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Using computer decision support systems in NHS emergency and urgent care: ethnographic study using normalisation process theory

Pope, Catherine, Halford, Susan, Turnbull, Joanne, Prichard, Jane S., Calestani, Melania and May, Carl (2013) Using computer decision support systems in NHS emergency and urgent care: ethnographic study using normalisation process theory BMC Health Services Research, 13, (111), pp. 1-13. (doi:10.1186/1472-6963-13-111).

Record type: Article


Background: information and communication technologies (ICTs) are often proposed as ‘technological fixes’ for problems facing healthcare. They promise to deliver services more quickly and cheaply. Yet research on the implementation of ICTs reveals a litany of delays, compromises and failures. Case studies have established that these technologies are difficult to embed in everyday healthcare.

Methods: we undertook an ethnographic comparative analysis of a single computer decision support system in three different settings to understand the implementation and everyday use of this technology which is designed to deal with calls to emergency and urgent care services. We examined the deployment of this technology in an established 999 ambulance call-handling service, a new single point of access for urgent care and an established general practice out-of-hours service. We used Normalization Process Theory as a framework to enable systematic cross-case analysis.

Results: our data comprise nearly 500 hours of observation, interviews with 64 call-handlers, and stakeholders and documents about the technology and settings. The technology has been implemented and is used distinctively in each setting reflecting important differences between work and contexts. Using Normalisation Process Theory we show how the work (collective action) of implementing the system and maintaining its routine use was enabled by a range of actors who established coherence for the technology, secured buy-in (cognitive participation) and engaged in on-going appraisal and adjustment (reflexive monitoring).

Conclusions: huge effort was expended and continues to be required to implement and keep this technology in use. This innovation must be understood both as a computer technology and as a set of practices related to that technology, kept in place by a network of actors in particular contexts. While technologies can be ‘made to work’ in different settings, successful implementation has been achieved, and will only be maintained, through the efforts of those involved in the specific settings and if the wider context continues to support the coherence, cognitive participation, and reflective monitoring processes that surround this collective action. Implementation is more than simply putting technologies in place – it requires new resources and considerable effort, perhaps on an on-going basis.

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Published date: 2013
Organisations: Faculty of Health Sciences


Local EPrints ID: 356939
ISSN: 1472-6963
PURE UUID: 7b527007-f4de-49f6-af14-9b05502c509f
ORCID for Catherine Pope: ORCID iD
ORCID for Joanne Turnbull: ORCID iD
ORCID for Jane S. Prichard: ORCID iD
ORCID for Carl May: ORCID iD

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Date deposited: 20 Sep 2013 15:31
Last modified: 18 Jul 2017 03:36

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Author: Catherine Pope ORCID iD
Author: Susan Halford
Author: Joanne Turnbull ORCID iD
Author: Melania Calestani
Author: Carl May ORCID iD

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