This paper reports the findings from a 4-year study on the UK National Health Service on the introduction of a national programme for information technology. 1 This is the largest civil IT programme worldwide at an estimated technical cost of d6.2 billion over a 10-year period. An institutional analysis of our historical and empirical data from six NHS organisations identifies growing fragmentation in the organisational field of healthcare, as past and present institutional logics both fuel and inhibit changes in the governance systems and working practices of healthcare practitioners. This is further complicated by new institutional logics that place the citizen at centre stage of the NPfIT, in a move to promote patient choice and public value.
Institutional isomorphism has been a major intellectual contribution within institutional theory for three decades. The effects and processes of institutionalization have traditionally focused on stability and persistence of institutions, and more recently on institutional change. This study contributes to the IS field using the lens of coercive, mimetic and normative isomorphism and change within a highly institutionalized organizational field of health care. The setting is the National Health Service in the United Kingdom, where in 2002 a major government policy was launched to introduce Electronic Health Records (EHRs) to over 50 million citizens. Using episodic interviewing techniques and content analysis of government health IT policy documents, this study provides a longitudinal analysis of the introduction of government policy to modernize health care using information technology. Institutional isomorphic conditions become conflicted with attempts to impose field and organizational change. As clinicians attempt to retain their professional dominance in a climate of almost continuous restructuring of health services, political initiatives to implement EHRs are met with resistance from key stakeholders, resulting in policy changes and further delayed implementation times.
PurposeThis paper sets out to examine the use of institutional theory in information systems research. It also seeks to consider recent debates within information systems, that the field should develop its own social theories. The purpose of the paper is to demonstrate that IS researchers need to engage more fully with the institutional theory literature as the body of work is conceptually rich and is more appropriately used to analyse and understand complex social phenomena.Design/methodology/approachReviewing the institutionalist literature from the field of IS, the paper shows that most accounts engage in empirically testing institutionalist concepts, rather than analysing the richness of these concepts to further develop and build the theory.FindingsThe paper finds that most institutionalist accounts within information systems research adopt an organisational unit of analysis as opposed to a multi‐level approach which encompasses societal and individual levels. Research further shows more studies on the “effects” of institutionalism than on the “processual” accounts.Research limitations/implicationsIt is argued that information systems researchers need to become more aware of the wider debates within the institutional theory literature, particularly as the theory is conceptually ambiguous, yet not amenable to over‐simplification as a means to achieve methodological rigour.Practical implicationsThe use of institutional theory offers practitioners conceptual tools and techniques for understanding complex change management scenarios relating to IS work.Originality/valueThe paper contributes to the IS literature through reviewing the range of studies using institutional theory. It illustrates the narrow use of the theory adopted by the IS community and suggests that a more fruitful approach is to use a wider multi‐level and multi‐method approach. The paper suggests that institutional theory offers a conceptually rich lens for analysing IS themes and issues and encourages further use of the theory for IS and management research.
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