification of structural, interpretive and evaluative knowledge. This is achieved by visualizng inter-relationships within the ISE decision-making approach in the case organization. A number of decision paths within the cognitive map are then identified such that a greater understanding of ISE can be sought. The authors therefore present a model that defines a relationship between Knowledge Management (KM) and Organisational Learning (OL), and highlights factors that can lead a firm to develop itself towards a learning organization

A pragmatics' view of patient identification.

Patient identification is a central safety critical aspect of healthcare work. Most healthcare activities require identification of patients by healthcare staff, often in connection with the use of patient records. Indeed, the increasing reliance on electronic systems makes the correct matching of patients with their records a keystone for patient safety. Most research on patient identification has been carried out in hospital settings. The aim was to investigate the process of identification of patients and their records in the context of a primary healthcare clinic

Information support for the sense-making activities of managers

This thesis addresses the problem of how computer technologies and associated systems can be used effectively to provide information, in particular organisational performance information, to support managers in their strategic activities, with particular reference to managers in public, professional bureaucracies such as universities. The objective of the thesis is to answer the following questions: 1. What do different disciplines and bodies of knowledge cwrently say about this problem? 2. Is there a theoretical approach that can provide a holistic, contextual and dynamic understanding of this problem? 3. Can this theory be used to develop a holistic, contextual and dynamic model of the problem? 4. Can the model provide guidelines or methodologies that can be of general use to real organisations faced with this problem? The approach taken is one of a qualitative, interpretive epistemology and the theoretical basis is that of the Cultural Historical Activity Theory (CHAT) based on the work of the Russian psychologists Vygotsky (1978) and Leontiev (1981). Following a review of the literature, a study was conducted of five projects aimed at the provision of information to management at a single site. This study used the historical research methodology of Mason et al (1997). From this study a new holistic model was developed of the use of computer technologies and associated systems in providing information to support managers in their strategic activities. This model is contrasted with a model of the same problem based on the current literature. A framework, derived from the model, is presented. The new model and framework were applied to a project concerning the creation of a prototype enterprise information system for research output performance in a university. This project, guided by the model, captured the imagination of management and is a significant improvement on previous attempts, thus verifying the validity of the model and the CHAT approach

Learning design – making practice explicit

New technologies have immense potential for learning, but the sheer variety possible also creates challenges for learners in terms of navigating through an increasingly complex digital landscape and for teachers in terms of how to design and support learning interventions. How can learners and teachers make informed decisions about what technologies to use in the design and support of learning activities? This presentation will consider this question and present a new methodology for design – 'learning design', which aims to shift the creation and support of learning from what has traditionally been an implicit, belief-based practice to one that is explicit and design based. Learning design research at the Open University, UK has included the development of a set of conceptual design views, a tool for visualising designs (CompendiumLD) and a social networking site, for sharing and discussing learning and teaching ideas and designs (Cloudworks). An overview of this work will be provided, along with a discussion of the perceived benefits of this new approach to educational design

Causal mapping and scenario building with multiple organisations

Thinking and planning for the future is critical in a competitive business world. Scenarios are a common technique for investigating the future, but can be time-consuming and challenging to develop, particularly when more than a single organisation is involved. An approach is presented here which shifts the focus of scenario building from the company level to the sector level, whereby a range of organisations engage collectively on a topic of mutual importance. A rapid technique was developed, with simple scenarios being constructed in 2 to 4 hours. This process was implemented in 13 multi-organisational workshops with participants from the construction and building industries, sectors which are traditionally short-term and reactive in their outlook. The resulting feedback, observations and experiences are discussed, together with examples of how the resultant scenarios have been applied. An example of causal map reflection (exposing an individual’s causal map to others) is also presented, described and critiqued. It was found that the process was successful in engaging participants in thinking about and discussing the future, appreciating the interconnectivities of the related issues, and understanding the collective implications of their potential decisions, as well as facilitating the socialisation of participant thinking and the construction of collective futures

Successful acquisition of IT systems

School of Managemen

The evaluation of relationship mapping as a tool for understanding the experience of change

The research for this dissertation was conducted at the Western Cape site of a national manufacturing organisation in the food and beverages industry. The study set out to attain two primary goals. The first was to examine the effectiveness of relationship mapping (a method for graphically depicting mental models) as a tool for exploring the participants' experience of, and evaluation of 'planned organisational change'. The second goal was to investigate the possible impact of relationship mapping on those using the method. Research results for both of these goals were examined through three 'lenses' or frames of analysis, 'empowerment', 'communication', and 'understanding the change'. These frames of analysis were derived from reviewed literature and interaction with the organisation. Incorporated into the design was an analysis of group processes, as an additional check on the impact of the relationship mapping procedure. The study assessed the above goals across four, hierarchically-divided organisational levels, with a total of 56 participants. A classical control group design was used, incorporating qualitative and quantitative methods. Control group participants underwent in-depth interviews, semi-structured focus group discussions and a group process scale (assessing group interaction). In addition to these, the experimental groups underwent relationship mapping, use of the group process scale, and a post relationship mapping questionnaire. Thematic and statistical analyses were used for the examination of qualitative and quantitative results, respectively. Although causality cannot be inferred with certainty, results indicate that these experimental groups paid increased attention to inter-relationships, questioning and problem solving, and the production of new information. Participants recognised that relationship mapping impacted on their sense of 'empowerment' by allowing for participation, facilitating thinking, and provoking personal realisations. Relationship mapping was seen as altering participant perception of communication and improving their understanding of the change