Unrealistic expectations, uncertainty plague rollout of U.K. program

August 29, 2005

It was supposed to be a world-class IT network, one of the largest and most sophisticated implementations of PACS and electronic medical records ever attempted. But somewhere along the way, the U.K.’s effort to wire 150 English hospitals into the digital age has gone awry.

It was supposed to be a world-class IT network, one of the largest and most sophisticated implementations of PACS and electronic medical records ever attempted. But somewhere along the way, the U.K.'s effort to wire 150 English hospitals into the digital age has gone awry.

Frontline National Health Service workers in the U.K. are disappointed with the suboptimal rollout of the country's national program for information technology, according to a survey published in the August issue of the British Medical Journal. Investigators reported that while a centralized approach to IT implementation was laudable, success depended on not alienating the staff involved. Apparently, this is exactly what has happened.

Researchers from the department of public health and policy at the London School of Hygiene and Tropical Medicine surveyed personnel at four different hospitals. Staff at all of the hospitals reported a lack of clarity and communication from the national IT program's headquarters regarding future program developments.

"We were most surprised by the lack of two-way communication and clinical engagement in the process of implementation," said lead author Dr. Jane Hendy, a research fellow at the London School.

Hendy and colleagues interviewed 23 key IT, finance, and clinical staff at four acute-care NHS hospitals in England and examined documents and published data on the national IT project. To achieve a generalizability of results, researchers chose hospitals of various sizes, financial status, and star ratings.

The hospitals varied widely in their IT implementation abilities. Unrealistic timelines and uncertain IT implementation schedules resulted in low morale in the NHS staff involved in IT implementation, according to the investigators. Even the promise of short-term benefits could not convince NHS staff to enthusiastically embrace the national program, especially if they lost local IT functionality during the transition to a national IT infrastructure.

Researchers will continue to evaluate from both patient and staff perspectives the experience of individual users and the impact of the implementation on the organization as a whole, on working practices, and on patient care as the program gains momentum, Hendy said.

Improving NHS staff opinion and morale will require better communication and a more realistic sense of what is likely to be achieved and when, she said.