Workflow by the Back Door? Using XML Systems in Health Service Processes, and Changing the System

摘要

The UK's National Health Service (NHS) was founded 50 years ago and is now the largest employer in Europe. As with any enormous corporation, there will be procedural and administrative problems in enacting any type of organizational change, and the NHS, run partly by government, partly by managers and partly by clinicians, has been subject to most of them. In hospitals - traditionally a battleground between senior clinicians and the other two interest groups - there are signs of a new accommodation in at least one area; Electronic Patient Records (EPR). Partly through government sponsorship and partly through clinical need, new technology - particularly XML-based processes - is being used, and is beginning to have positive effects both on administrative and clinical processes. Unlike the UK finance industry, where large scale workflow systems have been implemented since the mid- 1980s, the UK public health services have noticeably not automated the kind of prescriptive, repetitive workflow processes that have become popular in both cost-reduction and customer-focused programmes in the finance industry. However, evidence is now emerging that EPR processes are evolving, and crossing traditional departmental and informal 'turfdom' barriers. In this way, these XML systems are moving beyond the commonly accepted view of XML as a content management tool, and are now positioned to become a kind of 'proto-workflow' system. As such, they are beginning to display a number of characteristics of 'industrial strength' workflow systems, in creating changes in processes, user behaviour and possibly in organizational culture. This study is based on interviews and surveys with clinicians and administrators, and seeks to understand the development of EPR under a new government initiative. It also uses previous research into NHS systems, and into workflow management systems in the UK finance industry. It looks particularly at those hospitals that are implementing XML based solutions, and at the changes that are beginning to unfold.