This study is based on an analysis of administrative information processes within outpatient clinics within an NHS acute Trust. The aim is to improve outdated practice. Problems had previously been identified but the Trust had considered neither process refinement nor replacement. In order to determine a means for overcoming the emerging cultural obstructions, Ward and Elvin's 1999 framework for managing IT-enabled business change  provides a means to assess the likelihood of successful system improvement. This now needs to be updated in the light of the revised framework by Elvin and Davies . The current study concludes that process improvement would not deliver all of the anticipated benefits without process replacement.