David Finnegan

The policy‐practice nexus of electronic health records adoption in the UK NHS: An institutional analysis

Purpose – This paper seeks to report the findings from a seven‐year study on the UK National Health Service on the introduction of an electronic health record for 50 million citizens. It explores the relationship between policy and practice in the introduction of a large‐scale national ICT programme at an estimated value of £12.4bn.Design/methodology/approach – Using a longitudinal research method, data are collected on the policy‐practice nexus. The paper applies institutional theory using a conceptual model by Tolbert and Zucker on the component processes of institutionalisation.Findings – The findings suggest that institutional forces act as a driver and an inhibitor to introducing enabling technologies in the health‐care environment. A process analysis shows that, as electronic health records force disruptive change on clinicians, healthcare managers and patients, culturally embedded norms, values and behavioural patterns serve to impede the implementation process.Research limitations/implications – T...

Knowledge sharing issues in the introduction of a new technology

Purpose – This exploratory case study research aims to apply a processual analysis to the implementation of a customer relationship management (CRM) system from a knowledge management perspective to a contemporary (1999‐2004) situation within a UK city council. The paper seeks to place a specific focus on areas neglected in previous CRM studies – sub‐cultures, psychological contracts, how tacit knowledge is surfaced and transferred, and with what effects on implementation.Design/methodology/approach – The paper investigates how the system stakeholders and the information system (IS) itself evolved through encountering barriers, sharing knowledge, finding new uses, inventing work‐arounds.Findings – A rich picture emerges of sub‐cultural silos of knowledge linked with psychological contracts and power‐based relationships influencing and inhibiting adoption and acceptance of the CRM system.Originality/value – This case study research provides useful information on the implementation of a CRM system from a kn...

‘For the Greater Glory’: Irish Jesuit Letters and the Irish Counter-Reformation, 1598–1626

The historical myth persists that the Irish Jesuits were the critical force in defining the Irish Counter-Reformation and that until the establishment of a permanent Jesuit mission in Ireland in 1598, Irish Catholicism at best remained hidebound and at worst in danger of succumbing to Protestantism. This perception arises from the correspondence of the Irish Jesuits with their Generals on the continent, and in particular with Claudio Aquaviva, General between 1581 and 1615. From the moment the Irish mission was recommenced in 1598 its members were aware that to survive it was critical to persuade their General to support them given that they had no means of training men in Ireland owing to their poverty and government harassment. After 1604, under its recently arrived Superior, Christopher Holywood, the mission’s correspondence was increasingly devoted to that purpose, and claims of gains made in the face of almost insuperable difficulties became ever more strident. This essay seeks to show that the correspondence of the Irish Jesuits often exaggerated their achievements, claimed those of others for themselves or ignored the work of other clergymen completely and that Irish historians have, to a large extent, accepted these claims without thorough investigation of the sources.

A Centrist Approach to Introducing ICT in Healthcare: Policies, Practices, and Pitfalls

The challenge to provide a nation-wide healthcare service continues unabated in the 21st century as politicians and managers drive through policies to modernize the UK National Health Service (NHS). Established around 60 years ago to offer free healthcare at the point of delivery to all citizens, the NHS now accounts for the largest portion of public expenditure after social security, with total spending around £84 billion in 2006/2007. Over the past 3 decades, the political agenda within healthcare has moved from one of professional dominance, where clinicians and their representative bodies dominated the leadership and management of healthcare organisations, to one where politicians have imposed new ideas in the form of market mechanisms and the “new public management†which extend the use of private sector firms. The political justification for these reforms is to make the NHS more efficient and cost effective and to develop an ethos of patient choice.