25 research outputs found

    Integration of a nationally procured electronic health record system into user work practices

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    BACKGROUND: Evidence suggests that many small- and medium-scale Electronic Health Record (EHR) implementations encounter problems, these often stemming from users' difficulties in accommodating the new technology into their work practices. There is the possibility that these challenges may be exacerbated in the context of the larger-scale, more standardised, implementation strategies now being pursued as part of major national modernisation initiatives. We sought to understand how England's centrally procured and delivered EHR software was integrated within the work practices of users in selected secondary and specialist care settings. METHODS: We conducted a qualitative longitudinal case study-based investigation drawing on sociotechnical theory in three purposefully selected sites implementing early functionality of a nationally procured EHR system. The complete dataset comprised semi-structured interview data from a total of 66 different participants, 38.5 hours of non-participant observation of use of the software in context, accompanying researcher field notes, and hospital documents (including project initiation and lessons learnt reports). Transcribed data were analysed thematically using a combination of deductive and inductive approaches, and drawing on NVivo8 software to facilitate coding. RESULTS: The nationally led "top-down" implementation and the associated focus on interoperability limited the opportunity to customise software to local needs. Lack of system usability led users to employ a range of workarounds unanticipated by management to compensate for the perceived shortcomings of the system. These had a number of knock-on effects relating to the nature of collaborative work, patterns of communication, the timeliness and availability of records (including paper) and the ability for hospital management to monitor organisational performance. CONCLUSIONS: This work has highlighted the importance of addressing potentially adverse unintended consequences of workarounds associated with the introduction of EHRs. This can be achieved with customisation, which is inevitably somewhat restricted in the context of attempts to implement national solutions. The tensions and potential trade-offs between achieving large-scale interoperability and local requirements is likely to be the subject of continuous debate in England and beyond with no easy answers in sight

    Recruitment, Harassment, and Equal Rights: Human Resource Policies

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    Exploring the dynamics of gender, feminism and entrepreneurship : advancing debate to escape a dead end?

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    Contrary to the neo-liberal thesis that entrepreneuring is an open and accessible endeavour where personal effort alone determines reward and status, it has been demonstrated that there is a persistent, but occluded, gender bias within the entrepreneurial discourse. Accordingly, women are positioned as lacking and incomplete men; however, despite calls to employ feminist theory as an analytical frame to demonstrate the reproduction of such subordination, there is scant evidence this has emerged. Within this article, we respond to this call by demonstrating how post structural feminist analysis reveals the gendered assumptions informing entrepreneurship theory that embed prevailing hetero-normative assumptions. These assumptions limit the epistemological scope of contemporary research which positions women as failed or reluctant entrepreneurial subjects; as such, in the absence of feminist theorizing these analyses remain descriptive rather than explanatory. Accordingly, the current entrepreneurial research agenda is in danger of reaching an epistemological dead end in the absence of a reflexive critical perspective to inform the idea of who can be and what might be an entrepreneur. Finally, we draw upon these arguments to reflect upon current approaches to theorizing within the broader field of entrepreneurial enquiry
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