A study of the uptake and application of community information systems in England and Wales

The use of information systems in community healthcare has increased greatly over the last ten years. The primary motivation for this development was the need to produce national data sets. However, more recently, it has been recognised that such information systems also have the potential to deliver a wide range of benefits to administrative, managerial and clinical staff. This article describes an innovative research link that has been established between Central Nottinghamshire Healthcare (NHS) Trust and The Business School at Loughborough University that intends to provide independent research studying the effects of information systems on community trusts. The first stage of the research is a survey of community trusts in England and Wales studying the uptake and application of community information systems. Preliminary results of the survey indicate that the aim of delivering a wide range of benefits to staff is now being addressed in addition to the production of the national data sets

Lee and Mitchell's unfolding model of employee turnover - a theoretical assessment

This paper offers a critique of the ‘unfolding’ model of employee turnover (Lee, Mitchell, Holtom, Daniel & Hill 1999), and is intended to contribute to debate on the theoretical and operational merits of this alternate approach to analyzing turnover. The critique explores the model’s conceptual framework and theoretical contribution, as well as offering thoughts on logistical and operational issues

A re-conceptualization of the interpretive flexibility of information technologies: redressing the balance between the social and the technical

Interpretive flexibility – the capacity of a specific technology to sustain divergent opinions – has long been recognised as playing an important role in explaining how technical artefacts are socially constructed. What is less clear is how a system’s technical characteristics might limit its ability to be interpreted flexibly. This gap in the literature has largely arisen because recent contributions to this debate have tended to be rather one-sided, focussing almost solely upon the role of the human agent in shaping the technical artefact, and in so doing either downplaying or ignoring the artefact’s shaping potential. The broad aim of this study was to reappraise the nature and role of interpretive flexibility but giving as much consideration to how an information system’s technical characteristics might limit its ability to be interpreted flexibly, as we do to its potential for social construction. In this paper we use the results of two in-depth case studies, in order to propose a re-conceptualisation of the role of interpretive flexibility. In short, this model helps explain how the initial interpretations of stakeholders are significantly influenced by the scope and adaptability of the system’s functionality. Stakeholder interpretations will then, in turn, influence how the system’s functionality is appropriated and exploited by users, to allow divergent interpretations to be realised and sustained

Go forth and replicate: a revisionist account of the value of replication in management studies

This paper brings together three different accounts of the role of replication in management studies: replication as ‘scientific project’, replication as ‘socio-cultural artefact’; replication as ‘aesthetic practice’. Each of these is developed from within separate reference frames: epistemology, the sociology of science, and the philosophy of art. This offers new scope to revisit a fundamental question in management studies, namely: why is there a gap between the espoused value placed upon replication, and the actual paucity of replication studies? Each reference frame offers different insights into the nature of replication. The paper argues that by integrating all three, and by understanding the potential contribution of the philosophy of art, a more realistic account of theory development is possible; one that explains why successive calls to researchers to replicate fall on deaf ears. Despite the empirical evidence to suggest replication studies are undervalued, and the problems posed by postmodernist challenges to science, we reiterate the importance of replication

Exploring the duality of Information Technology in community health trusts

There are two important areas of inquiry, within the information systems domain, that are often framed as dualities. The first relates to the nature of the relationship between technological artefacts and human practices: does technology shape human practice or is technology shaped by human agency? The second concerns the impact of information technologies: does IT empower the user or is the user controlled by IT? The aim of this study is to provide new insights into the nature of these dualities by exploring the development, implementation and use of a standard software application, within a homogenous organisational sector, namely NHS Community Trusts. A multiple case-study design incorporating five Community Healthcare Trusts was utilised. The study found that whilst the information system was perceived as facilitating empowerment in two Trusts, it was felt to be reinforcing management control in another Trust; there was no significant change to the distribution of power in the other two Trusts. Moreover, the differences in outcome could be explained by the degree of ‘interpretive flexibility’ associated with each of the information systems projects: the empowerment of users was found in Trusts where the users were actively engaged in the system’s social and physical constitution

Factors affecting the level of success of community information systems

The factors that influence the ultimate level of success or failure of systems development projects have received considerable attention in the academic literature. However, previous research has rarely targeted different instances of a common type of system within a homogenous organisational sector. This paper presents the results of a survey of IM&T Managers within Community Trusts to gain insights into the factors affecting the success of Community Information Systems. The results demonstrate that the most successful operational systems were thoroughly tested prior to implementation and enjoyed high levels of user and senior management commitment. Furthermore, it has been shown that there is a relationship between the level of organisational impact and systems success, with the most successful systems engendering changes to the host organisation’s culture, level of empowerment and clinical working practices In addition to being of academic interest, this research provides many important insights for practising IM&T managers

The importance of user ownership and positive user attitudes in the successful adoption of Community Information Systems

The factors that influence the ultimate level of success or failure of systems development projects have received considerable attention in the academic literature. However, despite the existence of a ‘best practice’ literature many projects still fail. The record of the National Health Service has been particularly poor in this respect. The research reported in this paper proposes that two additional factors; user ownership and positive user attitudes warrant further development and investigation. The current study investigated these two factors in a homogenous organisational sector, Community NHS Trusts, using a common type of information system, in order to eliminate the potentially confounding influences of sector and system. A multiple case-study design incorporating five Community Healthcare Trusts was utilised. The key results from the analysis indicated that both user ownership and positive user attitudes were important mediating variables that were crucial to the success of a CIS. In addition, it was also identified that the adoption of best practice variables had a dual role, directly influencing the level of perceived success but also facilitating the development of user ownership and positive user attitudes. These results will be of particular interest to practising IM&T managers in the NHS and also to the wider academic research community

Unweaving leaving: the use of models in the management of employee turnover

The following paper offers a review of the literature on labour turnover in organizations. Initially the importance of the subject area is established, as analyses of turnover are outlined and critiqued. This leads to a discussion of the various ways in which turnover and its consequences are measured. The potentially critical impact of turnover behaviour on organizational effectiveness is presented as justification for the need to model turnover, as a precursor to prediction and prevention. Key models from the literature of labour turnover are presented and critiqued

How well can the theory of planned behavior account for occupational intentions?

We tested the capacity of an extended version of the theory of planned behavior (TPB) to account for intentions to work for the UK’s National Health Service as a nurse, physiotherapist or radiographer amongst three groups: professionally unqualified (N = 507), in professional training (N = 244), and professionally qualified (N = 227). We found strong support for attitude and subjective norm as predictors of behavioral intention, with or without controlling for alternative career intentions. There was some support for perceived behavioral control as a predictor of intention, but less for moral obligation and identity. As hypothesised, attitude was a stronger predictor of intention amongst the qualified respondents than the other two groups. We conclude that the TPB is less effective for the bigger and harder-toimplement decisions in life than for smaller and easier-to-implement ones. Also, the absolute and relative importance of some TPB variables varies with personal circumstances

Perceptions of radiography and the NHS: a qualitative study

Purpose: To identify the factors that determine the attractiveness of radiography as a career choice and the NHS as an employer to potential recruits and returners. Methods: Individual and group interviews were conducted in the East Midlands region to explore participants’ perceptions of the attractiveness of the NHS as an employer to potential radiography staff. Interviews were conducted with school pupils, radiography students, mature students, radiography assistants, agency radiographers and independent sector radiographers. Results: Eighty-eight individuals participated in the qualitative stage of the study. Analysis of the interview transcripts indicated that radiography as a career choice is perceived as boring and routine, involving high workloads and with little recognition from the general public. Working with patients is the source of considerable job satisfaction but is offset by staff shortages, lack of flexibility over working hours and a lack of consideration of family commitments in the NHS. Financial costs are highlighted as dissuading many participants from considering a career as a radiographer in the NHS or returning to work for the NHS. Greater use of open days in conjunction with more advertising of the profession is suggested as tactics to improve recruitment. Conclusions: The provision of more flexible working hours, greater consideration for family commitments and increased financial support for training are necessary to improve the attractiveness of a radiography career. NHS Human Resource Managers should consider these findings concerning the applicant and returner pools when developing strategies to address the current shortfall of radiographers