Ton Spil

Abstract – The combination of an agile or incremental approach with the implementation of Enterprise System (ES) is seen as a kind of catch 22. Vendors and implementers nevertheless lately tend to adhere to cyclical approaches with shortened implementation times. This way of working more and more approaches the incremental philosophy, but also influences the requirements on how the implementation process is managed in perspective of its ambitions. In this paper we explore ambition level and relate it to the used implementation approaches in five hospitals. Healthcare organizations are structured with a rather discrete separation between deterministic back office processes and the more flexible operational care processes. This differentiation makes the ambition level of an ES implementation of significant importance and offers opportunities for cyclical implementation approaches. The main question is whether the used implementation approaches align with the ambitions of the hospitals? To answer this question, a research model is build upon the MIT alignment model. From our model four hypotheses are derived and tested in five different cases. From the results we observe an increase in the use of cyclical approaches resulting in what we call macro dynamics at work in four out of the five hospitals studied. Macro dynamics means that the hospitals start drifting in either their ambition level, implementation approach or even both. Within the limitations of 5 cases we conclude that such a drift in most cases leads to implementation problems if not aligned within one implementation cycle. On the other hand persistence in ambition level and implementation approach results in a positive perception of the implementation project and its results