Review: The Alignment of Information Systems with Organisational Objectives and Strategies in Health Care


The article reviewed here is ‘The Alignment of Information Systems with Organisational Objectives and Strategies in Health Care’ by Bush and colleagues. In the conclusion in the abstract the researchers ‘confirm’ that alignment of IT is an important area in healthcare organisations and that

Finally, it contributes by suggesting future study of alignment’s predictors and effects in health care organi(s)ations

In the introduction, the researchers distinguish between strategic alignment of information systems and short term developments which are responses to new technology and use in other services amongst other reasons. They identify clear research questions such as the process by which healthcare services choose their information systems as well as barriers and incentives for managerial uptake of IT. They then cite evidence which supports their central argument for the importance of alignment of strategy and IT and examples of failure of IT systems when there is no clear alignment.

The researchers then describe the methodology for their study. They have identified ’20 healthcare organi(s)ations in a mid-western US city’. There weren’t explicitly stated inclusion criteria for the selected organisations and the researchers note that they chose a heterogenous group of organisations to represent variation in healthcare services. A structured interview was used but I thought the methodology for analysis of subject’s responses was not clear. The researchers identified people within the services who procured the IT systems and approached them to participate in the study.

The organisations chosen included a mental health service, acute and chronic care (presumably general medical) settings and outpatient clinics. The data on employee numbers and information system details are included also. There are a large number of sections in the results section corresponding to the components of the interview. They identified a number of strategies within the organisations that were objectives for alignment with IT systems and these included patient safety, growth, technology focus and staff development. They then describe the results for methods that managers used to choose IT systems. These methods included formal evaluation, return on investment analysis and ‘board of directors approval’. They then described the interview results relating to factors which supported uptake of IT systems. The key actions for managers which contributed to uptake seemed to be site visits. With regards to organisational characteristics facilitating uptake subjects most commonly thought this to be the involvement of senior management. Managerial actions which perceived to hinder uptake included involving ‘stakeholders too little’, ineffective communication and the decision making process itself. The hindering characteristics of the organisation included a ‘lack of management support’, ‘lack of resources’ and ‘resistance to change’ amongst others. The researchers then propose a system for alignment which involves identifying the organisational strategy, envisioning the information system through to implementation.

The study produced some interesting results although I would have been interested to learn more about the methodology for the analysis of results. The results here are higher level and subsequent research can move in various directions from the use of a different sample set with other specificied qualitative methodologies through to the use of quantitative methodologies including large surveys and cost-benefit analyses of information technology uptake when services have been stratified according to the results of the study.


Bush M, Lederer A L, Li X, Palmisano J and Rao S. The Alignment of information systems with organisational objectives and strategies in health care. International Journal of Medical Informatics. 78. 446-456. 2009.


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The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.


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