Institutionalization and de-institutionalization processes in the UK healthcare system : the role of emerging technologies

Abstract

This thesis is a result of a research project that examines the Information Systems strategy of the National Health Service (NHS). The researcher followed the process of implementing a Primary Service Provision (PSP). PSP is an initiative by the NHS Information Authority (NHSIA) to develop and establish a National Programme for Information Technology (NPfIT)—a means of providing a useable electronic health record nationally to the UK. Five case studies are presented in the thesis, containing: 1. Two primary care facilities; 2. Three secondary care facilities; These cases were developed as a result of studying the internal processes, decision and support paths applied individually in the NHS. The research approach adopts qualitative and interpretative analysis that includes longitudinal case studies. This multiple case study approach has an embedded design incorporating the components of work business processes as subunits to enhance insight. Data was collected predominantly from interviews supported by archive material, documents, and direct observation. Overlapping cross case, and within case analysis was undertaken, using Activity Records, Strategic Choice Analysis, and concepts supported by various researchers in the past (Avgerou & Cornford, 1993; Davenport, 1993; Eisenhardt, 1989; Galliers, 1991). While it might be possible for similar processes to result in different solution when adopted in another research context, in these seven cases quite different approaches were taken. The Thesis concludes that while the core processes were the same across the cases, the following issues combined together to lead to quite different approaches in each case: 1. The detail of the IS strategic processes; 2. The variation in the contexts; 3. The logic of the decision process as they evolved; and 4. The view of the actors involved. The researcher is of a strong belief that as time progresses and experience is gained and the situation with NPfIT evolves, the various actors would change their views towards IS strategy. This could result in changes in the overall NHS IS business model and healthcare delivery process support. This assumption, however, could be affected by the appearance of very little transfer of knowledge—across different parts of the NHS—regarding past experience with IS implementation. The author argues that NPfIT mainly serves to diffuse information and communication technologies in the NHS. As a result the NPfIT is changing the way by which the NHS competes and meets the needs of it patients, the business model and the value-creating processes. New opportunities are also taking place introducing new healthcare delivery processes and modifying the existing processes