Need for relevance in management information systems: what the NHS can learn from industry.
Authors: E Mumford
Journal: BMJ (1991)

BMJ 1991;302:1587-90 Information systems are no longer associated mainly with data processing; they are increasingly seen as a management tool and an aid to action.  means that the costs of failure are much greater, and these costs are incurred when expensive systems are not used or are inadequately used. Surveys have shown that in as many as half of systems there are large gaps between users' expectations and the system's performance.1 The increased cost of failure is leading to a rethink of approaches and strategies for the design of information systems. When computers first appeared in offices in the late '50s and '60s their costs and limitations meant that they were often introduced in an authoritarian manner: This is what we can provide and you must have  Then, as user resistance was encountered, strategies changed to a soft sell approach: This is what we can offer and it is just what you want. Overselling of poor systems led to user scepticism, and designers began to realise that they needed to talk to users before producing a product: We think we know what you want but we'd like to discuss this with you.  led to the practice of interviews with individual users, which is still popular. These interviews were often followed by the development of a simple prototype that the users could experiment with before the final product was created. The quasiparticipative approach is now increasingly used: We think we know what you want, but we'd like you to help us design the system to make sure we get it right.  usually requires users to spend time defining their information needs. It is an approach that pays off as a clear and correct specification of infor? mation needs has been found to be a critical factor for successful design of management information systems. A more progressive approach, which I favour, takes participation a stage further. Users are asked as a group to identify the problem that they would like a computerised system to tackle; to specify their infor? mation needs; to set objectives for the new system; and to redesign departments and jobs so that the total system can work effectively and achieve the organisational mission.2 Much attention is rightly being focused on the design and implementation of computer based systems, and systems are often evaluated on the extent to which these two stages are successfully completed. But there is a third, equally important stage: the extent to which systems are successful once they are implemented. I will concentrate on this third stage and the reasons why many systems cease to be used in an effective way.  analysis has to be based on behavioural and organis? ational rather than technical or financial factors. An important reason for lack of use is that the information provided is not seen as important or relevant by the group that inputs or accesses it. A technical systems design group is often unwilling to accept this. The group has spent hundreds of hours designing and implementing the system and there is a great reluctance to accept that it is not providing what i required.3 At the design stage computers are usually viewed as machines that will reduce uncertainty by providing more accurate and timely data. It is both challenging and threatening when uncertainty is increased because there is a doubt that the users will