1684
Organisational Challenges of Implementing E-Business in the Public Services
Table 3. continued
No. Organisational challenges Steps taken to meet organisational
challenges
Data from NMA
6 Establish the right model of organisational
design for the organisation
- Design and implement the right
structure for an e-business starting from
NMA’s core business processes
- Focus on core organisational
competences: data collection, data
management, exploitation of new
technologies and partner/customer
management
“ The normal practice would be: you take the
external consultancy methodology cookbook and
you apply things from it and other projects that you
worked for, and you get a sense of the right way to
do things … but this organisation is different and
ZHZDQWHGWKHVWUXFWXUHWRUHÀHFWZKDWZHGRQRW
what consultants want us to do”.(Board member
responsible for the structural change, 2003)
“We did not want an off-the-shelf structure.
Consultants came with a whole series of structural
models, they came with the toolkit but didn’t know
KRZWR¿WLW´6WUDWHJLVW
“ Don’t expect everything to work without some
adjustment and don’t be afraid to review changes
at an early stage to keep the reorganisation on

track”. (Business Group Director, 2003)
7 Top management commitment and the
business case
- CEO with experience and personally
LGHQWL¿HGZLWKWKHHVWUDWHJ\SURMHFW
- Have a multi functional leadership
team i.e. from sales, marketing and IT
-Involve senior management from
sales and marketing in the strategy
implementation
“The fundamentals are you need to have a really
clear leader of the structure, somebody who has
a very clear vision about what the endgame looks
like” (Senior Manager, 2002)
“ Sales and Marketing senior management buy-
in was absolutely fundamental for the process
to work … There must be a vision, there must be
a strategy and there must be support behind it.
(Senior change manager, 2003)
8 Political resistance to change of
various stakeholders and managing
simultaneously their diverse
expectations
- Consistent communication allied to
the use of facilitated workshops
“ Consistency of message and purpose is one of the
most important success factors in making change
happen. Crystal-clear purpose, understood by all,
including ‘what it means for me’, should be made
explicit” (NMA Employee, 2002)

1685
Organisational Challenges of Implementing E-Business in the Public Services
Table 3. continued
No. Organisational challenges Steps taken to meet organisational
challenges
Data from NMA
9 External ‘customer acceptance’ barriers
and problems
- Communicate consistently with
end users, at the beginning to build
FRQ¿GHQFH DQG WKURXJKRXW WR
communicate progress and to get
feedback
- Use customer relationship management
WRUHEXLOGWKHFRQ¿GHQFHRIFXVWRPHUV
who are confused about who they are
actually buying products and services
from
“ The changes in our business processes - for
example, procurement, reporting and customer
relationship management, were so massive
that the smallest error could have potentially
serious consequences during business processes
switching, damaging customer relationships
and delivery channels for a lengthy period of
time. Communicating proposed changes to our
customers, users and clients was essential. They
demanded honest, consistent and up-to-date
information whether the news were good or bad.”
(.” (Business Improvement Manager, 2002)

“ It was important to ensure all the time our
customers, users and clients that we had a back-
up or disaster recovery plan should something go
wrong during the transition” (Sales and Marketing
Manager, 2002)
10 Aligning the objectives of the 21
projects with the overall objectives of
the e-business strategy and establishing
timelines in place
- People involved in the projects have
clear understanding of their roles and
responsibilities
- Good project management to avoid
GXSOLFDWLRQV DQG FRQÀLFWLQJ EXVLQHVV
objectives
“ … this great big machine called project planning
comes in and it takes up vast amounts of time and
systems space, because of all these critical paths
which chunter away. Actually this is too big right
now, and frightening people.” (Senior Manager,
2002)
11 Blending major change with major
continuity
- Integrate the e-commerce strategy
with the business strategy and with the
core operations from the start
“ We needed to be able to adapt to shifting
circumstances in market conditions and identify
potential changes in course sooner rather than
later …” (Senior Marketing manager, 2003)

1686
Organisational Challenges of Implementing E-Business in the Public Services
agement Team to clearly articulate the vision,
purpose, goals, and values for the organisation
and to communicate them clearly businesswide.
It also required pulling together the leadership,
communication, and engagement activity, whilst
ensuring that all existing projects, initiatives, and
everyday activities were aligned and integrated
with this. This high level strategic activity was
also about leveraging what was already in place
and, most importantly, maintain consistency
across cultural, behavioural, and leadership ap-
proaches.
Second, the case of Britain’s National Map-
ping Agency shows that, in practice, the transi-
tion from government monopoly to commercial
organisation whilst embracing e-business as a
corporate philosophy can be extremely challeng-
ing to achieve. Although e-business has enabled
NMA to tap new customers and new revenues and
opened up a space for importation of private sector
practices into NMA, the strong public interest for
its activities was still present. Yet the organisa-
tion was expected to operate commercially, cover
its costs, and build up reserves through its own
commercial style operations. That situated the
organisation in the intersection of two different
spheres—the public and the private. Becoming
an e-bu si ness , in t his c ontext, require d colla bor a-

tive working not only with commercial partners
but also with different parts of the government.
7KH ³LQEHWZHHQ´ VLWXDWLRQ WKXV WHVWHG WR WKH
full extent the capability of the organisation to
lead and manage change, especially in terms of
¿QGLQJWKHSHUIHFWEDODQFHEHWZHHQIXO¿OOLQJLWV
still strategic role as national agency and provid-
ing high-quality services to its customers in a
dynamic marketplace.
One of the senior managers interviewed de-
scribed this situation with the following words:
³:H>DVDQRUJDQLVDWLRQ@ZDQWWREHKDYHDVLIZH
were situated in the commercial business sec-
tor, but we cannot escape our origins” (Senior
Manager, 2004).
7KLUGWKHFDVH¿QGLQJVGHPRQVWUDWHWKDWVXF-
cessful organisational transformation involving e-
business implementation relies on changing some
fundamental business processes and attitudes.
Close cooperation between many different sets
of people—from middle managers to program-
mers, and from technical architects to system
users within the organisation—is needed. This
convergence of business process, creative, and
technical skills created in NMA a new dimension
for teamwork, which in turn shifted the culture
RIWKHRUJDQLVDWLRQIURP³NQRZOHGJHLVSRZHU´
WR ³VKDULQJ NQRZOHGJH LV SRZHU´ 7HFKQRORJ\
can be an important enabler but not a driver of
knowledge sharing.

Finally, one key challenge in NMA was how
to blend major change with major continuity.
In this respect, a major lesson learnt from this
organisation’s experience was that it is essential
to integrate the e-commerce strategy with the
business strategy and with the core operations
IURPWKHVWDUW7KLVHFKRHVWKH¿QGLQJVRI'XWWD
and Segev (1999) that successes result from close
partnerships between commercial and IT man-
agers, and that companies making e-commerce
central to their organisation do better than those
that make it an afterthought.
CONCLUSIONS
This article aimed to reveal the processes of
strategic and organisational transformation en-
gendered by e-business during the implementa-
tion of a complex structural and cultural change
programme aimed at reshaping a commercialised
public sector organisation and rethinking how it
provided value to its customers. The discussion
H[DPLQHGWKHGLOHPPDVDQGFRQVWUDLQWVLGHQWL¿HG
by managers in the interpretation of the e-busi-
ness strategy concept and why its implementa-
tion in practice could be challenging. Whilst
the Internet offers a technological solution, the
¿QGLQJVRIWKLVFDVHVWXG\VXJJHVWWKDWWKHVXF-
cessful implementation of a wider e-business
1687
Organisational Challenges of Implementing E-Business in the Public Services
strategy depends on managing simultaneously

a number of projects which cross organisational
boundaries and linking together organisational
and technological factors.
:KLOVWWKLVUHÀHFWLYHDFFRXQWPD\EHXQLTXH
it does, however, provide pointers to other large
organisations undertaking a similar e-transforma-
WLRQDQGUHÀHFWVRQWKHGHJUHHRIRUJDQLVDWLRQDO
transformation required by traditional organisa-
tions in meeting this imperative and successfully
making the change to e-business. In particular,
WKH¿QGLQJVLOOXVWUDWHWKDWDQHEXVLQHVVVWUDWHJ\
is not just about technology. It also embraces the
business challenges that result from managing
change in a fast moving environment, as well as the
important issues of people, organisation, culture,
communication, and how an organisation must
create a process for delivering innovation.
)XUWKHU HPSLULFDO¿HOGVWXGLHV LQ RWKHU VHW-
tings would enrich the concepts developed in
WKLVVWXG\DQGZRXOGSURGXFHDGH¿QLWLYHOLVWRI
best practices. The case highlights, however, the
complex nature of the notion of e-business in a
public sector context and shows that when imple-
mented successfully, it can transform entirely
these organisations and their capabilities.
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pp. 39-60, copyright 2006 by IGI Publishing (an imprint of IGI Global).
1690
Copyright © 2009, IGI Global, distributing in print or electronic forms without written permission of IGI Global is prohibited.
Chapter 5.19
From ASP to Web Services:
Identifying Key Performance Areas and
Indicators for Healthcare
Matthew W. Guah
Warwick University, UK
Wendy L. Currie

Warwick University, UK
ABSTRACT
Value creation from e-business for customers
in healthcare is an important topic in academic
and practitioner circles. This chapter reports the
¿QGLQJVIURPDWZR\HDUUHVHDUFKVWXG\ZKLFK
found that disappointing results from the much-
hyped application service provider (ASP) business
model is currently being replaced by perceived
new opportunities from Web services. Yet past
failings from ASP do not guarantee future suc-
cess with Web services models, particularly as
evidence shows that accruing value-added ben-
H¿WVIURPHEXVLQHVVLQLWLDWLYHVLVRIWHQIUDXJKW
ZLWKGLI¿FXOW\+HDOWKFDUHLVQRH[FHSWLRQDQGLV
likely to pose more problems given the complex-
ity of the organizational structures, processes,
procedures, and activities within this vertical
sector. This research study calls for a more
rigorous approach in identifying and evaluating
key performance areas and indicators from new
e-business initiatives involving emerging tech-
nologies and platforms such as Web services.
Yet the measures and metrics used for healthcare
may differ from those adopted in other sectors.
Healthcare professionals will therefore need to
GHYHORSFRQWH[WVSHFL¿FNH\SHUIRUPDQFHDUHDV
(KPAs) and KPIs, and caution against accepting
DW³IDFHYDOXH´WKHYDOXHSURSRVLWLRQGHYLVHGE\
Web service providers.

INTRODUCTION
The process of healthcare management modern-
ization is maturing in Europe, North America, and
in other developed countries. This has resulted
to an exponential increase in demand for rapid
business process execution, more accurate and
timely information, and additional automated
1691
From ASP to Web Services
information systems (IS). Interest in Web services
is emerging in many different guises. As subset
of e-business, Web services offer customers soft-
ware as a service. The principle of operation is
similar to the application service provision (ASP)
model, priced on a pay-as-you-go, utility model
of business computing (Currie, Desai, & Khan,
2004). Against a background of disappointing
results from ASP (Hagel, 2002), Web services are
designed to resolve problems of poor integration
(interoperability) between software applications
and low customer satisfaction. This research study
treats the Web services business model as the
main unit of analysis and seeks to identify how
value is created for customers (Perseid, 2003;
Sleeper & Robins, 2001). Despite the promises
of vendors, Web services have fared poorly in
terms of attracting a large client base (CBDI,
2003). The reasons for this are both technical and
commercial (Hagel, 2002). The fallout from the
ASP market provides some important lessons for

vendors offering software as a service, and for
e-business models more generally.
7KLV FKDSWHU SUHVHQWV WKH ¿QGLQJV IURP D
two-year research that examines both the supply
side and customer side of deploying, hosting, and
integrating e-business models, focussing primar-
ily on Web services in the UK health sector. The
chapter is structured into three main areas. It
begins with a discussion of ASP taxonomies and
argues that the various templates for ASP were
HVVHQWLDOO\ÀDZHGIRUDFRPELQDWLRQRIWHFKQLFDO
or business reasons. Within the healthcare sector,
technology vendors failed to develop e-business
models that created value for customers. They
adopted a technology push strategy where product
and services are offered to customers without a
clear understanding of their business requirements
(Cassidy, 2002). This section is followed by an
overview of the research study and methods used
for data collection and analysis. Next, we pres-
ent the results from a questionnaire survey and
interviews with healthcare professionals. Using a
ULVNDVVHVVPHQWIUDPHZRUNZKLFKFDSWXUHV¿YH
key performance areas (KPAs) for evaluating
the software-as-a-service business model (which
includes both ASP and Web services) (Currie,
2003), this research applies this framework within
the healthcare sector. Comparing the results from
KHDOWKFDUHZLWKWKRVHRI¿YHVHFWRUV&XUULHHW
al., 2004), we observe that priorities and prefer-

ences vary. This suggests that service provider
vendors need to identify a more rigorous approach
in developing their value propositions from e-
EXVLQHVV IRUVSHFL¿F LQGXVWULDO VHFWRUVVLQFHD
RQHVL]H¿WVDOO approach is inappropriate. The
chapter concludes by offering future directions
for research on emerging technologies within
healthcare.
LESSONS FROM THE FIRST
PHASE OF THE ASP MODEL
The emergence of the ASP model suggested an
D Q V Z H U W R S U H Y D L O L Q J T X H V W L R Q  ³ : K \ V K R X O G V P D O O 
businesses and non-IT organizations spend sub-
stantial resources on continuously upgrading their
IT?” Many believed that application outsourcing,
using the ASP model could provide the solution
WRHQKDQFLQJ,7HI¿FLHQF\DQGUHGXFLQJWKHto-
tal cost of ownership of IT (IDC, 2000). Within
the context of healthcare, ASPs could offer both
horizontal (business facing) and vertical (sector
VSHFL¿FVRIWZDUHVROXWLRQV$QH[DPSOHRIWKH
latter could be in the form of electronic patient
records (EPR) systems (Guah & Currie, 2004).
An ASP assumes responsibility for buying, host-
ing, and maintaining a software application on
its own facilities, publishing its user interfaces
over the networks, and provides its clients with
a shared access to the published interfaces. The
customer simply has to subscribe to the service
to receive the application over an Internet or

dedicated intranet connection, as an alternative
to hosting the same application in-house (Guah
& Currie, 2004).
The impetus behind ASP was fuelled by the
1692
From ASP to Web Services
belief that utility computing offered a new business
model to customers, similar to electricity, gas,
and water. The commercialization of the Internet
PHDQWWKDWDVQHWZRUNWUDI¿FLQFUHDVHGLQD¿UP¶V
data centre, IT architecture would trigger other
resources into action, including idle servers, ap-
SOLFDWLRQVRUSRROVRIQHWZRUNVWRUDJH7KH¿UP
would pay only for the amount of time it used the
VHUYLFHV7KXVWKHFRQFHSWRI³VRIWZDUHDVDVHU-
vice” was created. Accessing IT resources in this
way would result in reduced up-front investment
DQGH[SHQGLWXUHHQDEOLQJ¿UPVWREX\VHUYLFHV
on a variable-price basis (Dewire, 2000). This
fuelled opportunities in the late 1990s for service
providers to offer software applications and IT
infrastructure on a rental, pay-as-you-go pricing
model (Bennet & Timbrell, 2000). An ASP could
be a commercial entity, providing a paid service
to customers (Susarla, Barua, & Whinston, 2003)
RUFRQYHUVHO\DQRWIRUSUR¿WRUJDQL]DWLRQVXS-
porting end users (Currie et al., 2004).
In healthcare, an ASP may provide some mix
of application services for laboratory, prescribing,
charting, outpatient visit, coding, and clinician

scheduling, and reporting. Some may even offer
clinical alerts normally associated with expensive
institution-based EPR systems, including health
warnings of potential drug reactions. Through
the provision of this one-to-many model over the
Internet, an ASP takes patient charts and medical
records and keeps them on a centrally managed
repository, to which a healthcare provider can
gain access from anywhere in the world. This
can allow for a physician to review the patient’s
medication lists from all previous encounters and
WKHLUSUHVFULSWLRQ¿OOLQJKDELWVSURYLGHGDOOWKH
OHJDOUHTXLUHPHQWVRISDWLHQWFRQ¿GHQWLDOLW\KDYH
been arranged).
ASP Taxonomies
7D[RQRPLHVUHSUHVHQW³LGHDOW\SH´VFHQDULRV
which may not exist in their pure form (Currie et
al., 2004). They are useful for providing a frame-
work for organizing phenomena by attempting
to deconstruct the various components and/or
characteristics. Variations exist within ideal-
typical categories, as well as overlap between
FDWHJRULHV 'XULQJ WKH ¿UVW ZDYH RI WKH $63
market, many different types of ASP emerged.
Some were concerned to offer a broad, horizon-
tal product and service portfolio, while others
WDUJHWVSHFL¿FYHUWLFDOLQGXVWU\VHFWRUVVXFKDV
healthcare. Table 10.1 focuses on a horizontal ASP
products/services portfolio, and Table 10.2 looks
at the service providers targeting the healthcare

vertical sector. Each of these categories implies
a different outsourcing relationship between sup-
plier and customer.
7KH¿UVW$63WD[RQRP\7DEOHGHOLQHDWHV
ASPs into vertical LQGXVWU\VSHFL¿Fhorizontal
(across/within business functions); enterprise
(complex software such as ERP and CRM);
pure-play (Web-enabled applications) and infra-
structure (data centre, networking, and other sup-
porting technology) (Currie et al., 2004). Whilst
many research analysts and pundits suggested
that vertical ASPs offered excellent opportunities
for business development, they also needed to ad-
dress key challenges, such as a limited customer
base; potential problems in serving only one
sector/subsector; potential overreliance on one
Internet service vendor (ISV); and others. By
restricting their potential customer base, vertical
ASPs believed they could offer a high level of
service since they marketed themselves as having
an in-depth knowledge of the sector/subsector
they served.
The second taxonomy (Table 2) of the ASP
PDUNHWDGRSWV¿YHFDWHJRULHVASP resellers, ASP
developers, ASP aggregators, hosting services,
and managed services providers (Hagel, 2002, p.
45). Comparing the two ASP taxonomies reveals
VLJQL¿FDQWVLPLODULWLHVZLWKFRQVLGHUDEOHRYHUODS
between categories and activities of the various
players. The ideal-typical categories provided by

different taxonomies offer an illustration of the
market/strategic positioning and product/service
1693
From ASP to Web Services
portfolios of ASPs, and should not be treated as
rigid categories in their own right. Given the
FRQIXVLRQ ZKLFK VXUURXQGHG WKH ¿UVW ZDYH RI
ASPs, attempts to deconstruct the ASP business
model and market into taxonomies is a useful
exercise, which may provide some clarity to the
phenomenon under scrutiny.
ASP taxonomies can be further mapped across
the netsourcing stack, which captures a variety of
customer/supplier scenarios “where relationships
in this space are very complicated” (Kern, Lacity,
& Willcocks, 2002, p. 115). For example, an ASP
delivering a hosted software application to the end
customer, may subcontract data centre services,
billing, help desk, and other support services to
DGGLWLRQDO¿UPV)XUWKHUPRUHWKH$63PD\QRW
even own or have developed the software, as this
may be the intellectual property of an Internet
service vendor. In the case of enterprise ASPs
and ASP resellers, developers, and aggregators,
WKHVH¿UPVPD\IRUPFRPSOH[VWUDWHJLFDOOLDQFHV
or partnerships with leading ERP vendors, usually
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As a forerunner to the current Web services
market, ASP was highly volatile, dynamic, and
immature market. A recent review of the ASP

industry (Susarla et al., 2003) concluded that the
technological factors like scalability, speed and
focus, and the behavioral aspects of price and
ÀH[LELOLW\ZHUHWKHNH\GULYHUVRIWKHPRGHO7KH
inhibitors of the model were poor connectivity,
lack of trust in the model, reluctance to be locked
into long-term contracts with suppliers, lack of
customization, poor choice and suitability of
software applications from ASPs, and few op-
portunities to integrate disparate applications
across technology platforms and business environ-
ments. These factors and others led Hagel (2002)
to conclude that
Table 1. Taxonomy of ASPs based on a horizontal product/service portfolio (Currie et al., 2004)
Type of ASP Description Generic Examples Key Challenges
Mixed/
Vertical
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KHDOWK¿QDQFH
transportation)
SchlumbergerSema (health)
Bloomberg (Finance)
S/W for Excellence (Dental)
Limited customer base
Reliant upon major vendors
Restricted by sector-based economic
Horizontal Business software
(accounting, human
resource, travel)
Salesforce.com (HR)

Concur (travel)
SAGE (accounting)
Low barriers to entry;
Undifferentiated products/services
Enterprise Complex business
software (ERP,
CRM, supply
andlogistics)
SAP
Oracle
McKesson
Very expensive for small/medium
organisations
&KDQQHOFRQÀLFWV
Data security/integrity
Pure-Play Internet/Web-
enabled software
application (email/
security/disaster
recovery)
Graphnet Health
iSoft
Mail.com
8QSUR¿WDEOHFRPPRGLW\DSSOLFDWLRQV
Reliant upon VC funding;
Unstable/volatile/dynamic market
Infrastructure Technology partners
to ASP (telco, data
centre, networking)
Cable andWireless

BT
CISCO
Technical inhibitors
Over-capacity
Severe competition