Developing an inclusive and balanced approach to the implementation of (mental health) information systems : a critique of the theory and practice dialectic of systems implementation
There is substantial evidence concerning the inability to achieve desired results and impact through what are commonly described as IS or IT projects, or implementation. The UK health sector provides a fertile ground for research, at a time of unprecedented investment, but with what is perceived to be a relatively poor record of achievement. Mental health services are held to be particularly problematic. This thesis explores the part played by technical, informational, organisational and human aspects, the relationship between these, and how in practice they are interpreted within what is defined as IS implementation. The aims were, a) definitional, concerning the specification of IS implementation, b) context appraising, to examine the impact of the host (mental health) context on both process and results, and through these c) problem solving, to propose an approach to IS implementation based on theory and practice. Drawing from interpretive theory, soft systems methodology and social cognitive theory an in-depth, longitudinal comparison study was performed, principally focussing on a single UK mental health Trust, and a directorate within that Trust. A multi-method approach included document review, questionnaire, structured and semi-structured interview, definitional exercises, focus groups, and action research. Findings concern the inability of organisations to manage the complexity of the process of implementation within challenging, multi-faceted contexts. To address the causes rather than symptoms of this difficulty it is necessary to re-interpret implementation itself, and its human element. A broad definition was proposed as a basis for an inclusive and balanced approach, and an Interface Management toolkit was produced. It is proposed that implementation should be considered and approached in practice as a dialectical situation, interpreting implementation as change within an organisation which encompasses technology. Alternative existing and proposed ideologies of change are suggested to frame a productive relationship between theory and practice.