IRC Seminar, presented by Dr Ela Klecun: "Multi-level inter-organizational alignment in national healthcare IT initiatives: Implementation of Integrated Digital Care Records in England"

Abstract

Governments worldwide are making substantial investments in implementing national health IT initiatives, a key example being integrated care records that are intended to facilitate a continuum of care for patients across organizational and geographic boundaries. Various approaches have been taken towards their implementation. These can be broadly categorized as top-down, bottom-up and middle-out. Increasingly, countries have been adopting the middle-out approach, because top-down implementations, particularly in complex healthcare contexts, have had limited success, whilst the bottom-up approach have posed interoperability challenges. The middle-out approach is based on combining national government direction with local autonomy. It involves coordinating organizations at multiple levels (e.g., national agencies, regional bodies and local hospitals), as well as peer-to-peer integration of care. However, the literature provides limited insights into how this can be achieved.

Through our study of a national initiative to implement Integrated Digital Care Records in England, we examine how the middle-out approach is carried out and how it might be facilitated. We propose that the approach involves two inter-related strategies: locality-based autonomy with national alignment and organizational autonomy within locality-based integration, and that those may require different types of mutual (bidirectional) inter-organizational alignments - vertically or across levels and horizontally within a level. Alignment here refers to a consistency of relevant strategies, objectives, operations, and values among involved entities with respect to the initiative.

Our paper makes several contributions to alignment theory and to the literature on national IT initiatives in healthcare by (a) conceptualizing the key elements of inter-organizational alignment, i.e. dimensions, context, structures and mechanisms, (b) theorizing the inter-relationships between them, and (c) highlighting emerging tensions.

Short Bio on Presenter: Dr Ela Klecun is an assistant professor in Information Systems at the London School of Economics and Political Science. She received a BSc in Computing from Guildhall University, and a Master degree and a PhD in Information Systems from the LSE.

Her research is oriented towards developing a greater understanding of the way information and communication technologies (ICT) shape institutions, work practices and experiences of professional groups and individual people. In pursuit of this goal she researched policy, strategy and deployment of ICT in healthcare, from nation-wide infrastructures, such as shared electronic health records, to medical apps. She also investigated the skills and dispositions required to pursue ICT-enabled activities and the consequences of digital exclusion. Her research has been funded by various UK research councils. She published in major information systems, organization and medical journals, such as JAIS, JIT, EJIS, Organization, and BMJ.