Skip to main content
SpringerLink
Log in

Institutional isomorphism and change: the national programme for IT – 10 years on

  • Research Article
  • Published:
Journal of Information Technology

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

Notes

  1. The Journal of Information Technology published a Special Issue in 2007 (Volume 22, Number 3), which covered the NPfIT from a theoretical and practitioner standpoint. Many of the papers in this edition are cited in this paper. An interesting observation is that these writers raised serious concerns about the potential of the NPfIT to deliver on its promises. These concerns were addressed in the three National Audit Office reports (2006, 2008, 2011) featured in this paper. Readers are invited to re-read the 2007 Journal of Information Technology Special Issue, as it provides a rich picture of the many problems that beset the NPfIT (the details of which are outside the scope of this paper).

  2. Friedson (2007) argued there were serious deficiencies in the nature of professionalism. His book was first published in 1970, and it is interesting to note that medical dominance has increasingly clashed with political and managerial dominance in the health sector. This is the context in which the NPfIT has played out, and is an area that offers much potential for further research.

  3. This has been well documented in detail by independent auditing, academia the media.

  4. The Journal of Information Technology published a Special Issue in 2009 (Volume 24, Number 4) on Institutional Theory in Information Systems Research, edited by Currie, W.L and Swanson, E.B. This issue contains many articles that extend the body of work on institutional theory and IS, often combining institutional theory with other theories (sense making, socio-technical approaches).

  5. The NPfIT geographical region includes England. Northern Ireland, Scotland and Wales had their own health IT policy.

  6. Data from the interviews carried out pre-2007 are published in Currie and Guah (2007), which tracks the NPfIT in its first 5 years.

  7. The media recently reported that the Cabinet Office promises to challenge ‘the culture of secrecy’ on IT projects. With fewer than ‘one-third of the government's major projects delivered to original estimates of time, cost and quality’, the Cabinet Office is under pressure to publish regular ‘Gateway Reviews’ of projects, which evaluate their progress (Bicknell, 2012). In the United States, the government IT project guidelines support the use of ‘Modular Contracting’ as a risk mitigation strategy (Wait, 2012).

  8. The policy to share clinical data electronically is one that is occupying the attention of global health systems. While this paper reports on the many pitfalls of meeting this challenge, it is worth emphasizing that the thorny issues of developing a legal and regulatory framework for sharing patient data across borders, data security, privacy and confidentiality, patient safety, and many more, all remain the subject of contentious debate. The experience of the NPfIT, while running into many serious problems, also provides many valuable lessons about introducing large-scale IT in health environments (Adler-Milstein and Jha, 2012; Currie, 2012 2012b).

References

  • Adler-Milstein, J. and Jha, A.K. (2012). Sharing Clinical Data Electronically, Journal of the American Medical Association 307 (16): 1695–1696.

    Article  Google Scholar 

  • Angst, C.M. and Agarwal, R. (2009). Adoption of Electronic Health Records in the Presence of Privacy Concerns: The elaboration likelihood model and individual persuasion, Management Information Systems Quarterly 33 (2): 339–370.

    Google Scholar 

  • Baum, J.A.C. and Oliver, C. (1991). Institutional Linkages and Organizational Mortality, Administrative Science Quarterly 36: 187–218.

    Article  Google Scholar 

  • Benson, T. (2002). Why General Practitioners Use Computers and Hospital Doctors Do Not – Part 1: Incentives, British Medical Journal 325: 1086.

    Article  Google Scholar 

  • Bicknell, D. (2012). Cabinet office promises to challenge ‘culture of secrecy’ on IT projects, The Guardian, 13 June. Online, http://www.guardian.co.uk/government-computing-network/2012.

  • Bloomfield, B.P. (1991). The Role of Information Systems in the UK National Health Service: Action at a distance and the fetish of calculation, Social Studies of Science 21 (4): 701–734.

    Article  Google Scholar 

  • Brennan, S. (2007). The Biggest Computer Programme in the World Ever! How's it Going? Journal of Information Technology 22 (3): 202–211.

    Article  Google Scholar 

  • Burgoyne, J.G., Brown, D.H., Hindle, A. and Mumford, M.J. (1997). Multi-Disciplinary Identification of Issues Associated with ‘Contracting’ in Market-Orientated Health Service Reforms, British Journal of Management 8 (1): 39–49.

    Article  Google Scholar 

  • Clegg, C. and Shepherd, C. (2007). The Biggest Computer Programme in the World Ever!: Time for a change in mindset, Journal of Information Technology 22 (3): 212–221.

    Article  Google Scholar 

  • Connecting for Health Business Plan (2004). NHS Connecting for Health Annual Report 2004-5 A brave new world? http://www.connectingforhealth.nhs.uk.

  • Currie, W. (2009a). Contextualizing the IT Artefact: Towards a wider research agenda, Information Technology and People 22 (1): 63–77.

    Article  Google Scholar 

  • Currie, W.L. (2004). The Organizing Vision of Application Service Provision: A process-oriented analysis, Information and Organization 14 (4): 237–267.

    Article  Google Scholar 

  • Currie, W.L. (2009b). Integrating Healthcare, in W.L. Currie and D.J. Finnegan (eds.) Integrating Healthcare with Information and Communications Technology, Oxford: Radcliffe Publishing.

    Google Scholar 

  • Currie, W.L. and Swanson, E.B. (2009). Editorial: Special issue on institutional theory in IS research, Journal of IT 24 (4): 283–285.

    Google Scholar 

  • Currie, W.L. (2012a). Editorial, Health Policy and Technology 3 (1): 1–3.

    Article  Google Scholar 

  • Currie, W.L. (2012b). TEMPEST: An integrative model of health technology assessment, Health Policy and Technology 1 (1): 35–49.

    Article  Google Scholar 

  • Currie, W.L. and Guah, M.W. (2007). A National Program for IT in the Organisational Field of Healthcare: A example of conflicting institutional logics, Journal of Information Technology 22 (3): 235–248.

    Article  Google Scholar 

  • Department of Health (2000). NHS Plan: An information strategy for the modern NHS, London: Department of Health.

  • Department of Health (2002). Delivering 21st Century IT Support for the NHS, London: Department of Health.

  • Dimaggio, P. (1983). State Expansion and Organizational Fields, in R.H. Hall and R.E. Quinn (eds.) Organizational Theory and Public Policy, Beverley Hills, CA: Sage, pp. 147–161.

    Google Scholar 

  • DiMaggio, P.J. and Powell, W.W. (1983). The Iron Cage Revisited: Institutional isomorphism and collective rationality in organizational fields, American Sociological Review 48 (2): 147–160.

    Article  Google Scholar 

  • DiMaggio, P.J. and Powell, W.W. (1991). Introduction, in W.W. Powell and P.J. DiMaggio (eds.) The New Institutionalism in Organizational Analysis, Chicago: University of Chicago Press.

    Google Scholar 

  • Eason, K. (2007). Local Sociotechnical System Development in the NHS National Programme for IT, Journal of IT 22 (3): 257–264.

    Google Scholar 

  • Ewusi-Mensah, K. and Przasnyski, Z.H. (1991). On Information Systems Project Abandonment: An exploratory study of organizational practices, Management Information Systems Quarterly 15 (1): 67–86.

    Article  Google Scholar 

  • Fennel, M.L. (1980). The Effects of Environmental Characteristics on the Structure of Hospital Clusters, Administrative Science Quarterly 25 (3): 485–510.

    Article  Google Scholar 

  • Flick, W. (2000). Episodic Interviewing, in M.W. Bauer and G. Gaskell (eds.) Qualitative Research with Text, Image and Sound, UK: Sage, pp. 76–92.

    Google Scholar 

  • Friedland, R. and Alford, R.R. (1991). Bringing Society Back in: Symbols, practices, and institutional contradictions, in W.W. Powell and P.J. Dimaggio (eds.) The New Institutionalism in Organizational Analysis, Chicago: University of Chicago Press, pp. 232–263.

    Google Scholar 

  • Friedson, E. (2007). Professional Dominance: The social structure of medical care, First published in 1970 Brunswick, New Jersey, US: Transaction Publishers.

    Google Scholar 

  • George, E., Chattopadhyay, P., Sitkin, S.B. and Barden, J. (2006). Cognitive Underpinnings of Institutional Persistence and Change: A framing perspective, Academy of Management Review 31 (2): 347–365.

    Article  Google Scholar 

  • Greenwood, R. and Hinings, C.R. (1996). Understanding Radical Organizational Change: Bringing together the old and new institutionalism, Academy of Management Review 21 (5): 1022–1054.

    Google Scholar 

  • Hasselbladh, H. and Kallinikos, J. (2000). The Project of Rationalization: A critique and reappraisal of neo-institutionalism in organization studies, Organization Studies 21 (4): 697–720.

    Article  Google Scholar 

  • Heathfield, H., Pitty, D. and Hanka, R. (1998). Evaluating Information Technology in Healthcare: Barriers and challenges, British Medical Journal 316 (7149): 1959–1961.

    Article  Google Scholar 

  • Hendy, J., Reeves, B.C, Fulop, N., Huchings, A. and Masseria, C. (2005). Challenges to Implementing the National Program for Information Technology: A qualitative study, British Medical Journal 331: 331–336.

    Article  Google Scholar 

  • Kaissi, A.A. and Begun, J.W. (2008). Fads, Fashions, and Bandwagons in Health Care Strategy, Health Care Management Review 33 (2): 94–102.

    Article  Google Scholar 

  • Keil, M. Mann, J. and Rai, A. (2000). Why Software Projects Escalate: an empirical analysis test of four theoretical models, MIS Quarterly, 24 (5): 631–664.

    Article  Google Scholar 

  • Kelly, H., Chiasson, M., Downey, A. and Pacaud, D. (2011). The Critical Impact of eHealth on the Self-Management of Diabetes: A double adoption perspective, Journal of the Association of Information Systems 12 (3): 208–234.

    Google Scholar 

  • Kenny, A. (2004). Medical Dominance and Power: A rural perspective, Health Sociology Review 13 (2): 158–165.

    Article  Google Scholar 

  • Lacity, M.C., Khan, S.A. and Willcocks, L.P. (2011). A Review of the IT Outsourcing Literature: Insights for practice, in R.D. Galliers and W.L. Currie (eds.) The Oxford Handbook of Management Information Systems, Oxford, UK; Oxford University Press, pp. 496–528.

    Google Scholar 

  • Laing, A. and Hogg, G. (2002). Political Exhortation, Patient Expectation and Professional Execution: Perspectives on the consumerization of healthcare, British Journal of Management 13 (2): 173–188.

    Article  Google Scholar 

  • Mark, A. (2007). Modernizing Healthcare – Is the NPfIT for purpose? Journal of Information Technology 22 (3): 248–256.

    Article  Google Scholar 

  • McNulty, T. and Ferlie, E. (2004). Process Transformation: Limitations to radical organizational change within public service, Organization Studies 25 (8): 1389–1412.

    Article  Google Scholar 

  • Meyer, A.d., Brooks, G.R. and Goes, J.B. (1990). Environmental Jolts and Industry Revolutions: Organizational responses to discontinuous change, Strategic Management Journal 11 (Special Issue: Corporate Entrepreneurship. Summer): 93–110.

    Google Scholar 

  • Meyer, J.W. and Rowan, B. (1977). Institutionalized Organizations: Formal structure as myth and ceremony, American Journal of Sociology 83 (2): 340–363.

    Article  Google Scholar 

  • Nadler, D.A. and Tushman, M.L. (1989). Organizational Frame Bending: Principles for managing reorientation, Academy of Management Executive 3 (33): 194–203.

    Article  Google Scholar 

  • National Audit Office (2004). Improving IT Procurement. London: The Stationary Office, 5 November. Report by the Comptroller and Auditor General, HC 877 Session 2003–2004.

  • National Audit Office (2006). The National Programme for IT in the NHS, London: The Stationary Office.

  • National Audit Office (2008). The National Programme for IT in the NHS: Progress since 2006, London: The Stationary Office.

  • National Audit Office (2011). The National Programme for IT in the NHS. London: The Stationary Office, May. An update on the delivery of detailed care records systems.

  • Pollock, A. (2005). NHS plc: The privatisation of our healthcare, London: Verso.

    Google Scholar 

  • Randell, B. (2007). A Computer Scientist's Reactions to the NPfIT, Journal of Information Technology 22 (3): 222–234.

    Article  Google Scholar 

  • Reay, T. and Hinings, C.R. (2005). Recomposition of an Organizational Field: Healthcare in Alberta, Organization Studies 26 (3): 351–384.

    Article  Google Scholar 

  • Rivard, S., Lapointe, L. and Kappos, A. (2011). An Organizational Culture-Based Theory of Clinical Information Systems Implementation, Journal of the Association for Information Systems 12 (3): 123–162.

    Google Scholar 

  • Sauer, C. and Willcocks, L.P. (2007). Editorial: Unreasonable expectations – NHS IT, Greek choruses and the games institutions play around mega-programmes, Journal of Information Technology 22 (3): 195–201.

    Article  Google Scholar 

  • Scott, W.R. (2001). Institutions and Organizations, USA: Sage Publications.

    Google Scholar 

  • Scott, W.R., Ruef, M., Mendel, P.J. and Caronna, C.A. (2000). Institutional Change and Healthcare Organizations, Chicago: University of Chicago Press.

    Google Scholar 

  • Shaw, M.C. and Stahl, B.C. (2011). On Quality and Communication: The relevance of critical theory to health informatics, Journal of the Association of Information Systems 12 (3): 255–273.

    Google Scholar 

  • Swanson, E.B. and Ramiller, N. (1997). The Organizing Vision in Information Systems Innovation, Organization Science 8 (5): 458–474.

    Article  Google Scholar 

  • Swanson, E.B. and Ramiller, N. (2004). Innovating Mindfully with Information Technology, Management Information Systems Quarterly 28 (4): 553–583.

    Google Scholar 

  • Tolbert, P.S. and Zucker, L.G. (1996). The institutionalization of institutional theory, in S. Clegg, C. Hardy and W. Nord (eds.) Handbook of Organisation Studies, London, Sage Publications, pp 175–190.

    Google Scholar 

  • Ure, J., Procter, R., Lin, Y.W., Hartswood, M., Anderson, S., Lloyd, S., Wardlaw, J. and Ho, K. (2009). The Development of Data Infrastructures for eHealth: A socio-technical perspective, Journal of the Association for Information Systems 10 (5): 415–429.

    Google Scholar 

  • Wait, P. (2012). Government IT projects pushed to use modular contracting, Information Week, 18 June. Online, http://www.informationweek.com/news/government/policy.

  • Wanless, D. (2002). Securing Our Future Health: Taking a Long-Term View, April. London. Final Report of an Independent Review of the long-term resource requirement for the NHS, http://www.hm-treasury.gov.uk/Consultations_and_Legislation/wanless/consult/wanless_final.cfm.

  • Willcocks, L. and Currie, W.L. (1997). Pursuing the Re-Engineering Agenda in Public Administration, Public Administration 75 (4): 617–650.

    Article  Google Scholar 

  • Zucker, L.G. (1977). The Role of Institutionalization in Cultural Persistence, American Sociological Review 42 (5): 726–743.

    Article  Google Scholar 

  • Zucker, L.G. (1983). Organizations as Institutions, in S.B. Bacharach (ed.) Research in the Sociology of Organizations, Greenwich, CT: JAI Press, pp. 1–42.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Audencia-PRES LUNAM, Audencia School of Management, Nantes, France

    Wendy L Currie

Authors
  1. Wendy L Currie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wendy L Currie.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Currie, W. Institutional isomorphism and change: the national programme for IT – 10 years on. J Inf Technol 27, 236–248 (2012). https://doi.org/10.1057/jit.2012.18

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/jit.2012.18

Keywords

Search

Navigation