Driving digital health transformation in hospitals: a formative qualitative evaluation of the English Global Digital Exemplar programme

BackgroundThere is currently a strong drive internationally towards creating digitally advanced healthcare systems through coordinated efforts at a national level. The English Global Digital Exemplar (GDE) programme is a large-scale national health information technology change programme aiming to promote digitally-enabled transformation in secondary healthcare provider organisations by supporting relatively digitally mature provider organisations to become international centres of excellence.AimTo qualitatively evaluate the impact of the GDE programme in promoting digital transformation in provider organisations that took part in the programme.MethodsWe conducted a series of in-depth case studies in 12 purposively selected provider organisations and a further 24 wider case studies of the remaining organisations participating in the GDE programme. Data collected included 628 interviews, non-participant observations of 190 meetings and workshops and analysis of 9 documents. We used thematic analysis aided by NVivo software and drew on sociotechnical theory to analyse the data.ResultsWe found the GDE programme accelerated digital transformation within participating provider organisations. This acceleration was triggered by: (1) dedicated funding and the associated requirement for matched internal funding, which in turn helped to prioritise digital transformation locally; (2) governance requirements put in place by the programme that helped strengthen existing local governance and project management structures and supported the emergence of a cadre of clinical health informatics leaders locally; and (3) reputational benefits associated with being recognised as a centre of digital excellence, which facilitated organisational buy-in for digital transformation and increased negotiating power with vendors.ConclusionThe GDE programme has been successful in accelerating digital transformation in participating provider organisations. Large-scale digital transformation programmes in healthcare can stimulate local progress through protected funding, putting in place governance structures and leveraging reputational benefits for participating provider organisations, around a coherent vision of transformation.

Enterprise Systems, Power and Improvisation

Enterprise systems (ES) have been extensively procured in large organizations but much research fails to develop sociotechnically informed approaches that facilitate their implementation whilst understanding the impact of integrated technology on professional working practices within complex organizational environments. This chapter takes a critically informed sociotechnical approach to power and improvisation in ES implementation. The contribution is a combined “circuits of power-improvisation” (CPI) framework which can facilitate a better understanding of ES implementation, sociotechnical theory, and practice. Practical lessons learned from the study may potentially be used to avoid some of the problems experienced with the over-zealous and rapid introduction of digital technologies into university organizations where the risk is that they become a student mass production system. It highlights the important role of power and improvisation, enabled and afforded by new digital technologies, in what may be misrepresented as planned strategic and deliberate organizational change.

School-based telemedicine: Perceptions about a telemedicine model of care

In New Zealand, a store-and-forward telemedicine programme is implemented in schools to address common health conditions. This study aimed to investigate perceptions of the non-clinical school staff involved on this telemedicine model of care. Interviews and analysis were framed by sociotechnical theory under constructs of identities, affiliations, interactions and environments. Findings show that telemedicine aligned with identities of staff as carers. Affiliations via close relationships with children and community support enabled the programme. Delivering telemedicine enhanced interactions with children. Environments related to practices and physical characteristics of the school were viewed as constrainers and enablers for delivery. School-based telemedicine delivered by school staff is perceived as an acceptable model of care. Benefits include empowerment, school cohesion and potential improvement in health literacy, with no major issues perceived. Telemedicine may be effective for treating common health conditions in school children, with potential for community members to be involved in health care.

Enterprise Systems, Power and Improvisation

Enterprise systems (ES) have been extensively procured in large organizations but much research fails to develop sociotechnically informed approaches that facilitate their implementation whilst understanding the impact of integrated technology on professional working practices within complex organizational environments. This chapter takes a critically informed sociotechnical approach to power and improvisation in ES implementation. The contribution is a combined “circuits of power-improvisation” (CPI) framework which can facilitate a better understanding of ES implementation, sociotechnical theory, and practice. Practical lessons learned from the study may potentially be used to avoid some of the problems experienced with the over-zealous and rapid introduction of digital technologies into university organizations where the risk is that they become a student mass production system. It highlights the important role of power and improvisation, enabled and afforded by new digital technologies, in what may be misrepresented as planned strategic and deliberate organizational change.

Putting a band-aid on a wooden leg

Purpose Decentralisation attempts that aim to increase job autonomy do not always succeed. This paper aims to study to what extent the tendency to maintain existing operational task divisions is an important explanation for this lack of success. Design/methodology/approach In total, 456 employees in 25 organisations participated in a cross-sectional intervention study. Each employee filled out a questionnaire on job autonomy both before and after the decentralisation process, in which all organisations shifted regulatory, preparatory and supportive tasks to the lowest organisational level. Findings This study found small, but significant, effects of decentralisation attempts on job autonomy. The size of the effects, however, depended on the way the way in which the operational tasks were divided. Simultaneously, larger effects were found for organisations which decentralised tasks and changed the way operational tasks were divided. Both findings reached the conclusion that although decentralisation attempts seemed important for increasing job autonomy, the way in which the operational tasks were divided and even changed, was at least as important for a successful decentralisation process. Originality/value After decades of research on modern sociotechnical theory, this study is the first to show that decentralisation attempts do not merely increase job autonomy. The effect of such attempts depends on the way in which operational tasks are divided in organisations.

Enterprise Systems Adoption

Enterprise wide integrated systems (ES) have been extensively procured in large organizations but much research fails to develop sociotechnically informed approaches that facilitate their implementation within complex organizational environments. In this paper the authors take a critically informed sociotechnical approach to power and improvisation in ES implementation. A review and synthesis of the pertinent literature, has led to the development of an analytical framework. This framework has been used to explore these concepts through a longitudinal, ethnographic study of an ES within a UK university. The contribution of this paper is a combined ‘circuits of power-improvisation' (CPI) framework which can facilitate a better understanding of ES implementation, sociotechnical theory and practice. Lessons learnt from the study may potentially be used to avoid some of the problems experienced due to the lack of recognition of the important role of power and improvisation in what may be misrepresented as planned strategic and deliberate organizational change.

Aligning the Virtual with the Physical

Social media need to be understood as more than engagement tools as they also impact an organization's internal systems. This chapter analyzes how the Cummer Museum of Art and Gardens (The Cummer), a medium-sized museum in Jacksonville, Florida, continues to adapt to both environmental and technical changes to successfully utilize social media, how it has overcome some obstacles, and the challenges it still faces. Using sociotechnical theory as a framework, the intersection of the museum's technical, social, and behavioral systems are brought to the fore to better understand the strategic changes the museum had to undergo to better utilize social media tools to align with its mission. A key component of effective social media use for The Cummer has been its ability to adapt its policies and procedures for online engagement through integration of its online and offline systems, so that online media align with off-line messaging and the dynamic changes in the technological platforms.

Competitive Intelligence in the Enterprise

Due to increasing challenges, as well as competitiveness, many organisations have sought advantaging and beneficiary techniques and options. One of those options is through Competitive Intelligence (CI) products, which some organisations have come to rely upon for sustainability and competitive advantage. Unfortunately, and to some degree, fortunately, there are different CI products which organisations could choose from. The products are supposed to be selected and deployed based on organizational requirements from both technical and business perspectives. Some organisations deploy more than one competitive intelligence product. Others are not guided, and do not understand the essence of the deployment, regarding achieving the organisational objectives. The fortunate and unfortunate situations which occur in the deployment of CI products in organisations are drawn from relationships amongst stakeholders in the selection and implementation processes. The relationships are manifested from control of sources which use the power for decision making. The relationships emanate from the fact that there are no proper comparisons of the products, driven by requirements. As a result, the organisations are faced and challenged with duplication and waste of resources. They struggle to determine their competitive advantage. This situation further manifests the complexity of technical and business artefacts. Case study research was conducted to understand how CI products are deployed in the organisation. A sociotechnical theory, actor-network theory was employed in the analysis of the data, primarily to examine and understand how control of resources for power defined and shaped relationships.