Supporting the emergence of a shared services organisation: Managing change in complex health ICT projects

Abstract

Although there is a high risk of failure in the implementation of ICT projects (which appears to extend to health ICT projects), we continue to implement health information systems in order to deliver quality, cost-effective healthcare. The purpose of the research was to participate in and study the change management as a critical success factor in health ICT projects, and to examine people’s responses to change so as to develop understanding and theory that could be used in future change management programmes.

The research was conducted within the context of a large infrastructure project that resulted from the emergence of a shared services organisation (from two participating District Health Boards in Auckland, New Zealand). Action research (AR) formed the basis of the methodology used, and provided the foundation for a change management programme: the AR intervention. Grounded theory (GT) was used for some of the data analysis, the generation of themes by means of constant comparison and the deeper examination of the change process using theoretical sampling. AR and GT together supported the development of theory regarding the change process associated with health ICT projects.

Health ICT projects were revealed in the findings as exhibiting the properties of complex adaptive systems. This complexity highlighted the art of change management as a critical success factor for such projects. The fabric of change emerged as a composite of processes linked to project processes and organisational processes. The turning point in the change process from the before state to the after state is marked by a capability crisis which requires effective patterns of leadership, sensitive targeting of communication, effective learning, and management of increased workload and diminishing resources during the course of health ICT projects. A well managed capability crisis period as a component of change management can substantially contribute to health ICT project success.