Editor—Littlejohns et al describe a failed attempt to implement a computerised information system among 42 hospitals in the Limpopo province of South Africa. They provide a typology of possible reasons for this failure, retrospectively summarising the lessons learnt.1
Implementing an information system can be viewed as an organisational innovation process that contributes to the maintenance and improvement of its overall performance and effectiveness.2 Some users may find themselves in a greater position of power and influence with the introduction of access to previously impenetrable organisational information, while others who have traditionally enjoyed legitimate power may find their power eroded by the innovation. If this potential problem is not dealt with during the implementation process, these people could militate against the process through incomplete implementation, rejection, or even sabotage.3
Littlejohns et al also viewed implementation as a clinical intervention and used randomised controlled trials of users as their study method to evaluate the system's effectiveness. Given that innovation implementation is a complex, longitudinal process entailing phases that evolve over time and comprise many layers of social interactions,4 this positivist research strategy seems misguided. Organisational learning and progressive user empowerment need to be accounted for in any information system evaluative framework in which both the user and the innovation are fluid and evolving. Real success may be achieved by iteratively recognising and accounting for the changes in human factors in organisations that arise during implementation. These include redistribution of responsibility, alteration in management structures, and changes in attitudes.3 Success also requires accounting for these phenomena in the chosen study methods.
Thus, innovation process theory for examining implementation of information systems is particularly relevant to understanding the relation between inputs to and outputs from the system, including the actions of key stakeholders and their collective effects on overall organisational change.5
See also editorial by Booth
Competing interests: None declared.
References
- 1.Littlejohns P, Wyatt JC, Garvican L. Evaluating computerised health information systems: hard lessons still to be learnt. BMJ 2003;326: 860-3. (19 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Damanpour F. Organizational innovation: a meta-analysis of effects of determinants and moderators. Acad Manage J 1991;34: 555-90. [Google Scholar]
- 3.Linton JD. Implementation research: state of the art and future directions. Technovation 2002;22: 65-79. [Google Scholar]
- 4.Dobbins M, Cockerill R, Barnsley J, Ciliska D. Factors of the innovation, organization, environment, and individual that predict the influence five systematic reviews had on public health decisions. Int J Technol Assess Health Care 2001;17: 467-78. [PubMed] [Google Scholar]
- 5.Kaplan B. Models of change and information systems research. In: Nissen H-E, Klein HK, Hirschheim R, eds. Information systems research: contemporary approaches and emergent traditions. Amsterdam: Elsevier Science, 1991: 593-611.