Benefits Realisation of Information Technology in the National Health Service: A Paradigmatic Review

The context for this research is the continued difficulties associated with realising benefits of IT in the NHS which, according to the National Audit Office (NAO), has failed to deliver two thirds of forecast benefits of a 10Bn pound national IT project. Benefits Realisation (BR) is an evaluation method used by NHS organisations to plan, deliver and measure benefits of IT. Developed as both a standalone enterprise and as a work package incorporated within Managing Successful Programmes (MSP) and Projects in Controlled Environments (PRINCE) BR is a recognised approach for informatics projects within the NHS. The concern is whether the existing approach to BR delivers meaningful benefits which adequately meet the needs of patients and staff. BR is identified in the academic literature as both a concept and a framework intended to ensure that an organisation realises the benefits it expects from an IT investment. The realisation of benefits matters to organisations and society because of the significant sums of money involved and because IT investments can often be central to an organisation's performance. It is therefore a relevant topic of study for both academics and practitioners. The focus and concerns of such studies range from positivist to more interpretive discussion with many prescribing practical methods for effective delivery of benefits from investment in IT. There is little evidence, however, that theory has translated into effective practice and insufficient attention given to the social and political aspects of the topic. In an effort to clarify alternative approaches this paper aims to stimulate reflection on how an inquiry of BR can be accomplished. Drawing attention to aspects of various paradigmatic approaches, the paper focuses on critical, interpretive and positivist and how these paradigms have contributed to research in the subject domain of BR. A plethora of studies exist within interpretive and positivist paradigms and the review emphasises the need for further development of the topic from a critical perspective. A critical orientation to the social and political aspects of benefits realisation and in particular the question of cui bono offers an alternative approach to provide more insight and ultimately progress theory and practice.