Challenges to implementing the national programme for information technology (NPfIT): a qualitative study

Appendix: Interview framework (as submitted by author)

NPfIT in general -

1. Previously, reaching national targets regarding the implementation of EPRs was primarily the responsibility of local trusts. The National Program for Information Technology (NPfIT) has now decided a more centrally controlled approach is needed. What do you think about this decision?

Prompts: explore wider organisational factors specific to the NHS that have hindered IT implementation?

What would have helped?

Will centrally controlled solutions be better or worse?

EPR development at the trust -

2. In 1998, Information for Health set out six levels of EPR development. By April 2002 it was reported that only 3% of trusts (five in total) had complete EPR systems in place – way under the hoped for target. In trying to achieve some level of EPR implementation - can you give me any insights into how (the trust) got on?

Prompts: explore the trust’s past experiences of implementation.

Previous in-house IT successes and failures

Any specific difficulties encountered - medical/ legal/ staffing problems.

3. What do you think were some of the barriers to implementation, and what could the trust could have done differently to achieve a higher level of EPR development?

Prompts: explore physical, informational and organisational resources (costs) that have

facilitated or hindered IT implementation.

Explore the relationship between Trust Managers and the information system in use.

Explore the role of wider organisational pressures – such as achieving operational targets.

4. In terms of preparing for the new LSP solutions what do you think needs to be done at (trust)?

Prompts: explore the change management associated with planning for the LSP solutions - setting goals, staff consultation, training etc. Explore any structural changes and strategy documents (obtain if available).

5. Who is driving these changes within the trust?

Prompts: explore the role of leaders and super-users - the organisational impact of key players.

6. How do you see your role impacting on the process of implementation?

Prompts: explore how motivated, efficacious, and involved they are.

Explore the organisational impact of their personal investment (or lack of it).

7. Across the trust, how much agreement do you think there is about the importance of achieving NCRS?

Prompts: explore organisational commitment to implementation – across the trust and within different groups.

The role of constant change in management teams and the NHS generally.

Explore whether high levels of change has impacted on IT focus and staff commitment? Explore the perceived commitment of different groups.

8. In implementing the LSP solutions – where do you see potential areas of difficulty?

Prompts: explore issues of ‘organisational fit’ and goal conflict – other pressures and priorities.

Differing agendas – how the EPR implementation programme needs to address the priorities of ‘everyman’ - trust, SHA, and National Program.

Explore the role of in-house IT innovations and their future.

Explore perceptions of what NCRS should deliver against what is perceived as being rolled out. Any organisational divide between mangers/clinicians/IT staff’s expectations and the deliverables?

9. What are the consequences of achieving the NPfIT goals – electronic patient records that support an integrated care records service?

Prompts: explore positive and negative outcomes - national and organisational. Explore impact on staff roles, relationships and patient care.

10. For you what constitutes EPR implementation success?

Prompts: explore how the meaning of success is defined, at what level, and for whom – the trust, the LSP or the National Program?

11. How can this success be best achieved?

Prompts: explore factors they consider necessary for success – such as staff relations, clinician engagement and finance.

How these can be factors be achieved and whether they think these factors will be forthcoming?

If time –

12. Regarding NPfIT - what do you think will be happening in the future?

Prompts: explore whether they think NPfIT will deliver long term – and the consequences of (non) delivery.

13. How do you think (trust) will respond to these changes?

Prompts: explore both positive and negative responses.

14. Lastly – whether they would like to make any other comments before ending.