Culture and behaviour in the English National Health Service:overview of lessons from a large multimethod study

Background - Problems of quality and safety persist in health systems worldwide. We conducted a large research programme to examine culture and behaviour in the English National Health Service (NHS). Methods - Mixed-methods study involving collection and triangulation of data from multiple sources, including interviews, surveys, ethnographic case studies, board minutes and publicly available datasets. We narratively synthesised data across the studies to produce a holistic picture and in this paper present a highlevel summary. Results - We found an almost universal desire to provide the best quality of care. We identified many 'bright spots' of excellent caring and practice and high-quality innovation across the NHS, but also considerable inconsistency. Consistent achievement of high-quality care was challenged by unclear goals, overlapping priorities that distracted attention, and compliance-oriented bureaucratised management. The institutional and regulatory environment was populated by multiple external bodies serving different but overlapping functions. Some organisations found it difficult to obtain valid insights into the quality of the care they provided. Poor organisational and information systems sometimes left staff struggling to deliver care effectively and disempowered them from initiating improvement. Good staff support and management were also highly variable, though they were fundamental to culture and were directly related to patient experience, safety and quality of care. Conclusions - Our results highlight the importance of clear, challenging goals for high-quality care. Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring cultures by ensuring that staff feel valued, respected, engaged and supported.

Electronic information sharing in local government authorities:factors influencing the decision-making process

Local Government Authorities (LGAs) are mainly characterised as information-intensive organisations. To satisfy their information requirements, effective information sharing within and among LGAs is necessary. Nevertheless, the dilemma of Inter-Organisational Information Sharing (IOIS) has been regarded as an inevitable issue for the public sector. Despite a decade of active research and practice, the field lacks a comprehensive framework to examine the factors influencing Electronic Information Sharing (EIS) among LGAs. The research presented in this paper contributes towards resolving this problem by developing a conceptual framework of factors influencing EIS in Government-to-Government (G2G) collaboration. By presenting this model, we attempt to clarify that EIS in LGAs is affected by a combination of environmental, organisational, business process, and technological factors and that it should not be scrutinised merely from a technical perspective. To validate the conceptual rationale, multiple case study based research strategy was selected. From an analysis of the empirical data from two case organisations, this paper exemplifies the importance (i.e. prioritisation) of these factors in influencing EIS by utilising the Analytical Hierarchy Process (AHP) technique. The intent herein is to offer LGA decision-makers with a systematic decision-making process in realising the importance (i.e. from most important to least important) of EIS influential factors. This systematic process will also assist LGA decision-makers in better interpreting EIS and its underlying problems. The research reported herein should be of interest to both academics and practitioners who are involved in IOIS, in general, and collaborative e-Government, in particular. © 2013 Elsevier Ltd. All rights reserved.

Identifying the configurational paths to innovation in SMEs:a fuzzy-set qualitative comparative analysis

Using fuzzy-set qualitative comparative analysis (fsQCA), this study investigates the conditions leading to a higher level of innovation. More specifically, the study explores the impact of inter-organisational knowledge transfer networks and organisations' internal capabilities on different types of innovation in Small to Medium size Enterprises (SMEs) in the high-tech sector. A survey instrument was used to collect data from a sample of UK SMEs. The findings show that although individual factors are important, there is no need for a company to perform well in all the areas. The fsQCA, which enables the examination of the impacts of different combinations of factors, reveals that there are a number of paths to achieve better incremental and radical innovation performance. Companies need to choose the one that is closest to their abilities and fits best with their resources.

Organisational learning - a critical systems thinking discipline

Original Paper European Journal of Information Systems (2001) 10, 135–146; doi:10.1057/palgrave.ejis.3000394 Organisational learning—a critical systems thinking discipline P Panagiotidis1,3 and J S Edwards2,4 1Deloitte and Touche, Athens, Greece 2Aston Business School, Aston University, Aston Triangle, Birmingham, B4 7ET, UK Correspondence: Dr J S Edwards, Aston Business School, Aston University, Aston Triangle, Birmingham, B4 7ET, UK. E-mail: j.s.edwards@aston.ac.uk 3Petros Panagiotidis is Manager responsible for the Process and Systems Integrity Services of Deloitte and Touche in Athens, Greece. He has a BSc in Business Administration and an MSc in Management Information Systems from Western International University, Phoenix, Arizona, USA; an MSc in Business Systems Analysis and Design from City University, London, UK; and a PhD degree from Aston University, Birmingham, UK. His doctorate was in Business Systems Analysis and Design. His principal interests now are in the ERP/DSS field, where he serves as project leader and project risk managment leader in the implementation of SAP and JD Edwards/Cognos in various major clients in the telecommunications and manufacturing sectors. In addition, he is responsible for the development and application of knowledge management systems and activity-based costing systems. 4John S Edwards is Senior Lecturer in Operational Research and Systems at Aston Business School, Birmingham, UK. He holds MA and PhD degrees (in mathematics and operational research respectively) from Cambridge University. His principal research interests are in knowledge management and decision support, especially methods and processes for system development. He has written more than 30 research papers on these topics, and two books, Building Knowledge-based Systems and Decision Making with Computers, both published by Pitman. Current research work includes the effect of scale of operations on knowledge management, interfacing expert systems with simulation models, process modelling in law and legal services, and a study of the use of artifical intelligence techniques in management accounting. Top of pageAbstract This paper deals with the application of critical systems thinking in the domain of organisational learning and knowledge management. Its viewpoint is that deep organisational learning only takes place when the business systems' stakeholders reflect on their actions and thus inquire about their purpose(s) in relation to the business system and the other stakeholders they perceive to exist. This is done by reflecting both on the sources of motivation and/or deception that are contained in their purpose, and also on the sources of collective motivation and/or deception that are contained in the business system's purpose. The development of an organisational information system that captures, manages and institutionalises meaningful information—a knowledge management system—cannot be separated from organisational learning practices, since it should be the result of these very practices. Although Senge's five disciplines provide a useful starting-point in looking at organisational learning, we argue for a critical systems approach, instead of an uncritical Systems Dynamics one that concentrates only on the organisational learning practices. We proceed to outline a methodology called Business Systems Purpose Analysis (BSPA) that offers a participatory structure for team and organisational learning, upon which the stakeholders can take legitimate action that is based on the force of the better argument. In addition, the organisational learning process in BSPA leads to the development of an intrinsically motivated information organisational system that allows for the institutionalisation of the learning process itself in the form of an organisational knowledge management system. This could be a specific application, or something as wide-ranging as an Enterprise Resource Planning (ERP) implementation. Examples of the use of BSPA in two ERP implementations are presented.

Casemix accounting systems and medical coding:organisational actors balanced on "leaky black boxes"

The adoption of DRG coding may be seen as a central feature of the mechanisms of the health reforms in New Zealand. This paper presents a story of the use of DRG coding by describing the experience of one major health provider. The conventional literature portrays casemix accounting and medical coding systems as rational techniques for the collection and provision of information for management and contracting decisions/negotiations. Presents a different perspective on the implications and effects of the adoption of DRG technology, in particular the part played by DRG coding technology as a part of a casemix system is explicated from an actor network theory perspective. Medical coding and the DRG methodology will be argued to represent ``black boxes''. Such technological ``knowledge objects'' provide strong points in the networks which are so important to the processes of change in contemporary organisations.

The evaluation of information systems in the organisational context of the National Health Service. Available in 2 volumes.

This thesis describes a project which has investigated the evaluation of information systems. The work took place in, and is related to, a specific organisational context, that of the National Health Service (NHS). It aims to increase understanding of the evaluation which takes place in the service and the way in which this is affected by the NHS environment. It also investigates the issues which surround some important types of evaluation and their use in this context. The first stage of the project was a postal survey in which respondents were asked to describe the evaluation which took place in their authorities and to give their opinions about it. This was used to give an overview of the practice of IS evaluation in the NHS and to identify its uses and the problems experienced. Three important types of evaluation were then examined in more detail by means of action research studies. One of these dealt with the selection and purchase of a large hospital information system. The study took the form of an evaluation of the procurement process, and examined the methods used and the influence of organisational factors. The other studies are concerned with post-implementation evaluation, and examine the choice of an evaluation approach as well as its application. One was an evaluation of a community health system which had been operational for some time but was of doubtful value, and suffered from a number of problems. The situation was explored by means of a study of the costs and benefits of the system. The remaining study was the initial review of a system which was used in the administration of a Breast Screening Service. The service itself was also newly operational and the relationship between the service and the system was of interest.

Development of performance models for co-operative information systems in an organisational context

The thesis reports of a study into the effect upon organisations of co-operative information systems (CIS) incorporating flexible communications, group support and group working technologies. A review of the literature leads to the development of a model of effect based upon co-operative business tasks. CIS have the potential to change how co-operative business tasks are carried out and their principal effect (or performance) may therefore be evaluated by determining to what extent they are being employed to perform these tasks. A significant feature of CIS use identified is the extent to which they may be designed to fulfil particular tasks, or by contrast, may be applied creatively by users in an emergent fashion to perform tasks. A research instrument is developed using a survey questionnaire to elicit users judgements of the extent to which a CIS is employed to fulfil a range of co-operative tasks. This research instrument is applied to a longitudinal study of Novell GroupWise introduction at Northamptonshire County Council during which qualitative as well as quantitative data were gathered. A method of analysis of questionnaire results using principles from fuzzy mathematics and artificial intelligence is developed and demonstrated. Conclusions from the longitudinal study include the importance of early experiences in setting patterns for use for CIS, the persistence of patterns of use over time and the dominance of designed usage of the technology over emergent use.

Information systems, inter-functional collaboration and innovation in Taiwanese high-tech manufacturing firms

This article investigates whether (1) cross-functional integration within a firm and the use of information systems (IS) that support information sharing with external parties can enhance integration across the supply chain and wider networks and (2) whether collaboration with customers, suppliers and other external parties leads to increased supply chain performance in terms of new product development and introduction of new processes. Data from a high-quality survey carried out in Taiwan in 2009 were used, and appropriate econometric models were applied. Results show that the adoption of IS that enhance information sharing is vital not only for the effective communication with suppliers and with wider network members, but their adoption also has a direct effect across a firm's innovative effort. Cross-functional integration appears to matter only for the introduction of an innovative process. Collaboration with customers and suppliers affected a product's design and its overall features and functionality, respectively. © 2013 Copyright Taylor and Francis Group, LLC.

Impact of inter-modal four-wave mixing on the performance of mode- and wavelength-division-multiplexing systems

In this paper, we investigate the impact of inter-modal four-wave mixing on mode- and wavelength-division-multiplexing systems. A set of coupled nonlinear Schrödinger equations, including linear mode coupling, is derived allowing to isolate the inter-modal four-wave mixing terms. The efficiency of inter-modal four-wave mixing between degenerate LP modes is found to be significantly higher than the intra-modal four-wave mixing efficiency. However, it is shown that the inter-modal four-wave mixing efficiency between degenerate modes is significantly reduced by the linear mode coupling.

Business systems purpose, analysis

This thesis deals with the problematic of the business systems systemic purpose definition. The definition of the systemic purpose, which is regarded as the utmost expression of the system's purposefulness, is to be achieved by ensuring the participation of all the stakeholders, if possible, who affect or they are affected by the business system's operations. The nature of participation, defined as a process of the stakeholders' perceptual exchanges, is deemed to be problematic in itself due to the influence exerted upon it by organisational power, coercion and false consciousness. The main focus of the thesis then is to make aware and provide the stakeholders with an explicit philosophical pedestal and a set of principles upon which a meta- epistemological framework for the enquiry of the business system's purposeful behaviour is developed. In addition, the thesis focuses on the development of a methodology that can be used by the stakeholders to achieve self-knowledge through the critical and systemic examination of their normative presuppositions, about the business system, at both sociological as well as the psychological levels concurrently and the subsequent development of an organisational intrinsically motivated information system. According to the critical systems philosophy and principles, developed in this thesis, normative presuppositions define the stakeholders' perceptions about the purposeful behaviour of the business system they perceived as having a material, an informational and/or an emacipatory stake (human interest) in. The methodology will provide Information Systems that demonstrably improve coordination of organisational activities by enabling the development and maintenance of a single/multifaceted view of purpose throughout organisations.

An interpretive approach to analysing the role and value of information systems in Jordanian financial organisations

Analysing investments in ISs in order to maximise benefits has become a prime concern, especially for private corporations. No formula of equilibrium exists that could link the injected amounts and accrued returns. The relationship is simply not straightforward. This thesis is based upon empirical work which involved sketching organisational ethnographies (four organographies and a sectography) into the role and value of information systems in Jordanian financial organisations. Besides deciphering the map of impacts, it explains the attributions of the variations in the impacts of ISs which were found to be related to the internal organisational processes: culturally and politically specific considerations, economically or technically rooted factors and environmental factors. The research serves as an empirical attempt to test out the applicability of adopting the interpretive paradigm to researching organisations in a developing country. The fieldwork comprised an exploratory stage, a detailed investigation of four case studies and a survey stage encompassing 16 organisations. Primary and secondary data were collected from multiple sources using a range of instruments. The evidence highlights the fact that little long term strategic planning was pursued; the emphasis was more focused on short term planning. There was no noticeable adoption of any strategic fit principle linking IS strategy to the corporate strategy. In addition, the benefits obtained were mostly intangible. Although ISs were central to the work of the organisations surveyed as the core technology, they were considered as tools or work enablers rather than weapons for competitive rivalry. The cultural specificity of IS impacts was evident and the cultural and political considerations were key factors in explaining the attributions of the variations in the impacts of ISs in JFOs. The thesis confirms that measuring the benefits of ISs is the problematic. However, in order to gain more insight, the phenomenon of "the use of ISs" has to be studied within its context.

Developing intrinsically motivated information systems - a critical systems approach

This paper deals with the problematic of development methodologies for organisational information systems and especially with their application to business systems. Historically, information systems development methodologies tend to fail, because either they take the organisational purposefulness for granted, or they do not analyse it thoroughly. This paper's position is that the analysis, and the definition or redefinition of the systemic purpose are regarded as the utmost expression of the system 's purposefulness. This is to be achieved by ensuring the participation of all the stakeholders who affect, or are affected by, a particular business system's operations. The nature of participation, defined as a process of the stakeholders' perceptual exchanges, is deemed to be problematic in itself, due to the influence exerted upon it by organisational power, coercion and false consciousness. The paper highlights the philosophical reasons for the failures of information systems development methodologies, and provides a conceptual solution to this problematic as well as a strategy for the development of intrinsically motivated organisational information systems. The intrinsically motivated information systems methodology outlined here (BSPA) is intended to yield organisational information systems that demonstrably improve co-ordination of organisational activities, by enabling the development and maintenance of a single/multifaceted view of purpose throughout organisations.

The missing ingredient:inter-municipal cooperation and central-local relations in the UK

The thrust of the argument presented in this chapter is that inter-municipal cooperation (IMC) in the United Kingdom reflects local government's constitutional position and its exposure to the exigencies of Westminster (elected central government) and Whitehall (centre of the professional civil service that services central government). For the most part councils are without general powers of competence and are restricted in what they can do by Parliament. This suggests that the capacity for locally driven IMC is restricted and operates principally within a framework constructed by central government's policy objectives and legislation and the political expediencies of the governing political party. In practice, however, recent examples of IMC demonstrate that the practices are more complex than this initial analysis suggests. Central government may exert top-down pressures and impose hierarchical directives, but there are important countervailing forces. Constitutional changes in Scotland and Wales have shifted the locus of central- local relations away from Westminster and Whitehall. In England, the seeding of English government regional offices in 1994 has evolved into an important structural arrangement that encourages councils to work together. Within the local government community there is now widespread acknowledgement that to achieve the ambitious targets set by central government, councils are, by necessity, bound to cooperate and work with other agencies. In recent years, the fragmentation of public service delivery has affected the scope of IMC. Elected local government in the UK is now only one piece of a complex jigsaw of agencies that provides services to the public; whether it is with non-elected bodies, such as health authorities, public protection authorities (police and fire), voluntary nonprofit organisations or for-profit bodies, councils are expected to cooperate widely with agencies in their localities. Indeed, for projects such as regeneration and community renewal, councils may act as the coordinating agency but the success of such projects is measured by collaboration and partnership working (Davies 2002). To place these developments in context, IMC is an example of how, in spite of the fragmentation of traditional forms of government, councils work with other public service agencies and other councils through the medium of interagency partnerships, collaboration between organisations and a mixed economy of service providers. Such an analysis suggests that, following changes to the system of local government, contemporary forms of IMC are less dependent on vertical arrangements (top-down direction from central government) as they are replaced by horizontal modes (expansion of networks and partnership arrangements). Evidence suggests, however that central government continues to steer local authorities through the agency of inspectorates and regulatory bodies, and through policy initiatives, such as local strategic partnerships and local area agreements (Kelly 2006), thus questioning whether, in the case of UK local government, the shift from hierarchy to network and market solutions is less differentiated and transformation less complete than some literature suggests. Vertical or horizontal pressures may promote IMC, yet similar drivers may deter collaboration between local authorities. An example of negative vertical pressure was central government's change of the systems of local taxation during the 1980s. The new taxation regime replaced a tax on property with a tax on individual residency. Although the community charge lasted only a few years, it was a highpoint of the then Conservative government policy that encouraged councils to compete with each other on the basis of the level of local taxation. In practice, however, the complexity of local government funding in the UK rendered worthless any meaningful ambition of councils competing with each other, especially as central government granting to local authorities is predicated (however imperfectly) on at least notional equalisation between those areas with lower tax yields and the more prosperous locations. Horizontal pressures comprise factors such as planning decisions. Over the last quarter century, councils have competed on the granting of permission to out-of-town retail and leisure complexes, now recognised as detrimental to neighbouring authorities because economic forces prevail and local, independent shops are unable to compete with multiple companies. These examples illustrate tensions at the core of the UK polity of whether IMC is feasible when competition between local authorities heightened by local differences reduces opportunities for collaboration. An alternative perspective on IMC is to explore whether specific purposes or functions promote or restrict it. Whether in the principle areas of local government responsibilities relating to social welfare, development and maintenance of the local infrastructure or environmental matters, there are examples of IMC. But opportunities have diminished considerably as councils lost responsibility for services provision as a result of privatisation and transfer of powers to new government agencies or to central government. Over the last twenty years councils have lost their role in the provision of further-or higher-education, public transport and water/sewage. Councils have commissioning power but only a limited presence in providing housing needs, social care and waste management. In other words, as a result of central government policy, there are, in practice, currently far fewer opportunities for councils to cooperate. Since 1997, the New Labour government has promoted IMC through vertical drivers and the development; the operation of these policy initiatives is discussed following the framework of the editors. Current examples of IMC are notable for being driven by higher tiers of government, working with subordinate authorities in principal-agent relations. Collaboration between local authorities and intra-interand cross-sectoral partnerships are initiated by central government. In other words, IMC is shaped by hierarchical drivers from higher levels of government but, in practice, is locally varied and determined less by formula than by necessity and function. © 2007 Springer.