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PurposeThis paper seeks to report the findings from a seven‐year study on the UK National Health Service on the introduction of an electronic health record for 50 million citizens. It explores the relationship between policy and practice in the introduction of a large‐scale national ICT programme at an estimated value of £12.4bn.Design/methodology/approachUsing a longitudinal research method, data are collected on the policy‐practice nexus. The paper applies institutional theory using a conceptual model by Tolbert and Zucker on the component processes of institutionalisation.FindingsThe findings suggest that institutional forces act as a driver and an inhibitor to introducing enabling technologies in the health‐care environment. A process analysis shows that, as electronic health records force disruptive change on clinicians, healthcare managers and patients, culturally embedded norms, values and behavioural patterns serve to impede the implementation process.Research limitations/implicationsThis research is limited in its generalisability to national, regional and local ICT implementations due to the complexity of the policy and practical issues at stake. Despite the longitudinal research approach, the use of institutional theory can only offer a flavour of how institutionalised values, norms and behaviours influence health IT policy and practice.Practical implicationsThe paper demonstrates the complexity of translating centralised ICT policy in healthcare to practical solutions for clinicians and other stakeholders. It shows how a large‐scale ICT programme based on procurement of technology is unlikely to succeed where important issues of user engagement and a sound “business case” have not been achieved.Originality/valueThis research contributes to the theoretical literature on institutionalism by addressing the dichotomy between institutional and technical environments. While technology is often discussed in isolation of an institutional process, it may become embedded in organisational practices, reaching a process of sedimentation (institutionalisation) or fail to take hold and fade from view.

Purpose -This exploratory case study research aims to apply a processual analysis to the implementation of a customer relationship management (CRM) system from a knowledge management perspective to a contemporary (1999)(2000)(2001)(2002)(2003)(2004) situation within a UK city council. The paper seeks to place a specific focus on areas neglected in previous CRM studies -sub-cultures, psychological contracts, how tacit knowledge is surfaced and transferred, and with what effects on implementation. Design/methodology/approach -The paper investigates how the system stakeholders and the information system (IS) itself evolved through encountering barriers, sharing knowledge, finding new uses, inventing work-arounds. Findings -A rich picture emerges of sub-cultural silos of knowledge linked with psychological contracts and power-based relationships influencing and inhibiting adoption and acceptance of the CRM system. Originality/value -This case study research provides useful information on the implementation of a CRM system from a knowledge management perspective with a specific focus on sub-cultures, psychological contracts, how tacit knowledge is surfaced and transferred, and with what effects on implementation, which are areas neglected in previous CRM studies.

Aims: To determine the prevalence of diabetes mellitus and its possible causes and to assess its control in a high secure hospital. Methods: A cross sectional survey and a prospective cohort study were conducted. The cross sectional survey included 408 patients admitted under the Mental Health Act, and the prospective study included 22 patients with known diabetes followed up for 24 months. The outcome measures evaluated were drug treatment, status of microvascular and macrovascular complications, glycated haemoglobin, and body mass index. Results: In the cross sectional survey, 35 out of 408 patients (8.6%; 95% confidence interval 5.9% to 11.3%) had known diabetes, and all of these had type 2 diabetes. Obesity, cigarette smoking, schizophrenia, and antipsychotic drug use were frequent, and weight gain was common after hospital admission. Glycaemic control was variable, and, although a majority of patients were above recommended treatment targets, control remained stable over the follow up period. Conclusions: Type 2 diabetes was common in this hospital. Both its prevalence and the suboptimal glycaemic control in some patients probably relate to sedentary life, dietary factors, smoking, and perhaps widespread use of antipsychotic drugs. However, regular multidisciplinary input enabled most patients to maintain relatively stable glycaemic control, with good control of blood pressure and lipids, at levels similar to those seen in community and hospital diabetic clinics. Further modification of lifestyle risk factors is probably needed to reduce the prevalence and impact of diabetes in this patient group.

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