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dc.contributor.authorPrice, Colin-
dc.contributor.authorGreen, William-
dc.contributor.authorSuhomlinova, Olga-
dc.identifier.citationJournal of the American Medical Informatics Association, 2019, 26(3), pp. 188–197en
dc.description.abstractObjective: There is global interest in implementing national information systems to support healthcare, and the National Health Service in England (NHS) has a troubled 25-year history in this sphere. Our objective was to chronicle structural reorganizations within the NHS from 1973 to 2017, alongside concurrent national information technology (IT) strategies, as the basis for developing a conceptual model to aid understanding of the organizational factors involved. Materials and Methods: We undertook an exploratory, retrospective longitudinal case study by reviewing strategic plans, legislation, and health policy documents, and constructed schemata for evolving structure and strategy. Literature on multi-organizational forms, complexity, national-level health IT implementations, and mega-projects was reviewed to identify factors that mapped to the schemata. Guided by strong structuration theory, these factors were superimposed on a simplified structural schema to create the conceptual model. Results: Against a background of frequent NHS reorganizations, there has been a logical and emergent NHS IT strategy focusing progressively on technical and data standards, connectivity, applications, and consolidation. The NHS has a complex and hierarchical multi-organization form in which restructuring may impact a range of intra- and inter-organizational factors. Discussion: NHS-wide IT programs have generally failed to meet expectations, though evaluations have usually overlooked longer-term progress. Realizing a long-term health IT strategy may be impeded by volatility of the implementation environment as organizational structures and relationships change. Key factors influencing the strategy-structure dyad can be superimposed on the tiered NHS structure to facilitate analysis of their impact. Conclusion: Alignment between incremental health IT strategy and dynamic structure is an under-researched area. Lessons from organizational studies and the management of mega-projects may help in understanding some of the ongoing challenges.en
dc.publisherOxford University Press (OUP) for American Medical Informatics Association (AMIA)en
dc.rightsCopyright © the authors, 2018. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-commercial License (, which permits unrestricted use, distribution, and reproduction in any medium non-commercially, provided the original author and source are credited.en
dc.subjectNational Health Programsen
dc.subjectUnited Kingdomen
dc.subjecthealth information systemsen
dc.subjectorganization structureen
dc.titleTwenty-five years of national health IT: exploring strategy, structure, and systems in the English NHS.en
dc.typeJournal Articleen
dc.description.versionPublisher Versionen
dc.type.subtypeJournal Article-
pubs.organisational-group/Organisation/COLLEGE OF SOCIAL SCIENCES, ARTS AND HUMANITIESen
pubs.organisational-group/Organisation/COLLEGE OF SOCIAL SCIENCES, ARTS AND HUMANITIES/School of Businessen
Appears in Collections:Published Articles, School of Management

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