PriceEtAl_NHS_25Years_FinalSubmission.pdf (1.03 MB)
Twenty-five years of national health information technology: the implication of structure on IT strategy in the NHS in England
journal contribution
posted on 2019-02-07, 09:28 authored by C Price, W Green, O SuhomlinovaObjective
There is global interest in implementing national information systems to support healthcare, and the National Health Service in England (NHS) has a troubled 25-year history in this sphere. Our objective was to chronicle structural reorganizations within the NHS from 1973 to 2017, alongside concurrent national information technology (IT) strategies, as the basis for developing a conceptual model to aid understanding of the organizational factors involved.
Materials and Methods
We undertook an exploratory, retrospective longitudinal case study by reviewing strategic plans, legislation, and health policy documents, and constructed schemata for evolving structure and strategy. Literature on multi-organizational forms, complexity, national-level health IT implementations, and mega-projects was reviewed to identify factors that mapped to the schemata. Guided by strong structuration theory, these factors were superimposed on a simplified structural schema to create the conceptual model.
Results
Against a background of frequent NHS reorganizations, there has been a logical and emergent NHS IT strategy focusing progressively on technical and data standards, connectivity, applications, and consolidation. The NHS has a complex and hierarchical multi-organization form in which restructuring may impact a range of intra- and inter-organizational factors.
Discussion
NHS-wide IT programs have generally failed to meet expectations, though evaluations have usually overlooked longer-term progress. Realizing a long-term health IT strategy may be impeded by volatility of the implementation environment as organizational structures and relationships change. Key factors influencing the strategy–structure dyad can be superimposed on the tiered NHS structure to facilitate analysis of their impact.
Conclusion
Alignment between incremental health IT strategy and dynamic structure is an under-researched area. Lessons from organizational studies and the management of mega-projects may help in understanding some of the ongoing challenges.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
History
Citation
Journal of the American Medical Informatics Association, Volume 26, Issue 3, 1 March 2019, Pages 188–197Author affiliation
/Organisation/COLLEGE OF SOCIAL SCIENCES, ARTS AND HUMANITIES/School of BusinessVersion
- AM (Accepted Manuscript)