IT, culture, context Emergency department modernisation can inform the NHS information programme.

Purpose — The purpose of this paper is to review the implementation of a service improvement in the UK National Health Service, relevant to the National Programme for IT in the N}IS. Design/methodology/approach — Case study and semi-structured interviews, relating users' interaction with information systems to other aspects of a service improvement programme. Findings — Information technology is a major plank of public sector service reform in general. Its impact will rely on the completeness of cultural reform and the transformation of a reactive information audience into one more proactive in seeking and making opportunities for beneficial change. Research limitations/implications — The research reported was conducted in a single setting, preliminary to an action research project The project's aim will be to engage NHS users in a critical appreciation of their information needs, and to contribute this appreciation to the evaluation and refinement of the National Programme for IT and its products. The advantage of a situated study stems from concrete perspective and the capture of detail. These elements are readily understood by the reader, who can then assess the level of relevance to his own situation. Practical implications — The intervention of a major information project ought to be synchronised in the host community with organisational development and the critical review of information needs. Originality/value — Inasmuch as the NHS can be said to epitomise the social complexity of other major public sector organisations, the paper will interest readers from outside and inside the NHS. The contribution of a recipient perspective will counterbalance the tendency to "technology push" detectable in the National Programme. [ABSTRACT FROM AUTHOR]