Enacting ICT strategy in Victorian public hospitals

Abstract

Information and communications technologies (ICTs) have the potential to create major increments in public value in the public sector. The gains are associated with greater cost efficiencies by replacing human labour with networked computing and new information systems. Greater operational effectiveness is possible from better information flows, fewer redundancies, and reconfiguring systems to suit the needs of customers and citizens. ICTs also allow public managers to restructure public agencies to maximise the benefits of ICTs by using interagency collaboration and reducing bureaucracies. Despite this great potential, ICT strategies in both the private and public sectors often fail to achieve their stated objectives. This thesis argues that simply comparing the set objectives with results misses essential managerial learnings that are specific to the context of implementation.

The research aim was to evaluate an ICT strategy to ascertain whether the strategy achieved its stated objective, the factors that assisted or impeded ICT strategy, and what lessons could be drawn from implementation. The analytical approach combines Fountain’s (2001) Technical Enactment Framework (TEF) and Mark Moore’s (1995) Public Value theory to conceptualise ICT strategic management in the public sector, incorporating insights from the literatures on emergent strategy and ICT management. Two principal research methods informed this investigation: documentary analysis and the analysis of transcribed recordings of interviews. The research investigates an Australian state government’s attempts, between 1996 and 2002, to implement a large-scale ICT strategy in its public hospitals. It is important because this government sought to apply its radical neo-liberal ideas to the state’s hospitals, and considered it could use ICTs as the glue to help enable their broader policy aims of changing hospitals to reflect the future needs of patients in the hospital system. However, the government soon lost interest and the strategy was not fully funded. A change of government in 1999 brought no improvement in funding. The status of ICT strategy in hospitals did not rise. Public managers in hospitals and the overseeing government department were left to reset strategy and implement it without instructions from their political masters.

A short-sighted evaluation would conclude that the strategy was a failure. However, the public managers charged with implementing it achieved several secondary objectives. These included developing ICT strategic focus where there was little before. Hospitals began to invest in ICTs, where previously they were hesitant. Managers learned to work with each other on ICTs, within their own organisations and across organisational borders, where previously there was suspicion. The thesis demonstrates that decentralised implementation forced hospitals managers to work together for mutual advantage. The federal e-governance model worked particularly well for achieving interagency coordination and sharing resources. The research concludes that managerial learnings should not be neglected in the evaluation of ICT strategy. Indeed, the ‘soft’ returns are potentially as important as the ‘hard’ returns. Importantly, they also provide the foundation for further iterations of ICT strategic management.

This thesis argues that ICT strategic management is an iterative process, where strategic objectives are more fluid than the formal strategy documents suggest. The political nature of budgeting means that there is a disconnection between setting objectives and what gets implemented. Where separate public organisations are required to collaborate on ICTs much ground work is necessary. Success should not be assumed in advance of attending to the issues of governance, sharing resources, and developing the technical, business and diplomatic skills necessary to drive an ICT strategic focus within public organisations.