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Title: Evaluating the implementation of case mix in the National Health Service: a grounded theory approach
Author: Barnes, Stuart John
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 1998
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Information systems (IS) and information technology (IT) failures appear to consistently make headline news in the media and to be a topic of discussion in the IS literature. In the UK, and untill very recently, such problems have largely focused upon organisations in the private sector. However, during the last decade, the public sector has been the subject of wide-ranging reforms involving the introduction of competitive practices, and significantly, the introduction of IS and IT to aid in this task. Many of these new developments have encountered problems. Included within this new area of IS implementation, we find systems associated with the NHS Resource Management Initiative (RMI), particularly the Case Mix system which is at the centre of the project. The Initiative revolves around cultural and structural change, and the provision of relevant information for clinical and management audit to support these purposes: to this end, Case Mix provides a tool for collecting and analysing data from all areas of hospital operations. However, the RMI Case Mix development has received very little attention in the IS literature, particularly with respect to the determinants of Case Mix project outcomes. An examination of existing theories concerning IS implementation reveals inadequacy, both in general, and in specific application to Case Mix. For example, it is apparent that numerous theories are linear and simplistic, or in many instances are too general to be of any real value other than as a very loose frame of reference. In short, they tend to lack sufficient attention to the process and context of implementation. In addition, there is evidence that the evaluation of systems is not being approached in a way that reflects stakeholders i!l an organisation. This thesis aims to tackle these problems by examining the introduction of Case Mix in four hospitals, using an approach adapted to overcome many of the criticisms voiced above: that of grounded theory. It aims to identify the context and processes oflS development which consequently affect project outcomes. However, the methodology integrates another contemporary technique of phenomenological analysis, that of cause mapping, reconciling the differences in the approaches, and building on the strengths of each. Together with such qualitative data, which are analysed using the assistance of specialist computer software, some quantitative data are also integrated via a survey. The result is a combination of interpreted cause map data and quantitative construct data. The results are very positive: the approach appears an excellent way of tackling research into this area, providing a detailed insight into the introduction of Case Mix and the subsequent outcomes of this new development. Among these results, in addition to the novel methodology for this type of research, a framework and a number of interesting findings were produced. The framework and findings suggest that in order to more fully account for experiences and outcomes related to Case Mix in hospitals, one should reflect upon overarching context, the behaviour of key individuals, the process pursued by the organisation, and the degree to which an IS project is localised, particularly via its evaluation and objectives. Similarly, in practitioner terms, hospitals are more likely to receive favourable outcomes if they understand that managing Case Mix requires attention to process and context, and not merely the importance of technology per se. The study concludes that more research is needed into Case Mix, and similar developments, and suggests that the mode of investigation pursued in this thesis could be productively employed elsewhere.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available