Telehealth Adoption: Three case studies at the organisational level

We present the results of an inductive analysis using interview data to establish core themes in organisational level adoption of telehealth. The source of the interview data was a large study to evaluate how telehealth can promote long term health and independence and improve quality of life for people suffering from chronic health conditions. The study took place over three different pilot sites and 41 interviews were conducted with healthcare professionals who collectively had responsibility for over 5000 patients. We explore the data from the perspective of the organisation, focusing on the unique features of each pilot site and seeking evidence for themes of adoption success at the organisational level, particularly via organisational identity. We explore the data via a set of propositions based on organisational theory and technology adoption. The major finding of this work is that experience in telecare was found to detract from telehealth adoption success

Telehealth adoption: three case studies at the organisational level

We present the results of an inductive analysis using interview data to establish core themes in organisational level adoption of telehealth. The source of the interview data was a large study to evaluate how telehealth can promote long term health and independence and improve quality of life for people suffering from chronic health conditions. The study took place over three different pilot sites and 41 interviews were conducted with healthcare professionals who collectively had responsibility for over 5000 patients. We explore the data from the perspective of the organisation, focussing on the unique features of each pilot site and seeking evidence for themes of adoption success at the organisational level, particularly via organisational identity. We explore the data via a set of propositions based on organisational identity theory and models of technology adoption. The major finding of this work is that experience in the adoption of telecare was found to detract from telehealth adoption success

Leadership for knowledge translation : the case of CLAHRCs

Calls for successful knowledge translation (KT) in healthcare have multiplied over recent years. The NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) program is a policy initiative in the UK aimed at speeding-up the translation of research into healthcare practice. Using multiple qualitative research methods and drawing on the ongoing processes used by individuals to interpret and contextualize information, we explore how new organizational forms for KT bridge the gap between research and practice. We pay particular attention to the relationship between the organization and practices of KT and leadership. Our empirical data demonstrate how the relationship between leadership and KT shifted over time from a push model where the authoritarian top-down leadership team set outcome measures by which to judge KT performance to one which aimed to distribute leadership capacity across a wide range of stakeholders in a health and social care systems. The relationship between the organization and practices of KT and leadership is affected by local contextual influences on policies directed at increasing the uptake of research in clinical practice. Policy-makers and service leaders need to recognize that more dispersed type of leadership are needed to accommodate the idiosyncratic nature of collective action

The importance of role sending in the sensemaking of change agent roles

Purpose – The purpose of this paper is to investigate what happens when a lack of role-sending results in ambiguous change agent roles during a large scale organisational reconfiguration. The authors consider the role of sensemaking in resolving role ambiguity of middle manager change agents and the consequences of this for organisational restructuring. Design/methodology/approach – Data were collected from a case study analysis of significant organisational reconfiguration across a local National Health Service Trust in the UK. Data consists of 82 interviews, complemented by analysis of over 100 documents and field notes from 51 hours of observations collected over five phases covering a three year period before, during and after the reconfiguration. An inductive qualitative analysis revealed the sensemaking processes by which ambiguity in role definition was resolved. Findings – The data explains how change agents collectively make sense of a role in their own way, drawing on their own experiences and views as well as cues from other organisational members. The authors also identified the organisational outcomes which resulted from this freedom in sensemaking. This study demonstrates that by leaving too much flexibility in the definition of the role, agents developed their own sensemaking which was subsequently very difficult to manipulate. Practical implications – In creating new roles, management first needs to have a realistic vision of the task and roles that their agents will perform, and second, to communicate these expectations to both those responsible for recruiting these roles and to the agents themselves. Originality/value – Much of the focus in sensemaking research has been on the importance of change agents’ sensemaking of the change but there has been little focus on how change agents sensemake their own role in the change. </jats:sec

When infrastructure transition and work practice redesign collide

Purpose – As management innovations become more complex, infrastructure needs to change in order to accommodate new work practices. Different challenges are associated with work practice redesign and infrastructure change however; combining these presents a dual challenge and additional challenges associated with this interaction. The purpose of this paper is to ask: what are the challenges which arise from work practice redesign, infrastructure change and simultaneously attempting both in a single transformation? Design/methodology/approach – The authors present a longitudinal study of three hospitals in three different countries (UK, USA and Canada) transforming both their infrastructure and work practices. Data consists of 155 ethnographic interviews complemented by 205 documents and 36 hours of observations collected over two phases for each case study. Findings – This paper identifies that work practice redesign challenges the cognitive load of organizational members whilst infrastructure change challenges the project management and structure of the organization. Simultaneous transformation represents a disconnect between the two aspects of change resulting in a failure to understand the relationship between work and design. Practical implications – These challenges suggest that organizations need to make a distinction between the two aspects of transformation and understand the unique tensions of simultaneously tackling these dual challenges. They must ensure that they have adequate skills and resources with which to build this distinction into their change planning. Originality/value – This paper unpacks two different aspects of complex change and considers the neglected challenges associated with modern change management objectives. </jats:sec

Public Sector Organizational Failure: A study of collective denial in the UK National Health Service

This paper argues that public sector organizational failure may be best understood from a perspective of collective denial. The rise of this phenomenon is examined using testimony from a Public Inquiry into the downfall of a UK hospital, where falling organizational standards led to unethical decision making and an unacceptable number of patient deaths. In this paper we show how collective denial, over time, became a process that resided within the fabric of organizational life. To explore the organizational processes associated with collective denial, and how and why it occurs, we identify the influence of a ‘narrative of silence’. This narrative allows ever more serious failings to be justified as organizational members lose contact with reality entering a downward spiral with no recovery. The combined impact of assumptions about leadership capability, enculturated professional identities and organizational loyalty create an environment where a narrative of silence can develop

Challenges to implementing the national programme for information technology (NPfIT): a qualitative study.

OBJECTIVES: To describe the context for implementing the national programme for information technology (NPfIT) in England, actual and perceived barriers, and opportunities to facilitate implementation. DESIGN: Case studies and in depth interviews, with themes identified using a framework developed from grounded theory. SETTING: Four acute NHS trusts in England. PARTICIPANTS: Senior trust managers and clinicians, including chief executives, directors of information technology, medical directors, and directors of nursing. RESULTS: The trusts varied in their circumstances, which may affect their ability to implement the NPfIT. The process of implementation has been suboptimal, leading to reports of low morale by the NHS staff responsible for implementation. The overall timetable is unrealistic, and trusts are uncertain about their implementation schedules. Short term benefits alone are unlikely to persuade NHS staff to adopt the national programme enthusiastically, and some may experience a loss of electronic functionality in the short term. CONCLUSIONS: The sociocultural challenges to implementing the NPfIT are as daunting as the technical and logistical ones. Senior NHS staff feel these have been neglected. We recommend that national programme managers prioritise strategies to improve communication with, and to gain the cooperation of, front line staff

Investigating healthcare IT innovations:A ‘conceptual blending’ approach

PURPOSE: The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS). DESIGN/METHODOLOGY/APPROACH: To analyse these multi-level dynamics, the authors blend Rogers' diffusion of innovations theory (DoIT) with Webster's sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts. FINDINGS: Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application - in particular speed, ease of use, reliability and flexibility and levels of readiness - were highly relevant but their influence was modulated through interaction with complex structural and relational issues. PRACTICAL IMPLICATIONS: Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of "co-construction" between designers and end-users. ORIGINALITY/VALUE: The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes

Implementation of computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) in the NHS: quantitative before and after study

Objective To assess the impact of components of the national programme for information technology (NPfIT) on measures of clinical and operational efficiency