{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T04:32:01Z","timestamp":1771907521228,"version":"3.50.1"},"reference-count":94,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2018,12,28]],"date-time":"2018-12-28T00:00:00Z","timestamp":1545955200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>There is global interest in implementing national information systems to support healthcare, and the National Health Service in England (NHS) has a troubled 25-year history in this sphere. Our objective was to chronicle structural reorganizations within the NHS from 1973 to 2017, alongside concurrent national information technology (IT) strategies, as the basis for developing a conceptual model to aid understanding of the organizational factors involved.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>We undertook an exploratory, retrospective longitudinal case study by reviewing strategic plans, legislation, and health policy documents, and constructed schemata for evolving structure and strategy. Literature on multi-organizational forms, complexity, national-level health IT implementations, and mega-projects was reviewed to identify factors that mapped to the schemata. Guided by strong structuration theory, these factors were superimposed on a simplified structural schema to create the conceptual model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Against a background of frequent NHS reorganizations, there has been a logical and emergent NHS IT strategy focusing progressively on technical and data standards, connectivity, applications, and consolidation. The NHS has a complex and hierarchical multi-organization form in which restructuring may impact a range of intra- and inter-organizational factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>NHS-wide IT programs have generally failed to meet expectations, though evaluations have usually overlooked longer-term progress. Realizing a long-term health IT strategy may be impeded by volatility of the implementation environment as organizational structures and relationships change. Key factors influencing the strategy\u2013structure dyad can be superimposed on the tiered NHS structure to facilitate analysis of their impact.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Alignment between incremental health IT strategy and dynamic structure is an under-researched area. Lessons from organizational studies and the management of mega-projects may help in understanding some of the ongoing challenges.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jamia\/ocy162","type":"journal-article","created":{"date-parts":[[2018,11,15]],"date-time":"2018-11-15T21:30:28Z","timestamp":1542317428000},"page":"188-197","source":"Crossref","is-referenced-by-count":22,"title":["Twenty-five years of national health IT: exploring strategy, structure, and systems in the English NHS"],"prefix":"10.1093","volume":"26","author":[{"given":"Colin","family":"Price","sequence":"first","affiliation":[{"name":"Management and Organisation Division, University of Leicester, School of Business, University Road, Leicester LE1 7RH, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4161-4490","authenticated-orcid":false,"given":"William","family":"Green","sequence":"additional","affiliation":[{"name":"Innovation, Technology and Operations Division, University of Leicester, School of Business, University Road, Leicester LE1 7RH, UK"}]},{"given":"Olga","family":"Suhomlinova","sequence":"additional","affiliation":[{"name":"Management and Organisation Division, University of Leicester, School of Business, University Road, Leicester LE1 7RH, UK"}]}],"member":"286","published-online":{"date-parts":[[2018,12,28]]},"reference":[{"issue":"12","key":"2020110613055727800_ocy162-B1","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1016\/j.ijmedinf.2008.06.007","article-title":"The use of health information technology in seven nations","volume":"77","author":"Jha","year":"2008","journal-title":"Int J Med Inform"},{"issue":"1","key":"2020110613055727800_ocy162-B2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1136\/amiajnl-2011-000674","article-title":"The dangerous decade","volume":"19","author":"Coiera","year":"2012","journal-title":"J Am Med Inform Assoc"},{"issue":"5","key":"2020110613055727800_ocy162-B3","doi-asserted-by":"crossref","first-page":"e87","DOI":"10.1016\/j.ijmedinf.2012.12.002","article-title":"Comparing New Zealand\u2019s \u2018Middle Out\u2019 health information technology strategy with other OECD nations","volume":"82","author":"Bowden","year":"2013","journal-title":"Int J Med Inform"},{"issue":"7608","key":"2020110613055727800_ocy162-B4","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1136\/bmj.39195.598461.551","article-title":"Implementing the NHS information technology programme: qualitative study of progress in acute trusts","volume":"334","author":"Hendy","year":"2007","journal-title":"Br Med J"},{"key":"2020110613055727800_ocy162-B5","doi-asserted-by":"crossref","first-page":"c3111.","DOI":"10.1136\/bmj.c3111","article-title":"Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study","volume":"340","author":"Greenhalgh","year":"2010","journal-title":"BMJ"},{"key":"2020110613055727800_ocy162-B6","doi-asserted-by":"crossref","first-page":"d6484.","DOI":"10.1136\/bmj.d6484","article-title":"NHS IT requires the wisdom of the crowd not the marketplace","volume":"343","author":"Bewley","year":"2011","journal-title":"BMJ"},{"key":"2020110613055727800_ocy162-B7","author":"Public Accounts Committee","year":"2013"},{"key":"2020110613055727800_ocy162-B8","doi-asserted-by":"crossref","DOI":"10.1007\/978-0-230-21364-7","volume-title":"Structuration Theory","author":"Stones","year":"2005"},{"issue":"4","key":"2020110613055727800_ocy162-B9","doi-asserted-by":"crossref","first-page":"532","DOI":"10.5465\/amr.1989.4308385","article-title":"Building theories from case study research","volume":"14","author":"Eisenhardt","year":"1989","journal-title":"AMR"},{"key":"2020110613055727800_ocy162-B10","volume-title":"Case Study Research: Design and Methods","author":"Yin","year":"2013","edition":"3rd ed"},{"key":"2020110613055727800_ocy162-B11","author":"National Health Service Reorganisation Act (c.32)","year":"1973"},{"key":"2020110613055727800_ocy162-B12","author":"NHS Confederation"},{"key":"2020110613055727800_ocy162-B13","author":"Webster C. 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