Power and interests in an implementation process

(1)

Power and interests in an implementation process

How power and interests of stakeholders influence the implementation of an

information system

University of Groningen, Faculty of Economics and Business

MSc. Business Administration, Change Management

S.A.R.Luttmer

Eendrachtskade Zuidzijde 10 E10

9726 CW Groningen

S.A.R.Luttmer@student.rug.nl

Student Number: 2220881

Supervisor: Dr. C. Reezigt

(2)

2

ABSTRACT

Implementing an information system requires significant organizational, as well as technical changes. Not much research has been done in the public healthcare industry in relation to an implementation process of an information system. To contribute to existing theory, this research takes a power and interests approach regarding stakeholders, to analyse the interaction between stakeholders, and their use of power in the implementation process of an information system. This research is conducted at GGD-Drenthe and used a qualitative case study to collect and analyse data. Powerful stakeholders with high interests implemented the information system in the organization. Due to the high level of involvement in the implementation process and in the decision making process their interests were high and they accepted the change. This study indicates that a low degree of involvement of stakeholders in the implementation process and decision-making process has a negative influence on the interests of stakeholders and eventually on the usage of the system. Stakeholders with a low level of power and low interest did not have enough power to influence the information system, however they did influence the usage of the system. Due to their low power and interests they experienced resistance to change which led to non-usage of the information system.

(3)

3

TABLE OF CONTENT

1. INTRODUCTION ... 5

1.1 Case Description... 7

1.2 Structure of Research Paper ... 8

2. THEORETICAL FRAMEWORK ... 8

2.1 Implementation Process of an IS ... 8

2.2 Identification of Stakeholders ... 9

2.3 Attitudes of Stakeholders ... 10

2.4 Power and Interests of Stakeholders ... 11

3. METHODOLOGY ... 13

3.1 Case Context ... 14

3.2 Data Collection ... 14

3.3 Data Analysis ... 16

4. RESULTS ... 17

4.1 Attitudes towards the Information System ... 17

4.1.1 Top Management Team ... 17

4.1.2 Implementers ... 17

4.1.3 Project Group ... 18

4.1.4 Feedback Group ... 18

4.1.5 Employees ... 18

4.2 Attitudes towards the Implementation Process ... 19

4.3.5 Employees ... 25

4.3 Interests of Stakeholders ... 27

4.3.5 Employees ... 28

4.4 Power Positions of Stakeholders ... 28

(4)

4

4.4.3 Project group ... 29

4.4.4 Feedback group ... 30

4.4.5 Employees ... 30

4.5 Interactions Between Stakeholders... 30

4.5.1 Overview of Interactions ... 32

5.DISCUSSION ... 33

5.1 Influence of Power and Interests on the Implementation Process. ... 33

5.2 Structuration Theory... 36

5.3 Interaction Theory ... 37

5.4 Equity-implementation Model ... 38

5.5 Status Quo Bias Theory ... 40

5.6 Technology Acceptance Literature... 42

5.7 Healthcare Literature ... 45

6. CONCLUSION ... 46

6.1 Theoretical Implications ... 46

6.2 Practical Implications ... 48

6.3 Limitations and Future Research Directions ... 49

6.4 Acknowledgements ... 49

REFERENCES ... 50

APPENDICES

(5)

5

1. INTRODUCTION

Nowadays, it is necessary for organizations to respond and react to their environment and anticipate on and adapt to new trends and changes. To respond to these changes, companies must be able to adapt quickly to new trends and must have innovative initiatives to stay ahead of competition (Lu & Ramamurthy, 2011). Organizations can do this by investing in information technology (IT), they expect it will improve their performance, reduce costs, increase quality and have a competitive advantage (Legris & Collerette, 2006).

It has proven to be a difficult challenge to actually benefit from IT implementation. The introduction of an IT system into an organization is generally accompanied by changes to organizational form and function (Volkoff, Strong, & Elmes, 2007).

IT implementation occurs in various industries but this paper will focus on the healthcare industry. Due to the importance of healthcare to individuals, governments and to its growing costs to the economy, healthcare is an important area of research for scholars in business and other disciplines (Fichman, Kohli, & Krishnan, 2011). Despite its importance, the healthcare domain has been underrepresented in leading IS journals and research (Fichman et al., 2011).

Healthcare organizations are complex, multi-functional, information-intensive organizations that require sophisticated, integrated clinical and business management information systems (Stefanou & Revanoglou, 2006). This integration was hardly achieved by the information systems used throughout the 1980s and in most of the 1990s. However, the emergence of new software radically transformed this (Stefanou & Revanoglou, 2006). According to Boonstra and Goovers (2008) the healthcare industry is a growing market for IT systems. Successful implementation of an information system can reduce inventory, production, shipping, labour, and IT maintenance costs, thus leading to greater efficacy and a better competitive advantage in terms of improved strategic initiatives and responsiveness to customers (Bharadwaj et al. 2007; O’Leary 2000).

(6)

6

When dealing with an information system (IS) implementation, stakeholders need to be identified in order to have a better understanding of which stakeholders should be involved in the implementation process (Mantzana et al., 2007). Organizations need to build relationships with and manage the expectations of the stakeholders and communicate eﬀectively with them (Assudani & Kloppenborg, 2010). While this may sound straightforward, the reality is that these tasks are seen as difficult (Jiang et al., 2009; Young et al., 2009;). The prioritization of stakeholders and managing them is becoming more important when the complexity of projects rises due to an increase in the number of stakeholders. Not only the number of stakeholders increases complexity but also the fact that an implementation process affects many stakeholders, who all have different interests, different degrees of autonomy and different levels of expertise (Boonstra & Govers, 2009).

Not only is the involvement of stakeholders important, according to Harris Weistroffer (2009), it is essential to the success of an IS implementation. It is important to know stakeholders’ influence and how they perceive an IS during the implementation process, as little is known about the projects’ activities and execution; uncertainty is high in this stage. Stakeholders are a primary source of uncertainty during the implementation process, because the implementation affects many stakeholders with different attitudes, interests and different degrees of autonomy and expertise (Boonstra & Govers, 2009). This source of uncertainty can be understood by identifying who the relevant stakeholders are, what are their interests, and how can the influence a change project (Ward& Chapman, 2008)

Only few academic accounts exist on the interaction of IS implementations on stakeholders, and just a few descriptive accounts of how groups and individuals in organizations interpret IS implementations and how they respond to them (Boonstra, 2006). Research that focuses on the role of power and interests in relation to IS is scarce (Boonstra & Govers, 2009). According to Boonstra & Goovers, our insight into the role of stakeholders in the design and implementation of IS is constrained, which means that there is a lack of understanding of why groups of individuals act the way they do. Due to this lack of understanding, this paper aims to uncover why stakeholders act the way they do, by focussing on how IS implementation may impact the interests of stakeholders in relation to the IS, and how these stakeholders may react by trying to influence the course of events to alter the implementation that is more consistent with their own interests. Understanding the possible impact of IS on interests of stakeholders may help project managers and others to manage IS implementations more effectively (Boddy et al., 2002). This paper shows how the implementation process of an IS can be affected by the attitudes that various stakeholders have towards the system, the actions they take throughout the process, and the power they possess.

(7)

7

(Hung, Chen, & Wang, 2014; Van Offenbeek et al.,2013; Fichman et al., 2011; Boonstra et al., 2010; Boonstra et al., 2009; Boonstra et al., 2008; Jensen and Aanestad, 2007). Not much research in relation to the implementation of IS could be found in public healthcare organizations, such as GGD. Therefore, by looking at stakeholders’ power and interests in relation to the implementation of an IS, adds new knowledge to the literature of public healthcare. The theoretical contribution of this research is to provide insights for organizations, in the public healthcare industry, in the role that stakeholders may play during an IS implementation.

To contribute to existing theory, this research takes a power and interests approach regarding stakeholders, to analyse the interaction between stakeholders, and their use of power in the implementation process of an IS. Having this understanding gives insights in how organizations can use the power and interests of the stakeholders, and how this may affect the usage of the IS. If stakeholders develop a negative attitude toward an IS, an organization needs to analyse both the interests that shape those attitudes, and assess the power of the stakeholders to affect the outcome (Boonstra et al., 2008). This study will provide new insights into how organizations in the public healthcare industry deal with the power and interests of stakeholders, and how this may affect the usage of the IS. The way the IS is ultimately used is also affected by the power and interests of the stakeholders involved. Therefore, the following research question will be investigated for this research:

How do the power and interests of stakeholders influence the implementation process of an information system?

The research question is exploratory in nature and aims at identifying stakeholders’ power and interests. A qualitative case study is applied by looking at a single case.

1.1 Case Description

This research was conducted at GGD-Drenthe, which is based in Assen, the Netherlands. The GGD the community health service, is responsible for preventive health care throughout the Netherlands. All Dutch municipalities have the task to protect, control, and promote the health of their inhabitants and they aim at preventing health risks and advancing the health of all citizens. To carry out these tasks, the municipalities have a community health service. GGD-Drenthe carries out these tasks for all the municipalities that are part of the region of Drenthe.

(8)

8

Based on several requirements a list of potential vendors was created and eventually top management choose FileLinx to be the most suitable system. Next to these requirements, there is also another reason that FileLinx was chosen. GGD-Drenthe closely operates with the Veiligheidsregio Drenthe (VRD), a regional institution that focuses on safety in the region of Drenthe, and VRD also works with the system FileLinx. GGD-Drenthe previously tried to implement the information system but they failed. At the time of this research the organization was going through the second attempt of the implementation process of the information system. This second attempt is also known as phase 2, as it is the second time they are implementing the IS. In order to have a successful phase 2 GGD-Drenthe was looking for a suitable “lean” project methodology to use for the implementation. Scrum is a lean methodology that is widely used in software development. GGD-Drenthe chose this methodology to implement FileLinx. The organization chose to implement FileLinx based on four modules over the course of six months, each module taking eight weeks. These modules included financial management, post registration, materials management and document management. This research looked at the second module of phase 2: the post registration. Investigating stakeholders’ attitudes towards the information system, their interests, and power positions, gave insight in how stakeholders can have influence on the implementation process. Having these insights can help organizations, in the public healthcare sector, use the power and interest of stakeholders to have a successful implementation.

1.2 Structure of Research Paper

The structure of this paper is as follows, in the next section the literature related to the research theme is discussed. This is followed by a section that describes the research methodology which includes the research design, case context, data collection and data analysis. Thereafter, the results will be given and analysed. The paper concludes with a discussion and conclusion of the research findings, it addresses some implications for those implementing IS in a public healthcare organization, and it gives implications for future research.

2. THEORETICAL FRAMEWORK

In order to gain an understanding of how literature, regarding power and interests of stakeholders in IS implementation is developed, a review of literature is needed. This literature review will define the following constructs: the implementation process of an IS, identification of stakeholders and the power and interests of stakeholders.

2.1 Implementation Process of an IS

(9)

9

IS implementation. The introduction of an IS into an organization is generally accompanied by changes to organizational form and function (Volkoff et al., 2007). IS implementations in some firms are successful; however, there are also many circumstances where the implementation was not successful (Dezdar & Ainin, 2011). Many fail due to weak implementation, problems related to stakeholder involvement, technical issues, or because the system did not meet business-specific needs (Legris & Collerette, 2006). The implementation of IS in the healthcare industry is even more challenging compared to other IS implementations because of the complexity of medical data, data entry problems, security and confidentiality concerns, and a general lack of awareness of the benefits of IS. Boonstra and Govers (2009) add three reasons of differentiation of healthcare compared to other industries, which might influence IS implementations as well. Healthcare has several objectives (curing and caring for patients, and educating new doctors and nurses), different processes than many other industries (more complicated and highly varied (Arrow, 1963)), and a diverse workforce (various professionals with their own expertise, power and autonomy(Johnson, 1972; Scott, 1982; Mintzberg, 1983; Raelin, 1991; Yi et al., 2006)).

Orlikowski (1992) proposed that the results of IT investments are dependent on the interactions between technology and people over an extended period of time (Boonstra & Govers, 2009). Information systems are both a product of human action and an influence of human action. According to Orlikowski, people initiate, design and use an IT system. Designers construct the system according priorities and expectations. Then, various stakeholders, such as users and managers, react in different ways, such as welcoming, rejecting, or adapting to it. In doing so, they socially construct the technology in the sense that these reactions may become features of the system (Boonstra, 2006). This continuing interaction means that the actual system implemented will be different than was originally expected (Boonstra & Govers, 2009). The integrationist model of Orlikowski (1992) suggests that people can modify technologies during design and also suggests that IT is not a fixed, given piece of technology. In this way stakeholders have many opportunities to influence to form of technology during the initial decision-making, the development, the implementation and the use of the system (Markus et al., 2000).

It is important to identify stakeholders when implementing an IS. Contributions from each stakeholder may vary in different stages in the course of the project due to unforeseeable and unpredictable events in the project (Assudani & Kloppenborg, 2010).

2.2 Identification of Stakeholders

(10)

10

literature (Scholl, 2004). Mitchell et al. (1997) further advanced the literature by proposing a theory of stakeholder salience. Stakeholder salience can be defined as “the degree to which managers give priority to competing stakeholder claims” (Mitchell et al., 1997: 854). This theory of stakeholder salience states that a stakeholder’s ability to command salience in a relationship is determined by the perceptions of three key attributes of stakeholders: power, legitimacy and urgency. Mitchell et al. (1997) define the concept of power as the extent to which a group can exert its coercive, utilitarian or normative means to force it’s will in a relationship.

Legitimacy is defined as “the general perception that the actions of an entity are desirable, proper or appropriate within some socially constructed system of norms, values, beliefs and definitions” (Mitchell et al., 1997). Urgency is focused on the time factor and refers to the extent to which a stakeholder claim calls for immediate attention; delay in attending to the claim is unacceptable to the stakeholder (Mitchell et al., 1997).

It is proposed that classes of stakeholders can be identified by their possession or attributed possession of the attributes power, legitimacy, and urgency (Mitchell et al., 1997). Based on these three attributes seven types of stakeholders can be identified namely, dormant, discretionary, demanding, dominant, dependent, dangerous and definitive stakeholders (Boonstra & Govers, 2009).

Dormant stakeholders have the power to influence, but this power remains unused for a certain period

of time. Discretionary stakeholders possess legitimacy, but do not have the power to influence the project. Demanding stakeholders have urgent claims, but lack the legitimacy or the power to materialize these claims. Dominant stakeholders are both powerful and legitimate. Their influence in the relationship is assured, since their power and legitimacy allows them to form the dominant coalition. Dependent stakeholders are characterized by a lack of power, despite having urgent and legitimate claims. These kinds of stakeholders depend on others to carry out their will. Dangerous

stakeholders possess urgency and power but no legitimacy, and may therefore be coercive or even

dangerous. Definitive stakeholders possess power, legitimacy and urgency (Boonstra & Govers, 2009).

2.3 Attitudes of Stakeholders

(11)

11

component is based on emotional experiences or preferences. People who have positive affect reactions to an experience with a product or service are more likely to evaluate an attitude object favourably than people who have negative affect reactions (Eagly and Chaiken, 1993). The last component, the behavioural component is based on the overt actions that people exhibit in relation to the attitude object (Eagly and Chaiken 1993; MacKenzie and Lutz 1989). Attitudes are based on past behaviour formed by direct or indirect experiences. Involvement can be seen as a core concept in explaining individuals participation in activities and their action with respect to the attitude object (Dimanche et al.,1993; Havitz & Dimanche 1999; Kim et al.,1997; Park 1996). According to Ajzen and Fishbein (1975), cognitive, affective, and behavioural components are often not empirically distinguishable and

and the three-component terminology is inappropriate in its implication that the three types of responses are generally distinct. They suggest that an unidimensional view of attitude is acceptable because all components (cognitive, affective, and behavioural) order individuals along an evaluative continuum 1975; Fishbein 1967). This research takes this approach on attitudes and defines them as

the overall evaluation of an object (Ajzen and Fishbein, 2000).

Stakeholder attitudes towards an IS implementation can change in response to the actions of others. When significant changes are made in an organization, the attitudes of each stakeholder should be understood and taken into consideration in the decision making process (Boonstra, 2006). Understanding stakeholder attitudes and interests, and the implementation process, enables organizations to manage a project in a way that increases their chances of a successful outcome (Boonstra et al., 2008).

2.4 Power and Interests of Stakeholders

In this paper, a power and interest perspective is adopted when assessing the influences of the stakeholders on the IS implementation. An IS implementation can disturb existing power positions and interests of stakeholders significantly (Boonstra & De Vries, 2005). As mentioned, the attitudes and behaviours of stakeholders regarding an IS implementation affects their interests and power positions (Boonstra & De Vries, 2012).

(12)

12

interests of a stakeholder relates to the perception that an IS highly contributes to the overall goals of the company (Boonstra & de Vries, 2005). Beside the fact that an IS can contribute to the overall goals of the company, it can also contribute to the individual interests of a stakeholder. For example, when a stakeholder will really benefit from the IS, the stakeholder will have high interest, even though the IS is not contributing to the overall goals of the company.

In this study the definition of interest is adopted from Boonstra & De Vries (2012) and adjusted to IS. They define interest as perceived interest, indicating that a stakeholder believes they will benefit from using the IS, and that it will outweigh the costs. For this study it is not relevant whether this perception can be realized or not. In literature, many authors (e.g., Bendoly, Soni, & Venkataramanan, 2004; Coltman et al., 2001) state that the perceived interests can constitute several elements and it is often based on economic and/or strategic objectives (Boonstra & de Vries, 2005). Stakeholers interests are formulated through a number of expectatios, i.e. beliefs and desires concerning how the IS will serve their interests (Boonstra, 2006; Lyytinen and Hirschheim, 1988).

An IS implementation does not solely depend on the interests of stakeholders but also on the power stakeholders possess. In practice, the attitude of stakeholders towards an IS and the implementation process of the IS depends on the power they possess to influence the implementation and usage of the system (de Vries, 2013). In this study we use a definition of power that is proposed by Boonstra & de Vries (2005). They define power as the capacity to exert the will over others in

order to realize certain intended benefits. Stakeholders may possess different sources of power that

they can use to make other stakeholders act in a certain way during the process of implementing an information system. According to Standifera & Wall (2003) a stakeholder who is powerful and has clear interest in an IS can apply its power to urge less powerful stakeholders to use the IS. For a stakeholder with high interest but a low level of power it might be hard to implement an IS if other stakeholders feel they do not have enough interest in the IS.

(13)

13

normative means, to impose its will in the organization. So, the model of Mitchell et al. (1997) uses three sources of power:

 Coercive power: The threat of negative consequences

 Utilitarian power: The use of material means for control purposes

 Normative power: The use of symbols for control purposes

Mitchell et al. (1997) state that access to these resources can be variable. So, power positions can change over time. These sources of power may exist independently or in combination. Stakeholders can use these sources of power to force others to implement an IS, to cooperate, and to use or not use the IS. Stakeholders use their sources of power to promote their own interests during the implementation process of an IS (Bingi, Sharma & Godla, 1999). The model of Mitchel et al. (1997) can be used to estimate the influences that stakeholders may have on the implementation process of the IS. A stakeholder has high priority when they possess the power to affect organizational activities, have a legitimate claim and has a high state of urgency. Stakeholder salience theory can be conducted to describe, analyse or interpret behaviour of stakeholders in relation to the implementation. Information systems are not simply technical systems but sociotechnical systems and their design, implementation and use involve dynamic social and political processes in articulating interests, building alliances and struggling over outcomes.

3. METHODOLOGY

(14)

14

3.1 Case Context

This research was conducted from February 2014 to October 2014 and executed at GGD-Drenthe. At this organization an implementation of a new information system took place, the system FileLinx. The implementation was focused on four main modules; financial management, post registration, information management, and relation management. These modules were dealt with one by one, beginning with financial management and ending with relation management. This research looked at one module of the implementation; the post registration. Due to time issues, this module was the only module that the researcher could investigate from beginning to end, therefore this module was chosen. It was very important that the researcher was able to investigate the module from beginning to end, this in order to have a complete picture of the whole process. Having a complete picture of the attitudes of the stakeholders, their power and interests, is necessary in order to see what the influence was on the implementation process. It also gave the researcher the opportunity to investigate if stakeholders’ power and interests changed during the implementation.

3.2 Data Collection

To gather information this research made use of in-depth interviews. These interviews started with open-ended questions about the new IS, followed by more specific questions that identified the attitudes towards the IS, and assessed their power and interests in relation to the implementation. The interview questions were based on literature which can be found in the theoretical framework of this research. The interviews took place between June and September 2014, and approximately lasted one hour. The case-study approach relies on theoretical sampling rather than statistical sampling. Because the goal of theoretical sampling is to extend emergent theory, it is preferable to select cases of extreme situations in which the process of interest in transparently observable, instead of randomly chosen cases (Pettigrew, 1988). This research chose the implementation process of an information system as an extreme case. Interviewees were selected based on the grounded theory approach of theoretical sampling (Strauss, 1987; Corbin and Strauss, 2008), along various dimensions such as disciplines, role in the process, and rank in the organization. Creswell (2007) suggests that an investigator should ‘select a sample of individuals to study based on their contribution to the development of theory (p.240). Data arising from interviews conducted earlier in the research process guided the decision for new interviewees later in the research process. In total five stakeholders groups were identified; top management team, implementers, project group, feedback group, and employees. It is important to mention that the feedback group members used to be part of the project group before this research was conducted.

(15)

15

function within the implementation. An overview of the interviewees is shown in Table 1. As depicted in the table, the interviewees were named and numbered in an anonymous manner.

Table 1: Overview of interviewees

Stakeholder Number Names Function

Top Management Team 2 TMT1; TMT2 Principal of the

implementation and are responsible for the organization

Implementers 2 IM1; IM2 Implement IS, purely the

system

Project group 4 PG1; PG2; PG3; PG4 Advising role, use own experience and

knowledge to contribute to the implementation

Feedback group 4 FG1; FG2; FG3; FG4 Give feedback on the proposals of project group and implementers.

Employees 4 E1; E2; E3; E4 Use the IS

(16)

16 Table 2: Additional data being used in the research

Form of data Source

Minutes of meetings Secretary

Email Implementers

Flow charts Implementers

Written reports Implementers

The researcher sought for internal validity by looking for patterns, dominant themes and explanations in the data and tried to avoid bias by asking respondents to comment on the interpretation. The researcher sought for external validity by interviewing multiple people from each stakeholder group.

3.3 Data Analysis

(17)

17

4. RESULTS

With respect to the implementation process of the IS, several stakeholders played a role during the implementation process. Five stakeholder groups were identified as key players: the top management team, the implementers, the project group, the feedback group, and the employees. The roles of the stakeholders during the process of implementing the information system differed. In this chapter the attitudes of the stakeholders towards the IS and the implementation process and their interests and power positions in relation to the implementation process will be described.

4.1 Attitudes towards the Information System

4.1.1 Top Management Team

Top management is content with the decision to purchase the new information system. They wanted a system that can be adapted to the operational processes of the organization. Also, the fact that the VRD works with the same system was very helpful for making the decision for FileLinx. The VRD benefits from the system and top management believes that the GGD-Drenthe will also benefit from it. GGD-Drenthe want to be a professional health care organization in which all departments handle their incoming and outgoing post the same way. They are convinced that having the IS will provide them with a lot of information about the post registration process and that the system will increase efficiency and saves a lot of time. TMT 1 stated: “It is important to have one system in which we deal with all the post registration processes. This will provide insight in all the processes”. TMT 2 noted that “It will help us to optimize our processes and it will save our employees, and especially our secretaries, a lot of time”. Drenthe strives to be innovative and to set an example for all GGD-organizations throughout the Netherlands. TMT2 noted: “We are one of the firsts to implement a system like this. We are an example for other GGD in the Netherlands and in this way we can improve our services on a national basis’’.

4.1.2 Implementers

(18)

18 4.1.3 Project Group

The members of the project group look at the IS as it is a helpful and professional system when implemented and working correctly. Having all the addresses, from all the relations, from all the departments in one system will save the organization a lot of time and allows employees to work more efficiently. PG 3 noted: “I do see why top management wants to implement this system. It is helpful and it will work. There are so many possibilities”. PG 4 stated: “It is essential for an organization such as GGD-Drenthe to have a professional system which is accessible for all the employees within the organization”. Having the IS will support their work practices, save them time and will reduce the administrative workload. PG 5 stated: “I expect that I do not need to do so many administration anymore. Also when writing letters I only have to push a few buttons and all the addresses will insert immediately. It will save me a lot of time”.

4.1.4 Feedback Group

Among the members of the feedback group there are different attitudes towards the IS. There are those who view the system as something that is not necessary. FG1 noted: “I have almost reached retirement and if a need to work with it I will but I will not invest much time in it.” And there are those who view the IS as something negative and as a step backwards opposed to their old system. FG 3 stated: “I will not work with FileLinx until it has the quality of my old system. I reward my old system with a 9, I will use FileLinx when it at least had a 7”. They are not willing to give up on their old system, and first want to see that the system is working correctly. Besides that they do not know how to work with the IS. FG1 stated: “I do not know how it works, I think it is not working properly. I cannot find any documents”. Not all technical features of the system were working correctly.

4.1.5 Employees

Employees have a negative attitude towards the IS. E3 noted that: “Because of the previous attempt to implement the IS people are not really positive towards the IS. We just wait and see and until it is fully implemented we just keep working the way we do now’’. Employees do not understand why the IS is necessary and think they can still execute their work with their old system. E3 stated: “I would like to hear more about the reasons. Why do we need a new system? I have no idea, my old system works perfectly fine”. The IS has a bad reputation and is at disadvantage due to the previous attempt. Expectations are very high and employees first want to see a properly working IS before they will end working with their old systems and fully adopt the new IS. E2 stated: “I am a little cautious towards the IS. They wanted to implement the system last year and that did not work out. I just wait and see, for now I do not need it”.

(19)

19

E1 stated: “I do not really have a choice, I may not like it but it is going to happen there is nothing I can do about it. I just have to deal with it and accept it”. Employees do not have the knowledge to work with the system and therefore are not able to work with it. This caused frustration and a negative attitude. E1 stated: “People do not know how to work with it and just stop trying. They blame the system for not working correctly while actually they do not know how to work with the system. And then they just talk badly about the system and do not want to work with it, I have experienced it myself. I do not know how the system works, so I do not work with it”.

4.2 Attitudes towards the Implementation Process

During the previous implementation top management underestimated the amount of time such project takes, mainly due to the time issues that attempt was not a success. They wanted to implement the whole system in four months, instead of taking time for each module separately. Top management learned from this experience and therefore takes more time for the implementation this time. Next to the bad planning, the implementer of the previous attempt was not so knowledgeable as the current ones. According to top management the implementers are suitable to implement the system due to their knowledge and previous experiences with other implementations. TMT 1 stated: “They both have a lot of knowledge about the system and have experience with previous projects. These projects turned out to be successful so I think this will be successful as well. They know everything about the system”. Top management gave the implementers the assignment to implement the IS and make it a working system, and need to adjust the IS to the processes of the post registration.

Having a project group is essential for the implementation, because project members possess knowledge about the current post registration processes and can use their work experiences to add value to the implementation process. Next to this they represent the other employees throughout the organization who do not take part in the project group. This representation ensures that a wide range of employees are taken into account. TMT 1 stated: “The project group consists of employees from different departments who work a lot with post registration. They have a lot of knowledge about the post registration processes and know what needs to be included in the IS”. Next to the project group there is also a feedback group, a small group of employees, also from different departments throughout the organization.

(20)

20

Final decisions about the implementation of the IS are made by top management, they have the final say. The decisions they make are based upon proposals which are presented by one of the implementers. The implementers make these proposals together with the project team. TMT 1 noted: “We have the final say in making the decisions. We are the top management team and we want to be in control of what is happening”. Top management has given the implementers some power to make decisions in regard to the planning and shaping of the IS. They are allowed to make small decisions such as decisions about which buttons to push in the system when writing a letter. More content-related decisions need to be approved by top management.

Top management views communication as an important aspect in relation to the implementation of the IS. Employees need to be informed about what is happening. Although top management acknowledges that communication is important they do not undertake any action to communicate with the employees. This is the tasks of those who actually implement the IS; the implementers and the project group. They need to consult this with the department of communication. Top management does not see this as a task they need to decide on, so they leave this up to the project group, the implementers and the department of communication. TMT 2 stated: “Communication is something that is part of the project and belongs to the project or to the communication department. That is part of their job.”

There are negative attitudes towards the information system. Top management blames this on the previous attempt. TMT 2 stated: ‘’Employees do have some negative attitudes towards FileLinx, but this has to do with the previous implementation”. Top management believes that when the system is implemented employees will see the benefits of the system, and they will no longer have these negative attitudes. Employees need to accept that the information system will be implemented which means that everybody needs to work with it and that there is nothing people can do to stop it. TMT 1 noted: “They just need to accept it. It is known for a long time that we will have a new system and that they need to work with it. I am sure that when it is implemented employees will see how useful and helpful it is they will work with it. FileLinx is coming and that is it, they just need to deal with it”. According to top management the implementation process is going smoothly and they have trust in a successful result.

(21)

21

and proposals in relation to the IS, they play a more involved and active role. It was not realizable to meet up every day and give the project group more responsibilities. The implementers believed that the members of the project group did not possess the knowledge to do this. Also they did not want to involve project members too much. This happened at the previous module financial management and caused long discussions which leaded to nothing. They did value the input that the project members gave and they felt that they gave everybody the opportunity to express themselves. They took all their inputs into account when making decisions and in order to have smooth project meeting they gave the project group some options to choose from. In the end the implementers had the final say in making the decisions and proposals.

The implementers were aware that there are negative attitudes toward the implementation process, they have heard this from the stakeholder groups. They hoped that when the system would be implemented these attitudes would be reduced and transformed into positive ones. They find it difficult to handle this because they do not know if it is their task to handle this. The boundaries of the project are not clearly set by top management and there is lack of clarity about what is, and what is not included in the project. The implementers try to come across as accessible and easy to talk to, this in order to prevent that employees are afraid to ask questions or approach them for other reasons in relation to the implementation. They really try to promote the IS throughout the organization. The implementers also came up with walk-in-hours. These hours are open for all the employees of GGD-Drenthe, and the purpose of these walk-in-hours was to give employees the opportunity to ask anything about the IS.

There is a lack of clarity about who is responsible for the communication about the implementation process. This is not clearly defined to the implementers by top management. The implementers view this as a task of top management, or at least top management needs to give implementers the task to communicate. The department of communication is in charge of all the communications of GGD-Drenthe, also the internal communication. Therefore, it is difficult for the implementers to communicate throughout the organization. According to the implementers the department of communication performs very poorly and does not support the implementation the way they implementers would want to. For example, placing a message on the intranet takes a lot of time and implementers are not always satisfied with the content of these messages. Implementers mentioned this to top management and also explained that there needed to be more communication towards the employees, but no actions were undertaken in order to communicate more.

(22)

22

simplistic and did not go very deep in to the proposals content wise. At the beginning of the post registration module the implementers presented their proposals in more detail. This resulted in a lot of discussions that eventually lead to the disapproval of the proposals, while according to implementers the proposals were the best options. Top management did not notice the difference in formulation of the proposals and approved them. This prevented to start over with the decision making process which could delay the implementation process.

Members of the feedback group used to be part of the project group during the module of financial management, but are now turned into the feedback group, due to the fact that these employees did not know much about the processes that needed to be described in the IS. This led to discussions about other issues that were not part of the project , which was not constructive for the process. After an evaluation of the module financial management, the implementers suggested to form a feedback group, to keep them involved. This new setting worked better, because they could still give their opinions and discussions have diminished. This was more productive for the implementation process.

4.2.3 Project Group

Members of the project group had a good feeling about the implementation process and about the scrum method. They had the feeling that top management was taking the implementation of the IS seriously this time. They did not experience those feelings during the previous attempt to implement the IS. Being part of the project group made these employees more enthusiastic about the IS, and has made them see the benefits of the IS. During the project meetings the implementers told a lot about the system. According to the project team, this contributed to understanding the necessity of the IS

Due to the fact that all project members are secretaries, they have a lot to do with the post-registration process. Although there are departments that solely work with patient-related data, that needs to be archived in a relevant certified system; FileLinx is not a certified system and therefore is not suitable for this kind of data. There is a lack of understanding about who will be an end user of the IS, and who will work with it. There has not been communication about who the actual end users are of the IS. The project group has discussed this with the implementers, but for implementers it is also not clear. Project members claim they are not the only employees for whom this is unclear and that throughout the whole organization there is a lack of clarity among employees about this issue.

(23)

23

participated in those training sessions. What they have learned during these sessions has been lost due to the fact that these sessions were too long ago. For the project members, this is not so much the case. Because they are part of the project group they have learned a lot about the IS and know how to work with it. They want to share what they have learned with their colleagues and they do their best to help them with working with the IS.

The project team gave their input during meetings to contribute to the implementation. They came up with ideas on how to structure the post registration process and were an example for their co-workers. They tried to promote the IS in the organization by talking about the IS in a positive manner and by explaining other employees how the IS works. Some project members find it hard to contribute to the project meetings due to the technical content of these meetings. PG 3 stated: “I do not understand much of all that technical stuff. Especially those schemes. Sometimes I am at a meeting wondering why I am there because there is nothing I can say about it”. An example of this are the flowcharts that are discussed during meetings. Most project members do not know why they are part of the project group, and sometimes feel they cannot add much value. This due to the fact that they do not work with the IS or that they only work with patient-related data. They do their best to add as much value as possible but sometimes they feel out of place. Being a project member is also very time consuming and there is no extra time available, which means they have to do the project activities next to their regular work. This results in not spending the amount of time they would like to on the project, simply because they do not have the time. The project members feel they are of importance in the implementation process and do their best to ensure a successful implementation. They feel involved in the implementation process and think that they can influence the decisions that are being made. During the project meeting they feel free to express whatever they are thinking and feeling, and are able to voice opinions, ideas, and thoughts. Project member felt there contributions were taken into account by the implementers when they make decisions. Decisions are made collectively and everybody has a say in these.

(24)

24 4.2.4 Feedback Group

During the implementation of the module financial management these members used to be part of the project group, and are now turned into the feedback group. It was unclear for them what their role was in the project group and felt they could not add much value. Also the implementers felt they could not add much value. Their task now is to look at the decisions that are being made and give their professional opinion about those decisions. However, not all members have something to do with the IS and therefore have a more neutral attitude. FG2 stated: “I never receive any post or packages. I also do not work with the old system. The post registration process is not part of my work activities”. They all had never heard of the scrum method before and feel that this method is chosen because it is trendy nowadays to use this. This method is not correctly used, only some parts of it.

Feedback group members are not willing to work with the IS until it meets to their expectations. They feel the IS is forced upon them, and upon the whole organization, by top management. They are surprised that it took this long to actually implement the system. The organization already invested a lot of time during the previous attempt and it is still not clear how the IS should be designed. FG1 noted: I was surprised that they still need to decide on so many levels. You would think that they had already thought about this kind of stuff.” This refers to the fact that there still were issues that top management needed to decide on. FG1 noted: “They still do not know what actually is included in the term post. Is that also email? I am very surprised that they still need to figure this kind of stuff out”. The feedback group members lack knowledge and expertise with and understanding of the system. They do not know how to work with the IS and did not receive training. FG2 stated: “ I do not know how to search for documents or addresses. Whenever I want to send a letter I try to find the addresses in FileLinx but I can never find them. Also some functions in the system do not work. I cannot understand how top management can think that we are able to work with this system. The members still work with their old system, which may also have been caused by the lack of clarity about who the end users of the system are. They would like to know which departments intend and which do not intend to use the system. There are a lot of employees who never receive or send post, these employees are not involved in the current post registration process and probably will not be in the new IS, but this is unclear. Knowing who the end user is, is very important because the strategy for the implementation will be based on this. FG3 stated: “It is unclear who the end user is in this implementation. It seems to me that this is important to know because implementing a system for the whole organization as end user seems different than doing this for only half of it.” Not knowing who is the end user, and who will eventually work with the IS, causes uncertainty. There is also a lack of clarity about who is accountable for administrating the post registration in the IS. During meetings it did not became clear who will monitor these new processes.

(25)

25

The feedback members feel they are not listened to in the implementation process. They do give their feedback during the meetings but have the feeling that that is not taken into account during the decision making. During the meetings, there was not a lot of room for suggestions and members did not feel that they were taken seriously. FG 3 stated: “Yes, they hear you, but they do not really listen to what you are saying”. The feedback group is not much involved in the implementation process. The decision making takes place during the project group meetings and top management meetings. There is no transparency of what is being discussed and decided on. At the beginning of the implementation process these members were part of the project group. The change from being project group to being a feedback group decreased their empowerment. When they were part of the project group they were able to take part in the decision process and now there are not. This decrease of empowerment has caused that feedback group members felt let down. They were of no real use and the feedback group was more for form than for content. Next to this, the meetings had a very specific content and were more related to the technical issues. The members did not have the knowledge to contribute to these discussions and wanted to talk more about other issues, such as communication and involvement. FG 3 stated: “We do not speak the same language. I do not speak in terms of technology and I do not know much about it. But I do know much about the reputation of the IS and that there is a need for communication in the organization”.

FG2 stated: “I never receive any post or packages. I also do not work with the old system. The post registration process is not part of my work activities”. They do not resist the IS, nor is it necessary for them to have a new IS. The feedback group members have the same view about the lack of clarity about who the end users are. The uncertainty about who will work with the IS prevents them from being really invested in the system. If they do get invested and it turns out that they do not have to work with it, their efforts will be wasted. They would like to have more communication, not only directed to them, but throughout the whole organization. They lack knowledge and expertise with and understanding of the system. This affected the way the system was being used.

4.3.5 Employees

Due to the fact that there is a more professional approach with the scrum method, the employees think this implementation will go better than the previous attempt. E2 noted: “There is a different approach and there are real implementers this time around. They have the knowledge and experience to do this”. They believe the project team and the implementers invested a lot of time to implement the IS. The employees have the feeling that the current approach is working and that top management understands that time needs to be invested in it in order to achieve a successful implementation.

(26)

26

the communication was minimal and employees were mainly informed via the intranet. Every employee has access to the intranet and can login at their workplace, and at their computer at home. However, these messages are hard to find on the intranet and disappear when new messages are posted. The employees really need to search for the messages in the archive, but do not have the time or interests to do this. E2 noted: “I have a lot to do every day and I do not have the time to look these messages up in the archive on intranet. I just do not read them.” Employees would like to be more informed and would like to know what the implementation means for their own functions and work processes. They feel insecure about their work practices and are afraid that the new system will give them a higher administrative workload or negatively affect them in a different way.

There is a lack of clarity about what exactly will change and to whom this will be of most interest. GGD-Drenthe consists of different departments, each working with their own system for post registration. E3 stated: “The only thing we know is that there is a new system coming, we do not know how it works and we do not know who needs to work with it. I know they are busy with the post registration but I do not know to what extent that applies to me and my own work.” The employees lack knowledge and expertise with and understanding of the system E4 stated: “ I do not know how the system works, I just work with it in a way I think is suitable. Actually I do not work with it at all, the system has many flaws and does not work properly. I still work with my old system. As a consequence, employees’ attitudes and reactions became negative, and some employees developed resistance towards the IS. Some employees are responsible for the post registration process for their department. It is not yet clear who will be responsible for FileLinx but it is clear that this will change for the employees. Most likely this responsibility will be transferred to the secretaries of each department. E2 stated: “I am in control of our system, I update it every week and when someone needs something I will take care of it. FileLinx will not be in my control anymore. I do not know who will be but I know it is not me”. This change in their work caused some resistance and uncertainty among employees.

(27)

27

All employees are convinced there is a high need for more communication and information. E3 stated: “I would like to have a meeting with my department. I would like to know what is going on.” Employees have the feeling that only people directly involved with the implementation of the system know what is happening. E2 noted: “I do not know much about the implementation. The only people that do, are those directly involved. My own manager never mentioned anything about it to me while I believe this new system also affects me.” Some employees indicated that they are not the only ones who resist the IS and the implementation of the IS. They do not want to work with it and are disappointed in top management about the course of the implementation.

4.3 Interests of Stakeholders

Implementing the IS will reduce costs and improve efficiency. The post will be archived correctly and this will ensure that no data will be lost. It will be more professional when the whole GGD-Drenthe uses the same format for incoming and outgoing post. Using the IS makes GGD-Drenthe one of the firsts GGDs in the Netherlands that uses such a system. GGD can serve as an example and educate other GGDs about the IS. Top management was convinced that one integrated system for post registration would provide them with the required management information and control about the post registration process. They also felt that the new system would help make GGD-Drenthe more transparent and integrated. Therefore, the management team had a high interest in a successful and efficient implementation.

The implementers want to realize a working system and achieve the goals they stated in their project plan. This includes staying within their planning and budget. They want to implement the system smoothly and satisfy the top management team by using their knowledge of the system and previous experiences. IM 2 stated: “We just want to implement the system and stick to the project plan. Also, we want to satisfy the top management team because they gave us this task, the task to implement the system”. Therefore, implementers have a high interest in a successful implementation.

4.3.3 Project Group

(28)

28

addresses. Having a system that has all these addresses will save me a lot of time”. Project group members had a moderate to high interest in the IS.

4.3.4 Feedback Group

The feedback group members have a low interest in the IS. This may be due to various reasons: they only work with patient-related data; their work activities do not include post registration; or their work activities do include post registration but they want to keep working with their old system.

4.3.5 Employees

The employees have a low interest in the IS. E3 stated: “The system I currently use works fine for me, I do not need a different system”. When they look at their own work activities it is not yet clear if they will use the IS, because they work with patient-related data. For this stakeholder group, the reasons for having low interests are the same as those for the feedback group: they only work with patient-related data; their work activities do not include post registration; or, their work activities do include post registration but they want to keep working with theirold system.

4.4 Power Positions of Stakeholders

The model of Mitchell et al. (1997) will be used to show the power positions of the stakeholders (Figure 1). This model shows the what type of stakeholders the top management team, implementers, project group, feedback group, and employees were according to the model of Mitchell et al. (1997). Mitchell. et al (1997) identifies three sources of power; coercive power, utilitarian power, and normative power. Although there was some variability in some stakeholders groups’ interests, attitudes towards the IS and the IS implementation, their power positions, the level of consistency in perceptions within these stakeholder groups was relatively high.

(29)

29 4.4.1 Top management

Top management team was convinced that one integrated system for post registration would provide them with the required management information about and control over the post registration process. They also felt that the new system would help make the GGD-Drenthe more transparent and integrated, which was one of the strategic objectives. They wanted to have a well-working system, and to be a role model for other GGDs throughout the Netherlands. Top management had a high interest in the IS and in a successful implementation. They did have the power to approve or disapprove proposals from the implementers and started out as definitive stakeholders. Top management team has the highest position in the organization and has the final say in the decision making process. They have a lot of coercive power, due to the fact that they can force people to act as they wanted based upon their position in the organization. Only the threat of negative consequences should compliance not to be forthcoming. They gave the implementers the task to implement the IS. If implementers did not executed this according to top management wishes, they could potentially lose their jobs. Later on in the implementation process, they delegated some power to make more decisions to the implementers. The implementers were in the position to make most decisions, top management became a dominant stakeholders.

The implementers had a clear interest in a smooth implementation process that would stay within time limits and budget. Implementers have a lot of knowledge about the IS and have previous experience with implementing information systems. Implementers possess coercion power, only not to the same extent as the top management team does. They do have the legitimacy to make decisions and have a high position in the implementation process. They could use their power to threaten members to exclude them from the project group and feedback group. This could be a serious threat, but not as serious as those made by top management team. In the beginning, they lacked the power to make important decisions, because they needed the approval of the management team: they were therefore first characterised as dependent stakeholders. Later on in the implementation process, however, top management gave them more power to deal with certain issues, such as communication and resistance. Although, according to employees and the feedback group they did not address these issues enough. Also, the implementers developed their own way of having more power in the decision making process by changing the formulation of their proposals: they became definitive stakeholders.

4.4.3 Project group

(30)

30

the IS increased and they had a voice in the decision making process. However, they needed the implementers to carry out their will, and are therefore characterized as dependent stakeholders.

4.4.4 Feedback group

The feedback group does not perceive themselves as a powerful stakeholder. They used to have more power when they were part of the project group, due to their changing role in the implementation process their power decreased. As a feedback group they were no longer involved in the decision making process. They feel the IS if forced upon them by top management by use of coercive power. They experience resistance to the IS, and their interests were limited by the fact that top management and the implementers did not pay sufficient attention to their needs. During the implementation process, they played a more background role. They did have urgent, legitimate claims, but depended on others to carry out their will, therefore the feedback group be characterised as a dependent stakeholders.

4.4.5 Employees

Employees do not feel involved in the implementation process and the decision making process. They feel the IS if forced upon them by top management by use of coercive power. They experience resistance to the IS, and their interests were limited by the fact that top management and the implementers did not pay sufficient attention to their needs. During the implementation process, they played a more background role. They did have urgent, legitimate claims, but depended on others to carry out their will, therefore the feedback group be characterised as a dependent stakeholders.

4.5 Interactions Between Stakeholders

At the beginning of the implementation process, the meetings with the top management were very time consuming and did not have clear results. The proposals suggested by the implementers were disapproved, and top management did not present alternatives. According to the implementers, this was due to the fact top management did not possess enough knowledge about the IS. The disapproval of the proposals caused delay in the implementation process, due to the fact that the implementers had to make new proposals. In order to prevent this from happening again, the implementers changed the form of their proposals and the way they presented them. Doing this, top management still had the idea that they made the decisions while, actually, the implementers had more power in the decision making.

(31)

31

was responsible for the communication. During project meetings, the project members gave their opinion about the IS in order to improve it. They were unhappy with the format of a letter. Based on their work experiences they knew this format would not be used. They informed the implementer of this, who reacted to this and changed the format. Also, the project group members wanted to send a letter to multiple contacts from different departments at the same time, and insert the addresses all together. This would be time consuming. The implementers agreed that this would be a better solution and changed this in the IS. Further, they gave the project members the task to insert all the addresses of theirold systems into the IS. However, the project members did not know how to do this, due to the lack of knowledge of the system. Eventually, the implementers started to collect the addresses from all the departments themselves and inserted these into the system. During meetings, the implementers wanted to discuss the processes and how these should be put into flowcharts. This was a difficult task for project members because they did not understood the flowcharts correctly and did not have previous experience with transforming processes into a flowchart. As a response to this, the implementers decided to do this themselves and to only show the final flowcharts instead of making these together with the project group.

Members of the project group had difficulties with working with the system because they lost knowledge of the system. They had had training sessions during the previous attempt to implement a new IS, but they lost this knowledge due to the long time period. They expressed this to the implementers and as a response they were enabled to follow a new training session to regain the knowledge. When project group members still experienced problems with the system, they went to see the implementers outside the project meetings to ask for help. The implementers were willing to help the project group members when they had questions. This contributed to the positive attitude towards of project group members the IS. By knowing how it worked, they became more enthusiastic and tried to convince employees to also work with the IS. Members of the project group noticed that their colleagues had difficulties with working with the IS. Whenever they saw this, they acted upon this by explaining how the IS works. However, they lacked the power to actually make them work with the IS, and employees refused this. Employees and feedback members also expressed that they lacked knowledge about the IS. The implementers did not respond to this, resulting in the situation that these stakeholders kept lacking knowledge.