Utilizing a discourse-based understanding of organizational change to explore the introduction of national electronic health records in England

The authors utilized pragmatic discursive analysis to consider their empirical study of the introduction of an electronic patient record system within hospitals based in a large region of the National Health Service in England. Their aim was to gain insight into the interplay between discourse and change as mediated by technology by exploring how a politically driven programme of change was translated during the introduction of a computer system intended to provide an electronic patient record. They identified contrasting discourses, determined by situated professional practices and stakeholder expectations that framed alternate understandings of the proposed systems implementation and related change processes. Over time, these contrasting local discourses in turn became increasingly dissonant with the national change programme policy rhetoric as the systems software failed to deliver anticipated benefits. The authors' work emphasizes the mediating effect of technology in discourses of change. Limitations in systems functionality and a related lack of discourses of success slowed social momentum. Consequently, local and political articulations of change began to fragment. The authors suggest that understandings of change are experienced through different interpretive frameworks and mediated through the materiality of technology, highlighting the possibility of many and alternate meanings within any change process, and the considerable challenges in the development and implementation of information technology in healthcare.