Clinical Informatics

Information System Failures and the NHS


  1. Introduction and Context of Information Systems Failure at large and in the NHS

  2. The Definition of Information System Failure

  3. The causes of Information System Failure

    1. Pre-implementation
    2. During Implementation
    3. Post-implementatio

  4. Managing Individual and Organisational Change

  5. Conclusions

  6. References

Managing Individual and Organisational Change

Individual change:

Human issues like attitudes towards change are also important. By default, human nature prefers to remain in the status quo; even if there are rational benefits for change. To quote Mark Twain, "It’s not the progress I mind, it’s the change I don’t like".

Change often involves a sense of "lost" for the individual. This can be in terms of a routine or even the threat of losing their job and only source of livelihood. Furthermore, although there may be acknowledged long term gain, there may also be initial short-term sacrifices to be made by the same individual.

On the other hand, human beings like to " feel responsible" for a job well done. They take pride in their work and like to feel a "sense of belonging", especially to a high quality enterprise (12). The feeling of a "sense of control" in their work is also very important

Hence, in order to manage change successfully, one needs to create the conditions that facilitate change. One needs to make the individual feel "safe" and "motivated" to change.

The "push" and "pull" factors above-mentioned can be analysed by using the Kurt Lewins field theory and force field diagram. By identifying and removing the opposing factors to change, one can then focus on factors that may motivate the individual towards change. (i.e. "pull" rather than "push") (14)

This concept of utilising pull rather than push is important because "people do not necessary resist change automatically; however, many people do resist being changed (i.e. having change imposed on them)" (12)

Organisational change:

Organisations may also behave like individuals and have their own inertia and characters. Tribalism, individualism and conservatism are some of these aspects that have been reported in a study within an NHS hospital.

Although tribalism may be an inherent characteristic resulting from different groups coming together to work in an organisation, excessiveness of this trait may lead to animosity between different groups and lead to anarchy within the organisation.

Individualism has been reported to arise as a result of professional isolation and age-old class and status social separations. Conservatism is again an innate characteristic that has arisen from the bureaucratic nature of professional organisation. Information Technology enables order and efficiency, the reason for its existence in the first place. However, in the extreme, it can also be an effective obstacle to change.

Top down hierarchical management structures cannot deal with these problems. Instead of enforcing "oneness", one needs to allow "pluralistic integration" and the formation of a " federal community".

This leads to the concept of horizontal networked relationships where a "unified diversity" is formed by embracing diverse pictures within a unifying frame.

Co-operation then does not rely on altruism or attrition, but on the fact that the "costs of not engaging is greater" (15). Engagement and collaboration would be the norm instead of the exception. " Openness to change" would be an unintended consequence in this model.

Finally, the implementation of Information Systems can also be viewed from the "model approach". This model puts forth the idea that any human organisation will inevitably contain human culture and politics, as these are the things that binds the working groups together.

As such, the Information Systems, the Clinical work and the organisation of medicine and health care system (i.e. the NHS) are all closely interlinked and can be seen as part of a bigger jigsaw puzzle.

Therefore each piece must complement and interact with the other two along the concept of "effective fit" in order to be able to produce the best results. Change in any one domain would automatically affect the other two domains. In essence, they " evolve together" and hence, must be addressed as a whole.

The model also stresses that change is a learning process in such a dynamic setting like the NHS, where there is no clear beginning or end.

Therefore, the most important aspect prior to change is to create a "responsive mindset" in the user (16).


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Page Updated: 17 May, 2017

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