A study of the factors influencing the successful development, implementation and operation of Community Information Systems in the NHS
The factors that influence the ultimate level of success or failure of systems development projects have received considerable attention in the academic literature. Two particularly significant areas of interest have been the importance of applying best practice during systems development and the need to explicitly consider organisational issues to ensure a positive organisational impact. However, despite the existence of a well developed best practice literature and an emergent organisational issues literature, many projects still fail. The record of the NHS has been particularly poor in terms of the successful development and implementation of information systems and it was thought that this area would provide a fertile domain for information system research. Whilst the use of information systems in community healthcare has increased greatly over the last ten years the majority of existing research has been conducted in acute hospital environments with little attention devoted to the community sector. Consequently, this research project has two main aims: To identify the key best practice variables and areas of organisational impact associated with the development, implementation and use of a Community Information System (CIS) in National Health Service Trusts; and to examine the relationships between these two sets of variables and the system's resultant level of effectiveness. This research project has a number of positive methodological attributes in that it studies a homogenous organisational sector using a common type of information system and so minimises the potentially confounding influences of sector and system. In addition, the research design involves a three stage approach, combining both quantitative and qualitative research approaches. The research project has produced several key findings. A positive relationship was identified between the adoption of best practice and system effectiveness and similarly, there was a positive relationship between the level of organisational impact and system effectiveness. In order to ensure a positive organisational impact it was found that the successful treatment of key organisational issues is required. In addition, two new variables have been identified, user ownership and positive user attitudes, that play an important mediating role in ensuring system effectiveness. Finally, it was also recognised that the adoption of best practice variables had a dual role, directly influencing the level of perceived system effectiveness but also as a method of effectively managing organisational issues, user ownership and user attitudes. In summary, this study has emphasised the importance of adopting best practice and assessing and managing organisational impact during a community information system development project to ensure system success. These results will be of particular interest to practising IM&T Managers in the NHS and to the wider academic community. A series of practical recommendations are presented at the end of the thesis.