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Family Name QUARTEY First Name Mary – Gloria
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Information School
Sustaining Alignment of IT and Business Strategy in Healthcare
Organizations: A Case Study
A dissertation submitted in partial fulfilment of the requirements for the Master of Science Degree in
Health Informatics
Information School
University of Sheffield
Mary-Gloria Quartey
September 2017
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Table of Contents
List of Figures..........................................................................................................................6
List of Tables...........................................................................................................................7
List of Abbreviations...............................................................................................................8
Acknowledgements..................................................................................................................9
Abstract....................................................................................................................................10
Chapter 1: Introduction...................................................................................11
1.1 Implementation of Information Systems in Healthcare...............................................11
1.2 The Case for Study.......................................................................................................13
1.3 Significance of Study...................................................................................................15
1.4 Research Question and Objectives...............................................................................15
1.5 Research Approach and Methodology.........................................................................16
Chapter 2 Review of Literature.......................................................................17
2.1 Introduction...................................................................................................................17
2.2 Difference between Information Technology and Information Systems......................17
2.3 Strategy within the Organisation...................................................................................19
2.3.1 Corporate strategy.................................................................................................19
2.3.2 Business Strategy..................................................................................................20
2.3.3 Functional Level Strategy.....................................................................................21
2.4 IT Strategy......................................................................................................................21
2.5 Organisational Structure.................................................................................................22
2.6 Organizational Leadership and Culture..........................................................................27
Chapter 3 Concept of Alignment of IT and Business Strategy......................27
3.1 Strategic Alignment Model (SAM)................................................................................28
3.2 Additions to the Strategic Alignment Model.................................................................30
3.3 Sustaining Alignment.....................................................................................................32
3.4 Misalignment..................................................................................................................34
3.5 Summary: Chapter 2 and Chapter 3................................................................................36
Chapter 4 Developing Initial Conceptual Framework....................................36
4.1 Calibration......................................................................................................................37
4.2 Causes and Situations of Misalignment..........................................................................37
4.3 Capabilities, Capacity and Competence..........................................................................37
4.4 Sustain Alignment...........................................................................................................38
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Chapter 5 Methodology....................................................................................43
5.1 Introduction..................................................................................................................43
5.2 Research Paradigm.......................................................................................................44
5.3 Research Methodology.................................................................................................45
5.4 Case Study Research Method.......................................................................................46
5.4.1 Data Collection Design........................................................................................47
5.4.2 Interviews.............................................................................................................47
5.4.3 Data Collection....................................................................................................48
5.5 Data Analysis................................................................................................................50
5.5.1 Transcription........................................................................................................50
5.5.2 Thematic Coding..................................................................................................50
5.6 Research Findings.........................................................................................................51
5.6.1 Change in National Policy....................................................................................51
5.6.2 General Financial Challenges...............................................................................52
5.7 Revisiting Initial Framework.........................................................................................52
5.7.1 Calibration............................................................................................................52
5.7.2 Causes and Situation of Misalignment.................................................................53
5.7.2.1 Lack of Funding........................................................................................53
5.7.2.2 Implementation..........................................................................................53
5.7.2.3 Internal and External Influences................................................................54
5.7.2.4 System Function.........................................................................................54
5.8 Seeking Capabilities......................................................................................................55
5.9 Sustain Alignment.........................................................................................................58
Chapter 6 Discussion and Conclusion..............................................................58
6.1 Proposed Sustaining Alignment Model.........................................................................60
6.2 Sustaining Alignment in a Dynamic Environment........................................................61
6.3 Contributions and Recommendation for Practice..........................................................62
6.4 Limitations and Possible Future Research.....................................................................63
References...................................................................................................................................66
Appendix 1 Interview Scripts......................................................................................................75
Appendix 2 Details of Interviewees.............................................................................................89
Appendix 3 Sample of Code Definition Table.............................................................................90
Appendix 4 Ethics Approval Letter..............................................................................................93
Appendix 5 Information Sheet......................................................................................................95
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Appendix 6 Confirmation of Address........................................................................................98
Appendix 7 Access to Dissertation............................................................................................101
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List of Figures
2.1 Functional Organizational Structure..................................................................................24
2.2 Product Division Structure.................................................................................................25
2.3 Geographic Divisional Structure........................................................................................26
2.4 Matrix Structure..................................................................................................................26
3.1 Strategic Alignment Model.................................................................................................29
3.2 Domains of Alignment........................................................................................................29
3.3 Maes Generic Framework...................................................................................................31
4.1 Initial Conceptual Framework.............................................................................................42
5.1 Research Process.................................................................................................................43
6.1 Proposed Conceptual Framework for Sustaining Alignment..............................................61
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List of Tables
1.1 Health Information Systems Implemented in LLR............................................................14
4.1 Relationships of Factors and Concepts in Initial Framework............................................41
5.1 Research Methodology Design..........................................................................................44
5.2 Differences between Positivism, Interpretivism, Critical Realism, and Soft Positivism...45
5.3 Summary of Interviewed Participants................................................................................49
5.4 Thematic Coding Generated for the Framework of Sustaining Alignment (Users)...........56
5.5 Thematic Coding Generated for the Framework of Sustaining Alignment (IT and NHS
managers).................................................................................................................................57
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List of Abbreviations
ACG Adjusted Clinical Groups
BCT Better Care Together
CAMHS Child Adolescent Mental Health Service
CCG Clinical Commissioning Group
DSS Decision Support System
eDSM Enhanced Data Sharing Mode
EMAS East Midlands Ambulance Service
EPR Electronic Patient Record
EPS2 Electronic Prescription Service
GEMIMA Greater East Midlands Information Management and Analysis
GP General Practitioners
GPSoC
HCO
GP Systems of Choice
Health Care Organization
HIS Health Information Systems
IM&T Information Management and Technology
IT Information Systems
KPI Key Performance Indicators
LAN Local Area Networks
LDR Local Digital Roadmap
LLR Leicester, Leicestershire and Rutland
MIG Medical Interoperability Gateway
MIS Management Information Systems
NHS National Health Service
NPfiT National Programme for IT
PAS Patient Administration System
SCR Summary Care Records
SSiDs Service Set Identifiers
STP Sustainability and Transformation Plans
TPP The Phoenix Partnership
TPS Transaction Processing System
UK United Kingdom
WAN Wide Area Network
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Acknowledgements
I will first and foremost thank the giver of life for providing me the strength and sense of direction to
complete this research. A special thank you goes to my supervisor Dr. Angela Lin, for her practical
support throughout my research. Many thanks also to the participants who responded to my interview
requests. Without your time and input, I wouldn’t have been able to complete this work. I am also grateful
to my husband and children, Erasmus, Fiona and Ryan, for bearing with the fact that I have to study so
the volume of the television must be very low. I thank my husband also for his many encouragements
along the way.
Finally and without hesitation, I thank my father Mr. Frederick Ashitey to whom this dissertation is
dedicated, for identifying my capabilities from childhood and nurturing them. You have been the best
teacher I have ever had in every aspect of my life and that has given me the strength to move on, and
apply what you have taught me in order to achieve the best results.
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Abstract
The purpose of this study resulted from the review of literature which revealed that there have been many
research in the past to determine how healthcare organizations are able to achieve alignment of
information technology (IT) systems with business strategy through various models and processes (Bush
et al. 2009). Although Sha et al. (2011) provided a model for implementing a new IT system focusing on
social dimension during misalignment, the study did not cover the broad areas of the situations in which
misalignment in IT and business strategy can occur (Chen 2015; Weill et al.1998; TechRepublic 2003).
Opinions are divided in the academic world regarding this, where some researchers have asserted that
sustaining alignment is through dynamic capabilities (Baker et al. 2008), while others have argued that
dynamic capabilities are plainly one strategic option in a dynamic environment which might not lead to
success (Winter 2003) since ad-hoc problem solving or resource picking skills could be alternatives
(Makadok 2001). Moreover in an environment where there is no competition, dynamic capabilities might
have a negative impact on performance (Winter 2003). These studies however, did not provide any
practical process or structure for sustaining alignment particularly in healthcare organizations.
To ensure sustained alignment, this study adopted the perspective that there must be a misalignment
identified be able to identify where alignment problems exist (Sha et al. 2011; TechRepublic 2003). A
qualitative case study was used to explore how alignment can be sustained in a continuous process. Open-
ended questions were used to collect data in interviews with IT executives, National Health Service
(NHS) managers and users of SystmOne at the Child and Adolescent Mental Health Services (CAMHS)
within the integrated healthcare system of Leicester, Leicestershire and Rutland (LLR).
A conceptual framework was developed which gives a broad view of how different misalignment
problems can be solved through mechanisms like calibration and seeking for capabilities to sustain
alignment. This research identified misalignment factors existing within IT department, NHS
management and with some system users which could be sustained through mechanisms like re-
prioritization, recommendation from NHS management to government as well as possible system
reconfiguration of functions from IT support. It was observed that the high level of management
leadership as a result of decentralization, IT expertise, resources and the strategic role IT plays in the
implementation process makes it possible for alignment to be sustained despite the funding constraints.
This research outlined a framework for sustaining alignment through calibration of causes and situations
of misalignment and seeking for capabilities. Furthermore, this model contributes to the understanding of
sustaining alignment by not just listing contingent factors for sustaining alignment but shows how it can
be practically applied in a process within a dynamic environment, and also contributes to further research.
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Chapter 1 Introduction
1.1 Implementing Information Systems in Healthcare
The UK NHS had its first national information for technology strategy in 1992 (Honeyman et al. 2016).
The National Programme for IT (NPfIT) known later as connecting for health was then introduced as a
new strategy from 2002 to 2011 for the creation of individual electronic care records for patients,
connecting primary and secondary care information systems (IS), and also allowing health professionals
to have a common IT platform (Honeyman et al. 2016).
Although it failed to meet its major objectives as well as setting up an integration of electronic health
record system throughout secondary care, there were some achievements in the establishment of digital
infrastructural services nationwide (Honeyman et al. 2016). Some of the contributing factors to this
failure were that decision making was too centralized together with the negligence of general involvement
making it difficult to identify with user needs (Honeyman et al. 2016). Providers were then given
directions to implement systems which they did not have much knowledge of (Honeyman et al. 2016).
Within the general practices, however, there has been more successful implementation of electronic
health records as well as computer systems for general practitioners (GPs) to interact with their patients
(Honeyman et al. 2016).
Despite the failure of NPfIT, a challenge came from the Secretary of State for Health, Jeremy Hunt to the
NHS for it to “go paperless” by the year 2018 which was later extended to 2020 in the NHS five year
forward view (Honeyman et al. 2016). To lead this new programme for supporting the healthcare system,
the National Information Board was created. As part of the commitments of the five year forward view,
efforts are being made towards interoperability whereby it will be possible for patient electronic records
to be shared promptly and securely between health professionals in support of patient care so that there
will be an integration of electronic health records (Honeyman et al. 2016). This goal is proving to be
difficult due to the different systems and practices within the NHS and this is why local commissioners
are involved together with healthcare providers to get it accomplished (Honeyman et al. 2016). This also
serves as a primary building block which forms part of the strategy in making use of information
technology since electronic health record can be a valuable source of information which can be used for
varied purposes (Honeyman et al. 2016).
Within primary care however, most health centres have some form of electronic record owing to the
central funding provided by commissioners who are able to choose a system agreed upon through the GP
Systems of Choice (GPSoC) on behalf of the local GPs they represent. Through this method there has
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been consolidation on the market (Hampson et al. 2015) such that EMIS Health and The Phoenix
Partnership (TPP) systems are predominantly used to provide care for most (90%) patients in England.
Looking outside of primary care, there are different and divided forms of electronic systems in use. There
was a self assessment made by all two hundred and thirty nine (239) NHS trusts and foundations in late
2015 on their present digital capabilities (Honeyman et al. 2016). The results showed the following:
Acute trusts are less able to share information electronically and also have a poor structure.
Although there is a similar situation within community trusts there is minor progress.
In the lead is mental health which is more able to share information electronically and almost
completed its implementation in health information systems.
Considering the investments made into the implementation of digital systems within the different care
settings in healthcare with the aim of interoperability, easy connection between health professionals,
integration, and easy access to care, it is worth performing a study within the context of sustaining
alignment of IT and business strategies which will help to shed light on the current situation of health
information system implementation within the NHS by using a case study. The health information system
used as the subject of this study was the SystmOne clinical system which is a system developed by the
TPP and is widely used by GPs as well as having other modules for child health, community and
palliative care, and secondary care.
Studies which have mentioned sustaining alignment are covered in four viewpoints. In the first instance,
there was the mention of sustaining alignment in the strategic alignment process (Luftman et al. 1999)
which considers enablers and inhibitors of alignment. This six-step process of alignment finally ends with
sustaining alignment which can be achieved by adopting “alignment behaviour” at the point of alignment
to be able to sustain alignment. However these alignment behaviours do not necessarily form the
structures or processes to go through to sustain alignment in times of change.
Secondly, by understanding that alignment is a dynamic process, there has been a look into models for
identifying misalignment. One model (El-Telbany et al. 2014) identified what happens at the point of
misalignment and realised that four particular areas can be affected; these are the type of business-IT
relationship, IT projects, business IT communication and business IT engagement. However, although the
areas of misalignment were identified there was no known process to follow to sustain alignment. Chen
(2015) also added to the literature of misalignment by identifying causes and situations of misalignment
and how it affects an organization but not necessarily how to sustain it.
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Sha et al. (2011) looked at how a hospital was able to identify a misalignment in IT and business strategy
paying attention to how IT projects are reflecting business plans and came up with a model of how to
combine the social dimension of alignment with IT and business strategy to implement new IT systems at
the time of misalignment. The social dimension of alignment which was identified in Sha et al. (2011)
study are communication and understanding between business executives and IT experts, and also the
relationship between them. The idea of calibration proposed by Sha et al. (2011) to sustain alignment
during misalignment guided the broad view of this study.
Finally, Barker et al. (2008) also proposed in their study that once an organization has had the experience
of achieving alignment, it will always have the skill and resources to sustain alignment according to the
dynamic capabilities theory. However, since dynamic capabilities theory is meant for sustenance of
competitive advantage in a highly dynamic environment some researchers believe that the reliance on that
alone might result in failure especially where the environment lacks competition (Winter 2003; Drnevich
et al. 2011). Makadok (2001) proposed that ad-hoc problem solving, or resource picking skills could be
alternatives.
After reviewing available literature the issue remains that there has to be a process or structure for
sustaining alignment in a changing business environment.
1.2 The Case for Study
Considering the initial failure of the NPfIT programme to meet the needs of healthcare facilities by
providing interoperable and patient focused IT systems, there is the need to look at how alignment of IT
and business strategy can be sustained in order to realise set goals. One major factor which led to the
failure of NPfIT was due to the fact that the programme was more of a centralised top-down IT strategy
driven without necessarily focusing on the needs of the local NHS (Honeyman et al. 2016). The new
strategy of localizing NHS digital systems are operated by ‘local digital roadmaps’ and led by clinical
commissioning groups (CCGs) (Honeyman et al. 2016). Ultimately with the digital roadmaps, the 2020
paperless goal should be realised by aligning with the five year sustainability and transformation plans
(STPs) (Honeyman et al. 2016).
In line with this new strategy of the NHS, the Leicester, Leicestershire and Rutland (LLR) health and
social care information community which is the case for this research, has also brought forward a Local
Digital Roadmap (LDR) in 2016 (Leicester, Leicestershire and Rutland Local Digital Roadmap 2016) and
serves as the IT strategy of the local area to be aligned with the local STPs which was developed based on
the Better Care Together (BCT) agenda. The local STPs are aimed at delivering primary care on a large
scale than the smaller scales, at which they operate; securing seven day services; supporting new care
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models; and transforming care in line with key clinical priorities, as outlined in the five year forward view
of NHS England (Leicester, Leicestershire and Rutland Local Digital Roadmap 2016). To improve patient
outcomes and supporting integrated care models, the LLR has a vision to ensure that patient records can
be shared throughout all clinical boundaries (Leicester, Leicestershire and Rutland Local Digital
Roadmap 2016).
Currently, the LLR has been able to implement different information systems to enable the STP goals
(Leicester, Leicestershire and Rutland Local Digital Roadmap 2016). Some of these systems and their
functions are listed in table 1.1. In order for there to be easy access to these systems, Service Set
Identifiers (SSiDs) allows Wi-Fi connection across healthcare organisations within LLR (Leicester,
Leicestershire and Rutland Local Digital Roadmap 2016).
System Function
Summary Care Records (SCR) For General Practitioners (GPs) to share information of patient record through the
Medical Interoperability Gateway (MIG); and sharing of information through The Phoenix Partnership (TPP) SystmOne within the local acute trust.
Patient Online For patients to book appointments, cancel appointments and order repeat
prescriptions.
Electronic Prescription Service
(EPS2)
For patients to pick up prescriptions sent from GPs directly to a selected pharmacy.
TPP SystmOne
EMIS Web
For referrals, communication and correspondence.
Greater East Midlands
Information Management and Analysis (GEMIMA)
Business intelligence for analyzing clinical data.
CareTrack Management of care.
Pathway and Referral
Implementation System (PRISM)
For GP referrals.
Adjusted Clinical Groups (ACG) Risk stratification for better management of those who have the potential of re-
admission.
Chathealth
NHS Now
Health for kids
Patient focused applications for assisting patients in accessing health needs through
information, communication and self-monitoring.
Electronic Pathology Report
System
Electronic lab reports.
RiO Electronic care record system.
Spine Supporting health and social care for exchange of information.
Enhance Data Sharing Mode
((eDSM)
For sharing of patient records within the NHS with the patient’s consent.
Table 1.1 Health Information Systems Implemented in LLR (Leicester, Leicestershire and Rutland Local Digital
Roadmap 2016)
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With these implementations in place and the LLR standing at a digital maturity for strategic alignment at
fifty five (55) for East Midlands Ambulance Service (EMAS), seventy five (75) for Leicestershire
Partnership Trust (LPT), and University Hospital Leicester at eighty (80) which are close to and above the
national average of seventy six (76), it is a positive sign towards delivering the five year forward view for
2020/21(Leicester, Leicestershire and Rutland Local Digital Roadmap 2016). Leadership is at sixty five
(65), eighty five (85), and hundred (100) respectively for the above organizations which are very near and
above the national average of seventy seven (77). The readiness for the digital vision has been clearly
identified to be in the areas of sourcing for funds, structured governance, infrastructure and method for
delivering the digital capabilities which will be supported by research. Since funding and leadership are
known to be a major challenge to achieving alignment, it is impressive to see efforts being made within
the LLR to ensure alignment of their STP and LDR.
1.3 Significance of Study
From earlier discussions in the previous section, this study is significant, based on the notions from
previous studies about alignment, misalignment, sustaining alignment and how they relate to
implementation of health information systems. There is limited study which sheds light on sustaining
alignment especially in healthcare. There has been connections made between the importance of
sustaining alignment between IT and business strategy (Luftman et al.1999, Sabherwal et al. 2001; Baker
et al. 2008; Sha et al. 2011; TechRepublic 2003) however, there has not been any study to show what
processes are needed to sustain alignment considering its dynamic nature.
As the LLR works towards aligning their STP with the LDR for vision 2020, it is necessary to look at the
continuous alignment process which will help to sustain the alignment already achieved and possibly how
alignment will be sustained while work is being progressed towards the visions of the STPs and beyond.
1.4 Research Question and Objectives
From the above discussions, it is relevant to explore sustaining IT and business alignment in a changing
work environment considering the dynamic nature of alignment (Weill et al. 1998).The research question
therefore is: how is alignment of IT and business strategy sustained in healthcare organizations?
The question will be explored using the following objectives:
To perform a literature review on the concept of business-IT alignment as well as the business-IT
alignment model.
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Identifying causes and situations of misalignment. This will assist in finding where there are
alignment problems and the reasons why they exist.
Elaborate on the factors and processes through which misalignment of IT and business strategy
can be corrected if they are detected so as to sustain alignment.
1.5 Research Approach and Methodology
To examine how organizations can sustain IT and business alignment, the study was focused on the
alignment of the local LDR with the STPs as well as SystmOne in Child and adolescent mental health
service (CAMHS). By looking at it from a broad organizational level it helps to analyze the general IT
and business strategy alignment and how it is being sustained. Studying SystmOne will also allow us to
see how its alignment is being sustained with business strategy.
A single case study with a qualitative approach was used. The feature of a case study research is its focus
on ‘how’ and ‘why’ questions (Rowley 2002) making it appropriate for descriptive and exploratory study.
Secondly, looking at alignment from the dynamic perspective is complex in nature, making the qualitative
approach useful in producing a holistic understanding of contextual non-numeric data (Mason 2002) to
explore the question of this research. Data collection and analysis was guided by soft positivism (Kirsch
2004; Leidner et al. 2009). This approach allowed me to conduct the data analysis with prior expectations
based on prior theories, which is consistent with positivism and permitting unexpected discovery and
explanations emerging from the data which is consistent with interpretivism. Directed by soft-positivism,
data was collected with the objective of identifying causes of misalignment, situations of misalignment
and the factors that contribute to sustaining alignment of IT and business strategy which is a pre-existing
phenomena and also drawing from interpretivist point of view. This study therefore expects that factors
causing misalignment, situations of misalignment and how to sustain alignment will emerge from the
collected data.
A literature review was first undertaken to look at previous work on alignment and sustaining alignment.
The factors of misalignment were identified as well as gaining insight into how misalignment can be
corrected to sustain alignment. Relevant concepts were drawn from previous literature and theory by
using an eclectic approach (Garfield et al. 1977). The eclectic approach allowed for the inclusion of
different viewpoints. An initial conceptual framework included factors causing misalignment,
misalignment situations, factors for sustaining alignment and calibration from review of literature became
the basis for establishing how to sustain alignment.
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A case study of the Leicester, Leicestershire and Rutland Digital Roadmap which is supposed to be
aligned with the local Sustainability and Transformation Plans (STP) was used. Also, the implementation
of SystmOne in CAMHS was looked at to be able to obtain the perspectives of end users.
Since a qualitative case study was being used, data collection was done through open-ended
questionnaires. There was a mixture of face to face interviews, speaking to participants on telephone as
well as sending questionnaires to be completed via e-mail. Inclusive data were analyzed through
categorizing and then interpreted for the formulation of a framework for sustaining alignment.
Chapter 2 Review of Literature
2.1 Introduction
The review of literature helps to find the main concepts and understanding the theoretical background
with the following discussions. Firstly, the difference between IT and IS are described, followed by
strategy within an organization, organizational leadership and culture, and concept of alignment of IT and
business strategy. Within the chapter of alignment concept there are some insights into prior research on
sustaining alignment and misalignment.
2.2 Difference between Information Technology and Information Systems
An organization normally functions in an environment where it needs information for feedback from
inputs and outputs in order to have control to enable high performance (Chaffey et al. 2005). Information
represents the knowledge derived from recorded facts or data (Kroenke et al. 1993) and it improves
organizational performance. Through the use of information resources, products and services can be
delivered at high quality resulting in high profits. Timely information also helps with decision making of
the individual hence resulting in productivity (Reddy et al. 2009). An information system provides the
means of gathering, processing, storing, sharing and analysis of information for the needs of users.
Chaffey et al. (2005) related that an information system is a system that utilizes information technology in
the management of information. This underlines the fact an information system is not essentially
computer-based but could be likened to any system providing information for an organization (Hicks
1993; Maddison et al.1996) such as a manual information system (Hicks 1993). The information
contained in the information system is about the organization as well as its environment (Laudon et al.
2006, p. 15).
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Information technology however, refers to the computer hardware and software for collecting, storing,
analyzing and disseminating information through network systems (Slack 2007; Cooper et al.1990) like
LAN (local area networks) and WAN (wide area networks) for the achievement of business objectives.
Kroenke et al. (1993) suggested that in technology, the hardware refers to computer equipment whereas in
a manual system a paper is referred to as hardware. In addition, the components of the hardware in an
information system are made up of devices for input, output, storage, memory and the central processing
unit. The software on the other hand is the program that interacts with the hardware in the form of
applications software or system software (Hicks 1993). The applications software are the programs used
by businesses to support their work whiles the systems software is responsible for controlling the
computer system in performing tasks for the end user (Chaffey et al. 2005 p. 59-60). Different kinds of
applications software can be used example, enterprise software, departmental applications, and personal
productivity and group working applications which are used in different ways to manage information
(Chaffey et al. 2005). Similarly, operating systems, development software and database systems are the
three different types of systems software for linking hardware and application software, programming and
managing data respectively (Chaffey et al. 2005).
Theoretically any system can be referred to as an information system since any system can be used to
provide information to an organization without necessarily involving technology (Maddison et al. 1996).
Information systems involving manual methods are however facing out. The use of information
technology (IT) in this research refers to the implementation of information systems (IS) through the use
of information technology. As has been the case for present management literature, the term information
system and information technology are used interchangeably (Wager et al. 2005) in this study to mean
information systems supported by technology. As mentioned before, information technology
encompasses the computer hardware, software and the network systems for telecommunication.
Information technology is a component of every information system. Through applications software an
information system can be developed for an organization which requires an understanding of the
organization, management and information technology (Laudon et al. 2006) in order to create value for
the organization.
Some information systems which can be used with technology are decision support systems (DSS),
management information systems (MIS) and transaction processing systems (TPS) (Laudon et al. 2006;
Hicks 1993; Kroenke et al.1993). This research will be focusing on health information systems (HIS)
some of which have already been mentioned in section 1.2 with elaborations on their uses.
In order to be able to manage business processes IS helps to automate work processes which are referred
to as workflows (Dwivedi et al. 2001). Workflow is very important especially in healthcare where vast
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amount of information will have to be processed. This enables the processing and transfer of information
in a timely manner in the healthcare context for both clinical and administrative tasks to improve
performance (Dwivedi et al. 2001).
2.3 Strategy within the Organization
Strategy describes policies and decisions put in place, as well as the adoption of courses of action and
allocation of resources needed by an organization to achieve its long terms goals (Nickols 2011). The
decisions put together in a strategy are what guide the relationships of the organization and its
environment, direct the structural processes and also affect performance (Hambrick 1980). Strategies are
laid out to determine direction, focus effort, clarify the organization and provide guidance in response to
the environment (Mintzberg 1987) and these strategies are embedded within corporate strategy, business
strategy and functional strategy.
2.3.1 Corporate strategy
Corporate strategy involves patterns with decisions in an organization which will determine the
objectives, purposes and goals, policies and how these goals are going to be achieved (Andrews 1971). It
also defines the scope of business which will be pursued by the organization, the kind of economic
organization or human organization it is or intends to be, and the kind of economic and noneconomic
contribution it intends to make to its shareholders, employees, customers and communities (Andrews
1971). Corporate strategy is normally applied to the whole enterprise, while business strategy is less
comprehensive and defines the choice of product or service and market of individual businesses within a
firm (Andrews 1971). Corporate strategy is an organization process which cannot be separated from the
structure, behaviour and culture of the organization (Andrews 1971). However, two important aspects of
corporate strategy which will be touched on here are formulation and implementation. An important
activity in strategy formulation includes the ability to identify threats and opportunities in the
environment, being able to analyze the risks and how to mitigate them (Leontiades 1987; Andrews 1971).
Before making any choices, the external environment of operation needs to be considered (Lynch 2006;
Johnson et al. 2008) by taking into account the political, economic, socio-cultural, technological,
environmental and legal characteristics (PESTEL analysis) (Lynch 2006; Johnson et al. 2008). Within the
environment of the organization, the behaviour of competitors or rival organizations, bargaining ability of
customers and suppliers, threats from new businesses and buyers ability to substitute goods can be
analyzed using Porter’s five forces analysis (Lynch 2006; Johnson et al. 2008). The SWOT analysis is
used to ascertain the internal strengths and weaknesses of the organization’s resources as well as knowing
the opportunities and threats that originate from outside the organization (Pickton et al. 1998). Insights
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from these environmental assessments help in making strategic decisions as to how the organization can
compete and assist in answering questions such as; what type of customers to be targeted for products and
services? What the scope of operation in geographic terms will be? What skills and capabilities are
needed? What the risks and opportunities are? How the organization can grow from the starting business
as well as new businesses? How value can be generated? Answers from these questions together with
many other strategic questions brings about the formulation of organizational strategy as well as spelling
out the short and long term objectives including other control systems (Mintzberg 1996).
It is important to spell out the organization’s capabilities and this refers to where the strengths of the
organization lays and also the potentials of adding value (Andrews 1971). Capability is the ability of
integrating organizational assets and resources to sustain competitive advantage (Guan et al. 2003). This
comes with being clear on what makes the organization stand out and how well the organization can
gather resources and work around the capabilities to realise the required organisational goals (Johnson et
al. 2008). The sustainability of the capabilities will have to be considered to ensure that they can
withstand the test of time as well as projecting the future capabilities and how they can be achieved
(Johnson et al. 2008). Strategic capabilities might not stay stable in dynamic conditions and as such there
has to be a reliance on dynamic capabilities to enable strategic capabilities to be changed continually
(Johnson et al. 2008). Dynamic capabilities will be needed to readjust the needed competencies (Johnson
et al. 2008).
Implementation deals with aligning the resources, that is, labour, skills and IT, with the objectives of the
organization through the structuring leadership, communication, product, geography and systems to
monitor and audit progress ( Andrews 1971). The combination of individual competencies, organizational
resource and values are unique among companies due the differences (Andrews 1971). Therefore being
able to match all these components effectively does not yield results unless it is worked out, which ends
up being unique for each organization (Andrews 1971).
2.3.2 Business Strategy
In healthcare organizational context, Miles et al. (1978) classification of business strategies is widely used
and falls into the categories of prospectors, defenders, analyzers and reactors. A prospector describes an
organization according to its level to initiate changes, innovative in bringing forth latest technologies and
exploring avenues for new markets and products. Defenders will barely make any changes to their
products on the market and this is common to engineering oriented organizations for example (Miles et al.
1978). The focus of defenders is mainly to ensure that they remain competitive with pricing, quality,
delivery of service and being operationally efficient (Miles et al. 1978). The analyzer will give
consideration to a second best business orientation hopefully to maximize profits (Miles et al. 1978). The
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business could therefore be run based on both the prospector and defender strategies. Organizations with
a reactor strategy are mostly considered unsuccessful because they lack consistency in the structure of
strategy therefore are unable to make tangible changes even though it becomes obvious that there are
uncertainties in the business environment (Miles et al. 1978).
As part of business strategy different kinds of themes can be adopted across businesses and the corporate
environment and these define exactly the strategy of the organization as to what will be done to achieve
set goals (Porter 1996; Petersen et al. 2014; Perry 2011). Some of these themes are high quality, customer
intimacy and low cost (Petersen et al. 2014). Based on the premises of this study, it is very important to
mention the emergence of sustainability as a strategy theme which considers how to sustain a company
within the conditions of a fast changing environment, health, social and economic circumstances (Perry
2011).
2.3.3 Functional Level Strategy
Functional strategy relates to the departments of operations and the main strategic issues are the
functional business processes as well as value chain (Jones et al.2010). The various processes are
manufacturing, which entail marketing, finance and human resources (Jones et al.2010). These are made
possible through the gathering of resources making it possible for the effective and efficient execution of
business strategies (Jones et al 2010). The functional strategies work together with the higher levels of
strategy that is, business and corporate, through the provision of information relating to feedback from
customers, resources and capabilities which can help to make strategic decisions (Jones et al. 2010). Once
strategy at the higher level is formulated with the information provided, the operational departments must
act on those plans and accomplish them to attain strategic success (Jones et al. 2010).
2.4 IT Strategy
From the scholarly point of view, Broadbent et al. (1997) define an IT strategy as a way of making IT
investments that balance short term investment with future flexibility that support the business’s
objectives. IT strategy is normally documented together with the whole corporate strategy and business
strategy and is formulated by both IT and business executives (Gunasekaran et al. 2004). In order to
achieve successful implementation to create value there is the need to be informed about how to gain
competitive advantage, sustain and compete where it is needed (Gunasekaran et al. 2004).
The main purpose for an IT strategy is to ensure that it reflects and aligns with business strategy
(Gunasekaran et al. 2004). When IT functionality has the capability of structuring and supporting the
business strategy then there is IT strategy alignment (Henderson et al. 1993). Strategy alignment will be
22
looked at in detail in Chapter 3. There are developed enterprise architecture frameworks which assists
with the alignment of IT and business strategy as organizational changes occur, however they have
different methods such as The Open Architechture Framework and Zackman Framework ( McGinley
2016).
2.5 Organizational Structure
An organizational structure represents how organizational goals can be achieved through task allocation,
coordination and supervision (Pugh et al. 1971). The strategy of an organization will determine its
structure (McWatters et al. 2015). The actions of an organization are affected by its structure through the
laid down standard procedures for operations and also through establishing the particular persons who
will contribute to the decision-making process, and the degree to which their opinions will influence the
actions of the organization (Jacobides 2007).
Researchers agree that there are two basic dimensions to structure in terms of the policies that affect
operations and sets down guidelines on how employees should behave in organizational activities, and
these are centralization and formalization (Griffin et al 2011). Centralization means concentration of
authority at the top level of the administrative system (Marume et al. 2016). It determines the level at
which higher management can delegate authority for decision making (Gibson 2000: 345). There is high
centralization when important decisions are made by managers at the top level of hierarchy and regarded
as having most authority (Jones 2013). There is decentralization when managers at all levels within the
hierarchy contribute to making important decisions (Jones 2013). In general, when there is high
specialization of labour, there is lesser delegation of authority which brings on more involvement of the
functional departments hence spreading the level of control (Gibson 2000). The advantages of
centralization are that there is consistency in the general policies and strategies making it easier to
implement. Also, there is less independence for the subordinate divisions which makes it easy to co-
ordinate and exercise control in management in a centralized organization (Jones 2013: Mullins 2002). In
addition, there is a larger economies of scale and lower overhead costs for a centralized organization as
well as a faster decision making process since there is no dispersed authority (Caker et al. 2014; Mehta et
al. 2007). Advantages within a decentralized organization are the promotion of flexibility and
responsiveness which comes about through permitting managers in the lower levels to partake in
important decision making (Caker et al. 2014; Jones 2013). The flexibility brings about consistency in
development in the various divisions (Mullins 2002) and this brings about effectiveness in the activities
of support services and customer services since they become closer to operations and the services they are
supposed to give (Mullins 2002).
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Formalization represents the rules in an organization which brings about standardized behaviour
(Villagarcia 2011). Formalization can lead the organization into spending less, high quality products and
efficient operations (Villagarcia 2011). The advantages associated with standardization are that the need
to process information is reduced due to the fact that more information can be passed on with the same
representation (Galbraith 1974). It also increases the capacity of processing information since lower
hierarchies are able to make their own decisions supported by the rules of the organization (Villagarcia
2011). Balochian et al. (2012) however argued that formalization can result in inflexibility. The informal
organization refers to the unofficial and unauthorized relationships that inevitably occur between
individuals and groups within a formal organization or a network on its own (Sarlak et al. 2014). The
advantages of informal organization lie in the fact that it could easily be incorporated into the formal
organization through informal relations, easy cooperation between workers and managers making it easy
to delegate, decentralize and a lot of support from managers resulting in higher performance and
productivity (Sarlak et al. 2014). Some organizations have been successful through the utilization of
informal business approach such as Starbucks who incorporated the fast growth strategy of combining
formal processes with the creative spirit of innovation (Newell et al. 2009).
Mintzberg (1983) proposed five structural designs; simple structure, machine bureaucracy, professional
bureaucracy, divisionalized form and adhocracy. Due to changes in industry, the business environment, as
well as the modern times, there are new organizational structure designs which can be used to describe
organizations at present and these are functional structure, bureaucratic structure, divisional structure and
the matrix structure (Jones 2013; Mullins 2002). These structures determine how the organization will
operate and perform.
A functional structure has various specialized groups or departments in its configuration such that the
workers in that group have shared common skills and resources for productivity (Jones 2013). Some of
these specialties could be IT, marketing, finance, accounting, engineering, assembly and so on (Jones
2013). Similarly, the senior management team will have functional heads such as chief financial officer
and chief information officer (Jones 2013). The department head usually transfers communication within
the department to other departments (Jones 2013). The advantages with the functional structure are that it
allows employees to share knowledge and skills resulting in efficiency in operations (Jones 2013). There
is also the avenue to learn more skills to become specialized and productive (Jones 2013). However, there
could be communication problems between the different functions which can potentially decrease
flexibility and innovation (Jones 2013). The groups within the functions may also be subject to tunnel
vision where each of the functions only perceives the organization from the borders of its own operation
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(Jones 2013). Cross-functional communication is a current method which is used to bridge the
communication gaps between the boundaries of the departments (Jones 2013).
Figure 2.1 Functional organization structure (source: Jones 2013)
The German sociologist and political economist, Max Weber (Weber 1978) is widely known for his
studies on bureaucratic structure of the organization. In organization theory, bureaucracy refers to an
organization that emphasizes on a formal hierarchy, rules, impersonality, routine and merit based
environment (Van der Voet 2014). The rules and regulation in such organizations are planned to ensure
the simple operation of a complex system. According to the Weber’s idea, bureaucracy in the
organization is hierarchical, with well defined authority in particular areas of activity, so that actions are
documented according to written rules, and bureaucratic heads should be expertly trained. The
disadvantages to bureaucratic structure are the tendency for managers to fail in controlling the
development of the organizational hierarchy in the course of time which causes a tall inflexible and
centralized system (Jones 2013). In addition, managers may be too reliant on rules and standard
procedures in decision making which results to the inability to respond to the needs of customers and
environmental changes (Jones 2013). Aside its disadvantages, bureaucratic ideas are adopted in every
organization due to the fact that it provides a structure for clear guidelines and procedures which helps in
planning hierarchy and also points out clear direction requirements for vertical authority and relationships
among horizontal tasks (Jones 2013).
A divisional structure is usually designed using divisions so that each of the divisions represents a
product, market or geographical location and this kind of structure comes about as a result of growth of
the organization (Jones 2013). In this way, the company is able to respond to high demands of products,
markets or customers (Jones 2013). Each of the divisions (refer to figure 2.2 and 2.3) is equipped with the
needed resources and functions which can support it with a particular product or geography such as
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having its own financial, marketing and IT departments. There could also be a multidivisional structure
where the original company opens different divisional branches operating different businesses (Jones
2013). Divisional structure can put the organization in a position of reducing risks since investments has
been allocated in many industries which can increase investment returns and also the organizations might
react differently to similar conditions which is known as risk diversification (Donaldson 2001). Also one
division’s failure is not affected directly by other divisions since they all have unique terms of operation
(Donaldson 2001).
The matrix structure comes about as a result of the combining two different operational perspectives
which are believed to be the best option for the organization (Jones 2013). Frequent combinations include
function and product, region and product or function and region (Jones 2013). In an organization which
has the grouping together of function and product for instance, it will have the management for each
function as shown in figure 2.4 (Jones 2013). If three functions are grouped together then the matrix will
have three managerial interactions (Jones 2013). Advocates of the matrix structure of management
recommend that it easily provides team members the opportunity to cross the boundaries of their
divisions to other divisions for communication, allows for sharing of knowledge for specialization and
easy assignment of individuals according to the needs of a project (Jones 2013).
Figure 2.2 Product division structure (source: Jones 2013)
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Figure 2.3 Geographic divisional structure (source: Jones 2013)
The disadvantages are that the managing authority could be complex since an employee could be
allocated to the functional and project managers, and this could result in more managers than workers
which can result in increased cost and employee having conflict of loyalty (Jones 2013). Disagreements
between managers could cause a deadlock in decision making and conflict resolution (Jones 2013). A
matrix can only be useful when there is a need for it due to the complex nature of operations of the
organization in order to be able to adjust to the changing environment (Jones 2013).
Figure 2.4 Matrix Structure (source: Jones 2013)
Healthcare organizations (HCOs) have been categorized to have certain structural characteristics. The
classifications are; differentiation, integration and centralization (Bazzoli et al., 1999). Differentiation
describes the ability of the HCO to provide the suitable number and different kinds of services throughout
the continuum of care. Integration describes the ability of the HCO to put pieces together to increase the
value of services provided (Bazzoli et al., 1999). Centralization or decentralization focuses on decision
27
making (Mckelvey 1975) and its implication on the speed with which it is executed as well as
accountability to stakeholders.
2.6 Organizational Leadership and Culture
Leadership forms an important component of the process of management who act as figures of change by
affecting other people through motivation and influence towards a successful and productive organization
(Bass et al.1993). There are different management leadership styles existing in the work environment and
the culture and goals dictates the kind of leadership style adopted or fits (Eagly et al. 2003; Hwang et al.
2008). There could be the autocratic for example which only allows managers to take decisions , or the
democratic style (Hwang et al. 2008) which involves everyone or the laissez-faire which does not
supervise employees directly and lack of feedback to subordinates (Eagly et al. 2003) . The performance,
change and innovation of an organization are influenced by leadership however the leadership style
adopted will depend on the culture (Nanjundeswaraswamy et al. 2014).
Organizational culture relates with the values, norms and assumptions shared within the organization
(Schein 1985). The culture within an organization is a foundation for competitive advantage (Barney
1991) and experimental research reveals that it is a major factor for effectiveness (Gordon et al. 1992; Fey
et al. 2003) with four different dimensions, which are adaptability, consistency, involvement and mission
(Denison 1990; Fey et al., 2003).
Chapter 3 Concept of Alignment of IT and Business Strategy
The importance of alignment becomes even more increased (Luftman et al. 2005) considering that there
continues to be changes in business strategies and also technology keeps evolving. In light of this, many
studies have been carried out which have looked at alignment in different perspectives so as to identify
what contributes to alignment, how alignment is achieved and even how alignment is sustained (Luftman
et al. 1999; Henderson et al.1989; Henderson et al.1993) . Having mentioned that, there have also been a
lot of arguments to say that no study has actually focused on how organizations can attain alignment
(Smaczny, 2001). Studies have found that alignment has got different dimensions to it which is made up
of the formal and informal structures (Chan et al. 2007). What constitute the formal structures are the
strategic and intellectual, and the structural dimensions (Chan et al. 2007).
The strategic and intellectual structures of alignment are concerned with the degree to which the business
and IT strategies are able to fit or integrate (Weill et al. 1998) or link (Henderson et al. 1989). It will be
therefore difficult for alignment to be achieved if there is no well documented business plan or strategy
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(Wang et al. 2006). The structural dimension is to do with the level of structural fit between IT and the
business, and this can be influenced by the decision making rights of IT, reporting relationships,
decentralization or centralization of IT and the deployment of IT personnel (Chan et al. 2007; Haes et al.
2016). When there are few bureaucratic levels between IT management and senior management there are
better chances of IT being able to support the essential needs of the business (Pyburn 1983).
The social dimension looks at the people involved (Galliers et al. 2014; Haes et al. 2016) and that
concerns the level at which business and IT executives have a common understanding and commitment to
the mission, objectives and plans of the business and IT (Reich et al. 1996). In order to get to a high level
of alignmnent there must be constant collaboration between the two parties which could be hindered by
lack of communication, organizational members outlook towards technology, shared domain knowledge,
history of business IT relationships and leadership (Reich et al. 1996).
Lastly, the cultural dimension refers to understanding of how things are done within the business. Such
cultural elements include the different styles in which the business draws out plans, the structure and
nature of the organization, how management communicates as well as dealing with behavioural change
(Haes et al.2016). It is important to consider that the culture of a business is related to the successful
implementation of IT systems (Haes et al. 2016).
Reich et al. (2000) related that the determinants of strategic alignment are the intellectual and social
dimensions. The following sections will highlight on the key strategic alignment models.
3.1 Strategic Alignment Model (SAM)
Henderson et al. (1989) developed the Strategic Alignment Model (SAM) which seems to be the basis for
many other models or frameworks of achieving alignment. The model has proposed that IT-Business
alignment can be achieved through a linkage between four domains: business strategy, IT strategy,
organizational infrastructural processes and IT infrastructural processes. The model (see figure 3.1)
presents two dimensions of achieving strategic alignment which are: strategic fit (interrelationship
between internal and external domain) and functional integration (between the business and IT domain).
There are three further individual components for each one of the models at the external and internal. For
the external structure there are scopes, competencies and governance, whereas the internal comprises of
infrastructure, skills and processes. The main supposition is that for a business to be prosperous all the
four domains must be well coordinated.
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By applying the SAM, Luftman (1996) and Papp et al. (1995) elaborated on alignment perspectives
through which organizations could achieve alignment. They explained that by being able to identify the
best combination of internal and external business and IT domains for alignment, it brings about the
biggest opportunity for improvement. The alignment perspectives for an organization could be through an
anchor domain, a pivot domain and impacted domain (see figure 3.2). An anchor domain usually
influences alignment by initiating the changes for IT implementation and requesting for needed resources.
Pivot domain: this domain indicates which functional or strategic domain will ultimately be affected by
the change initiated within the anchor domain. Luftman (1996) and Papp et al. (1995) identified this as
the weakest domain.
Impacted domain: Any changes that occur in the anchor domain are affected by the impacted domain.
This domain is impacted the greatest by the change initiated in the anchor domain.
Figure 3.1 Strategic Alignment Model (source: Hendersen et al. 1989)
Figure 3.2 Domains of Alignment (Adapted from Papp et al. 1995)
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The different alignment perspectives are well explained (Henderson et al. 1989; 1993; Luftman 1996;
Papp et al. 1995) providing examples which can be applied within an organization. Despite the fact that
the examples are old, they allow for an understanding of all the different perspectives in terms of how the
direction of alignment starts from the anchor domain, through the pivot to the impacted domain.
3.2 Additions to the Strategic Alignment Model
Following the initial SAM Model from Henderson et al. (1989), Luftman et al. (1999) applied the
different alignment perspective in more practical terms and expanded the research by identifying enablers
and inhibitors of alignment within a firm. Their research identified and confirmed communication and
support between IT and business executives as the major enablers and/or inhibitors to alignment. They
also confirmed the need to include IT managers in the process of strategic planning.
Another addition to the SAM model are the works of Maes (1999) and Maes et al. (2000) which
attempted to actually add on to the SAM model to reflect how IT and business strategies are merging due
to the advancement of technology. They came up with the Unified Framework (UF) where new levels of
strategy and functionality were added to the model to highlight the need for information and
communication in recent times. The framework focused on how the various components of information
management are interrelated by demonstrating how business, information, communication and
technology are highly linked within strategy, operations and structure.
They started with a generic framework (Figure 3.3) introducing a separation of
information/communication from technology. Emphasis is more placed on the sharing of information
rather than the provision of information. They related that the business is able to realise more gains
through usage and sharing of information since information sharing serves as an agent between business
and technology. Within the generic framework, the vertical section represents internal and external
communication/information for interpretation and sharing of knowledge. This is the area where language
is translated for there to be a universal language existing between technology and business. At the middle
section, there is an intersection between (infra) structure and information/communication; and this is
where information and resource management is operated for there to be gains through sharing of
information and knowledge within all the domains of the framework.
An improvement on Maes’ generic framework was later carried out by Goedvolk et al. (2000) where they
placed their attention on the technical aspect of the SAM model. They introduced the architectural design
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to Maes’s work and called it the architectural framework (IAF). Within the IAF, new information
domains were added so that there will be a representation for knowledge, communication as well as co-
ordination of information. A third dimension was also added prescribing the design for areas in the
organization as a result of the introduction of an information system. A combination of the generic
framework (Maes 1999) and the architecture framework (Goedvolk et al. 2000) resulted in the unified
framework (Maes 2000).
Figure 3.3 Maes Generic Framework (source: Maes 1999)
Other researchers have noted that the SAM model and the additions to it have presented the different
general structure and components for achieving alignment but not how alignment can be achieved
(Leonard 2008). It could also be challenging in applying these theories in business since all the
frameworks do are the description of the components of alignment. Ciborra (1997) mentioned that it is
difficult for a management to interpret the idea of the SAM model into business practice. Despite
Smaczny (2001) argument that no research has really explained how alignment can be achieved, Leonard
(2008) was of the opinion that the alignment maturity assessment research by Luftman (2004) rather gives
a better understanding of how alignment can be achieved. Their earlier work on enablers and inhibitors
based on SAM contributed to the Strategic Alignment Maturity model which can be used to assess the
maturity level of alignment within an organization through understanding the six components that
contributed in achieving alignment in the first place. They are communication, competency/value
measurement, governance, partnership, scope and architecture, and skills.
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Communications underlines how well an understanding exists between IT management and
business executives. There has to be frequent communication between all stake holders, that is,
consultants, IT vendors and all others concerned. Also, there has to be proper dissemination of
knowledge materials available for the alignment process.
Competency/value management is concerned with how well the company measures her
performance and the evaluation of completed projects to ensure that there is value for money. This
also looks at whether there is improvement in the processes utilized for the betterment of
upcoming projects.
Governance has to ensure that the projects undertaken are a reflection and understanding of the
business strategies.
Partnerships should exist between IT and business executives so that they are able to share
successes and failures.
Scope and architecture concerns how well new technologies are managed as well as ensuring
that there is architectural integration and transparency so that business can remain competitive and
grow.
Skills are required by staff to be able to understand business processes. IT staff are also expected
to have the skills needed to understand the language of the business. Business executives will also
have to be abreast with evolving technological systems so that they can be familiar with the IT
systems to be utilized.
3.3 Sustaining Alignment
It has been discovered that once alignment is achieved it does not come to an end as it keeps evolving due
to various changes both within the business environment which might result in new information needs
(Baets 1992: Chan et al. 2007). Dr. Peter Weill director of MIT Centre for Information Systems Research
(CISR) has said that “synchronization between IT and business strategy is not a natural state. IT
organizations may be aligned now but you are likely to go out of alignment because strategies and
technology change. Organizations face a never ending quest to keep IT and business strategy aligned”
(TechRepublic 2003). Researchers looking into how IT can be used as a sustainable tool for competitive
advantage have given examples of the factors that are supposed to help sustain alignment. These are
developing superior IT management skills competency (Mata et al. 1995); building IS competencies,
which cross functional boundaries (Peppard et al. 2000); and business management’s leadership role in
key IT decisions (Ross et al. 2002).
The following paragraphs shed more light on other factors which researchers have suggested can be
utilized in sustaining alignment. However, Sabherwal et al. (2001) recommended that there need to be
33
more research on sustaining alignment during misalignment which should be added as a structure to IT
and business strategy to make the process of sustaining alignment more successful.
Luftman et al. (1999) has suggested that an organization must adopt alignment behaviour so that even
after achieving alignment, it can be sustained. Wager et al. (2017) have also mentioned some very critical
factors to consider in sustaining alignment in health information systems. The ongoing challenge of
companies being able to find solutions for the constant changes in their environment that affects the
alignment of IT and business strategy has resulted in researchers shifting their attention from the content
of strategy, to the process of strategy, stressing that alignment is more of an ongoing process than an end
state (Baker et al. 2008). This means that there has to be a collaboration of the processes between all the
factors and units involved so that there is not just an understanding of the factors but also to understand
how they are related (Baets 1996). Furthermore, considering the dynamic nature of alignment it becomes
important to readjust and realign the components of strategy so as to be able to reach expected targets
(Rondinelli et al. 2001).
Reich et al. (2000) have investigated more into the social dimension of alignment and found four factors
which can possibly influence alignment. They are, shared domain knowledge between business and IT
executives, IT implementation success, communication between business and IT executives, and
connections between business and IT planning processes. These four factors were all found to contribute
to short-term alignment whereas shared domain knowledge was the only factor found to influence long-
term alignment.
From a similar perspective as this study, Sha et al. (2011) considered the multidimensional and the
dynamic nature of alignment of health information systems, and they were able to find that alignment
could be IT strategy-driven and business strategy-driven at different periods of time in an organization at
the time of misalignment. They presented a process model which combines IT strategy-driven
implementation with the social dimensions of alignment stressing the importance of social alignment
throughout the process of achieving strategic alignment. In their efforts to highlight the above findings,
Sha et al. (2011) were able to identify that the dynamic nature of alignment can cause a system to go
through misalignment. To identify misalignment, frequent calibration will have to be used to sense the
problem, be it low efficiency, a mistake, a negative feedback or any other problems disturbing alignment.
Calibration helps to seek for the required capabilities needed to adjust the appropriate business and IT
strategy for re-alignment. Although sustaining alignment was not the main focus of their research, their
process model about how the process of IT implementation and social alignment can help with re-
alignment has provided a lot of insight on sustaining alignment through the use of calibration which helps
to sustain alignment.
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Baker et al. (2008) found some factors that can be used to sustain alignment. They are shared domain
knowledge, strategic business plans, aligned reporting relationships and aligned incentive structures. They
further proposed that an organization that has been successful at achieving alignment will have the needed
skill to sustain alignment in future based on dynamic capabilities. However, other studies have found that
for alignment to be sustained, misalignment will have to be identified (Sha et al. 2011) before the
appropriate measures can be applied to sustain that specific misalignment. Considering that misalignment
situations and causes of alignment come in different forms (Sabherwal et al. 2001; Chen 2015,
TechRepublic 2003, p. 15-17), it is questionable on how an experience in achieving alignment can
provide the skill to sustain alignment since within the context of this research every misalignment
situation is different and might need different skills and capabilities to rectify the problem. Rather than
relying on just dynamic capabilities, it is possible to also seek for other required capabilities (Makadok
2001) especially when the misalignment situation is new and unexpected. Also, not all business
environments will be in a competitive environment to mainly rely on competitive advantage (Winter
2003).
In an effort to prove that alignment is a dynamic continuous process rather than a static end state
Sabherwal et al. (2001) looked into the changes that occur in alignment with time by the use of the
punctuated equilibrium model which studied the long phase of steadiness followed by a short pause in
stability. This research found that, the changes in the environment can affect and reduce alignment after it
has been achieved due to over emphasising, satisfaction in the status quo and apathy, hence prompting the
necessity for change. The conclusion reached is to solve the problem through a new design; however that
did not yield positive results, though the idea for changes went beyond the expected. The solution
recommended is that there has to be a structure included in the strategic management of IT and business
strategy. Sabherwal et al. (2001) study present the need for further research into sustaining alignment
during misalignment and low alignment, utilizing a structure in addition to IT and business strategy so as
not to plan beyond what is expected.
3.4 Misalignment
Luftman (2003) proposed some experiences that organizations with misalignment might have which
shows that the organization is not optimized. This proposal discloses the idea that, misalignments may
come with signs and also stops organizations from reaching their full potential. Misalignment is therefore
an important topic just as alignment which needs to be looked at in a dynamic business environment
when investigating sustaining alignment and when explored and understood, can help to support
alignment of IT and business strategy (El-Telbany et al. 2014). Misalignment occurs when the business
35
strategies are not in sync with IT strategy and this will be examined in this chapter based on misalignment
situations (Chen 2015) and misalignment causes (TechRepublic 2003; Chen 2015).
Some causes of misalignment identified were that IT teams get misaligned with business strategy due to
miscommunication of business goals and expectations through the layers of management (TechRepublic
2003). Joe Santana found this through a survey he did as head of an IT team (TechRebublic 2003). He
found that the five top things that managers do to add value to the company as well as the key objectives
are completely different from IT team members. In deciphering the cause of misalignment, he realised
that two problems existed. Even though it seemed like team members were attending meetings to be
presented with company objectives; 1) messages were lost as they passed through the different levels of
management, 2) staff at the lower levels were not given a clear insight on how their efforts tie into the
bigger corporate picture. Odiorne (1974) explains that there is a phenomenon that causes erosion of
alignment of purpose through the layers of an organization. He suggested that “people tend to become so
engrossed in activity that they lose sight of purpose”. Joe Santana proposed three steps for Chief
Information Officers to follow so as to avoid deviation of purpose (TechRebublic 2003).
By communicating a portfolio management medium which categorizes IT investment, the
investment is allocated in support of the company’s overall business strategy. This tool helps the
IT function to link and drive technology investment to conform to the company’s business strategy.
This also provides a means of communicating through the layers of the organization what their
basic objectives are in simple language (TechRebublic 2003).
Secondly, there could be an alignment chart created for every layer of the management team
which outlines the objectives of the company, the alignment objectives of company, the IT
alignment objectives that support the company objectives, the objectives of a team that support the
IT alignment objectives, what actions the team must take to meet the objectives and what the
manager of the team must do to support the team’s success (TechRebublic 2003).
Finally, by teaching the team to adjust to tasks and make good judgement calls that are focused
on meeting alignment objectives, communicating how alignment objectives flow through every
layer of the team to engage them in the process of alignment so as to increase overall business
production and impacting value (TechRebublic 2003).
Dr. Peter Weill also proposed a financial portfolio management for IT investment which has to be
reviewed constantly to keep it synchronized with business strategy and balance its risk versus return
profile (Weill et al. 1998).
36
Chen (2015) also found some causes and situations of misalignment. When these causes and situations of
misalignments are identified it will then be possible to implement mechanisms of sustaining alignment as
revealed in Sha et al. (2011) study. Some organizations are however able to tell where the misalignment
areas are, but do not have mechanisms in place which can assist in correcting misalignment so that
alignment can be sustained (El- Telbany et al. 2014). Their findings agree very much with the research
gap on sustaining alignment identified by Sabherwal et al. (2001).
3.5 Summary: Chapter 2 and Chapter 3
There has been a review of the different topic areas of the research to gain a suitable conceptual
understanding as well as theoretical sensitivity which will help in suggesting the research methodology.
The first section highlighted on organizational strategy and structure, together with leadership and culture
which are all interconnected and helps management in achieving business objectives. IT strategy supports
these objectives. When alignment is sustained it affects the structure at different levels of operation.
Secondly, different models on business-IT alignment have also been explored. Although the concepts
from these models have been included in many studies in the past years, they do not help in practical
terms as to how they can be applied in real situations. They are mostly focused on the end state of
alignment and the antecedents that can be manipulated to achieve alignment. Also the descriptions of the
domains that are needed to be aligned do not necessarily help with any processes for identifying
misalignment within the context of this study so that they can be corrected and sustained.
Thirdly, prior literature on identifying misalignment and sustaining alignment were reviewed to discover
the factors affecting alignment and for sustaining alignment. The review was based on healthcare
literature as well as other organizational sectors. Several influencing factors were identified. However in
all these fields, there was scarcity of literature that plainly and methodically provided a process to follow
in sustaining alignment. In recognizing this gap, a case study was carried out to examine what process
could be followed in sustaining alignment. A detailed description of the study is provided in Chapter 5.
Before that, an initial conceptual framework was formulated in Chapter 4 based on the findings of
literature review in Chapter 3.
Chapter 4 Developing of Initial Conceptual Framework
This research is dealing with five conceptual domains; calibration, causes of misalignment,
misalignment situations, seeking capabilities (capacity and competence), sustain alignment as shown
in figure 4.1, and follows the soft-positivism perspective (Kirsch 2004) which proposes that the
37
phenomena under investigation exists objectively and is represented by an initial conceptual framework. I
was however not limited to examining pre-existing constructs only but also used emerging concepts from
the study through the use of an interpretivist view to reveal new concepts and relationships (Klein et al.
1999; Walsham 1993). By using an eclectic approach, relevant concepts were obtained from previous
literature and theory. The discussions that follow in this chapter focus on the development of a conceptual
framework of the five domains.
4.1 Calibration
Calibration was chosen because it suggests a useful mechanism for looking out for changes in the
environment which are bringing about misalignment ( Sha et al.2011). As revealed in Sha et al. (2001)
study, calibration is a practical method to identify a misalignment cause or situation. Calibration also
helps to sense low organizational performance, inefficiencies and negative feedback which might then
prompt for seeking the required solutions to help in adjusting alignment problems in a dynamic process.
Due to the above mentioned conditions, the calibration proposal is relevant in the current research
context.
4.2 Causes and Situations of Misalignment
Literature review in section 3.4 identified major causes and situations of misalignment. According to Sha
et al. (2001) when misalignment problems are well identified through calibration there are better chances
of being able to sustain alignment.
4.3 Capability (Capacity and Competence)
These form a part of the conceptual framework of this research since they represent from literature how
alignment can be sustained. According to Collis (1994) the capabilities of an organization is set within
routines and is made up of how inputs can be transformed into outputs. Capabilities are defined as
competencies that are built by combining resources (Grant 1991).
These three components define another level in the process which allows the organization to find a
collaborative process (capability) of how the factors of sustaining alignment can be deployed. The inputs
within this process therefore are the knowledge and skills needed (competence) to carry out the process
and finally resources (capacity) such as human resource, financial resource, information resource and
material resource which will be needed to sustain alignment. Under this domain, the dynamic capability
of being able to create new unique knowledge to sustain competitive advantage can also be relied on.
According to Teece et al. (1997) dynamic capability is “the firm’s ability to integrate, build, and
reconfigure internal and external competencies to address rapidly changing environments”.
38
4.4 Sustain Alignment
Elements within the inputs of capabilities will now direct to sustain alignment through the practical
application of the some particular factors to adjust alignment. Table 4.1 and figure 4.1 illustrate the
relationships between the factors and concepts in the initial conceptual framework.
From the framework, it is proposed that for every cause of misalignment identified there comes a
situation of misalignment which can be solved through the use of particular competencies and capacities
within the calibration process to sustain alignment. Also, at the point of sustaining alignment, there are
practical solutions which can be put in place to return alignment to normal.
39
Calibration Causes of misalignment Situations of Misalignment
Capabilities Sustain Alignment
Competencies Capacity
Sensing
problems by
surveying or
scanning
Seek for
Capabilities
Lack of training of new staff and key users
(Chen 2015)
Lack of IT knowledge sharing (Chen 2015)
No capability to operate IT system: poor training,
poor information from management, lack of a
universal operation manual for IT systems, lack of a
standard IT operation and even redundancies due to lack of confidence for the IT systems being used
(Chen 2015)
Develop top IT management
skills for success (Mata et al.
1995)
Build IS competencies which
cross functional boundaries
(Peppard et al. 2000)
Empower
workers as a team
(Luftman et al
1999)
Equal IT and business
capabilities (Luftman et al.
1999)
IT issues: Non-strategic role of IT, insufficient decision making rights in IT
department, insufficient resources and
financial support in IT department, improper
IS unit structure, IT applications do not change with organizational structure changes,
IS applications do not change due to
complicated process (Chen 2015)
Lack of importance for IT strategy: poor IT strategy implementation, not being able to realise the
profitability in investing in IT, governance problems
with IT, IT not playing a strategic role, poor
communication between business managers and IT managers and vise versa, operational people
unawareness of the contents of IT strategy (Chen
2015)
IT not in support of main business components: lack of IT support, poor support from managers, IT is
not contributing to the market advantages, lack of
motivation to use IT, and not searching for IT capability sustainability (Chen 2015)
Misalignment between operation of IT system and
business processes: low importance of IT strategy, IT not contributing to the effectiveness of operations, the
operation of the IT system not matching with the
business structure, lack of system functions, poor flexibility of IT system, business processes different
from system operations, no integration between
business processes and transformation of business,
business executives not understanding IT development, frequent changes (Chen 2015)
Understand clinical work flows and managing change
application (Wager et al. 2017)
Clinicians and administration staff must understand impact of
Health Information Exchange
application and work flow and
identify opportunity to improve application (Wager et al. 2017)
Make strategic choices for
alignment (Wager et al. 2017)
Assess stakeholder’s alignment
against organizational vision
before pursuing them (Wager et al. 2017)
Funding should have support of
stakeholders
(Wager at al.
2017)
Use alignment charts (TechRepublic 2003)
Culture of open
communication Luftman et al. 1999)
Shared domain knowledge
between IT and business executives (Reich et al. 2000)
40
Managers negative attitude to IS use (Chen
2015)
Business people poor understanding of IS
(Chen 2015)
Inadequate support for IT managers: resistance
from managers to use IT, centralisation, difference in
management requirements for their departments and branches, no standardisation of management
processes, poor IT strategy implementation, in
different departments, business managers lack of
understanding for IT usage, little support for IT from
business managers and IT application not fulfilling
management requirements (Chen 2015)
Business management role in
key IT decisions (Ross et al.
2002)
Shared domain knowledge
between IT and business
executives (Baker et al. 2008; Reich et al. 2000)
Centralization - poor communication between branches and headquarters, management
processes not standard, lack of unified IS
manual (Chen 2015)
Build IS competencies which cross functional boundaries
(Peppard et al. 2000)
Culture of open communication (Luftman
1999)
Environmental influences – poor business performance, poor IT infrastructure, lack of IT
knowledge sharing, frequent reforms, lack of
technological support (Chen 2015)
Sense of urgency in managing IT –
enabled project
(Luftman et al.
1999)
Consider structural characteristic and dynamics
of the HIE market. The
geographic location,
composition of stakeholders, and the resource (Wager et al.
2017)
Create customer value (Luftman 1999)
Data use and data integrity
(Glaser et al. 2013)
Infrastructure must ensure accuracy, reliability and
trustworthiness of patient
data (Wager et al. 2017)
Continuous alignment of
stakeholder’s priorities
(Wager et al. 2017)
Shared vision with stakeholders (Wager et al.
2017)
Environment of trust for
learning and resolving differences with stake holders
41
(Wager et al. 2017)
Policies and procedures for
equal competitive advantage of all stakeholders (Wager et
al. 2017)
Portfolio management of IT
investment (TechRepublic
2003; Weill et al. 1998)
Miscommunication of business goals through layers of management and staff
(TechRepublic 2003)
Business managers and IT team members having different views and priorities of business goals and
objectives (TechRepublic 2003)
IT portfolio management in simple language
Alignment charts
(TechRepublic 2003; Weill et
al. 1998)
Table 4.1 Relationships of Factors and Concepts in Initial Framework (Adopted from the Process of Calibration Sha et al.2011)
42
Figure 4.1 Initial Conceptual Framework (Adopted from Process of Calibration Sha et al. 2011)
Misalignment
Situations
Causes of
Misalignment
Capabilities/Dynamic
Capability
Competency
Capacity
Sustain Alignment
New Alignment
Calibration
Sensing the
problem by
surveying
Applying
solutions
Capacity
Empower workers as a team
Funding should have support
of stakeholders
Sense of urgency in
managing IT – enabled
project (Luftman et al. 1999)
Competency
Understand clinical work
flows and managing change
application
Clinicians and administration
staff must understand impact
of Health Information
Exchange application and
work flow and identify
opportunity to improve
application.
Make strategic choices for
alignment
Assess stakeholders
alignment against
organizational vision before
pursuing them
Develop top IT management
skills for success
Build IS competencies which
cross functional boundaries
Policies and procedures for
equal competitive advantage
of all stakeholders
Consent and security policies
must meet requirement of
stakeholder and regions or
states
Sustain Alignment
Culture of open communication
Continuous alignment of stakeholders
priorities
Shared vision with stakeholders
Environment of trust for learning and
resolving differences with stake
holders
Data use and data integrity
Infrastructure must ensure accuracy,
reliability and trustworthiness of
patient data
Shared domain knowledge between IT
and business executives
Use an alignment chart
Portfolio management of IT
investment
Create customer value
Business management role in key IT
decisions
Considering structural characteristic
and dynamics of the HIE market. The
geographic location, composition of
stakeholders, and the resource
Equal IT and business capabilities
Situations of Misalignment
No capability to operate IT system
IT not in support of main business
components
Lack of importance for IT strategy
Misalignment between operation of IT
system and business processes
Inadequate support for IT managers
Causes of Misalignment
Lack of training of new staff and key users
Non-strategic role of IT
Managers negative attitude to IS use
Business people poor understanding of IS
Centralization - poor communication between branches and
headquarters, management processes not standard, lack of
unified IS manual.
Environmental influences – poor business performance,
poor IT infrastructure, lack of IT knowledge sharing,
frequent reforms, lack of technological support
43
Chapter 5 Methodology
5.1 Introduction
In order to conduct a social research there has to be considerations given to the methods utilized in
relation to the research instruments since social scientists have different perspectives of how realities in
society can be perceived (Draper 2004; Gray 2004). The choice of research instruments will have to be in
connection with the goals of the research, research objectives as well as whatever problems the research is
seeking to address which can be found in the research question (Rajasekar et al. 2006). The process of
conducting research could be looked at in terms of research philosophy, the research strategy, research
approach, time horizons and methods of data collection (Gray 2004; Saunders 2009). In this chapter, the
methodology of the research will be explored by discussing the research philosophy, research approach
and method of data collection. Figure 5.1 and table 5.1 show the research process and the design of
research methodology.
Figure 5.1 Research Process
Phase A
Literature Review
Developed Conceptual
Framework
Application for Ethics
Approval
Developed three sets of
interview questions
Interviewed five
participants
Case study and data
analysis Phase C
Phase B
Discussion and theory
proposition development Conclusion
44
Level of Decision Choice Section
Research Paradigm Soft-positivism paradigm 5.2
Research Methodology Qualitative research methodology 5.3
Research Method Case Study research design 5.4
Data Collection Semi – structured interviews
Review of documents
5.4.3
Data Analysis Thematic coding
Categorizing
5.5
Table 5.1 Research Methodology Design
5.2 Research Paradigm
This defines the principles and understanding by which the researcher believes to be the most fitting
process for the data on the research to be gathered and analyzed in order to provide knowledge about the
phenomenon under study (Guba et al. 1994). This is influenced by the paradigm of conducting the
research which is made up of epistemology, ontology and methodology (Guba et al. 1994). The research
paradigm describes “the set of common beliefs and agreements shared between scientists about how
problems should be understood and addressed” (Kuhn 1962). Ontology is concerned with what consists
of reality; epistemology seeks to find knowledge or be in the know; and methodology is the process
utilized in finding knowledge (Scotland 2012). The different philosophical positions which help to
understand reality are positivism, interpretivism and realism. Positivism believes that there is a single
reality and is focused on objectively analyzing collected data in the social world rather than doing so
subjectively (Cooper et al. 2006). Data collection and information is mostly obtained from a large sample
within the public than relying on information from research (Cooper et al. 2006; Guba et al. 1994).
Furthermore, the beliefs of the researcher cannot influence the study, and the observations and
experiments are based on quantitative data (Easter-by-Smith et al. 2002) which helps with statistical
analysis and replication in an experimental research (Mingers et al. 1997). The Interpretivist has the belief
that there is no single reality or truth, since reality is created by individuals in groups and therefore it is
only through interpreting reality subjectively which allows for the full understanding of reality (Guba et
al. 1994). This involves the study of the phenomena within its natural environment and is vital in
interpreting reality and can be achieved through qualitative interviews, observation, participation or non
participation (Guba et al. 1994). Realism has a philosophical position which suggests that there are
already existing realities and beliefs within the environment of the individual and it could be direct or
critical (Guba et al. 1994). Direct reality relates to what a person feels, sees, hears and so on, while
45
critical realism is how the individual explains their knowledge and understanding in a particular situation
(Sekaran et al. 2010) which is connected with social constructivism since the person seeks to prove what
his beliefs and values are.
In order for this research to be relevant to the research question and thorough in its operationalization, the
research will be guided by the soft positivism approach (Kirsch 2004). This approach allowed me to
conduct the study based on previous theories and the positivist view that supposes that the phenomena
being investigated exists objectively (Kirsch 2004), however the interpretivist approach was used in
revealing new concepts, findings and relationships that will emerge from data (Klein et al. 1999). The
characteristic of soft-positivism is to develop an initial conceptual framework which guides data
collection and structures data analysis with expectations on a priori theory (Kirsch 2004). The different
paradigm perspectives are shown in table 5.2.
Positivism Interpretivism Critical Realism Soft-Positivism
Ontology Reality is real and
apprehensible
Multiple local and
‘constructed’ realities
Reality is ‘real’ but only
imperfectly and
probabilistically
apprehensible
Objective reality exists beyond
the human mind, but how it is
perceived depends on culture
and life experiences
Epistemology Objectivist: Findings are true
Subjectivist:
Created Findings
Modified objectivist:
Findings are probably true
Epistemologically, reality can be captured empirically,
however, acquired knowledge
is context-bound by culture,
time and circumstances
Common
Methodologies
Experiments/Surveys: Mostly
concerned with testing of theory and verification of
hypothesis
Hermeneutical or
dialectical: Researcher is a ‘passionate
participant’ in the
investigated world
Case studies and
convergent interviews; Triangulation,
interpretation is mainly
qualitative but also
quantitative methods
Positivist case study design
with important contributions from an interpretivist analysis
and use of qualitative method
Table 5.2 Differences between Positivism, Interpretivism, Critical Realism and Soft-positivism (Source: Adapted from Guba et
al. (1994) for the first three paradigms; Seddon et al. (2006) for the soft –positivism paradigm)
5.3 Research Methodology
As already described in previous sections, I developed an initial conceptual framework based on
synthesizing background literature. This supports the positivist view by allowing me to assume the
position that the issue of sustaining alignment exists objectively and also reveal the relationships between
the constructs.
A qualitative research perspective was used since a qualitative research allows researchers to study the
social and cultural phenomena which help in understanding from the social and cultural context of the
people (Myers et al. 2002) and has a holistic point of view (Creswell 2013). Creswell (2013) related that a
46
qualitative approach involves gaining knowledge mainly through constructivist perspectives by
constructing meanings from social and historical experiences to develop a theory or pattern, or from
participations in advocacy or both. On the contrary, Miles et al. (1984) was of the view that qualitative
research entails the ability of the researcher to interpret phenomenon through contrasting, comparing,
replicating, cataloguing and classifying the entity being studied. The fundamental philosophical
supposition to be adopted in qualitative research can be positivist, interpretive or critical realist which is
dependent on the qualitative research method chosen (Myers et al. 2002). This study adopted the soft-
positivism paradigm as mentioned in section 5.2. The reason for choosing the qualitative method in this
research was to be able to find the causes and situations of misalignment from the IT and NHS business
perspective of the digital roadmap of LLR which is supposed to be aligned with the local STPs; as well as
post-implementation of SystmOne, and how those problems are dealt with to sustain alignment. This
allowed me to get the details and insights of the experiences of participants in the area being studied. A
case study was the medium through which the qualitative method was carried out.
5.4 Case Study Research Method
A single case study was chosen since it allows for the phenomenon to be studied in its natural setting
thereby making it possible to use different methods to collect data from one or a few groups of people
(Crowe et al. 2011). Case studies can either be single or multiple (Eisenhardt 1989). Although it is
believed that a single case study cannot provide information which can be generalized, it could be useful
in the initial stages of research investigation by providing propositions which could be used as a premise
to be examined in other bigger case studies (Denzin et al. 2011). The case study was designed by defining
boundaries for the existing theory used (Shanks 2002) in terms of presenting five domains. The
development of the initial framework was made up of constructs which were based on the calibration
process from Sha et al. (2011), which posits that when influencing factors of misalignment are identified
successfully, the capabilities needed to sustain alignment can be sought to solve the problem. The factors
for the misalignment and sustaining alignment were obtained from literature, as well as the introduction
of the dynamic capabilities theory.
Research questions were generated which gave the study a well defined focus thereby allowing me to be
specific with the data to be collected such as, support from NHS business managers, communication
between IT and NHS business managers, training for users and so on. Three categories of research
questions were formulated for IT managers, NHS business managers and users of SystmOne respectively
(see appendix 1).
47
5.4.1 Data Collection Design
A purposive sampling technique (Teddlie et al, 2007) was utilized to target managers and executives on
the Information Management and Technology (IM&T) team of the LLR digital roadmap, since they
contribute in the strategic planning of either the business strategy or the IT strategy of the local NHS. This
is mainly for the fact that they are in the best position of highlighting the different variables and
constructs which causes misalignment and also the mechanisms put in place to sustain misalignment.
Similarly, users of SystmOne in NHS CAHMS were targeted since it will help in knowing how
misalignment factors are being identified and the efforts made to sustain alignment. Based on purposive
sampling, the contacts of the digital roadmap team were obtained from available literature and also
having automatic access to users of SystmOne since the researcher is a SystmOne user.
Data collection started on 2nd
of August to 24th
of August 2017 in Leicester and Leicestershire. Ethics
application was approved from the University of Sheffield Information School on 18th
of July 2017 (see
Appendix 4), before data collection. After ethics was approved, invitations were sent out to participants
via email for interview together with an information sheet (see Appendix 5) which elaborated on the
purpose of study as well as seeking informed consent of participants. The collection of data was done
using both interviews and reviewing relevant local NHS documents. Time constraints did not allow a
longer period of data collection in general.
5.4.2 Interviews
The utilization of interviews makes it possible for rich data to be gathered from people in different roles
and situations (Myers 2009). The case of sustaining alignment of IT and Business Strategy will be best
understood through interactions between the researcher, managers and executive of the digital roadmap,
and users of SytmOne. Three types of interviews were identified by Myers (2009): structured, semi-
structured and unstructured. Structured interviews have choices of answers for the interview to pick from.
Unstructured interviews are intended for exploring the views and opinions of the interviewee and are
more of open-ended questions. Semi-structured are a mixture of the structured and unstructured types.
This study made use of unstructured interviews through face-to-face, telephone and email according to
the convenience of participants. The interview questions were designed through the guidance of the
research objectives as well as the initial conceptual framework. Three different interview guides were
prepared for three different groups: IT managers, NHS executives and end users (see Appendix 1).
Interview guide for IT managers/executives was meant for personnel in the Leicester Health Informatics
Department (HIS) who are engaged in the planning of the digital roadmap as well as implementation of
IT systems. This is especially important since IT managers help in creating the IT strategy and policy
48
which suits the local NHS and ensuring that the business objectives (STP) of the local NHS are aligned
with the IT strategy (digital roadmap). The interview guide was for discovering the managers’
experiences surrounding misalignment and the methods used in sustaining alignment during planning and
implementation. Interview for NHS managers/executives were meant for members in Clinical
Commission Groups (CCGs), Chief Information Officers, personnel representing the NHS Trust, local
council, Better Care Together and Leicester Partnership Trust who are all members of IM&T enablement
group. Interview guide for users was meant for operational staff in CAHMS using SystmOne. This was
meant to include clinical professional as well as administrative staff. The guide was meant to examine
their experiences in the usage of SystmOne, the kind of problems they faced in using the system which
could cause misalignment in IT and business strategy and how the misalignment problems are solved to
sustain alignment.
5.4.3 Data Collection
Since the participant selection is based on purposive sampling, the most useful sample was selected to
answer the research questions as recommended by Marshall (1996). Although only five (5) out of the
thirty four(34) targeted participants responded to take part in the research interview after invitations were
sent out via email, the responses provided enough data to express the themes in the study. It is generally
of the view that qualitative analysis requires smaller samples than quantitative methods since the main
aim is to map out qualitatively the different types of patterns observed in the data-set instead of
quantifying (Sandelowski 1995). Although there are no specific rules in attaining a suitable sample size
for qualitative research some researchers have recommended guidelines for choosing a sample size. For
instance, for grounded theory Creswell (1998) suggested twenty (20) to thirty (30) as opposed to the
thirty (30) to fifty (50) interviews suggested by Morse (1994). Creswell (1998) recommended five (5) to
twenty five (25) interviews for phenomenological studies whiles Morse (1994) suggested at least six (6)
interviews. Glaser et al. (1967) introduced theoretical saturation as a way of determining sampling size
since this is the point where no new data or themes are found hence saturation points may vary. However,
some even argue that in situations where each life is very unique, data cannot be saturated (Wray et al.
2007). Moreover, Patton (1990) was of the view that qualitative sample size could best be established by
the available time, resources and study objectives. Based on this assumption, this study did not follow any
rule in determining a sample size mainly due to time constraints as mentioned before, and also the fact
that the responses obtained can represent all research themes.
Once the acceptance emails to take part in interview were received, a suitable date, time and venue was
arranged between the researcher and participants to either perform a face to face interview, telephone
interview or to send open-ended questionnaires through email. Two of the participants were from
49
Leicester Health Informatics Department, one participant was from East Leicestershire CCG, and two
participants were SystmOne users. Interviews were conducted in English and supported by the script of
the interview, a mobile recorder application as well as jotting down notes.
The open-ended questions guided in collecting significant information from literature to discuss themes
and developing a conceptual framework. For some of the questions there were explanations given to the
participants surrounding the reasons for asking those questions so that they can understand the question
and answer them better. Some questions also had follow up questions which helped the participants to
think and give detailed responses. Each question had blank spaces where information given by
participants was jotted down. There were three categories of research questions for IT managers, NHS
managers and SystmOne users respectively.
Recording started in the middle of the first telephone interview when the researcher realised that a home
phone and mobile phone could be used simultaneously; therefore it was partly recorded. However, it was
not possible to use the mobile application to record the last interview since only the mobile phone was
available as a resource. The other two interviews which were conducted face-to-face were fully recorded.
Before recording the interview, the researcher sought for permission from participants. The recordings
helped to preserve accurate information. Notes were created for all interviews and where any clarity was
needed participants were contacted. One participant answered open-ended questions via email. A
summary of invited participants is represented in table 5.3.
Method of Sampling Sample of Participants Number Invited Number
agreed
Number
interviewed
Purposive sampling
IT Executives/Manager
2 2 2
NHS Executives/Managers
11 1 1
SystmOne Users 21 2 2
Total 34 5 5
5.3 Summary of Interviewed Participants
50
5.5 Data Analysis
This approach was carried out in three stages; transcribing, coding and analysing.
5.5.1 Transcription
Recorded interviews were converted into notes and added on to the notes that were taken during the
interview. This process helped with clarifying any information that did not seem clear in the notes which
were taken during the interview and to correct any errors. The process of analysis then continued with
coding.
5.5.2 Thematic Coding
A thematic approach was used for data analysis. This technique is mostly used in qualitative data analysis
which involves searching and discovering, and categorizing codes and themes based on using initial ideas
in describing a phenomenon (Daly et al. 1997). The approach of thematic coding used is based on the
method proposed by (Boyatzis 1998). This method involves firstly determining the sampling and design,
creating themes and codes, and finally validating and using the codes. The first stage of coding was
achieved prior data collection. In the second stage of developing themes, interview data were organised.
A theme describes a pattern found in information describing and interpreting characteristics of a
phenomenon which is of interest to the researcher (Boyatzis 1998). The initial conceptual framework
provided a unique template for identifying themes for analysis. This kind of approach permits the usage
of existing themes and codes in order to replicate, extend or refute prior discoveries (Boyatzis 1998).
Themes were identified from initial conceptual framework, followed by the emerging themes. Based on
this, five predetermined categories within the framework of sustaining alignment were used. These
constructs were calibration, causes of misalignment, situations of misalignment, seeking capabilities and
sustain. Then, after reading through the data, emergent findings were added which redefined the initial
framework. This process allowed for new categories to be added and these identified the condition faced
by the organization as an entity, IT department and users. New sub-categories emerged as the process
went on which were added and redefined to represent the framework for sustaining alignment within the
individual categories. A code definition table was used in supporting data analysis. Anytime new codes
are discovered from empirical data, they were compared with existing codes according to the definitions.
Comparisons assisted in deciding whether new codes should be added or combined with existing ones.
Tables 5.4 and 5.5 illustrate the thematic coding for the framework of sustaining alignment. The code
definition table is attached in Appendix 3.
51
5.6 Research Findings
This section is aimed at discussing research findings and will begin by describing the ongoing general
situations of the local NHS in regards to implementing IT systems. This will assist in putting into context
the discussion of sustaining alignment, thereby helping to understand the theory developed from this
research.
5.6.1 Change in National Policy
As already mentioned, there was change in national policy on implementation of health information
systems. This brought about the inception the Five Year Forward View in 2014 (England 2014) with main
priority of ensuring that all health information systems are interoperable and having a paperless system by
2020. To ensure the realisation of this new policy, local partners led by CCGs have been made to prepare
their respective LDRs in 2016 which are supposed to align with their STPs against the centralised process
previously in place. The local STPs of LLR is based on the visions of Better Care Together (BCT)
programme and is planned to be updated at scheduled times based on experiences.
“IT strategy is absolutely fundamental in the STP, also part of the LDR and primary care strategy, also
included in the GP five year forward view and local response to NHS directory....(A3 Manager CCG).
Always in annual report, the strategy.....we’ve got it all there in the operational plan. It is linked. I have
already mentioned about the STP. It’s definitely within each CCG and NHS organization’s plan. (A3
Manager CCG).
At the moment I am working on seven IT priorities for this year. They are local priorities and then we
have the national directives. So for example, another one that has come through is Wifi for patients
within primary care and I have to implement that by 31st of September.” (A3 Manager CCG).
The responses from the CCG representative indicates the nature of the new changes to IT implementation
in the NHS. As much as there are national priorities in general, there are also local priorities. Considering
that IT systems are still being implemented to meet the national vision of interoperability and going
paperless, there will constantly be changes coming through to affect the alignment between IT and
business strategy as reflected in the statements of the IT Manager.
“Legislation.....I think government strategy 2020 paperless vision. That has got the greatest impact on
alignment. At local level the general things that people want to be done. Example, new data protection
laws means we have to change systems to fit.” (A1 Manager IT).
52
5.6.2 General Financial Challenges
In view of the fact that information management and technology (IM&T) is the enabler of the priorities of
the STPs in delivering a paperless NHS at the point of care, funding has to be made available to meet set
down objectives. Despite the millions of pounds available and also proposed to be available for the
implementation strategy, there are still general funding problems given the broad national objectives for
health improvement.
“Not enough. It’s got to do with understanding there are a lot of things to be done with NHS budget and
not just IT. (M3 Manager CCG).
No. It’s stretched (the IT strategy of the local system). We’ve got visions and plans but reality is, there is
no funding. We have the strategy but whether it becomes a reality is a different thing.” (M3 Manager
CCG).
The different strategic plans on the local level are seen in the different IT systems for different health and
care functions now implemented and also needed in future to enable STP goals. Examples of these
systems are summary care records (SCR), TPP SystmOne, GEMIMA and PRISM as already mentioned
in section 1.2. Systems are still being implemented and many adjustments are being made to meet vision
2020 goals however the broad plans of NHS is affecting budget for IT implementation.
5.7 Revisiting Initial Framework
In order to describe the theory to be developed the five main themes which represent the process of
sustaining alignment, will be described as discovered for the local NHS organization, IT department and
users. These themes are interrelated and show how the coding progressed. The fundamental theory
represents a conceptual framework developed based on initial framework for sustaining alignment in
healthcare organizations.
5.7.1 Calibration
Calibration represents any method one uses in sensing a misalignment. Through the meetings held
between IT and NHS managers, they are able to notice existing misalignment problems. NHS managers
use this opportunity to inform IT managers of any problems that might be affecting the alignment of IT
and business strategy.
“What we do, we have regular dialogue between us and NHS management in Information Strategy
Groups. The service tells us what is coming up for us to think about it, and give them options.” (A1
Manager IT).
53
Users generally have an awareness of the existing misalignment problems as they work on the system.
There is also awareness by IT managers on the field of implementation concerning the various
misalignment problems affecting NHS lower level management. This observation was made through the
responses given on the existing misalignment problems some clinicians experience when using the
systems. Some of these responses will be highlighted in the next section where the causes and situations
of misalignment will be discussed.
5.7.2 Causes and Situations of Misalignment
5.7.2.1 Lack of funding
Within the local NHS organization the causes of misalignment with funding was to do with the fact that
the NHS budget is covering other projects which makes it seem as though the plans of IT strategy are too
stretched due to lack of funding. This has brought about a situation where there is insufficient budget for
projects, and the possibility of projects not materialising. The response from the CCG representative in
the previous discussions on general financial challenges explains this.
IT managers had a similar opinion on funding problems. They were of the view that fixed budgets over
the years as well as budget delays caused by the NHS financial year cycle has brought about a situation of
misalignment where there is insufficient budget for projects and delays in projects.
“No and never.... budget is a challenge from several angles. There is a problem with timeliness. NHS
money is on a year cycle. So if there is any project within the year, it has to wait for the beginning of the
financial year which delays everything”. (A2 Manager IT).
“Not massively. Money has remained stable. Budget is frozen while the cost we incur each year is
increasing against the same budget”. (A1 Manager IT).
5.7.2.2 Implementation
IT managers noticed a cause of misalignment during implementation discussions. Clinicians were not
able to understand the theoretical perspective of the system functions.
“Usually at the beginning of implementation they struggle, for example moving from Patient
Administration System (PAS) to Electronic Patient Record (EPR). At the beginning when we were
discussing in scope and out of scope, the theoretical aspect of the presentation was difficult for them to
understand. After it was implemented in a ward and being reviewed, that was when they understood.”
(A2 Manager IT).
54
Although the implemented systems offer advantages to clinicians and other users such as the ease of
requesting for pathology reports electronically, and also the possibility of requesting for additional
functions to bring about efficiency, there was a cause of misalignment where clinicians and other users
found implemented systems to be increasing the time of processing patient information which made it
impossible to see as many patients. This has brought about some less support for IT implementation at
lower level of NHS management locally.
“At the high level they do. But they don’t support at the lowest level when it comes to implementation.
This is because clinicians feel there is a lot of time spent in processing with the functions implemented.
There are advantages and disadvantages. The electronic system makes it easy for requesting pathology
reports and requesting for more functions. There is a time factor with electronic systems. It is easier for
them with paper documentation since with the electronic system they are not able to see many patients.
The environment of work is also a disadvantage. They don’t like the circumstance where systems are
sitting on trolleys since they combine other systems.” (A2 Manager IT).
5.7.2.3 Internal and External environmental influences
Changes in both local directives and national laws cause a misalignment since systems have to be
changed to suit the new laws and directives. Although there has been a change in policy to implement
new IT and business strategy, there are reviews held on these policies which affect the alignment already
achieved as mentioned by A1 Manager IT. A2 Manager IT was of a similar view.
“All the time within the provider organizations, their contracts run within a period and there are reviews
of key performance indicators (KPIs). The national strategy paperless 2020 and contract changes driven
by national directives and commissioner contract level... all have an effect on the alignment between IT
and business strategy.”(A2 Manager IT).
5.7.2.4 System function
Some users generally had a problem with complexity of the system, unnecessary system function and lack
of system functions. Such causes of misalignment has resulted in situations where systems were not user
friendly, too many words without much visuals, unawareness of a system manual and the preference for a
paper system. Other situations are counter productivity, not completing tasks in time and not having
access to patient lists.
“SystmOne could be better and more user friendly. Quite complicated to use... It could be improved. I use
it for what I need. There could be other things, but I use what I know works for me. Personally, I prefer a
55
paper system, but I can see the benefits of having a computer system. It helps with easy reference to
records. It saves you having paper notes all around.” (A4 User CAMHS).
The responses from the user showed that even though the system was supporting current work processes
there were some changes that need to done in order to appreciate the full benefits of the implemented
system. The user suggested some changes that could make the system more users friendly.
“Yes. It could just do with having the screen with more visuals...less wordy, bolder, snappier, and user
friendly. And pulling reports easily, I suppose it can be done, but I don’t feel it would be that easy. But I
think it’s due to lack of knowledge and not using the function often.” (A4 User CAMHS).
“I think it will be useful that when someone works across different units all their tasks and ledgers
should be appearing in the current unit of work so they don’t have to log on to other units. Example, I
work with school nursing, north and south. If I was working in school nurse south and they don’t use that
unit very much, they will not see their tasks, since they didn’t log on to that unit. I wonder if there could
be a function where when someone is on holiday and you task them, there should be a reply message to
say they are out of office and provide another contact.” (A4 User CAMHS).
There were other functions which the user felt do not contribute to productivity and efficiency but
appeared every time one logs on to the system. “I don’t know. What is annoying is that ‘Countdown’
thing when you log on. I think it is counterproductive as when you are in a rush or busy you have to wait
for it to countdown before you can get on with what you need to do and each time you open up SystmOne
it happens – for example if I opened it up in the morning and then shut down my computer to go to
another location or out for lunch et cetera, you will have to load it up again, it is frustrating when you
are busy.” (A4 User CAMHS).
The above comments show some of the causes of misalignment with some users, IT managers and NHS
managers, which lead to situations that might affect efficiency and organizational productivity and as
such will need to be sustained.
5.8 Seeking for capabilities
The methods applied in searching for solutions for causes and situations of misalignment were varied
among NHS managers, IT managers and users. Some capabilities were not really explored since the
misalignment is not having a direct impact on the work processes and also the method involved in
utilizing this capability is found to be a long process. “Going through IT helpline is a long process
56
therefore I don’t bother. I just use what is available for my work” (A4 User CAMHS). Nevertheless, the
research findings indicated that IT support was very efficient and provided the needed training and
assistance. “Yes, training is available during implementation and during review. There is assistance for
calls on hardware devices, applications could be down or network issues. Configurations are made
through helpdesk when systems are not behaving the way they should. Yes they contact service desk” (A2
Manager IT). “About hundred thousand calls a year from users needing help with IT and they are all
mostly solved” (A1 Manager IT). A5 User CAHMS confirmed the statement from the IT manager
regarding contacting IT helpdesk for any support. “Yes and I have communicated it with the SystmOne
team and they have implemented some of the changes”.
IT managers were able to find the needed support from NHS management locally and nationally to get the
tools needed for sustaining alignment. The meetings held at information strategy groups have been useful
in finding where misalignment exists and helped in deciding on what is priority. “Yes, it changes
priorities. Suddenly something else becomes more important. It causes reprioritization” (A1 Manager
IT). The resources as well as the expertise are available and this assists the team in getting things done
however, funding is a major setback.
Category Calibration/Sensing
the Problem
Cause of Misalignment Situation of
Misalignment
Seeking
Capabilities
Sustain
User
General awareness (El-
Telbany et al. 2014)
Unawareness of IT and
business strategy (Chen
2015)
Complicated system
Unnecessary system
functions
Lack of functions for work processes – out of office
message for sent tasks, all
tasks and ledgers appearing
in one work unit ( Chen 2015)
System not user
friendly
Too wordy
Unawareness of
system manual
Preference for
paper system
Counterproductivity
Not completing
tasks in/on time
Not having access
to patient list
Possible help
from IT helpdesk
Possible help
from IT
helpdesk
Possible help
from IT
helpdesk
Possible
solutions
from IT department
5.4 Thematic Coding Generated for the Framework of Sustaining Alignment (Users)
57
5.5 Thematic Coding Generated for the Framework of Sustaining Alignment (IT and NHS managers)
Category Calibration/sensing
the problem
Cause of
Misalignment
Situation of
Misalignment
Seeking
Capabilities
Sustain
Local NHS
Organization
Dialogue through
Information Strategy
Groups
NHS budget covering
many projects.
Stretched IT strategy
Insufficient budget for
projects
Lack of funding for
projects
Projects might not
materialise
NHS managers
making key
decisions
Through national
governing body
Recommendation
IT
Department
Dialogue through
Information Strategy Groups
General awareness (El-
Telbany et al. 2014)
Increased time in processing patient
information.
Lack of working space for systems
Theoretical perspective
of implementation
discussions
Fixed budget (Chen 2015)
Budget delays
Changes in national
directives and laws – vision 2020 going
paperless, new data
protection laws (Chen
2015)
Changes in local
directives-
delivery of clinic outcome letters
electronically, change
in STP work (Chen
2015)
Lack of support for IT implementation at
lower level of NHS
management, example
clinicians.(Chen 2015)
Fewer patients being
seen by clinicians
Systems sitting on
trolleys
Lack of understanding
for system functions at
implementation discussions
Insufficient budget for
projects.
Delay in projects
Changes to systems to
fit laws.
Change in priorities.
Changes in systems to
fit directives.
Changes in priorities
IT Support
IT support
IT support
NHS managers
making key
decisions
Through
national governing body
NHS managers making key
decisions
More people expertise in
decision making
More people
expertise in
decision making
Frequent Training
Practical
explanations during implementation
Budgets issued at scheduled times
however still fixed
Re-prioritization by
IT department
Re-prioritization by
IT department
58
5.9 Sustain Alignment
Sustain, within the framework represents how capabilities are deployed in repairing misalignment. At
local NHS management level, recommendations were made to the national governing body. “I can
recommend but I cannot directly change anything. It would need to go through governing body” (A3
Manager CCG). There is frequent training and support from IT and reprioritization to repair the alignment
of IT and business strategy. “Yes, we generally change things. Sometimes there are consequences. But
mostly we reprioritize so that one project is put on hold for next year, for us to focus on a new one which
is more important. But generally, we get things done” (A1 Manager IT).
Chapter 6 Discussion and Conclusion
The objective of this research was to outline a framework that allows specific causes and situations of
misalignment which have been identified, the possibility of being specifically solved in order to sustain
alignment in a dynamic environment. This research discovered some of the misalignment causes and
situations which already existed in previous research. From the responses given by participants in most
cases there is definitely a channel for sustaining alignment through capabilities like IT support, general
expertise and solutions from the national governing body when misalignments are detected. This is
mainly be owed to the current decentralized system of the NHS structure. The decentralized structure of
the NHS has allowed for IT to play a strategic role thereby making it possible for local partners to present
to government leadership, the misalignment factors being experienced in IT implementation and also
recommend for solutions. Decentralization and for that matter the strategic role IT has also made it
possible for IT managers to be more involved in decision making thereby allowing IT managers to notice
where there are any misalignments and seek for possible solutions . From reviewed literature, a
misalignment of the lack of importance for IT strategy is characterized by the unawareness by operational
staff of the content of IT business and strategy and insufficient resources and financial support in IT
department (Chen 2015), and these two were found to be misalignment causes in the LLR integrated
service. There was no misalignment situation noticed as a result of unawareness of content of IT and
business strategy by some users, however considering the decentralized nature of the national NHS, and
the fact that most of the organizational information are available on the world wide web, it will be very
easy for any user seeking to have an insight on the IT and business strategy of the LLR system to have
access to that information. Nonetheless, it will also be helpful for users to have access to some form of
alignment chart in simple language (TechRepublic 2003) to provide information needed on the business
objectives being supported by IT strategy so that users will be able to understand why IT implementations
are made. This also helps with understanding why misaligning factors will need to be identified and
sustained.
59
Lack of funding has been a local and national cause of misalignment which could affect the IT and
business strategy of the local NHS. There is an awareness of this disturbance caused by lack of funding in
the alignment of IT and business strategy both locally and nationally. The response from local
representatives concerning lack of funding indicated that the national NHS funding is the only means of
support for completing local projects and lack of it, lateness in receiving it and the fixed yearly amounts
brings about delays in projects and unaffordability of project costs. As much as the five year forward view
is for all IT systems to be interoperable in order to improve patient care, there are other objectives to be
worked on within the STPs concerning the improvement of the delivery of primary care, secondary care
and community care which go in tandem with reaching paperless 2020. Considering that these projects
also require funding, there is a knock on effect on the funding for IT implementation. This has brought
about a doubt as to whether the plans contained in the local IT strategy will be realised since it is regarded
as stretched as a result of lack of funding.
The present ability to sustain alignment through the application of available competencies and resources
makes it possible to have a dynamic capability in sustaining alignment in future when there are similar
misalignments. That notwithstanding, there was still the misalignment of funding disturbing the
alignment process. It was not clear in the findings how the government can sustain the general gaps in
funding and this could be a persisting problem in aligning STPs with LDRs. A Sustainability
Transformation Fund (Dunn et al. 2016; Gainsbury 2016) has been set up which helps in achieving
financial balance for the achievement of the visions of the five year forward view. However, there were
still financial gaps discovered.
It was observed that any changes within the local or external environment that might affect alignment
such as changes in STP work, renegotiation of IT KPIs and new government directives did bring about
situations in misalignment which had an impact on IT support to business processes. The major impact
was the task of changing IT functions or implementing new systems to suit these changes. The
technological support available as well as the general expertise involved made it possible for such
misalignment situations to be resolved. Practical solutions which brought about a success in sustaining
alignment was reprioritization by IT department thereby showing a high level of equal IT and business
capabilities (Luftman et al.1999), continuous alignment of stakeholder’s priorities and making strategic
choices for alignment (Wager et al. 2017). The high level of IT flexibility exhibited helped in responding
to the changing environment since that can be viewed as a dynamic capability (Tian et al. 2010).
Although there was a situation of misalignment with some users not having knowledge of a universal
manual, there was an effective IT support system available which could assist in sustaining this problem
if the users chose to use that process. Some user issues like complicated systems, unnecessary system
60
function and lack of system functions for work processes could all be channelled to the effective IT
support system since there was an efficient help line as well as ‘Change Request Form’ functionality
within SystmOne which the user could use to request for any changes for the improvement of work
processes. There was generally awareness (El-Telbany 2014) by users of the processes to follow in
correcting these misalignments for sustenance.
Misalignment situations caused by lower level management, example clinicians’ lack of understanding at
implementation discussions and increased time in processing patient information were factors that had
been recognized by the IT department and therefore IT staff put in much effort during implementation to
assist managers in understanding the practical application of system functions and also provided training
to increase operational capabilities generally, thereby sustaining alignment.
6.1 Proposed Sustaining Alignment Model
Based on the above discussions, the findings have been formulated to give the conceptual framework
model for sustaining alignment in healthcare organizations in figure 6.1.
External directives and laws
Figure 6.1 Proposed Conceptual Framework for Sustaining Alignment
NHS
Department
IT
Department
Users
Information
Strategy Groups
Information
Strategy Groups
General
awareness
Internal directives
Numerous NHS
projects affecting
budgets
Lack of Funding
-Implementation problems -Fixed budgets -Continuous changes with internal and external directives
-Lack of support from lower management -Insufficient funding -Changes in systems to fit laws
-System function problems -Complex system -Unawareness of IT and business strategy
-Counter productivity -Expected tasking results not available -Not appreciating full benefits of system functions
-Government expertise -NHS managers making key decisions
-IT support -IT Skills -NHS managers making key decisions -Government Expertise
IT support
Recommend
-ation
Re-
prioritization
System
reconfiguration
New Alignment
61
The model shows the different causes and situations of misalignment within NHS management, IT
department, and among users respectively. By conceptualizing a process for sustaining alignment, this
study highlights the importance of knowing where specifically to sustain alignment in strategy
implementation and what capabilities come into play in doing so.
This case study is not just to identify specific factors or antecedents for sustaining alignment as has been
done in other studies but to demonstrate where those factors might come into play in a dynamic
environment considering the different causes and situations of misalignment. The misalignments found to
be most sustained were those found within IT department since there is the availability of knowledge,
skills, and resources and supported by management to continually improve the objectives of the
organization. As discussed previously, in the responses of A1 Manager IT, despite the lack of funds, and
the many changes the department faces, they manage to get things done. This confirms the strategic role
IT plays in giving a strong support to business strategy. Furthermore, this proves that IT is not just
playing a traditional supportive role, and this is an essential change in thinking that has to occur for
alignment to be successful (Henderson et al. 1993).
6.2 Sustaining Alignment in a Dynamic Environment
By looking at alignment as a process in a dynamic context rather than an end state, this study has proven a
theoretical proposal which suggests that calibration is a useful method in detecting the existing causes and
situations of misalignment for the sustenance of alignment (Sha et al. 2011). The methods of calibration
could be different for every organization; there could be formal methods as well as informal methods.
Furthermore, it can be argued that alignment is different for different organizations when approached as a
process (Tallon 2007) and as such the causes and situations of misalignment could be different for every
organization or business sector and therefore the method of sustaining alignment for those misalignment
factors could also differ when approached in a process. This is also related to the different business
strategies that organizations may have (Miles et al. 1978) as well as unique competencies and resources
(Andrews 1971). Some of the causes of misalignment in one organization could even be a situation of
misalignment in another organization and vice versa. All the above mentioned characteristics are
consistent with this study since it can be seen that some of the causes and situations of misalignment in
the case organization which needed to be sustained are different from those found in previous literature.
However, there were two common causes of misalignment found, which were funding, frequent changes
in laws, and one common situation of misalignment found to be, and poor support for IT managers from
lower management when comparing the findings of the study to literature (Chen 2015). On the contrary,
the issue of lack of system functions for example, was found to be a cause of misalignment in the
62
integrated NHS of LLR, whiles this same issue was rather a situation of misalignment in prior literature
(Chen 2015).
Although there has been contingent factors suggested to be utilized in sustaining alignment in previous
literature, (Wager et al. 2017; Luftman et al. 2011; TechRepublic 2003; Baker et al. 2008) it was found
that the methods adopted in sustaining alignment in an organization could also depend on factors like
organizational structure, management leadership, IT resources, IT flexibility, IT competency, skilled IT
personnel, strategic role of IT and the business environment (Jorfi 2011; Baker et al. 2008; Luftman 1999;
Reich et al. 2000). When these factors are working in favour of the organization, then alignment can be
sustained. These observations are in agreement with researchers who suggested that there has to be a
structure of sustaining alignment added to IT and business strategy when misalignments are identified
within an organization as it goes through evolutionary and revolutionary changes (Sabherwal et al. 2001)
considering that the circumstance of the organization may be different in many aspects and therefore
those changes can be handled better according to the capabilities of the organization (Chen et al. 2008;
Baker et al. 2008).
6.3 Contributions and Recommendation for Practice
The above findings show that the integrated healthcare system of Leicester, Leicestershire and Rutland
has embedded IT strategy into the plans of STP work to enable interoperability and easy access to
information. There are efforts being made to sustain alignment however, there are issues with funding,
implementation as well as systems functioning according to work processes. This implies that a
formalized system for mapping specific misalignment factors could be developed to provide a structure
for sustaining alignment. This will assist in serving as a prompt for users, IT staff and healthcare
managers for them to be aware that there is a deviation from strategic alignment and achieving
organizational objectives. The structure also helps in identifying the capabilities and practical methods to
be applied within the healthcare environment for sustaining alignment.
During strategy implementation there are possibilities of facing misalignment problems which will have
to be sustained. Sustaining alignment does not only have to be considered at the end of alignment as
suggested by Luftman et al. (1999) but right from the beginning of strategy implementation process. The
ability of an organization to apply the best possible solutions to specific misalignment problems is when
those causes and situations are noted early. The practical solutions applied in sustaining alignment will
also have to be noted so that it becomes a record which can easily be referenced and built on. These
misalignment factors discovered in this case study are experiences which already exist within the
alignment process of LLR, but since there is no formalized system or structure dedicated to monitoring
63
them, they could be easily ignored to the point where the local integrated health system will go paperless
and this could cause inefficiencies even in a paperless system.
The framework developed in this research could be used by healthcare managers to support the alignment
of IT and business strategy during implementation and after. Furthermore, there are important suggestions
which can be used as a theoretical foundation for future studies in sustaining alignment in diverse
perspectives. However, it is worth mentioning that the results obtained from any case study may not be
generalized and while the findings can be applied in other situations, it is not intended to be generalized.
6.4 Limitations and Possible Future Research
Limitations in this study imply an opportunity for research. The limitations are: not capturing
misalignment problems at different time periods; not recording any cultural factors that might influence
sustaining alignment; lack of generalization due to single case study in a local health and care system;
validation and testing of the proposed framework; and not analyzing the impact of sustaining alignment
on performance of the organization.
Since the study focused on alignment as a process than the end-state, it would have been useful to capture
misalignment factors at different time periods. The data collected was before complete alignment as
targeted in the year 2020; it helps in fixing early identified problems in the process. However, future
longitudinal studies could be done for post alignment to capture the different misalignment problems and
how they can be sustained.
It is known that organizations may have unique cultural characteristics; hence the results might not reflect
what happens in another local area in the UK or other healthcare organizations worldwide. Considering
the fact that cultural factors were not included in this research it makes it impossible to illustrate how
misalignments resulting from cultural factors can be sustained. A research could be done in other local
areas which will consider the different cultural contexts as well as other countries for cross cultural
comparison. Comparison of cultures would present insights on the different misalignment problems in
healthcare and the methods of sustaining through an ethnography study and multiple data collection
methods.
The study is limited by the single case design as well as one section of the healthcare organization in the
UK and as such limits generalization. The framework developed is therefore limited to the selected case.
Also healthcare organizations will have a different approach of sustaining alignment based on the
environment, structure, strategy, leadership, culture and resources. Just as alignment approach will differ
64
(Maes 2000; Brown et al. 1994), one method of sustaining alignment cannot be used for all other
contexts. Therefore generalizations can be gained through any future studies.
In validating and testing the proposed framework, the process for sustaining alignment in this case study
is an opportunity for future research. Research is needed to test and validate the conceptual framework.
For instance a future quantitative study could be done to measure and analyze whether there are any
causal and correlational relationships between the domains of calibration, causes and situations of
misalignment, seeking capabilities and sustaining alignment.
It will also be useful to explore into how sustaining alignment can impact on the performance of
healthcare organizations.
65
References
Andrews, K. R. (1971). The concept of corporate strategy. New York.
Baets, W. (1992). Aligning information systems with business strategy. The Journal of Strategic
Information Systems, 1(4), 205-213.
Baets, W. R. (1996). Some empirical evidence on IS strategy alignment in banking. Information &
Management, 30(4), 155-177.
Baker, J., & Jones, D. (2008, December). A theoretical framework for sustained strategic alignment and
an agenda for research. In Proceedings of JAIS Theory Development Workshop. Sprouts: Working
Papers on Information Systems (Vol. 8, p. 16).
Balochian,F., Ansari, M. R. J. & Balochian, S. (2012). “ Evaluating the relationship between information
technology and organizational structure ” . Advances in Information Technology and Management,
1 (3), 123-12.
Barney, J. (1991). Firm resources and sustained competitive advantage. Journal of management, 17(1),
99-120.
Bass, B. M., & Avolio, B. J. (1993). Transformational leadership and organizational culture. Public
administration quarterly, 112-121.
Bazzoli, G. J., Shortell, S. M., Dubbs, N., Chan, C., & Kralovec, P. (1999). A taxonomy of health
networks and systems: bringing order out of chaos. Health services research, 33(6), 1683.
Bergeron, F., & Raymond, L. (1995, December). The contribution of IT to the bottom line: a contingency
perspective of strategic dimensions. In ICIS (pp. 167-181).
Boyatzis, R. E. (1998). Transforming qualitative information: Thematic analysis and code development.
sage.
Broadbent, M., & Weill, P. (1997). Management by maxim: how business and IT managers can create IT
infrastructures. MIT Sloan Management Review, 38(3), 77.
Brown, C. V., & Magill, S. L. (1994). Alignment of the IS functions with the enterprise: toward a model
of antecedents. MIS quarterly, 371-403.
Burn, J. M., & Szeto, C. (2000). A comparison of the views of business and IT management on success
factors for strategic alignment. Information & management, 37(4), 197-216.
Bush, M., Lederer, A. L., Li, X., Palmisano, J., & Rao, S. (2009). The alignment of information systems
with organizational objectives and strategies in health care. International journal of medical
informatics, 78(7), 446-456.
Cäker, M., & Siverbo, S. (2014). Strategic alignment in decentralized organizations–The case of Svenska
Handelsbanken. Scandinavian Journal of Management, 30(2), 149-162.
Chaffey, D., & White, G. (2010). Business information management: Improving performance using
information systems. Pearson Education.
66
Chaffey, D. & Wood, S. (2005). Business Information Management: improving performance using
information systems. Harlow: Financial Times Prentice Hall.
Chan, Y. E., Huff, S. L., Barclay, D. W., & Copeland, D. G. (1997). Business strategic orientation,
information systems strategic orientation, and strategic alignment. Information systems research,
8(2), 125-150.
Chan, Y. E., & Huff, S. L. (1992). Strategy: an information systems research perspective. The Journal of
Strategic Information Systems, 1(4), 191-204.
Chan, Y. E., & Reich, B. H. (2007). IT alignment: what have we learned?. Journal of Information
technology, 22(4), 297-315.
Chen, R. S., Sun, C. M., Helms, M. M., & Jih, W. J. K. (2008). Aligning information technology and
business strategy with a dynamic capabilities perspective: A longitudinal study of a Taiwanese
Semiconductor Company. International Journal of Information Management, 28(5), 366-378.
Chen, S. (2015). The character, causes and consequences of IS strategic misalignment in a Chinese State
Owned Enterprise (Doctoral dissertation, University of Sheffield).
Ciborra, C. U. (1997). De profundis? Deconstructing the concept of strategic alignment. Scandinavian
journal of information systems, 9(1), 2.
Collis, D. J. (1994). Research note: how valuable are organizational capabilities?. Strategic management
journal, 15(S1), 143-152.
Cooper, R. B., & Zmud, R. W. (1990). Information technology implementation research: a technological
diffusion approach. Management science, 36(2), 123-139.
Cooper, D. R., Schindler, P. S., & Sun, J. (2006). Business research methods (Vol. 9). New York:
McGraw-Hill Irwin.
Crabtree, B. F., & Miller, W. L. (1992). Doing qualitative research. In Annual North American Primary
Care Research Group Meeting, 19th, May, 1989, Quebec, PQ, Canada. Sage Publications, Inc.
Creswell, John (1998). Qualitative inquiry and research design: Choosing among five traditions.
Thousand Oaks, CA: Sage.
Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. Sage
publications.
Crowe, S., Cresswell, K., Robertson, A., Huby, G., Avery, A., & Sheikh, A. (2011). The case study
approach. BMC medical research methodology, 11(1), 100.
Daly, J., Kellehear, A., & Gliksman, M. (1997). The public health researcher: A methodological
approach.
Denison, D. R. (1990). Corporate culture and organizational effectiveness. John Wiley & Sons.
67
Denzin, N. K., & Lincoln, Y. S. (Eds.). (2011). The Sage handbook of qualitative research. Sage.
Draper, J. (2004). The relationship between research question and research design.
Donaldson, L. (2001). The contingency theory of organizations. Sage.
Drnevich, P. L., & Kriauciunas, A. P. (2011). Clarifying the conditions and limits of the contributions of
ordinary and dynamic capabilities to relative firm performance. Strategic Management Journal,
32(3), 254-279.
Dunn, P., McKenna, H., & Murray, R. (2016). Deficits in the NHS 2016. The King‘s Fund, London.
Dwivedi, A., Bali, R. K., James, A. E., & Naguib, R. N. G. (2001). Workflow management systems: the
healthcare technology of the future?. In Engineering in Medicine and Biology Society, 2001.
Proceedings of the 23rd Annual International Conference of the IEEE (Vol. 4, pp. 3887-3890).
IEEE.
Eagly, A. H., Johannesen-Schmidt, M. C., & van Engen, M. L. (2003). Transformational, transactional,
and laissez-faire leadership styles. Psychological Bulletin, 129(4), 569-591.
Easterby-Smith, M. T., & Thorpe, R. (2002). R. and Lowe, A.(2002). Management research: An
introduction, 2, 342.
Eisenhardt, K. M. (1989). Building theories from case study research. Academy of management review,
14(4), 532-550.
El-Telbany, O., & Elragal, A. (2014). Business-information systems strategies: A focus on misalignment.
Procedia Technology, 16, 250-262.
England, N. H. S. (2014). Five year forward view. Retrieved 17 August, 2017 from
https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
Fey, C. F., & Denison, D. R. (2003). Organizational culture and effectiveness: can American theory be
applied in Russia?. Organization science, 14(6), 686-706.
Gainsbury, S. (2016). Feeling the crunch: NHS finances to 2020. London: The Nuffield Trust.
Galbraith, J. R. (1971). Matrix organization designs How to combine functional and project forms.
Business horizons, 14(1), 29-40.
Galbraith, J. R. (1974). Organization design: An information processing view. Interfaces, 4(3), 28-36.
Galliers, R. D., & Leidner, D. E. (Eds.). (2014). Strategic information management: challenges and strategies in managing information systems. Routledge.
Garfield, S. L., & Kurtz, R. (1977). A study of eclectic views. Journal of Consulting and Clinical
Psychology, 45(1), 78.
Gibson, J. L., Ivancevich, J. M., & Donnelly, J. H. (2000). Organizations: behaviour, structure,
processes. Mcgraw Hill Education.
68
Glaser, B. and A. Strauss. 1967. The discovery of grounded theory: Strategies for qualitative
research. New York: Aldine Publishing Company.
Goedvolk, H., A. Van Schijndel, V. Van Swede, and R. Tolido. "The design, development and
deployment of ICT systems in the 21st century: integrated architecture framework (IAF)." Cap
Gemini Ernst and Young (2000).
Gordon, G. G., & DiTomaso, N. (1992). Predicting corporate performance from organizational culture.
Journal of management studies, 29(6), 783-798.
Grant, R. M. (1991). Analyzing resources and capabilities. Contemporary strategic analysis: Concepts,
techniques and applications Cambridge, MA: Blackwell.
Gray, B. (1989). Collaborating: Finding common ground for multiparty problems.
Gray, D. E. (2004). Theoretical perspectives and research methodologies. Gray, DE Doing.
Griffin, R. W., & Moorhead, G. (2011). Organizational behavior. Cengage Learning.
Guan, J., & Ma, N. (2003). Innovative capability and export performance of Chinese firms. Technovation,
23(9), 737-747.
Guba, E. G., & Lincoln, Y. S. (1994). Competing paradigms in qualitative research. Handbook of
qualitative research, 2(163-194), 105.
Gunasekaran, S., & Garets, D. (2004). Managing the IT strategic planning process. In Healthcare
Information Management Systems (pp. 22-34). Springer New York.
Haes, S. D., Haes, S. D., & Grembergen, W. V. (2016). Strategic IT Governance and Alignment in
Business Settings.
Hambrick, D. C. (1980). Operationalizing the concept of business-level strategy in research. Academy of
Management Review, 5(4), 567-575.
Hampson E, Malouf N, Crallan R, Soneji U, Standing M, George R (2015). Digital health in the UK:
an industry study for the Office of Life Sciences. London: Monitor Deloitte. Retrieved 18 August, 2017
from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/461479/BIS-
15-544-digital-health-in-the-uk-an-industry-study-for-the-Office-of-Life-Sciences.pdf
Henderson, J. C., & Venkatraman, N. (1989). Strategic alignment: a framework for strategic information
technology management.
Henderson, J. C., & Venkatraman, H. (1993). Strategic alignment: Leveraging information technology for transforming organizations. IBM systems journal, 32(1), 472-484.
Hicks, J. O. (1993). Management Information Systems: a user perspective. West Publishing Company.
Honeyman, M., Dunn, P., & McKenna, H. (2016). A digital NHS. An introduction to the digital agenda
and plans for implementation. London: The King’s Fund.
69
Hwang, S., & Cameron, G. T. (2008). Public's expectation about an organization's stance in crisis
communication based on perceived leadership and perceived severity of threats. Public Relations
Review, 34(1), 70-73.
Jacobides, M. G. (2007). The inherent limits of organizational structure and the unfulfilled role of
hierarchy: Lessons from a near-war. Organization Science, 18(3), 455-477.
Johnson, G., Scholes, K., & Whittington, R. (2008). Exploring corporate strategy: text & cases. Pearson
Education.
Jones, G. R., & Jones, G. R. (2010). Organizational theory, design, and change.
Jones, G. R. (2013). Organizational theory, design and change,7th ed. Boston, Mass; London: Pearson.
Jorfi, S., Nor, K. M., & Najjar, L. (2011). The relationships between IT flexibility, IT-Business strategic
alignment, and IT capability. International Journal of Managing Information Technology, 3(1), 16-
31.
Kaplan, R. S., & Norton, D. P. (2001). The strategy-focused organization: How balanced scorecard
companies thrive in the new business environment. Harvard Business Press.
Kirsch, L. J. (2004). Deploying common systems globally: The dynamics of control. Information systems
research, 15(4), 374-395.
Klein, H. K., & Myers, M. D. (1999). A set of principles for conducting and evaluating interpretive field
studies in information systems. MIS quarterly, 67-93.
Kroenke,D.&Hatch,R.(1993).Business Information Systems: an Introduction. Mitchell McGraw-Hill.
Kuhn, T. S. (1962). The Structure of Scientific Revolutions Vol.
Laudon, K. C. & Laudon, J. P. (2006). Management Information Systems: managing the digital firm, 10th
ed. New Jersey: Pearson Education.
Leicester, Leicestershire and Rutland Local Digital Roadmap. (2016). Retrieved 21st May, 2017 from
http://www.bettercareleicester.nhs.uk/EasysiteWeb/getresource.axd?AssetID=48200
Leidner, D. E., Pan, G., & Pan, S. L. (2009). The role of IT in crisis response: Lessons from the SARS
and Asian Tsunami disasters. The Journal of Strategic Information Systems, 18(2), 80-99.
Leonard, J. (2008). What are we aligning? Implications of a Dynamic Approach to Alignment. ACIS 2008
Proceedings, 76.
Leontiades, J. C. (1987). Multinational corporate strategy: Planning for world markets. Lexington books.
Luftman, J., & Brier, T. (1999). Achieving and sustaining business-IT alignment. California management
review, 42(1), 109-122.
Luftman, J., Papp, R., & Brier, T. (1999). Enablers and inhibitors of business-IT alignment.
Communications of the AIS, 1(3es), 1.
70
Luftman, J. N. (2003). Competing in the information age: Align in the sand. Oxford University Press.
Luftman, J. (2003, 1996), “Competing in the Information Age – Strategic Alignment in
Practice”, Oxford press.
Luftman, J. N. (1996). Applying the strategic alignment model. Competing in the information age:
Strategic alignment in practice, 43-69.
Luftman, J. (2004). Assessing business-IT alignment maturity. Strategies for information technology
governance, 4, 99.
Luftman, J; Kempaiah, R and Nash, E. (2005). “Key Issues for IT Executives 2005”, MIS
Quarterly Executive, Vol 5(2), pp.81–101.
Lynch, R. L. (2006). Corporate Strategy, 4th ed. New York: FT/Prentice Hall.
Maddison, R. N. & Darnton, G. (1996) Information systems in organizations: improving business
processes. London: Chapman & Hall.
Maes, R. (1999). A generic framework for information management. Universiteit van Amsterdam,
Department of Accountancy & Information Management.
Maes, R., Rijsenbrij, D., Truijens, O., & Goedvolk, H. (2000). Redefining business: IT alignment through
a unified framework.
Makadok, R. (2001). Toward a synthesis of the resource‐based and dynamic‐capability views of rent
creation. Strategic management journal, 22(5), 387-401.
Mason, J. (2002). Qualitative researching. Sage.
Marshall, M. N. (1996). Sampling for qualitative research. Family practice, 13(6), 522-526.
Marume, S. B. M., & Jubenkanda, R. R. (2016). Centralization and Decentralization.
Mata, F. J., Fuerst, W. L., & Barney, J. B. (1995). Information technology and sustained competitive
advantage: A resource-based analysis. MIS quarterly, 487-505.
Miles, M. B., Huberman, A. M., & Saldana, J. (1984). Qualitative data analysis: A sourcebook. Beverly
Hills.
Miles, R. E., Snow, C. C., Meyer, A. D., & Coleman, H. J. (1978). Organizational strategy, structure, and
process. Academy of management review, 3(3), 546-562.
McGinley, T. (2016). An architecture framework for open building.
McKelvey, B. (1975). Guidelines for the empirical classification of organizations. Administrative Science
Quarterly, 509-525.
71
McWatters, C. S., & Zimmerman, J. L. (2015). Management Accounting in a Dynamic Environment.
Routledge.
Mehta, M., & Hirschheim, R. (2007). Strategic alignment in mergers and acquisitions: theorizing IS
integration decision making. Journal of the Association for Information Systems, 8(3), 143.
Meyer, C. B. (2001). A case in case study methodology. Field methods, 13(4), 329-352.
Michael, M. D. (2009). Qualitative Research in Business & Management.
Mingers, J., & Gill, A. (1997). Multimethodology: theory and practice of combining management science
methodologies. Wiley.
Mintzberg, H. (1996). Generic business strategies. The Strategy Process-Concepts, Contexts, Cases, 3,
83-92.
Mintzberg, H. (1987). Crafting strategy (pp. 66-75). Boston, MA, USA: Harvard Business School Press.
Mintzberg, H. (1983). Structures in fives. Designing effective organizations.
Morse, J. M. (1994). Designing funded qualitative research.
Mullins, L. J. (2002). Management and organisational behaviour. Pearson education.
Myers, M. D. (2009). Qualitative research in business and management. London, UK: Sage.
Myers, M. D., & Avison, D. (Eds.). (2002). Qualitative research in information systems: a reader. Sage.
Newell, S., Robertson, M., Scarbrough, H., & Swan, J. (2009). Managing knowledge work and
innovation. Palgrave Macmillan.
Nanjundeswaraswamy, T. S., & Swamy, D. R. (2014). Leadership styles. Advances in management, 7(2),
57.
Nickols, F. (2011). Strategy, strategic management, strategic planning and strategic thinking. Distance
Consulting LLC, 1-8.
Odiorne, G. S. (1974). Management and the activity trap. New York: Harper & Row.
Papp, R., & Luftman, J. (1995, August). Business and IT strategic alignment: new perspectives and
assessments. In Proceedings of the Association for Information Systems, Inaugural Americas Conference
on Information Systems (pp. 25-27).
Patton, M. Q. (1990). Qualitative evaluation and research methods. SAGE Publications, inc.
Peppard, J., & Campbell, B. (2014). The Co-evolution of Business/Information Systems Strategic
Alignment: An Exploratory Study. Manuscript for Journal of Information Technology Special Issue
“Strategic IT Alignment: Twenty Five Years On.
72
Peppard, J., Lambert, R., & Edwards, C. (2000). Whose job is it anyway?: organizational information
competencies for value creation. Information Systems Journal, 10(4), 291-322.
Perry, G. S. (2011). Strategic Themes–How Are They Used and WHY? Retrieved 06th
September, 2017
from
https://www.balancedscorecard.org/portals/0/pdf/Strategic_Themes_How_Are_They_USed_And_
Why.pdf
Petersen, L. B., Person, R., & Nash, C. (2014). Connect: How to Use Data and Experience Marketing to
Create Lifetime Customers. John Wiley & Sons.
Pickton, D. W., & Wright, S. (1998). What's swot in strategic analysis?. Strategic change, 7(2), 101-109.
Porter, M. E. (1996). What is strategy. Published November.
Pugh, D. S., & Pugh, D. S. (Eds.). (1971). Organization theory: Selected readings (Vol. 126).
Harmondsworth, UK: Penguin.
Pyburn, P. J. (1983). Linking the MIS plan with corporate strategy: an exploratory study. MIS quarterly,
1-14.
Rajasekar, S., Philominathan, P., & Chinnathambi, V. (2006). Research methodology. arXiv preprint
physics/0601009.
Raymond, L., & Bergeron, F. (2008). Enabling the business strategy of SMEs through e-business
capabilities: A strategic alignment perspective. Industrial Management & Data Systems, 108(5),
577-595.
Reddy, G. S., Srinivasu, R., Rikkula, S. R., & Rao, V. S. (2009). Management information system to help
managers for providing decision making in an organization. International Journal of reviews in
Computing, 1-6.
Reich, B. H., & Benbasat, I. (1996). Measuring the linkage between business and information technology
objectives. MIS quarterly, 55-81.
Reich, B. H., & Benbasat, I. (2000). Factors that influence the social dimension of alignment between
business and information technology objectives. MIS quarterly, 81-113.
Rondinelli, D., Rosen, B., & Drori, I. (2001). The struggle for strategic alignment in multinational
corporations:: Managing readjustment during global expansion. European Management Journal,
19(4), 404-416.
Ross, J. W., & Weill, P. (2002). Six IT decisions your IT people shouldn't make. Harvard business review, 80(11), 84-95.
Rowley, J. (2002). Using case studies in research. Management research news, 25(1), 16-27.
Sabherwal, R., Hirschheim, R., & Goles, T. (2001). The dynamics of alignment: Insights from a
punctuated equilibrium model. Organization Science, 12(2), 179-197.
73
Sandelowski, M. (1995). Sample size in qualitative research. Research in nursing & health, 18(2), 179-
183.
Sarlak, M. A., & Salamzadeh, Y. (2014). Analyzing the impacts of informal organizations on formal
routines in a networked organization. Journal of Asian Scientific Research, 4(12), 768.
Saunders, M., Lewis, P., & Thornhill, A. (2009). Understanding research philosophies and approaches.
Research methods for business students, 4, 106-135.
Schein, E. H. (1985). Organisational culture and leadership: A dynamic view. San Francisco.
Scotland, J. (2012). Exploring the philosophical underpinnings of research: Relating ontology and
epistemology to the methodology and methods of the scientific, interpretive, and critical research
paradigms. English Language Teaching, 5(9), 9.
Seddon, P., & Scheepers, R. (2006). Other-settings generalizability in IS research. ICIS 2006
Proceedings, 70.
Sekaran, U., & Bougie, R. (2010). Research Methods for Business: A Skill. Building Approach. UK:
John Wiley.
Sha, X., Cheng, Y., Pan, S. L., & Teoh, S. (2011, October). The implementation success of healthcare
information systems: a business-IT alignment perspective. In ECIS (p. 29).
Shanks, G. (2002). Guidelines for conducting positivist case study research in information systems.
Australasian Journal of Information Systems, 10(1).
Slack, N., Chambers, S. & Johnston, R. (2007). Operations Management, 5th ed. Harlow: Financial
Times/Prentice Hall.
Smaczny, T. (2001). Is an alignment between business and information technology the appropriate
paradigm to manage IT in today’s organisations?. Management Decision, 39(10), 797-802.
Sha, X., Cheng, Y., Pan, S. L., & Teoh, S. (2011, October). The implementation success of healthcare
information systems: a business-IT alignment perspective. In ECIS (p. 29).
Tallon, P. P. (2007). A process-oriented perspective on the alignment of information technology and
business strategy. Journal of Management Information Systems, 24(3), 227-268.
TechRepublic. (2003). IT Manager's Guide to Business Strategy. Retrieved 10th
August, 2017 from
https://books.google.co.uk/books?id=F4SHsk-
Y7w0C&pg=PT22&lpg=PT22&dq=TechRepublic+Joe+Santana&source=bl&ots=pRABwz_apC&
sig=IiH7z76QR-
IvQ_PV0S2ZwhIVSRM&hl=en&sa=X&ved=0ahUKEwjI17bpyIbWAhVSOMAKHWNzCwcQ6A
EIVTAI#v=onepage&q=TechRepublic%20Joe%20Santana&f=false
Teddlie, C., & Yu, F. (2007). Mixed methods sampling: A typology with examples. Journal of mixed
methods research, 1(1), 77-100.
74
Teece, D. J., Pisano, G., & Shuen, A. (1997). Dynamic capabilities and strategic management. Strategic
management journal, 509-533.
Tian, J., Wang, K., Chen, Y., & Johansson, B. (2010). From IT deployment capabilities to competitive
advantage: An exploratory study in China. Information Systems Frontiers, 12(3), 239-255.
Villagarcia, S. (2011, July). Formalization as a Way of Coordination and Control in a Construction Firm.
In Rooke, J. & Dave, B., 19th Annual Conference of the International Group for Lean Construction.
Lima, Peru (pp. 13-15).
Van der Voet, J. (2014). The effectiveness and specificity of change management in a public
organization: Transformational leadership and a bureaucratic organizational structure. European
Management Journal, 32(3), 373-382.
Wager, K. A., Lee, F. W., & Glaser, J. P. (2005). Managing? Health Care Information Systems: A
Practical Approach for Health Care Executives. John Wiley & Sons.
Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems: a practical approach
for health care management. John Wiley & Sons.
Walsham, G. (1993). Interpreting information systems in organizations. John Wiley & Sons, Inc..
Wang, E. T., Tai, J. C., & Wei, H. L. (2006). A virtual integration theory of improved supply-chain
performance. Journal of Management Information Systems, 23(2), 41-64.
Weber, M. (1978). Economy and society: An outline of interpretive sociology (Vol. 1). Univ of California
Press.
Weill, P., & Broadbent, M. (1998). Leveraging the new infrastructure: how market leaders capitalize on
information technology. Harvard Business Press.
Whitten, J. F., Bentley, L. D., & Kevin, C. Dittman.(2004) Systems analysis and design methods.
Wray, N., Markovic, M., & Manderson, L. (2007). “Researcher saturation”: The impact of data
triangulation and intensive-research practices on the researcher and qualitative research process.
Qualitative Health Research, 17(10), 1392-1402.
Winter, S. G. (2003). Understanding dynamic capabilities. Strategic management journal, 24(10), 991-
995.
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Appendix 1: Interview Scripts
Interview for NHS Business Executives and Managers
Hello, glad you responded to my request to participate in the research. My name is Mary-Gloria Quartey.
I am a Master of Science Student in Health Informatics at the University of Sheffield. I am performing a
research on alignment of IT and Business strategy in healthcare. This interview is about sustaining IT-
Business alignment in the local NHS.
What position do you hold?
Are you involved in the planning of IT and business strategy for the local NHS?
What role do you play in the decisions made towards the kind of budget to be invested into IT systems?
Are the IT managers involved in the decision-making process? Why?
Does the business strategy include IT strategy?
Are there enough resources and budget available for IT projects from the NHS?
76
Are there enough resources and budget available for IT projects from the NHS?
How is the IT strategy of the local NHS? Is it fit for purpose considering the objectives of the local NHS?
Do you know if there is a link between IT and business? How well is the business strategy connected with
the IT strategy?
Are you able to report to IT managers with any business needs for the local NHS?
77
Is there constant communication and briefing between IT and business managers?
Do you have any idea of how budget is decided for IT ventures? Are IT managers involved in deciding on
budget?
What type of information system do you use?
Do you use information systems to a large extent in carrying out your management activities?
Are the IT systems supportive in your general managerial activities?
78
Are the IT systems users friendly? Is there a manual for the system for reference? Is it helpful?
How has the implementation of the IT systems changed your work?
Does the IT department play an important role in the local NHS? Are there enough resources and budget
available for IT projects from the NHS?
Considering the organizational and business structure, are all management activities supported by the IT
systems?
79
Has there been any influence from within or outside the organisation which will cause any changes in the
link between business and IT strategy, example changes in legislation, customer satisfaction, training,
information, communication, budgeting, organisational performance or technology?
Do you know if these changes affected the link of IT and business strategy in any way? How?
How were you able to identify the changes in the link between IT and business strategy?
If you detect any changes in the link between IT and business strategy, are you able to fix it? How?
Do you have anything else to add?
80
Interview Questions for IT Managers
Hello, glad you responded to my request to complete this questionnaire. My name is Mary-Gloria
Quartey. I am a Master of Science Student at the University of Sheffield. I am performing a research on
alignment of IT and Business strategy in healthcare. This questionnaire is about sustaining IT-Business
alignment in the local NHS.
What is your job tile?
In your line of work do you get involved with IT strategy?
Do you have any knowledge of the business strategy or aims of the local NHS?
When developing IT strategy are you able to refer to business strategy?
Do you know if there is a link between IT and business? How well do they link?
81
Do you know if there is a link between IT and business? How well do they link?
Do you incorporate business strategy into IT strategy?
Are you involved in meetings for discussions on business plans?
Do business managers support IT staff in the planning of IT strategy and any other need of IT
implementation? How?
Do you think business managers are able to understand how the systems function?
82
Considering the organizational and business structure, are all management activities supported by the IT
systems?
Does the IT department play an important role in the local NHS? Are there enough resources and budget
available for IT projects from the NHS?
Are the operational staffs and managers capable of operating the systems well? Do they have enough
training?
Do the operational staffs and managers contact you for any assistance? What are some of the problems
you assist with?
83
Are there any changes from within the organisation that affects the linkage between the business and IT
strategy? Example changes in legislation, customer satisfaction, training, information, communication,
budgeting, organisational performance or technology?
Did these changes affect the link of IT and business strategy in any way? How?
How were you able to identify the changes in the link between IT and business strategy?
If you detect any changes in the link between IT and business strategy, are you able to fix it? How?
Do you have anything else to add?
84
Interview Questions for IT Users
Hello, glad you responded to my request to participate in the research. My name is Mary-Gloria Quartey.
I am a Master of Science Student in Health Informatics at the University of Sheffield. I am performing a
research on alignment of IT and Business strategy in healthcare. This interview is about sustaining IT-
Business alignment in the local NHS.
What is your job tile?
In your line of work do you get involved with IT strategy?
Do you have any knowledge of the IT and business strategy of the local NHS?
Are you aware of the aims and objectives of the IT and Business Strategy of the local NHS?
85
What do you think of the current IT Systems you use? Are they performing according to your
expectations? How?
Do the IT systems help with how you manage your work, such as planning tasks?
Do you recieve regular information from management about the reasons for the functions in the system
and any upcoming changes to the system?
Do you think the information systems in your department are user friendly? Do they help with work
processes?
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Are you able to operate the information system well? Do you have any problems with how the system
operates?
Are you able to get assistance from IT department anytime you are having problems with the operation of
your system?
Do you have access to training courses which can help with operating the information system?
Is there a manual for the system for reference? Is it helpful?
Do you think it was a good decision to implement the information systems?
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Would you like the system to be changed in any way to suit your work processes? How?
Have you communicated any changes you prefer to IT?
If yes, what was the outcome?
Have you noticed any function in the system that is not performing according to work processes?
Are there any other changes that affect the effective usage of the system from within or outside your
department? Example changes in legislation, customer satisfaction, training, information,
communication, budgeting, organisational performance or technology?
Do you have any other thing to add?
Did these changes affect the use of the system or your work processes in any way?
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If you detect any changes which affect your usage of the system or work processes are you able to get
help to fix it? How?
Do you have anything else to add?
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Appendix 2: Details of Interviewees
ID Job Position Department
A1 Manager IT Department
A2 Manager IT Department
A3 Manager CCG Manager
A4 User CAHMS
A5 User CAHMS
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Appendix 3: Sample of Code definition table
Category Codes Definition
Calibration/Sensing
Problem
Dialogue through Information
Strategy Groups
IT and NHS executives are able
to identify misalignment
problems through Information
Strategy Groups.
General awareness There is an awareness of the
existing misalignment problems
by IT managers, NHS managers
and Users.
Causes of Misalignment NHS budget covering many
projects
There are many other projects in
the STP work to be achieved for
the five year forward view, and
not just implementation of IT
systems.
Stretched IT strategy Due to lack of funds IT Strategy
looks stretched with many plans
which might not be achieved.
Increased time in processing
patient information.
Some clinicians are of the view
that the time used in the
processing information with
implemented systems as
compared to paper system is too
long
Lack of working space for
systems in wards
IT systems for processing
information in wards are placed
on trays which are not spacious
enough, since they are used
alongside other health systems.
Theoretical perspective of
implementation discussions
The theoretical phase of
discussions surrounding the IT
projects to be implemented
makes it difficult for some
clinicians to understand the
system to be implemented
-Fixed budget
-Budget delays
Budgets released by
government have been the same
amount for years.
The financial cycle of the NHS
in general results in managers
of the IT department in
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Leicester experiencing delays in
release of budget for execution
of projects.
-Changes in national directives
and laws – vision 2020 going
paperless, new data protection
laws
-Changes in local directives-
-Delivery of clinic outcome
letters electronically, change in
STP work
Alignment of strategy is
affected by change in local and
national laws and directives
-Unawareness of IT and
business strategy
Some Users are not aware of the
plans in IT and business
strategy
-Complicated system
-Unnecessary system functions
-Lack of functions for work
processes – out of office
message for sent tasks, all tasks
and ledgers appearing in one
work unit
Some Users are of the view that
IT systems are not user friendly,
have functions which are not
needed and at the same time do
not have functions to support
some work processes.
Situations of Misalignment -Insufficient budget for projects
-Lack of funding for projects
-Projects might not materialise
-Delay in projects
The cause of fixed budget,
budget delays. and broad NHS
project result in the delay of
projects. There could be even
no funds and when funds are
available, it is not enough to
take care of the projects.
-Changes to systems to fit laws.
-Change in priorities.
-Changes in systems to fit
directives.
When local and national
directives and laws change it
results in a situation where the
systems have to be changed to
fit those laws. This means that
IT managers will have to
change their priorities and hold
on with ongoing projects.
-Lack of support for IT
implementation at lower level
of NHS management, example
clinicians.
IT managers face the challenge
of lack of support for system
implementation due to the
delays caused in information
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-Fewer patients being seen by
clinicians
-Systems sitting on trolleys
processing. The delays in
information processing also
results in fewer patients being
seen by Doctors. Since there is
not enough working space,
systems end up sitting on
trolleys in the wards which is
not very convenient.
Lack of understanding for
system functions at
implementation discussions
Some clinicians are not able to
understand system function due
to theoretical presentation.
-System not user friendly
-Too wordy
-Unawareness of system
manual
-Preference for paper system
-Counterproductivity.
-Not completing tasks in/on
time.
-Not having access to patient
list.
The complication of SystmOne
for some users and the lack of
functions for processes have
resulted in the system being
unfriendly, too wordy,
counterproductive, and many
more.
Seeking Capabilities -IT Support.
-National governing body.
-NHS managers making key
decisions.
-More people expertise in
decision making.
-Possible help from IT helpdesk
The resources available which
can be relied on to solve
specific misalignment
problems.
Sustain -Recommendation from local
NHS managers to national
governing body
-Frequent Training.
-Practical explanations during
implementation.
-Budgets issued at scheduled
times however still fixed.
-Re-prioritization by IT
department.
-Possible solutions from IT
department.
Practical solutions applied to
sustain alignment of specific
misalignment problems.
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Appendix 4: Ethics Approval Letter
Downloaded: 02/09/2017
Approved: 18/07/2017
Mary - Gloria Quartey
Registration number: 140122491
Information School
Programme: MSc Health Informatics
Dear Mary – Gloria
PROJECT TITLE: Sustaining Alignment of IT and Business Strategy and Its Impact on
Performance in Healthcare Organisations
APPLICATION: Reference Number 015915
On behalf of the University ethics reviewers who reviewed your project, I am pleased to inform you that
on 18/07/2017 the above-named project was approved on ethics grounds, on the basis that you will
adhere to the following documentation that you submitted for ethics review:
University research ethics application form 015915 (dated 16/07/2017).
Participant information sheet 1034221 version 3 (16/07/2017).
If during the course of the project you need to deviate significantly from the above-approved
documentation please inform me since written approval will be required.
Yours sincerely
Matt Jones
Ethics Administrator
Information School
Ethics Email
Information School Research Ethics (sent by [email protected])
1 Sep
Dear Mary,
Further to my earlier email, I see that your email does relate to your ethics application 15915.You stated
in your email that:
"My current topic is Sustaining Alignment of IT and Business Strategy in Healthcare Organizations
and its Impact on Performance.
First of all, my research was a case study so I am thinking it will be more appropriate to add, 'A Case
Study' at the end.
Secondly, I plannned to use secondary data to demonstrate the impact on performance, however due to
94
time contraints this is prooving to be a difficult task.
I am therefore requesting that I change the topic to Sustaining Alignment of IT and Business Strategy
in Healthcare Organizations: A Case Study"
In terms of the change to your title, this is a minor change and does not require any further approval.
Equally, my reading of your email is that you had previously planned to use secondary data, but are now
not doing this. Again, this constitutes a minor change, and does not require any further approval.
As such, the research and change to the title can continue as described above, and no further approval is
required.
I would advise you to keep a copy of this email for your records.
Thanks and best,
Matt Jones
Research Ethics Administrator
95
Appendix 5: Information Sheet
The University of Sheffield.
Information School
Project Title:
Sustaining Alignment of IT and Business Strategy and its
Impact on Healthcare Organizations
Researchers
Mary – Gloria Quartey
Master Student
University of Sheffield
302 Checkland Road
LE4 8ES
Email: [email protected]
Mobile: 077 115 768 95
Purpose of the research
The research is about how the link between the usage of IT systems and the work of the NHS in
Leicester and surrounding areas is maintained over time. Also, the changes in the NHS, within or outside
the working environment which can affect the link between IT and business strategy of the local NHS will
be explored to come up with a framework to help support the effects of the changes and how it will be
maintained. Recommendations will be given to healthcare organizations to help with maintaining how IT
systems can be used effectively within the NHS as the years go by.
Who will be participating?
Participants will be the members of the Leicester, Leicestershire and Rutland health and social care
Information Technology community, and SystmOne users in CAMHS.
What will you be asked to do?
I will go through a 20 minute interview about the usage of information systems in the NHS. If you cannot
find the time for the interview, let me know in your response to this email and a questionnaire will be
sent out to you to provide answers after which I might have a telephone conversation with you for any
clarification.
What are the potential risks of participating?
There are no risks involved. No personal data will be collected.
What data will we collect?
If you are a user of IT systems within Leicester and surrounding areas, then data will be collected concerning the usage of IT systems in relation to how easy it makes your work, the support you get with usage in terms of training, whether there are any problems at the work place or outside work which affects your usage, and whether you get any help with these problems from IT managers or NHS managers.
96
If you are an IT manager responsible for implementation or support of IT systems in the NHS within Leicester and surrounding areas, then data will be collected concerning how you are able work with NHS managers, support the system users and whether there are any changes within or outside the business environment which affects the kind of support you give to NHS staff and management or affects the implementation plans, and how those problems are resolved to help with the implementation of IT systems.
If you are on the NHS Information Systems management board of Leicester and surrounding areas, data will be collected to find out how you are able to work with IT managers and support users, and whether there are any issues within or outside the business environment which affects the implementation plans of IT systems and how these problems are resolved to help with the implementation of IT systems.
What will we do with the data?
I will be analyzing the data to be included in my master’s dissertation. After that point, it will be kept
encrypted in one secure cloud storage, managed by the University as well as on my own password
protected computer until I complete my degree, after which it will be destroyed.
Will my participation be confidential?
The questions will be completed anonymously therefore there will be no data revealing your identity.
What will happen to the results of the research project?
The results of this study will be included in my master’s dissertation which will be publicly available.
Please contact the School in six months.
I confirm that I have read and understand the description of the research project, and that I have
had an opportunity to ask questions about the project.
I understand that my participation is voluntary and that I am free to withdraw at any time without
any negative consequences.
I understand that I may decline to answer any particular question or questions, or to do any of
the activities. If I stop participating at all time, all of my data will be purged.
I understand that my responses will be kept strictly confidential, that my name or identity will not
be linked to any research materials, and that I will not be identified or identifiable in any report or
reports that result from the research.
I give permission for the research team members to have access to my anonymised responses.
I agree to take part in the research project as described above.
Participant Name (Please print) Participant Signature
97
Researcher Name (Please print) Researcher Signature
Date
Note: If you have any difficulties with, or wish to voice concern about, any aspect of your
participation in this study, please contact Dr Jo Bates, Research Ethics Coordinator,
Information School, The University of Sheffield ([email protected]), or to the
University Registrar and Secretary.
101
Appendix 7: Access to Dissertation
Information
School.
Access to Dissertation
A Dissertation submitted to the University may be held by the Department (or School) within which the
Dissertation was undertaken and made available for borrowing or consultation in accordance with University
Regulations.
Requests for the loan of dissertations may be received from libraries in the UK and overseas. The Department
may also receive requests from other organisations, as well as individuals. The conservation of the original
dissertation is better assured if the Department and/or Library can fulfill such requests by sending a copy. The
Department may also make your dissertation available via its web pages.
In certain cases where confidentiality of information is concerned, if either the author or the supervisor so
requests, the Department will withhold the dissertation from loan or consultation for the period specified below.
Where no such restriction is in force, the Department may also deposit the Dissertation in the University of
Sheffield Library.
To be completed by the Author – Select (a) or (b) by placing a tick in the appropriate box
If you are willing to give permission for the Information School to make your dissertation available in these ways,
please complete the following:
a (a) Subject to the General Regulation on Intellectual Property, I, the author, agree to this dissertation being
made immediately available through the Department and/or University Library for consultation, and for
the Department and/or Library to reproduce this dissertation in whole or part in order to supply single
copies for the purpose of research or private study
(b) Subject to the General Regulation on Intellectual Property, I, the author, request that this dissertation be
withheld from loan, consultation or reproduction for a period of [ ] years from the date of its
submission. Subsequent to this period, I agree to this dissertation being made available through the
Department and/or University Library for consultation, and for the Department and/or Library to
102
reproduce this dissertation in whole or part in order to supply single copies for the purpose of research
or private study
Name: Mary - Gloria Quartey
Department: Information School
Signed: Mary-Gloria Quartey Date: 29/08/2017
To be completed by the Supervisor – Select (a) or (b) by placing a tick in the appropriate box
(a) I, the supervisor, agree to this dissertation being made immediately available through the Department
and/or University Library for loan or consultation, subject to any special restrictions (*) agreed with
external organisations as part of a collaborative project.
*Special
restrictions
(b) I, the supervisor, request that this dissertation be withheld from loan, consultation or reproduction for a
period of [ ] years from the date of its submission. Subsequent to this period, I, agree to this
dissertation being made available through the Department and/or University Library for loan or
consultation, subject to any special restrictions (*) agreed with external organisations as part of a
collaborative project
Name
Department
Signed Date
THIS SHEET MUST BE SUBMITTED WITH DISSERTATIONS IN ACCORDANCE WITH DEPARTMENTAL
REQUIREMENTS.