Power and politics in a system implementation

The central concern of this study is to identify the role of power and politics in systems implementation. The current literature on systems implementation is typically divided into two areas, process modelling and factor based studies. Process modelling classifies the implementation into a linear process, whereas factor based studies have argued that in order to ‘successfully’ implement a system, particular critical factors are required. This literature misses the complexities involved in systems implementation through the human factors and political nature of systems implementation and is simplistic in its nature and essentially de-contextualises the implementation process. Literature has investigated some aspects of human factors in systems implementation. However, it is believed that these studies have taken a simplistic view of power and politics. It is argued in this thesis that human factors in systems implementation are constantly changing and essentially operating in a dynamic relationship affecting the implementation process. The concept of power relations, as proposed by Foucault (1976, 1977, 1978, 1980, 1982), have been utilised in order to identify the dynamic nature of power and politics. Foucault (1978) argued that power is a dynamic set of relationships constantly changing from one point in time to the next. It is this recognition that is lacking from information systems. Furthermore, these power relations are created through the use of discourse. Discourse represents meaning and social relationships, forming both subjectivity and power relations. Discourses are also the practices of talk, text and argument that continuously form that which actors speak. A post-structuralist view of power as both an obvious and hidden concept has provided the researcher a lens through which the selection and implementation of an enterprise-wide learning management system can be observed. The framework aimed to identify the obvious process of system selection implementation, and then deconstruct that process to expose the hegemonic nature of policy, the reproduction of organisational culture, the emancipation within discourse, and the nature of resistance and power relations. A critical case study of the selection and implementation of an enterprise-wide learning management system at the University of Australia was presented providing an in-depth investigation of the implementation of an enterprise-wide learning management system, spanning five years. This critical case study was analysed using social dramas to distinguish between the front stage issues of power and the hidden discourses underpinning the front stage dramas. The enterprise-wide learning management system implemented in the University of Australia in 2003 is a system which enables academic staff to manage learners, the students, by keeping track of their progress and performance across all types of training activities. Through telling the story of the selection and implementation of an enterprise-wide learning management system at the University of Australia discourses emerged. The key findings from this study have indicated that the system selection and implementation works at two levels. The low level is the selection and implementation process, which operates for the period of the project. The high level is the arena of power and politics, which runs simultaneously to the selection and implementation process. Challenges for power are acted out in the front stage, or public forums between various actors. The social dramas, as they have been described here, are superfluous to the discourse underpinning the front stage. It is the discourse that remains the same throughout the system selection and implementation process, but it is through various social dramas that reflect those discourses. Furthermore, the enactment of policy legitimises power and establishes the discourse, limiting resistance. Additionally, this research has identified the role of the ‘State’ and its influence at the organisational level, which had been previously suggested in education literature (Ball, 1990).

History of contact and change in the Goroka Valley, Central Highlands of New Guinea, 1934-1949

The thesis traces the interaction of the Goroka Valley people with European and coastal New Guinean intruders during the pacification stage of contact and change. In this 15 year period the people moved from a traditional subsistence culture to the threshold of a modern, European-influenced technological society. The contact experiences of the inhabitants of the Valley and the outsiders who influenced them are examined, using both oral and documentary sources. A central theme of this study is the attempts by Europeans and their coastal New Guinean collaborators to achieve the pacification of a people for whom warfare has been described as 'the dominant orientation'. The newcomers saw pacification as being inextricably linked with social, economic and religious transformation, and consequently it was pursued by patrol officers, missionaries and soldiers alike. Following an introductory chapter outlining the pre-contact and early-contact history of the Goroka Valley people, there is a discussion of the causes of tribal fighting in Highlands communities and two case studies of violent events which, although occurring beyond the Goroka Valley, had important consequences for those who lived within its bounds. The focus then shifts to the first permanent settlement of the agents of change -initially these were coastal New Guinean evangelists and policemen - and their impact on the local people. A period of consolidation is then described, as both government and missions established a permanent 'European presence in the Valley'. This period was characterised by vigorous pacification coupled with the introduction of innovations in health and education, agriculture, technology, law and religion. The gradual transformation of Goroka Valley society as a result of the people's interaction with the newcomers was abruptly accelerated in 1943, when many hundreds of Allied soldiers occupied the Valley in anticipation of a threatened Japanese invasion. Village life was disrupted as men were conscripted as carriers and labourers and whole communities were obliged to grow food to assist the Allied war effort. Those living close to military airfields-and camps were subject to Japanese aerial attacks and the entire population was exposed to an epidemic of bacillary dysentery introduced by the combatants. However the War also brought some positive effects, including paradoxically, the almost total cessation of tribal fighting, the construction of an ail-weather airstrip at Goroka which ensured its future as a town and administrative and commercial centre, and the compulsory growing of vegetables, coffee, etc, which laid the foundations for a cash economy and material prosperity. The final chapter examines the aftermath of military occupation, the return of civil administration and the implementation of social and economic policies which brought the Goroka Valley people into the rapid-development phase of contact. By 1949 Gorokans were ready to channel their aggressive energies into commercial competitiveness and adopt a cash-crop economy, to accept the European rule of law, to take advantage of Western innovations in medicine, education, transport and communications, to seek employment opportunities at home and in other parts of the country and to modify their primal world view with European religious and secular values. A Stone Age people was in process of being transformed into a modern society.

Implementation of student active learning in primary mathematics in Indonesia

Twenty years after the first pilot projects began to develop Student Active Learning (SAL) in Indonesia, and four years since it was adopted for use in the last provinces, this research investigates the implementation of Student Active Learning in Indonesian primary mathematics classrooms. A study of the relevant literature indicates that teaching based on constructivist principles is unlikely to be implemented well in mathematics classrooms unless there are high quality teachers, readily available manipulative materials, and a supportive learning environment. As Indonesian schools often lack one or more of these aspects, it seemed likely that Student Active Learning principles might not be ‘fully’ implemented in Indonesian primary mathematics classrooms. Thus a smaller scale, parallel study was carried out in Australian schools where there is no policy of Student Active Learning, but where its underlying principles are compatible with the stated views about learning and teaching mathematics. The study employed a qualitative interpretive methodology. Sixteen primary teachers from four urban and four rural Indonesian schools and four teachers from two Victorian schools were observed for four mathematics lessons each. The twenty teachers, as well as fourteen Indonesian headteachers and other education professionals, were interviewed in order to establish links between the background and beliefs of participants, and their implementation of Student Active Learning. Information on perceived constraints on the implementation of SAL was also sought. The results of this study suggest that Student Active learning has been implemented at four levels in Indonesian primary mathematics classrooms, ranging from essentially no implementation to a relatively high level of implementation, with an even higher level of implementation in three of the four Australian classrooms observed. Indonesian teachers, headteachers and supervisors hold a range of views of SAL and also of mathematics learning and teaching. These views largely depended on their in-service training in SAL and, more particularly, on their participation in the PEQIP project Typically, participants’ expressed views of SAL were at the same or higher level as their views of mathematics learning and teaching, with a similar pattern being observed in the relationship between these latter views and their implementation of SAL principles. Three factors were identified as influencing teacher change in terms of implementation of SAL: policy, curricular and organisational, and attitudes. Recommendations arising from this study include the adoption of reflection as an underlying principle in the theory of SAL, the continuation and extension of PEQIP type projects, changes in government policy on curriculum coverage and pre-service teacher training, and more support for teachers at the school and local authority levels.

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

Background

Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore.
Methods

Nurses were surveyed to identify their perceptions regarding barriers to implementation of clinical practice guidelines in their practice setting. The validated questionnaire, 'Barriers and facilitators assessment instrument', was administered to nurses (n = 1830) working in the medical, surgical, geriatric units, at five acute care hospitals in Singapore.
Results

An 80.2% response rate was achieved. The greatest barriers to implementation of clinical practice guidelines reported included: knowledge and motivation, availability of support staff, access to facilities, health status of patients, and, education of staff and patients.
Conclusion

Numerous barriers to the use of the Fall Prevention Clinical Practice Guideline have been identified. This study has laid the foundation for further research into implementation of clinical practice guidelines in Singapore by identifying barriers to change in acute care settings.

The introduction, management and assessment of change process at Barwon Water, a technology based water authority

Covers managing change through a multifunctional change model linking a corporate strategy, longitudinal and cross organisational strategic drivers to a suite of change processes integrated synergistically to optimise customer service and business efficiency. Testing, analysis and benchmarking provide conclusions about the utility of the model and implementation strategies, change objective attainment, the strategic focus, learning outcomes and output achievement efficiency.

Corporate intranet implementation : managing emergent technologies and organizational practices

This paper examines the adoption and development of intranets in large business organizations. The authors demonstrate that intranet technology introduces a host of new managerial and technical challenges and requires new approaches to IS development. Evidence from two European corporations indicates that the traditional division of labor and definition of work roles in IS development breaks down. The distinction between developers and users becomes increasingly blurred and new organizational roles and structures associated with intranets are emerging. However, ready-made organizational models for implementing and managing intranets do not exist and the two organizations in this study have followed two different approaches. One organization favors a “planned change” approach, emphasizing management control and careful planning. The other organization prefers an “improvisational” approach, emphasizing experimentation, innovation and local initiative.

Droughts, floods and freshwater ecosystems : evaluating climate change impacts and developing adaptation strategies

Climate change is expected to have significant impacts on hydrologic regimes and freshwater ecosystems, and yet few basins have adequate numerical models to guide the development of freshwater climate adaptation strategies. Such strategies can build on existing freshwater conservation activities, and incorporate predicted climate change impacts. We illustrate this concept with three case studies. In the Upper Klamath Basin of the western USA, a shift in land management practices would buffer this landscape from a declining snowpack. In the Murray–Darling Basin of south-eastern Australia, identifying the requirements of flood-dependent natural values would better inform the delivery of environmental water in response to reduced runoff and less water. In the Savannah Basin of the south-eastern USA, dam managers are considering technological and engineering upgrades in response to more severe floods and droughts, which would also improve the implementation of recommended environmental flows. Even though the three case studies are in different landscapes, they all contain significant freshwater biodiversity values. These values are threatened by water allocation problems that will be exacerbated by climate change, and yet all provide opportunities for the development of effective climate adaptation strategies.

Environmental sustainability change management in SMEs : learning from sustainability champions

This study identifies the change management processes involved in undertaking environmental sustainability (ES) initiatives within Small and Medium Size Enterprises (SMEs) and relate these to the main attributes of learning organisations. Using case study techniques, the study draws from the change management experiences of a sample of 12 ES champions in different industries. The findings suggest that the ES champions experience four distinct change management stages in undertaking ES initiatives; namely the design, internalise, implement and evaluate stages. Each stage is also found to relate strongly with a number of key characteristics of learning organisations. Overall, the findings suggest that SMEs with strong learning organisation attributes are more likely to be successful in implementing and managing ES change initiatives. The implications of the findings are also discussed.

The CDM-Net project : the development, implementation and evaluation of a broadband-based network for managing chronic disease

Background. In Australia most chronic disease management is funded by Medicare Australia through General Practitioner Management Plans (GPMPs) and Team Care Arrangements (TCAs). Identified barriers may be reduced effectively using a broadband-based network known as the Chronic Disease Management Service (CDMS).

Aims. To measure the uptake and adherence to CDMS, test CDMS, and assess the adherence of health providers and patients to GPMPs and TCAs generated through CDMS.

Methods. A single cohort before and after study.

Results. GPMPs and TCAs increased. There was no change to prescribed medicines or psychological quality of life. Attendance at allied health professionals increased, but decreased at pharmacies. Overall satisfaction with CDMS was high among GPs, allied health professionals, and patients.

Conclusion. This study demonstrates proof of concept, but replication or continuation of the study is desirable to enable the impact of CDMS on diabetes outcomes to be determined.

Realist synthesis : illustrating the method for implementation research

Background
Realist synthesis is an increasingly popular approach to the review and synthesis of evidence, which focuses on understanding the mechanisms by which an intervention works (or not). There are few published examples of realist synthesis. This paper therefore fills a gap by describing, in detail, the process used for a realist review and synthesis to answer the question 'what interventions and strategies are effective in enabling evidence-informed healthcare?' The strengths and challenges of conducting realist review are also considered.
Methods
The realist approach involves identifying underlying causal mechanisms and exploring how they work under what conditions. The stages of this review included: defining the scope of the review (concept mining and framework formulation); searching for and scrutinising the evidence; extracting and synthesising the evidence; and developing the narrative, including hypotheses.
Results
Based on key terms and concepts related to various interventions to promote evidenceinformed healthcare, we developed an outcome-focused theoretical framework. Questions were tailored for each of four theory/intervention areas within the theoretical framework and were used to guide development of a review and data extraction process. The search for literature within our first theory area, change agency, was executed and the screening procedure resulted in inclusion of 52 papers. Using the questions relevant to this theory area, data were extracted by one reviewer and validated by a second reviewer. Synthesis involved organisation of extracted data into evidence tables, theming and formulation of chains of inference, linking between the chains of inference, and hypothesis formulation. The narrative was developed around the hypotheses generated within the change agency theory area.
Conclusions
Realist synthesis lends itself to the review of complex interventions because it accounts for context as well as outcomes in the process of systematically and transparently synthesising relevant literature. While realist synthesis demands flexible thinking and the ability to deal with complexity, the rewards include the potential for more pragmatic conclusions than alternative approaches to systematic reviewing. A separate publication will report the findings of the review.

Screening and intervention for mental health problems in alcohol and other drug settings: Can training change practitioner behaviour?

Aims: The comorbidity of substance use and mental health problems poses a significant challenge for alcohol and other drug (AOD) treatment services. In many cases, AOD practitioners do not have experience or training in identifying or managing mental health conditions. Methods: This project examined the implementation of screening and intervention practices for mental health disorders among AOD clients. Training and supervision was provided to 20 AOD practitioners across five sites in four agencies with a focus on enhancing skills in detection of, and intervention for, mental health conditions among their clients. A package developed for this purpose, known as PsyCheck, was used. A random file audit was undertaken to examine changes in detection of mental health conditions. Findings: There were significant improvements in detection after training and supervision, with detection rates almost doubling in this time. Conclusions: Training and supervision using the PsyCheck package appears to have the potential to improve mental health detection and intervention in AOD services. This study shows promise for the implementation of mental health intervention in AOD services.

Introducing mental health and substance use screening into a community-based health service in Australia : usefulness and implications for service change

Mental health issues such as depression or anxiety and alcohol or other drug (AOD) problems often remain undiagnosed and untreated despite their prevalence in the community. This paper reports on the implementation and evaluation of an AOD and depression/anxiety screening programme within two Community Health Services (CHS) in Australia. Study 1 examined results from 5 weeks of screening (March–April 2008) using the Patient Health Questionnaire (two- and nine-item, Kroenke et al. 2001, 2003), the Conjoint Screen for Alcohol and other Drug Problems (Brown et al. 2001) and the Alcohol, Smoking and Substance Involvement Screening Test (Humeniuk & Ali 2006). Of the 55 clients screened, 33% were at risk of depression or anxiety, 22% reporting moderate-severe depression. Thirteen per cent were at risk of substance use disorders. A substantial proportion of at-risk clients were not currently accessing help for these issues from the CHS and therefore screening can facilitate identification and treatment referral. However, the majority of eligible clients were not screened, limiting screening reach. A second study evaluated the screening implementation from a process perspective via thematic analysis of focus group data from six managers and 14 intake/assessment workers (April 2008). This showed that when screening occurred, it facilitated opportunities for education and intervention with at-risk clients, although cultural mores, privacy concerns and shame/stigma could affect accuracy of screen scores at times. Importantly, the evaluation revealed that most decisions not to screen were made by workers, not by clients. Reasons for non-screening related to worker discomfort in asking sensitive questions and/or managing client distress, and a reluctance to spend long periods of time screening in time-pressured environments. The evaluation suggested that these problems could be resolved by splitting screening responsibilities, enhancing worker training and expanding follow-up screening. Findings will inform any community-based health system considering introducing screening.

Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan

Background: 

Scaling up diabetes prevention in Victoria, Australia: policy development, implementation and evaluation

Objective
The Australian lifestyle intervention program Life! is only the second reported, large-scale diabetes prevention program. This paper describes the genesis and the successful establishment of Life! and its key outcomes for participants and implementation.

Research
Design and Methods Life!, a behavior change intervention, comprises six group sessions over eight months. The Victorian Department of Health funded Diabetes Australia-Victoria to implement the program. Experience of the Greater Green Triangle diabetes prevention implementation trial was used for intervention design, workforce development, training and infrastructure. Clinical and anthropometric data from participants, used for program evaluation, was recorded on a central database.

Results
Life! has a state-wide workforce of 302 trained facilitators within 137 organizations. 29,000 Victorians showed interest in Life! and 15,000 individuals have been referred to the program. In total, 8,412 participants commenced a Life! program between October 2007 and June 2011. 37% of the original participants completed the eight month program. Participants completing sessions one to five lost an average of 1·4 kg weight (p<0·001) and waist circumference of 2·5cm (p<0.001). Those completing six sessions lost an average of 2·4 kg weight (p<0·001) and waist circumference of 3·8 cm (p<0·001). The weight loss of 2.4 kg represents 2.7% of participants’ starting body weight.

Conclusion
The impact of Life! is attributable to applying available evidence for the systems design of the intervention, and collaboration between policy makers, implementers and evaluators using the principles of continuous quality improvement to support successful, large scale recruitment and implementation.

Application of GIS-based computer modelling to planning for adaption to climate change in rural areas

A GIS-based computer modelling methodology was developed and applied to identify climate change adaptation issues arising in regional agricultural production systems (including forestry). Agricultural production in Australia is very susceptible to the adverse impacts of climate change due to projected shifts in rainfall and temperature. The methodology integrates land suitability analysis with uncertainty analysis and spatial (regional) optimisation to determine optimal agricultural land use at a regional scale for current and possible future climatic conditions. The approach can be used to recognise regions under threat of productivity decline, identify alternative cropping systems that may be better adapted to likely future conditions, and investigate implementation actions to improve the sub-optimal situations created by climate change. An example of how the methodology may be used is outlined through a case study involving the South West Region of Victoria, Australia. The case study provides information on the tools available to support the formulation of a regional adaptation strategy.