UK National Health Service Information Systems Implementation: Emergence in Informal Groups

Wilegoda-Wickramage, Amila Shantha (2025) UK National Health Service Information Systems Implementation: Emergence in Informal Groups. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

The implementation of Information Systems (IS) is a critical area of study in both academic research and industry practice. However, a research gap remains in understanding the role of spontaneous, informal interactions during IS implementation and their impact on the overall process. This gap was identified through two literature searches conducted in 2011—one combining systematic and unsystematic approaches—and a comprehensive systematic review in 2023. In the context of the United Kingdom’s National Health Service (NHS), IS developed by vendor organisations under the National Programme for Information Technology (NPfIT) are typically designed based on predefined scenarios, rather than the complex, real-world dynamics of the organisations they aim to support. The implementation of such highly specified IS fails to accommodate the emergence of informal interactions within the organisational context, creating a design-reality gap. This gap poses significant challenges to the success of IS implementation, as it disrupts organisational routines and hinders the adaptability of individuals and teams. To address this issue, the research aims to contribute to understanding the design-reality gap through the development of the Informally-interactive Deferred Adaption Process (IDAP) model. The IDAP model posits that the design-reality gap disrupts organisational routines, influencing informal interactions reflective of complex adaptive systems (CAS). The model suggests that recognizing and supporting these adaptations is crucial for the successful implementation of IS. The research investigates IS implementation projects in 10 NHS organisations using ethnographic interviews, practitioner observations, and documentary evidence. Data analysis, conducted through NVivo and employing a thick description analysis method, provides empirical evidence supporting the IDAP model's propositions. The key findings include (1) the design-reality gap as a fundamental cause for CAS behaviour; (2) disruption of individuals' organisational routines due to the design-reality gap; (3) localized actions resulting in adaptations resembling 'deferred actions'; (4) individuals aligning their behaviour with natural designs or organisational life rather than specified designs; and (5) diffusion management mechanisms supporting deferred action. These findings contribute to the understanding of how organisational actors' informal interactions align with the IDAP model to achieve desired adaptations despite specified IS designs. The implications of this research extend to IS developers and implementation managers, highlighting the importance of considering IDAP processes in their work.