Case study 7 chapter 141. 2. Answer the Case Study Questions (.docx

Case study 7 chapter 14
1.
2. Answer the Case Study Questions (found at the end of each
case study) in 500-750 words total (not including reference
list).
3. Include at least one additional, external reference to sources
such as an article or video. Cite the reference(s) in your study.
Your case study will be graded on the following:
Grading: 20 points
Content 80% (how thoroughly and logically you answer the
questions, how well you incorporate your reference(s), how well
you make arguments and state facts to support your answers).
Spelling/Grammar/Punctuation 20%
14-4 What are the principal risk factors in information systems
projects, and how can they be managed?
We have already introduced the topic of information system
risks and risk assessment in Chapter 8. In this chapter, we
describe the specific risks to information systems projects and
show what can be done to manage them effectively.Dimensions
of Project Risk
Systems differ dramatically in their size, scope, level of
complexity, and organizational and technical components. Some
systems development projects are more likely to create the
problems we have described earlier or to suffer delays because
they carry a much higher level of risk than others. The level of
project risk is influenced by project size, project structure, and
the level of technical expertise of the information systems staff
and project team.
· Project size. The larger the project—as indicated by the
dollars spent, the size of the implementation staff, the time
allocated for implementation, and the number of organizational
units affected—the greater the risk. Very large-scale systems
projects have a failure rate that is 50 to 75 percent higher than
that for other projects because such projects are complex and

difficult to control. The organizational complexity of the
system—how many units and groups use it and how much it
influences business processes—contributes to the complexity of
large-scale systems projects just as much as technical
characteristics, such as the number of lines of program code,
length of project, and budget. In addition, there are few reliable
techniques for estimating the time and cost to develop large-
scale information systems.
· Project structure. Some projects are more highly structured
than others. Their requirements are clear and straightforward, so
outputs and processes can be easily defined. Users know exactly
what they want and what the system should do; there is almost
no possibility of the users changing their minds. Such projects
run a much lower risk than those with relatively undefined,
fluid, and constantly changing requirements; with outputs that
cannot be fixed easily because they are subject to users’
changing ideas; or with users who cannot agree on what they
want.
· Experience with technology. The project risk rises if the
project team and the information system staff lack the required
technical expertise. If the team is unfamiliar with the hardware,
system software, application software, or database management
system proposed for the project, it is highly likely that the
project will experience technical problems or take more time to
complete because of the need to master new skills.
Although the difficulty of the technology is one risk factor in
information systems projects, the other factors are primarily
organizational, dealing with the complexity of information
requirements, the scope of the project, and how many parts of
the organization will be affected by a new information system.
The Interactive Session on Management about the UK National
Health Service’s move toward paperless recordkeeping
illustrates a project with some of these risks.Change
Management and the Concept of Implementation
The introduction or alteration of an information system has a
powerful behavioral and organizational impact. Changes in the

way that information is defined, accessed, and used to manage
the organization’s resources often lead to new distributions of
authority and power. This internal organizational change breeds
resistance and opposition and can lead to the demise of an
otherwise good system.
A very large percentage of information systems projects stumble
because the process of organizational change surrounding
system building was not properly addressed. Successful system
building requires careful change management.The Concept of
Implementation
To manage the organizational change surrounding the
introduction of a new information system effectively, you must
examine the process of implementation. Implementation refers
to all organizational activities working toward the adoption,
management, and routinization of an innovation, such as a new
information system. In the implementation process, the systems
analyst is a change agent. The analyst not only develops
technical solutions but also redefines the configurations,
interactions, job activities, and power relationships of various
organizational groups. The analyst is the catalyst for the entire
change process and is responsible for ensuring that all parties
involved accept the changes created by a new system. The
change agent communicates with users, mediates between
competing interest groups, and ensures that the organizational
adjustment to such changes is complete.Interactive Session:
Management Can the National Health Service Go Paperless?
The National Health Service (NHS) is the United Kingdom’s
publicly funded national healthcare system. Funded primarily by
taxation, NHS provides free or low-cost healthcare to all legal
residents of the United Kingdom. NHS services include
hospitals, family doctors, specialists, dentists, chemists
(pharmacists), opticians, and ambulance service. Medications
are subsidized as well. Specific policies vary among England,
Scotland, Wales, and Northern Ireland.
The UK Department of Health oversees the NHS. Patient
records are maintained by healthcare providers, who must

ensure confidentiality of patient data and compliance with
regulatory standards. Like other healthcare systems, such as in
the United States, patient records were primarily paper-based.
Physician and hospital offices had shelves full of folders and
papers devoted to the storage of medical records, making
patient and treatment information very difficult to access or
share. Just pulling the notes for NHS patients to be seen in the
morning was a nightmare.
In January 2013 Health Secretary Jeremy Hunt called for
making the NHS paperless by 2018 to save billions, improve
services, and help meet the challenges of an aging population.
Hunt and many others believe that patients should have
compatible digital records so their health information can
follow them around the health and social care system. Whether
patients need a general practitioner (GP), hospital, or care
home, the professionals involved in their treatment should be
able to see their history at the touch of a button and share
crucial information. Improved use of technology would allow
health professionals to spend more time with patients and help
patients take control of their own care, saving more than £4
billion.
Hunt announced the following goals:
· Paperless referrals: Instead of sending a letter to the hospital
when referring a patient, the GP can send an e-mail instead.
· Secure linking of the electronic health and care records
wherever they are held, so there is as complete a record as
possible of the care someone receives.
· Ability of those records to be able to follow individuals, with
their consent, to any part of the NHS or social care system.
· Ability of individuals to get online access to their own health
records held by their GP by March 2015.
· Digital information fully available across NHS and social care
services by April 2018 unless individuals opt out.
Paperless solutions can lead to a reduction in
treatment/medication errors, quicker time to diagnosis, shorter
time to treatment, more collaborative diagnostics (allowing a

wider range of specialists to be involved), and better overall
patient care.
However, many working in the NHS and private sectors—
including those within the technology industry—believe that a
paperless NHS is not achievable within a five-year time frame.
This is an extremely ambitious target, and critics question how
much this will really improve NHS services, if it’s worth the
cost of implementing new IT systems, and if it’s even
achievable.
According to S. A. Mathieson, an EHI Intelligence analyst, the
English NHS is made up of several hundred organizations with
greatly differing IT capabilities as well as thousands of
independent GPs. All of them would have to acquire new
software and hardware and convert their paper records to digital
form. To make the new system effective, they would also have
to change their procedures (business processes) to take
advantage of the new technology. Answering patient phone
calls, examining patients, and writing prescriptions will need to
incorporate procedures for accessing and updating electronic
medical records; paper-based records will have to be converted
into electronic form, most likely with codes assigned for
various treatment options and data structured to fit the record’s
format. Training can take up to 20 hours of a doctor’s time, and
doctors are extremely time-pressed. In order to get the system
up and running, physicians themselves may have to enter some
of the data, taking away time they could be spending with their
patients. When the United States tried to implement electronic
medical records in healthcare nationwide, many physicians
complained about the time and effort required to make these
changes. NHS has experienced some of this resistance.
The UK doctors’ union, the British Medical Association (BMA),
says there are several challenges to be overcome in order to
make the NHS paperless and is skeptical about the extent of the
benefits such a system can offer. According to the BMA, the
biggest challenges to making the NHS paperless by 2018 are
funding, resources, prioritization, and the choice of in

secondary care. As well as ongoing hardware and software
funding, sufficient resources will be required to support training
of users and IT specialists to use the paperless system and to
provide IT support and administrative support. Although there
may potentially be some efficiencies, technology alone will not
necessarily create very large cost savings.
Currently, 40 percent of a clinician’s time is spent waiting for
relevant information or making decisions based on information
that is inaccurate or unreliable, and digitization needs to tackle
these problems as well.
The House of Commons Public Accounts Committee warned
that making the NHS paperless requires significant additional
investments in IT and business transformation. Yet the
Department of Health had not even set aside a specific budget
for this purpose. The department said it was investing £1 billion
(approximately $1.5 billion) in the paperless project—half from
the central government and the rest from local health and care
budgets.
A report by a Public Accounts Committee (PAC) recently said
that changes made toward a digital NHS system “has not gone
to plan,” and some are saying it has been an “expensive waste
of time.” For any large organization, going paperless is a
challenge, but when it is cash strapped and under intense public
scrutiny and has a dismal history of IT failure (including
unsuccessful earlier efforts to digitize patient records), the task
looks like mission impossible, observes Michael Cross, news
editor at The Law Society Gazette. Can the health service meet
that deadline? Or will the NHS just end up with less paper than
it did when the paperless project started?
Sources: Kat Hall, “NHS IT Projects Worth £5bn at ‘High Risk’
of Failure, Warns HSCIC,” The Register, December 8, 2015;
Clare McDonald, “What Is Standing in the Way of a Paperless
NHS?” Computer Weekly, September 2015; S. A. Mathieson,
“How Can IT Contribute to NHS Efficiency?” Computer
Weekly, September 2015; Michael Cross, “NHS Chases a
Paperless Tiger,” Raconteur, April 29, 2014; Claire Read,

“Barriers to a Paperless NHS: Are You Ready for Your Screen
Test?” HSJ, March 14, 2014; Ben Rossi, “Going Paperless: The
Clash Between IT Staff and NHS Trust Heads,” Information
Age, February 18, 2014; Department of Health and the Rt Hon
Jeremy Hunt MP, “NHS Challenged to Go Paperless by
2018,” www.gov.uk, accessed January 4, 2016; “The Paperless
NHS…?” Computacenter, April 12, 2013.Case Study Questions
1. Why is paperless NHS a risky project? Identify the key risk
factors.
2. What management, organization, and technology problems is
the paperless NHS likely to encounter?
3. What steps should be taken to make the paperless NHS more
successful?The Role of End Users
System implementation generally benefits from high levels of
user involvement and management support. User participation in
the design and operation of information systems has several
positive results. First, if users are heavily involved in systems
design, they have more opportunities to mold the system
according to their priorities and business requirements and more
opportunities to control the outcome. Second, they are more
likely to react positively to the completed system because they
have been active participants in the change process.
Incorporating user knowledge and expertise leads to better
solutions.
The relationship between users and information systems
specialists has traditionally been a problem area for information
systems implementation efforts. Users and information systems
specialists tend to have different backgrounds, interests, and
priorities. This is referred to as the user-designer
communications gap. These differences lead to divergent
organizational loyalties, approaches to problem solving, and
vocabularies.
Information systems specialists, for example, often have a
highly technical, or machine, orientation to problem solving.
They look for elegant and sophisticated technical solutions in
which hardware and software efficiency is optimized at the

expense of ease of use or organizational effectiveness. Users
prefer systems that are oriented toward solving business
problems or facilitating organizational tasks. Often the
orientations of both groups are so at odds that they appear to
speak in different tongues.
These differences are illustrated in Table 14.4, which depicts
the typical concerns of end users and technical specialists
(information systems designers) regarding the development of a
new information system. Communication problems between end
users and designers are a major reason why user requirements
are not properly incorporated into information systems and why
users are driven out of the implementation process.
Case study 7 chapter 14
1.
2. Answer the Case Study Questions (found at the end of each
case study) in 500-750 words total (not including reference
list).
3. Include at least one additional, external reference to sources
such as an article or video. Cite the reference(s) in your study.
Your case study will be graded on the following:
Grading: 20 points
Content 80% (how thoroughly and logically you answer the
questions, how well you incorporate your reference(s), how well
you make arguments and state facts to support your answers).
Spelling/Grammar/Punctuation 20%
14-4 What are the principal risk factors in information systems
projects, and how can they be managed?
We have already introduced the topic of information system
risks and risk assessment in Chapter 8. In this chapter, we
describe the specific risks to information systems projects and
show what can be done to manage them effectively.Dimensions

of Project Risk
Systems differ dramatically in their size, scope, level of
complexity, and organizational and technical components. Some
systems development projects are more likely to create the
problems we have described earlier or to suffer delays because
they carry a much higher level of risk than others. The level of
project risk is influenced by project size, project structure, and
the level of technical expertise of the information systems staff
and project team.
· Project size. The larger the project—as indicated by the
dollars spent, the size of the implementation staff, the time
allocated for implementation, and the number of organizational
units affected—the greater the risk. Very large-scale systems
projects have a failure rate that is 50 to 75 percent higher than
that for other projects because such projects are complex and
difficult to control. The organizational complexity of the
system—how many units and groups use it and how much it
influences business processes—contributes to the complexity of
large-scale systems projects just as much as technical
characteristics, such as the number of lines of program code,
length of project, and budget. In addition, there are few reliable
techniques for estimating the time and cost to develop large-
scale information systems.
· Project structure. Some projects are more highly structured
than others. Their requirements are clear and straightforward, so
outputs and processes can be easily defined. Users know exactly
what they want and what the system should do; there is almost
no possibility of the users changing their minds. Such projects
run a much lower risk than those with relatively undefined,
fluid, and constantly changing requirements; with outputs that
cannot be fixed easily because they are subject to users’
changing ideas; or with users who cannot agree on what they
want.
· Experience with technology. The project risk rises if the
project team and the information system staff lack the required
technical expertise. If the team is unfamiliar with the hardware,

system software, application software, or database management
system proposed for the project, it is highly likely that the
project will experience technical problems or take more time to
complete because of the need to master new skills.
Although the difficulty of the technology is one risk factor in
information systems projects, the other factors are primarily
organizational, dealing with the complexity of information
requirements, the scope of the project, and how many parts of
the organization will be affected by a new information system.
The Interactive Session on Management about the UK National
Health Service’s move toward paperless recordkeeping
illustrates a project with some of these risks.Change
Management and the Concept of Implementation
The introduction or alteration of an information system has a
powerful behavioral and organizational impact. Changes in the
way that information is defined, accessed, and used to manage
the organization’s resources often lead to new distributions of
authority and power. This internal organizational change breeds
resistance and opposition and can lead to the demise of an
otherwise good system.
A very large percentage of information systems projects stumble
because the process of organizational change surrounding
system building was not properly addressed. Successful system
building requires careful change management.The Concept of
Implementation
To manage the organizational change surrounding the
introduction of a new information system effectively, you must
examine the process of implementation. Implementation refers
to all organizational activities working toward the adoption,
management, and routinization of an innovation, such as a new
information system. In the implementation process, the systems
analyst is a change agent. The analyst not only develops
technical solutions but also redefines the configurations,
interactions, job activities, and power relationships of various
organizational groups. The analyst is the catalyst for the entire
change process and is responsible for ensuring that all parties

involved accept the changes created by a new system. The
change agent communicates with users, mediates between
competing interest groups, and ensures that the organizational
adjustment to such changes is complete.Interactive Session:
Management Can the National Health Service Go Paperless?
The National Health Service (NHS) is the United Kingdom’s
publicly funded national healthcare system. Funded primarily by
taxation, NHS provides free or low-cost healthcare to all legal
residents of the United Kingdom. NHS services include
hospitals, family doctors, specialists, dentists, chemists
(pharmacists), opticians, and ambulance service. Medications
are subsidized as well. Specific policies vary among England,
Scotland, Wales, and Northern Ireland.
The UK Department of Health oversees the NHS. Patient
records are maintained by healthcare providers, who must
ensure confidentiality of patient data and compliance with
regulatory standards. Like other healthcare systems, such as in
the United States, patient records were primarily paper-based.
Physician and hospital offices had shelves full of folders and
papers devoted to the storage of medical records, making
patient and treatment information very difficult to access or
share. Just pulling the notes for NHS patients to be seen in the
morning was a nightmare.
In January 2013 Health Secretary Jeremy Hunt called for
making the NHS paperless by 2018 to save billions, improve
services, and help meet the challenges of an aging population.
Hunt and many others believe that patients should have
compatible digital records so their health information can
follow them around the health and social care system. Whether
patients need a general practitioner (GP), hospital, or care
home, the professionals involved in their treatment should be
able to see their history at the touch of a button and share
crucial information. Improved use of technology would allow
health professionals to spend more time with patients and help
patients take control of their own care, saving more than £4
billion.

Hunt announced the following goals:
· Paperless referrals: Instead of sending a letter to the hospital
when referring a patient, the GP can send an e-mail instead.
· Secure linking of the electronic health and care records
wherever they are held, so there is as complete a record as
possible of the care someone receives.
· Ability of those records to be able to follow individuals, with
their consent, to any part of the NHS or social care system.
· Ability of individuals to get online access to their own health
records held by their GP by March 2015.
· Digital information fully available across NHS and social care
services by April 2018 unless individuals opt out.
Paperless solutions can lead to a reduction in
treatment/medication errors, quicker time to diagnosis, shorter
time to treatment, more collaborative diagnostics (allowing a
wider range of specialists to be involved), and better overall
patient care.
However, many working in the NHS and private sectors—
including those within the technology industry—believe that a
paperless NHS is not achievable within a five-year time frame.
This is an extremely ambitious target, and critics question how
much this will really improve NHS services, if it’s worth the
cost of implementing new IT systems, and if it’s even
achievable.
According to S. A. Mathieson, an EHI Intelligence analyst, the
English NHS is made up of several hundred organizations with
greatly differing IT capabilities as well as thousands of
independent GPs. All of them would have to acquire new
software and hardware and convert their paper records to digital
form. To make the new system effective, they would also have
to change their procedures (business processes) to take
advantage of the new technology. Answering patient phone
calls, examining patients, and writing prescriptions will need to
incorporate procedures for accessing and updating electronic
medical records; paper-based records will have to be converted
into electronic form, most likely with codes assigned for

various treatment options and data structured to fit the record’s
format. Training can take up to 20 hours of a doctor’s time, and
doctors are extremely time-pressed. In order to get the system
up and running, physicians themselves may have to enter some
of the data, taking away time they could be spending with their
patients. When the United States tried to implement electronic
medical records in healthcare nationwide, many physicians
complained about the time and effort required to make these
changes. NHS has experienced some of this resistance.
The UK doctors’ union, the British Medical Association (BMA),
says there are several challenges to be overcome in order to
make the NHS paperless and is skeptical about the extent of the
benefits such a system can offer. According to the BMA, the
biggest challenges to making the NHS paperless by 2018 are
funding, resources, prioritization, and the choice of

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