'Access denied'? : barriers for staff accessing, using and sharing published information online within the National Health Service (NHS) in England : technology, risk, culture, policy and practice

The overall aim of the study was to investigate barriers to online professional information seeking, use and sharing occurring within the NHS in England, their possible effects (upon education, working practices, working lives and clinical and organisational effectiveness), and possible explanatory or causative factors. The investigation adopted a qualitative case study approach, using semi-structured interviews and documentary analysis as its methods, with three NHS Trusts of different types (acute - district general hospital, mental health / community, acute – teaching) as the nested sites of data collection. It aimed to be both exploratory and explanatory. A stratified sample of participants, including representatives of professions whose perspectives were deemed to be relevant, and clinicians with educational or staff development responsibilities, was recruited for each Trust. Three non-Trust specialists (the product manager of a secure web gateway vendor, an academic e-learning specialist, and the senior manager at NICE responsible for the NHS Evidence electronic content and web platform) were also interviewed. Policy documents, statistics, strategies, reports and quality accounts for the Trusts were obtained via public websites, from participants or via Freedom of Information requests. Thematic analysis following the approach of Braun and Clarke (2006) was adopted as the analytic method for both interviews and documents. The key themes of the results that emerged are presented: barriers to accessing and using information, education and training, professional cultures and norms, information governance and security, and communications policy. The findings are discussed under three main headings: power, culture, trust and risk in information security; use and regulation of Web 2.0 and social media, and the system of professions. It became evident that the roots of problems with access to and use of such information lay deep within the culture and organisational characteristics of the NHS and its use of IT. A possible model is presented to explain the interaction of the various technical and organisational factors that were identified as relevant. A number of policy recommendations are put forward to improve access to published information at Trust level, as well as recommendations for further research.