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Can an Integration of Soft Systems Methodology & the ETHICS Framework Enhance Socio-Technical Systems Design in Large and Co Can an Integration of Soft Systems Methodology & the ETHICS Framework enhance Socio-technical Systems Design in Large and Complex Organizations? : An Action Research Study on Two NHS Pathways and their Design Strategies Dicle Timurtas - 1 - Project report submitted in part fulfilment of the requirements for the degree of Master of Science (Human-Computer Interaction with Ergonomics) in the Faculty of Life Sciences, University College London, 2011. NOTE BY THE UNIVERSITY This project report is submitted as an examination paper. No responsibility can be held by London University for the accuracy or completeness of the material therein. - 2 - ACKNOWLEDGMENTS This research project was a real challenge and a wonderful experience for me. I learnt so much from this thesis study and I would like to thank people who made it possible. I would like to thank my supervisor Malcolm Ballantine for his endless encouragement, supervision and support throughout this study. I was very fortunate to be introduced to Ken Eason who generously shared relevant Pathway Study data with me, answered my many questions in the meetings and through emails whilst providing guidance in all the stages of my research. Furthermore, I would like to express my gratitude to the rest of the EPICog team members; Dylan Eric Tutt, Patrick Waterson and Mike Dent for giving their valuable time to participate and share their knowledge during the interviews. - 3 - ABSTRACT Finding solutions to Information System (IS) design problems requires attention to both technical and organisational matters. System designers frequently ignore the organisational design issues and instead they almost entirely focus on technical design. This frequently leads to unsatisfactory designs.' This thesis is an account of an Action Research study which had three purposes. Initially, it investigated the compatibility of two Action Research techniques; Soft Systems Methodology (SSM), which gives importance to the definition of the organisational and technical purpose of the system, and the Effective Technical and Human Implementation of Computer-based Systems Framework (ETHICS), which gives importance to the co- optimisation of organisational and technical design. Secondly, the main purpose of the study investigated whether their complementation can enhance socio-technical design in IS problems. Lastly, it investigated the feasibility of applying this integrated methodology in the real world.To arrive at a conclusion, two NHS pathway cases provided by the EPICog team are used as practical examples to investigate this general research question. The research question is answered with two main studies. A Design Strategy Analysis, which investigates a new design strategy to be applied in the NHS pathway designs including the integrated methodology. A Pathway Analysis, in which the integrated strategy applied on the provided pathway examples to generate socio-technical design alternatives to each pathway. Lastly interviews with EPICog team provided exploration and support of the findings of the two main studies and provided opinions for alteration of the integrated methodology into a simpler and possibly more feasible structure. Through these two practical pathway studies, the integrated methodology is found to be very compatible and promising to enhance the socio-technical design of information systems. However the methodology is found to be over structured for the NHS and for practicality reasons a new simplified and much practicable version is introduced. - 4 - CONTENTS Chapter 1. INTRODUCTION .......................................................................... 6 Chapter 2. LITERATURE REVIEW .............................................................. 9 2.1 Alternative Approaches to Information Systems Design ................................... 9 The Soft Systems Methodology ............................................................................. 10 The ETHICS Framework ....................................................................................... 15 2.2 Related research on NHS ................................................................................. 20 Chapter 3. CONDUCTING THE STUDY .................................................... 23 3.1 Investigation of Methodology .......................................................................... 25 Rich Picture ............................................................................................................ 25 Root Definition and Purposeful Activity Model for Methodology ........................ 26 3.2 Pilot Study ........................................................................................................ 32 3.3 Study One: NHS Design Process Analysis ...................................................... 35 Rich Pictures .......................................................................................................... 35 Root Definition and Conceptual Model for Recommended Design Strategy ........ 47 Summary ................................................................................................................ 50 3.4 Study Two: Pathway Analysis ......................................................................... 52 The Integrated Methodology Process, its Complementation and Advantages ...... 53 Summary ................................................................................................................ 74 ................................................................................................................................ 75 3.5 Meetings with The Socio-technical EPICog team ........................................... 76 The Process ............................................................................................................ 76 The Findings........................................................................................................... 79 Summary ................................................................................................................ 87 Chapter 4. DISCUSSION ................................................................................ 89 Chapter 5. CONCLUSION ............................................................................. 92 REFERENCES ....................................................................................................... 94 Appendix ...................................................................................................... 100 APPENDIX 1. Integrated Methodology Report for Stroke Pathway .................. 100 APPENDIX 2. Integrated Methodology Report for Retinopathy Pathway ......... 154 APPENDIX 3: Questionnaire Questions ............................................................. 196 APPENDIX 4: Interview Questions ..................................................................... 201 APPENDIX 5: Presentation Slides ...................................................................... 204 - 5 - CHAPTER 1. INTRODUCTION This research began with the researcher‟s wish to perform an Action Research study to investigate whether Soft Systems Methodology could complement Socio-technical Systems approach to considerably enhance organisational and technical design strategies. Initially I was introduced to Ken Eason who is an Emeritus Professor in Loughborough University working on a Socio-technical systems consultation project called EPICog and asked him to help me find a case study where I could apply Soft Systems analysis and a Socio-technical technique together. He suggested a project he is currently working on; EPICog, which gave me access to suitable data on the National Health Service (NHS) pathways. In the 1st face-to-face meeting, Ken introduced several NHS pathway services he was socio-technically consulting on. A „pathway‟ is a healthcare description of a procedure to perform a multi-disciplinary healthcare service that provides for a specific type of patient‟s needs through a sequence of interdependent tasks performed by the service agents, within a specific time period. (Kingdon, Gregoire, 2011) In this meeting he mentioned that he would like to have a secondary opinion about the pathways and their design processes and found it interesting to investigate whether socio-technical systems and soft systems approaches could add value to the NHS pathways with a view to improve healthcare services and IT systems. In a 2nd phone meeting, the researcher selected two pathways to scope the context. Firstly, the Stroke Pathway aims to serve stroke patients with healthcare including diagnosis, treatment and monitoring for up-to three years. Secondly, the Retinopathy Diabetic Screening pathway aims to identify patients with diabetes, monitor their disease and provide clinical eye screening from age twelve. (Garvican, O‟Leary, 2008) The EPICog team‟s ten interviews with the clinical teams and socio-technical summaries of the selected pathways were shared with the researcher. - 6 - These two pathways were selected from several options since they have different pathway patient handover structures and are designed by different IT teams. These are the NHS Walsall Informatics Stroke team and NHS Northampton Informatics Retinopathy team which have different sizes and embrace different participatory design strategies. In light of these meetings with the EPICog Research Director and the shared resources, the researcher started looking for another action research tool that could be coherent with the initially selected action research tool (SSM) and the participatory perspectives
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