Researching big IT in the UK National Health Service:A systematic review of theory-based studies

ObjectiveTo identify and discuss theory-based studies of large-scale health information technology programs in the UK National Health Service.Materials and MethodsUsing the PRISMA systematic review framework, we searched Scopus, PubMed and CINAHL databases from inception to March 2022 for theory-based studies of large-scale health IT implementations. We undertook detailed full-text analyses of papers meeting our inclusion criteria.ResultsForty-six studies were included after assessment for eligibility, of which twenty-five applied theories from the information systems arena (socio-technical approaches, normalization process theory, user acceptance theories, diffusion of innovation), twelve from sociology (structuration theory, actor-network theory, institutional theory), while nine adopted other theories. Most investigated England’s National Program for IT (2002–2011), exploring various technologies among which electronic records predominated. Research themes were categorized into user factors, program factors, process outcomes, clinical impact, technology, and organizational factors. Most research was qualitative, often using a case study strategy with a longitudinal or cross-sectional approach. Data were typically collected through interviews, observation, and document analysis; sampling was generally purposive; and most studies used thematic or related analyses. Theories were generally applied in a superficial or fragmentary manner; and articles frequently lacked detail on how theoretical constructs and relationships aided organization, analysis, and interpretation of data.ConclusionTheory-based studies of large NHS IT programs are relatively uncommon. As large healthcare programs evolve over a long timeframe in complex and dynamic environments, wider adoption of theory-based methods could strengthen the explanatory and predictive utility of research findings across multiple evaluation studies. Our review has confirmed earlier suggestions for theory selection, and we suggest there is scope for more explicit use of such theoretical constructs to strengthen the conceptual foundations of health informatics research. Additionally, the challenges of large national health informatics programs afford wide-ranging opportunities to test, refine, and adapt sociological and information systems theories

prior shared experience and survival of spin-offs from restructured state enterprises

Many organizations, especially in emerging economies, trace their origins to restructured state enterprises, and this study explores the implications of such origins for organizational adaptation to changing environmental conditions. We compare the activity choices and survival chances of spin-offs from restructured state enterprises with those of de novo organizations. We argue that prior shared experience of spin-offs’ managers and employees facilitates the redeployment of routines developed in parent state enterprises. This should predispose spin-offs to pursue familiar activities, but this choice is not completely predetermined, and its survival implications depend on the environmental conditions. Our empirical findings suggest that spin-offs from restructured state enterprises are less likely to engage in new activities than de novo organizations. However, those restructuring spin-offs that do engage in new activities before the regulatory regime shift significantly improve their survival chances after the shift. Moreover, we find that the detrimental effect of the regulatory regime shift and the beneficial effect of engaging in new activities are stronger for spin-offs from restructured state enterprises than for de novo organizations.authorsversionpublishe

Toward a Model of Organizational Co-Evolution in Transition Economies

The paper presents a model of organization-environment co-evolution, which portrays the joint impact of organizational and environmental characteristics on organizational survival. The four organizational characteristics included in the model are: (a) control structure, (b) product strategy, (c) exchange strategy, and (d) distance to the market. The three environmental characteristics are: (a) control structures, (b) competitive structures, and (c) exchange structures. In line with the general co-evolutionary approach, the model highlights the interrelationship between micro and meso level phenomena, specifically, between firm-level adaptation and industry-level selection of organizational forms. The paper focuses on transition economies and uses the empirical evidence from these economies to illustrate the model's potential. The model, however, is sufficiently general to be applied in other organizational environments. Copyright Blackwell Publishing Ltd 2006.

Doubly imprisoned: Transgender and non-binary prisoners experiences in England and Wales

In this chapter we explore the lived experiences of transgender and gender non-conforming (TGNC) prisoners, arguably the most vulnerable minority in the prison estate, using the data from our correspondence study with transgender women and non-binary individuals incarcerated in male establishments in England and Wales. We provide a brief review of the extant literature, describe the English prison system and the regulations concerning transgender prisoners, and analyse two axes of vulnerability of TGNC prisoners: social (stemming from relationships between prisoners) and institutional (resulting from the prison regime). Along the social axes, we find, in contrast with prior research, that our respondents defied the stereotypes of trans prisoners as submissive to males in a hypermasculine prison society and as involved primarily in abusive relationships. Along the institutional axes, we find that, despite the progressive by international standards transgender prison regulations, prisoners were subject to vicissitudes in treatment that negatively affected their ability to express their gender and their health. Focusing on access to gender-affirming items (clothing, prosthetics, make-up) and gender-affirming medical treatment, we develop recommendations for the prison service that could improve the conditions of confinement for TGNC prisoners

Leadership and institutional change in the public sector : the case of secondary schools in England

Leadership should be viewed as being embedded in a societal context and influenced by (as well as influencing) the institutional environment of organizations. Extant research on leadership, however, has largely neglected the effect of the institutional environment. To redress this imbalance we examine leadership in the context of institutional change in secondary school education in England. Specifically, we examine the co-existence of an emerging, government-prescribed, results-oriented approach to leadership (the new institution) with a more traditional professional value-based approach (the old institution). Our methodological approach utilized both quantitative and qualitative methods. The quantitative analysis suggests that there are no significant performance differences between the two leadership approaches. Furthermore, school context does not appear to influence the leadership style employed. The qualitative analysis enabled us to better interpret these findings and to examine the enactment of leadership. The analysis suggests that although the new regulatory environment has fostered the development of the results-oriented leadership, it has not fully replaced professional value-based leadership. Rather, we found pockets of resistance to the policy-prescribed approach precisely in those areas that were targeted by the policy, namely, in schools with high percentage of socially deprived students. We conclude that a complex relationship exists between leadership and its institutional context

Funnel of interests: the discursive translation of organizational change

In this article, the authors examine the role of discourse in the implementation of organizational change. They develop the concept of the “funnel of interests” to describe the process through which the perceived goals, concerns, and interests of different actors are aligned with change. To illustrate the argument, the authors analyze organizational change in a U.K. public—private partnership and show how the creative use of discourse helps to “funnel” the perceived interests of different groups and thereby facilitate the implementation of change. In particular, the authors examine the role of change agents as “translators,” who use discourse to actively reconstruct and realign change as congruent with the recipient’s interests. The findings suggest that change agents need to act as a mediator, interpreting and reinterpreting the change, rather than as a passive intermediary that simply diffuses a fixed set of ideas and practices, letting them pass without modification. It was through translation that the change agents in this study helped to funnel the broad range of concerns expressed by the recipients in the required direction. This study thereby opens up a new research agenda that seeks to examine how interests and interest groups are constructed through discourse, rather than viewing interests as preexisting entities that are simply expressed in discourse