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INFORMATION STRATEGY: AN INTRODUCTION 121 INTRODUCTION In Chapter 5, two simultaneous strategies were developed to deal with the tension between the demands for standardization of information systems and the nature of medical work, offering a way to move forward. The first strategy is to unravel care processes and to redistribute information handling and coordination tasks anew between the professionals and between the professionals and the information system. The second strategy is to grant the professionals the skills and resources to manage the tensions between standardization and the unpredictable nature of (the disease of) the patient. The chapter thus introduces two important notions. First, in order to come to grips with the complex problems described in Part I, it is necessary to have some kind of strategy. Implicitly, it is assumed that having a particular strategy will produce the outcomes for which the strategy was developed. Second, this strategy should encompass the redevelopment of hospitals’ core processes, organizational structures and possibly context. Such a strategy would be considered to be ambitious by most knowledgeable observers and the effort and risk involved would only be worthwhile if an imperative need to change the outcomes of the hospitals’ production (for example on the dimensions of quality and/or productivity) would be felt. We believe that in many countries and health care organizations this need for change is increasingly being felt. In this chapter we endeavour to increase insight into the potential of the concept of strategy as a means of achieving desired results in hospitals, thus laying the basis for systems development, implementation and standardization directions. Strategy in this sense is intended to be the beacon for the multitude of big and small decisions that will have to be made by a great number of people within and outside of the organization as the organizational change process unfolds. Those with responsible positions (high or low hierarchically, elected or appointed) in health care are in need of coordinating insights and mechanisms, which will allow them to direct their organizations through complex change processes towards desired goals. Doing so, they will have to serve the interests of their stakeholders and fulfil their governance responsibilities, while also taking into account the specific characteristics of the industry as described in the previous chapters. Politicians, executives and managers 1 try to perform these tasks by deploying human and other resources to their organizations’ best advantage. This is called strategy. Although the term has its origins in the military domain, it has been used in almost all areas of human endeavour where the complexity of decision making increased and leadership and coordination were needed. Strategy, thus, is about setting goals, a course of action and allocating resources. For larger organizations, among which hospitals can be counted, the goals, actions and resources for one activity or department (such as the information management function) need to be synchronized with the goals and
122 STRATEGY, IMPLEMENTATION AND EVALUATION actions set for and the resources allocated to the other activities. This is called alignment or fit, which is an essential element of strategy implementation. In this chapter, we will focus on recent issues in strategy and directions for information strategy formation and implementation in health care. We will do so by presenting the debate between theory and practice. We will also address the question whether health care and health care information management are different from other socio-economical activities from the strategy point of view, and whether they thus merit separate treatment. Next, we will distil general directions for new approaches to health care information strategy. In the next chapter, these issues will be filled in further in a series of concrete steps to take and issues to consider in developing an information strategy. Because of the importance of the alignment of information strategy to an organization’s overall strategy, we will start our discussion ‘top-down’. DO WE KNOW WHAT STRATEGY ACTUALLY IS? In an article called ‘What is strategy?’ (Porter 1996), Michael E.Porter, perhaps the world’s most widely read author on competitive strategy, distinguishes between strategy and the operational effectiveness focus, which dominated business until at least the mid—1990s. Although he does not address health care as such in this article, there are some lessons to be learned from his approach for this industry as well. Operational effectiveness is about productivity, quality and speed. In other words, do we perform similar activities better than rivals? Strategy, according to Porter, is about choosing to perform different activities than rivals or perform the same activities in a different way. Why do these approaches work out in a different way? If organizations try to compete on doing the same things better than their rivals, they actually compete on their ability to adopt best practices. It has turned out that many companies can become quite good at that game, thus collectively improving operational effectiveness in absolute terms. Relatively, however, this ability to adopt best practices does not help them much. It does not translate into a sustainable competitive advantage. Strategy is about choosing to perform (certain) activities other companies do not perform, or perform them in a different way. These choices make the company different, with the goal of creating a unique and valuable position. Choosing to be different also implies choosing not to be everything to everybody. Finally, as opposed to operational effectiveness, strategy is about what Porter calls fit (others would call this alignment). Whereas operational effectiveness is about performing certain individual activities better than rivals, strategy is about combining the disparate activities effectively. Strategic fit among activities is fundamental to competitive advantage, and it is also crucial to the ability to sustain that advantage. In order to implement the choice to be different and to create an effective fit, planning horizons should be longer than just a single planning cycle, but cover a decade or more. Strategy, according to Porter, is the core responsibility of general
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Health Information Management In al
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Health Information Management Integ
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Contents List of illustrations vii
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Illustrations FIGURES 3.1 Medicatio
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Contributors Marc Berg is a physici
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Series preface In almost all Wester
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Acknowledgements I would like to th
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Chapter 1 Introduction In all Weste
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INTRODUCTION 3 touch upon the deplo
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INTRODUCTION 5 can draw upon to mai
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INTRODUCTION 7 Physician Order Entr
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Part I Starting points Understandin
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WAITING FOR GODOT 11 KEY TERMS ■
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WAITING FOR GODOT 13 Netherlands an
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WAITING FOR GODOT 15 facts to show
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WAITING FOR GODOT 17 (Lewinski-Corw
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WAITING FOR GODOT 19 In most cases,
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WAITING FOR GODOT 21 (Anonymous 191
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WAITING FOR GODOT 23 Because of the
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WAITING FOR GODOT 25 they simply sa
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WAITING FOR GODOT 27 expected. Stil
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WAITING FOR GODOT 29 organize their
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WAITING FOR GODOT 31 performance in
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WAITING FOR GODOT 33 different HIS
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WAITING FOR GODOT 35 CONCLUSION: TH
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WAITING FOR GODOT 37 assumption tha
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WAITING FOR GODOT 39 Anonymous (191
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WAITING FOR GODOT 41 Berg, M. (1997
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Chapter 3 Health care work and pati
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HEALTH CARE WORK AND INFORMATION SY
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THE CONTEXTUAL NATURE OF INFORMATIO
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Page 98 and 99: STARTING POINTS 83 Now, imagine an
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Page 102 and 103: STARTING POINTS 87 Figure 5.2 Incre
Page 104 and 105: STARTING POINTS 89 already overflow
Page 106 and 107: STARTING POINTS 91 responsibilities
Page 108 and 109: STARTING POINTS 93 answer the quest
Page 110 and 111: STARTING POINTS 95 Kohn, L.T., J.M.
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Page 122 and 123: DESIGNING INTERACTIONS 107 Figure 6
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IMPLEMENTING INFORMATION SYSTEMS 17
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Chapter 10 Project management of in
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STRATEGY, IMPLEMENTATION AND EVALUA
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Index accumulation 53-4, 61, 73-4,
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INDEX 223 contingent and emergent c
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INDEX 225 satisfaction 176 patient
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INDEX 227 support 164 technology de
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