Patel I & Gillies AC (2009) Between a national programme and a local hard place - a mental health case study in soft systems

The UK NHS National Programme for IT has been criticized for a lack of clinical engagement. This paper uses a soft systems methodology (SSM) analysis of a case study from the use of electronic systems within a National Health Service (NHS) Mental Health Trust in the United Kingdom (UK) to explore the legal and ethical implications of the failure to develop clinical systems which are fit for purpose.

Soft systems methodology (SSM) was used as a theoretical model both to derive deeper insights into the survey data and suggest how communication between those producing information and those using it, could be improved. Multiple methods were employed which included a postal survey and participant interviews to triangulate the data.

The use of SSM reinforced the concept that the national IT programme is based on a ‘hard' systems view and does not take local factors (which are related to ‘soft systems' thinking) into account. The study found administrative staff to be a crucial link between clinicians and information departments and highlighted the need for a joint-up information strategy and integrated systems.

The article concludes with a discussion of the legal and ethical implications of the findings and the lessons for the broader UK national programme. It argues that the failure to deliver systems that are fit for purpose is not value neutral but an ethical issue.

Gillies, Alan C. and Patel, Inderjit (2009) "IT and the NHS: Investigating Different Perspectives of IT using Soft Systems Methodology," Studies in Ethics, Law, and Technology: Vol. 3 : Iss. 2, Article 10. DOI: 10.2202/1941-6008.1094 Available at: