Entangled Stakeholder Roles and Perceptions in Health Information Systems: A Longitudinal Study of the U.K. NHS N3 Network

The combination of pervasive and complex technology and an increasingly challenging healthcare environment is the setting for this research study. As a longitudinal case study, the research tracked the development and implementation of a large private information systems network in the U.K. National Health Service (NHS). Using stakeholder theory, we unpacked the story of a complex network of stakeholder roles and perceptions and how they changed over time. Our findings suggest that favorable and unfavorable positions held by multiple stakeholder groups become entangled and that even the same focal group may adopt competing positions that undermine the adoption of the health network. As this situation develops, the policy and implementation of the broader health IT program becomes confused and destabilized. This study makes three contributions. First, it expands the literature on stakeholder theory in the IS domain. Second, it extends the managerial focus of stakeholder approaches to include policymaking in the diverse multi-stakeholder setting of healthcare. Third, it demonstrates how IS research can employ stakeholder analysis by adopting a broader, dynamic approach to identify different stakeholder groups and by focusing on their varied roles and views during the course of a large-scale health IT program.