Understanding the dynamics of information technology implementation: The case of clinical information systems

The ultimate intent of this dissertation was to broaden and strengthen our understanding of IT implementation by emphasizing research efforts on the dynamic nature of the implementation process. More specifically, efforts were directed toward opening the "black box" and providing the story that explains how and why contextual conditions and implementation tactics interact to produce project outcomes. In pursuit of this objective, the dissertation was aimed at theory building and adopted a case study methodology combining qualitative and quantitative evidence. Precisely, it examined the implementation process, use and consequences of three clinical information systems at Jackson Memorial Hospital, a large tertiary care teaching hospital.^ As a preliminary step toward the development of a more realistic model of system implementation, the study proposes a new set of research propositions reflecting the dynamic nature of the implementation process.^ Findings clearly reveal that successful implementation projects are likely to be those where key actors envision end goals, anticipate challenges ahead, and recognize the presence of and seize opportunities. It was also found that IT implementation is characterized by the systems theory of equifinality, that is, there are likely several equally effective ways to achieve a given end goal. The selection of a particular implementation strategy appears to be a rational process where actions and decisions are largely influenced by the degree to which key actors recognize the mediating role of each tactic and are motivated to action. The nature of the implementation process is also characterized by the concept of "duality of structure," that is, context and actions mutually influence each other. Another key finding suggests that there is no underlying program that regulates the process of change and moves it form one given point toward a subsequent and already prefigured end. For this reason, the implementation process cannot be thought of as a series of activities performed in a sequential manner such as conceived in stage models. Finally, it was found that IT implementation is punctuated by a certain indeterminacy. Results suggest that only when substantial efforts are focused on what to look for and think about, it is less likely that unfavorable and undesirable consequences will occur. ^

The applied computer science of economic analyses: Internet prioritization and Internet pricing, and software engineering and software pricing for the mass market

This research examines evolving issues in applied computer science and applies economic and business analyses as well. There are two main areas. The first is internetwork communications as embodied by the Internet. The goal of the research is to devise an efficient pricing, prioritization, and incentivization plan that could be realistically implemented on the existing infrastructure. Criteria include practical and economic efficiency, and proper incentives for both users and providers. Background information on the evolution and functional operation of the Internet is given, and relevant literature is surveyed and analyzed. Economic analysis is performed on the incentive implications of the current pricing structure and organization. The problems are identified, and minimally disruptive solutions are proposed for all levels of implementation to the lowest level protocol. Practical issues are considered and performance analyses are done. The second area of research is mass market software engineering, and how this differs from classical software engineering. Software life-cycle revenues are analyzed and software pricing and timing implications are derived. A profit maximizing methodology is developed to select or defer the development of software features for inclusion in a given release. An iterative model of the stages of the software development process is developed, taking into account new communications capabilities as well as profitability. ^

An examination of attitude toward change as a predictor of policy/program implementation

Policy/program implementation, e.g., the process of fulfilling policy/program directives, is fundamentally tied to change. Implementation studies have examined the process, identifying many critical organizational variables although individuals perform the activities.^ Many of the studies are predicated on the rational, goal oriented model of organizations and examine implementation, presenting only the goal-oriented view. Organizational change and its resistance, however, are not fully explained by the rational model of organizations. There are other schools of thought providing different views of organizations from which explanation may emerge. Bolman and Deal (1984, 1991a, 1994) provide a different perspective for examining organizations Bolman and Deal argue organizations should be viewed through four different frames or lenses. Framing and reframing organizational action captures the complexity of action and provides better understanding of organizational processes. Understanding of implementation of policies/programs also will benefit from the use of the four-frame approach.^ The goal of this research is to provide a better understanding of the implementation process by examining individual attitudes toward change, the dependent variable of this research, and studying the relationship between the dependent variable and frame. The research was conducted in two phases. In Phase One, a survey was sent to 306 school administrators and teachers in magnet programs in Dade County, Florida. The survey instrument was composed of 55 questions including six from Bolman and Deal's Leadership Orientation Survey (1988) and 38 questions about organizational change. In Phase Two, more in-depth analysis of four school was conducted, to further explore the relationship between frame and attitude toward change.^ The results revealed that frame was a factor in explaining differences in personal Attitude Toward Change and Comfort Level with Change. Individuals using the symbolic frame had more positive attitudes toward change and were also more comfortable with change. The results of Phase Two of the research partially supported this finding in that the most fully implemented program was the product of an administrator who had chosen the symbolic frame. ^

Profile of planning: A study of a three-year project on the implementation of collaborative library media programs

The implementation of collaborative planning and teaching models in ten flexibly scheduled elementary and middle school library media centers was studied to determine which factors facilitated the collaborative planning process and to learn what occurs when library media specialists (LMSs) and classroom teachers (CTs) plan together. In this qualitative study, 61 principals, CTs, and LMSs were interviewed on a range of topics including the principal's role, school climate, the value of team planning, the importance of information literacy instruction, and the ideal learning environment. Other data sources were observations, videotapes of planning sessions, and documents. This three-year school reform effort was funded by the Library Power Project to improve library programs, to encourage collaborative planning, and to increase curricular integration of information literacy skills instruction. ^ The findings included a description of typical planning sessions and the identification of several major factors which impacted the success of collaborative planning: the individuals involved, school climate, time for planning, the organization of the school, the facility and collection, and training. Of these factors, the characteristics and actions of the people involved were most critical to the implementation of the innovation. The LMS was the pivotal player and, in the views of CTs, principals, and LMSs themselves, must be knowledgeable about curriculum, the library collection, and instructional design and delivery; must be open and welcoming to CTs and use good interpersonal skills; and must be committed to information literacy instruction and willing to act as a change agent. The support of the principal was vital; in schools with successful programs, the principal served as an advocate for collaborative planning and information literacy instruction, provided financial support for the library program including clerical staff, and arranged for LMSs and CTs to have time during the school day to plan together. ^ CTs involved in positive planning partnerships with LMSs were flexible, were open to change, used a variety of instructional materials, expected students to be actively involved in their own learning, and were willing to team teach with LMSs. Most CTs planning with LMSs made lesson plans in advance and preferred to plan with others. Also, most CTs in this study planned with grade level or departmental groups, which expedited the delivery of information literacy instruction and the effective use of planning time. ^ Implications of the findings of this research project were discussed for individual schools, for school districts, and for colleges and universities training LMSs, CTs, and administrators. Suggestions for additional research were also included. ^

Performance accountability in the federal-state transportation program: Factors affecting successful implementation

Governmental accountability is the requirement of government entities to be accountable to the citizenry in order to justify the raising and expenditure of public resources. The concept of service efforts and accomplishments measurement for government programs was introduced by the Governmental Accounting Standards Board (GASB) in Service Efforts and Accomplishments Reporting: Its Time Has Come (1990). This research tested the feasibility of implementing the concept for the Federal-aid highway construction program and identified factors affecting implementation with a case study of the District of Columbia. Changes in condition and performance ratings for specific highway segments in 15 projects, before and after construction expenditures, were evaluated using data provided by the Federal Highway Administration. The results of the evaluation indicated difficulty in drawing conclusions on the state program performance, as a whole. The state program reflects problems within the Federally administered program that severely limit implementation of outcome-oriented performance measurement. Major problems identified with data acquisition are: data reliability, availability, compatibility and consistency among states. Other significant factors affecting implementation are institutional barriers and political barriers. Institutional issues in the Federal Highway Administration include the lack of integration of the fiscal project specific database with the Highway Performance Monitoring System database. The Federal Highway Administration has the ability to resolve both of the data problems, however interviews with key Federal informants indicate this will not occur without external directives and changes to the Federal “stewardship” approach to program administration. ^ The findings indicate many issues must be resolved for successful implementation of outcome-oriented performance measures in the Federal-aid construction program. The issues are organizational and political in nature, however in the current environment resolution is possible. Additional research is desirable and would be useful in overcoming the obstacles to successful implementation. ^

An analysis of teachers' perceptions of informal science professional development

Science professional development, which is fundamental to science education improvement, has been described as being weak and fragmentary. The purpose of this study was to investigate teachers' perceptions of informal science professional development to gain an in-depth understanding of the essence of the phenomenon and related science-teaching dispositions. Based on the frameworks of phenomenology, constructivism, and adult learning theory, the focus was on understanding how the phenomenon was experienced within the context of teachers' everyday world. ^ Data were collected from eight middle-school teachers purposefully selected because they had participated in informal programs during Project TRIPS (Teaching Revitalized Through Informal Programs in Science), a collaboration between the Miami-Dade school district, government agencies (including NASA), and non-profit organizations (including Audubon of Florida). In addition, the teachers experienced hands-on labs offered through universities (including the University of Arizona), field sites, and other agencies. ^ The study employed Seidman's (1991) three-interview series to collect the data. Several methods were used to enhance the credibility of the research, including using triangulation of the data. The interviews were transcribed, color-coded and organized into six themes that emerged from the data. The themes included: (a) internalized content knowledge, (b) correlated hands-on activities, (c) enhanced science-teaching disposition, (d) networking/camaraderie, (e) change of context, and (f) acknowledgment as professionals. The teachers identified supportive elements and constraints related to each theme. ^ The results indicated that informal programs offering experiential learning opportunities strengthened understanding of content knowledge. Teachers implemented hands-on activities that were explicitly correlated to their curriculum. Programs that were conducted in a relaxed context enhanced teachers' science-teaching dispositions. However, a lack of financial and administrative support, perceived safety risks, insufficient reflection time, and unclear itineraries impeded program implementation. The results illustrated how informal educators can use this cohesive model as they develop programs that address the supports and constraints to teachers' science instruction needs. This, in turn, can aid teachers as they strive to provide effective science instruction to students; notions embedded in reforms. Ultimately, this can affect how learners develop the ability to make informed science decisions that impact the quality of life on a global scale. ^

Conflict and Consonance: Implementing an Evidence-Based Middle School Science Curriculum

This study is to investigate the middle school teachers’ concerns and perspectives during the implementation of an evidence-based curriculum that supports the development of both content knowledge and scientific practices. Two themes emerge from data analysis: consonance and conflict.

AIDS workplace *policy adoption and implementation in local government: An analysis of departmental variation

This is an empirical study whose purpose was to examine the process of innovation adoption as an adaptive response by a public organization and its subunits existing under varying degrees of environmental uncertainty. Meshing organization innovation research and contingency theory to form a theoretical framework, an exploratory case study design was undertaken in a large, metropolitan government located in an area with the fourth highest prevalence rate of HIV/AIDS in the country. A number of environmental and organizational factors were examined for their influence upon decision making in the adoption/non-adoption as well as implementation of any number of AIDS-related policies, practices, and programs.^ The major findings of the study are as follows. For the county government itself (macro level), no AIDS-specific workplace policies have been adopted. AIDS activities (AIDS education, AIDS Task Force, AIDS Coordinator, etc.), adopted county-wide early in the epidemic, have all been abandoned. Worker infection rates, in the aggregate and throughout the epidemic have been small. As a result, absent co-worker conflict (isolated and negligible), no increase in employee health care costs, no litigation regarding discrimination, and no major impact on workforce productivity, AIDS has basically become a non-issue at the strategic core of the organization. At the departmental level, policy adoption decisions varied widely. Here the predominant issue is occupational risk, i.e., both objective as well as perceived. As expected, more AIDS-related activities (policies, practices, and programs) were found in departments with workers known to have significant risk for exposure to the AIDS virus (fire rescue, medical examiner, police, etc.). AIDS specific policies, in the form of OSHA's Bloodborn Pathogen Standard, took place primarily because they were legislatively mandated. Union participation varied widely, although not necessarily based upon worker risk. In several departments, the union was a primary factor bringing about adoption decisions. Additional factors were identified and included organizational presence of AIDS expertise, availability of slack resources, and the existence of a policy champion. Other variables, such as subunit size, centralization of decision making, and formalization were not consistent factors explaining adoption decisions. ^

Analysis of global compliance and implementation of the goals of international environmental treaties: A case study of the Convention on Biodiversity (CBD)

The Convention on Biodiversity (CBD) was created in 1992 to coordinate global governments to protect biological resources. The CBD has three goals: protection of biodiversity, achievement of sustainable use of biodiversity and facilitation of equitable sharing of the benefits of biological resources. The goal of protecting biological resources has remained both controversial and difficult to implement. This study focused more on the goal of biodiversity protection. The research was designed to examine how globally constructed environmental policies get adapted by national governments and then passed down to local levels where actual implementation takes place. Effectiveness of such policies depends on the extent of actual implementation at local levels. Therefore, compliance was divided and examined at three levels: global, national and local. The study then developed various criteria to measure compliance at these levels. Both qualitative and quantitative methods were used to analyze compliance and implementation. The study was guided by three questions broadly examining critical factors that most influence the implementation of biodiversity protection policies at the global, national and local levels. Findings show that despite an overall biodiversity deficit of 0.9 hectares per person, global compliance with the CBD goals is currently at 35%. Compliance is lowest at local levels at 14%, it is slightly better at national level at 50%, and much better at the international level 64%. Compliance appears higher at both national and international levels because compliance here is paper work based and policy formulation. If implementation at local levels continues to produce this low compliance, overall conservation outcomes can only get worse than what it is at present. There are numerous weaknesses and capacity challenges countries are yet to address in their plans. In order to increase local level compliance, the study recommends a set of robust policies that build local capacity, incentivize local resource owners, and implement biodiversity protection programs that are akin to local needs and aspirations.^