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INFORMATION STRATEGY: AN INTRODUCTION 125 transformations needed to achieve these objectives. Because the information systems which will be deployed will have to support the transformations, it is important to have alignment between the information systems strategy and transformations strategy. It is notable that the Department of <strong>Health</strong> (DOH) has chosen not just to be explicit about the function of the information systems required (National Programme for IT) but also on the way in which they will have to be procured. This may indicate that the DOH considers the procurement process to be a considerable risk to the success of the National Programme for IT and through that to the success of the general health care programme objectives. The Procurement strategy may be seen as one layer in the IT-hierarchy of the strategy portfolio of the NHS. The National Programme for IT is meant to be subordinate to the National Plan to improve care and services in the NHS, the Procurement strategy subordinate to the National Programme for IT. The same ‘layering’ of strategies occurs in other functions of the health care system, such as human resources, buildings and technical services, medical equipment, etc. Maintaining a logical and efficient fit between the overall strategy, the strategy layers of one function and the strategy layers of the other functions is called alignment. In the case of the NHS, alignment is felt to be needed for the entire health care system on a national scale. In many other countries, where the main decision making authority has been vested with regions or individual institutions, the scope of the alignment issue may be smaller. SHOULD STRATEGY IN HEALTH CARE BE DIFFERENT? If we focus our attention on the health care industry, the question arises why this sector would merit a different approach than other types of industry. ‘<strong>Health</strong> care is different’ is a statement heard quite often from those who are working in the health care industry, mostly to explain to ‘outsiders’ why concepts used in industry couldn’t be applied to health care. Discussing the possibilities for the standardization in health care work, for example, Strauss et al. conclude that coordination of care, for which personnel are constantly striving but know they are not often attaining, is something of a mirage, except for the most standardised of trajectories. Its attainment is something of a miracle when it actually occurs. (Strauss et al. 1985, p. 155) Apart from reasons cited in Part I of this book complexity is identified quite often as an explanation for being different. The word has been and will be used a
126 STRATEGY, IMPLEMENTATION AND EVALUATION lot in this book. What do we mean by the word and are we using it correctly, in the sense of not exaggerating? Many of the present day strategy 2 development situations can be characterized as complex (Mason and Mitroff 1981), because ■ ■ ■ Any strategy development situation comprises many problems and issues. These problems and issues tend to be highly interrelated. Consequently, the solution to one problem requires a solution to (all) the other problem(s). At the same time, each solution creates additional dimensions to be incorporated in the solutions to other problems. Few, if any, problems can be isolated effectively for separate treatment. Connecting all of these problems are active networks of stakeholders, which are not neutral, in the sense that they will change when one or more problems change. This is called organized complexity. In such an environment, changes in one problem may be transmitted to other problems, changes can be magnified, modified or reverberated, so that the system takes on a life of its own. Problems of organized complexity are also called ‘wicked’ problems (Rittel 1972). They are characterized as follows: ■ ■ ■ ■ ■ Interconnectedness. Strong connections link each problem to other problems. As a result, these connections sometimes circle back to form feedback loops. ‘Solutions’ aimed at the problem inevitably seem to have important opportunity costs and side effects. How they work out depends on events beyond the scope of any one problem. Complicatedness. Wicked problems have numerous important elements with relationships among them, including important feedback loops, through which a change tends to multiply itself or perhaps even cancel itself out. Generally, there are various leverage points where analysis and ideas for intervention might focus, as well as many possible approaches and plausible programmes of action. There is also the likelihood that different programmes should be combined to deal with a given problem. Uncertainty. Wicked problems exist in a dynamic and largely uncertain environment, which creates a need to accept risk, perhaps incalculable risk. Contingency planning and also the flexibility to respond to unimagined and perhaps unimaginable contingencies are both necessary. Ambiguity. The problem can be seen in quite different ways, depending on the viewer’s personal characteristics, loyalties, past experiences, and even accidental circumstances of involvement. There is no single ‘correct view’ of the problem. Conflict. Because of competing claims, there is often a need to trade off ‘goods’ against ‘bads’ within the same value system. Conflicts of interest among persons or organizations with different and even antagonistic value systems are to be expected. How things will work out may depend on
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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 94 and 95: Chapter 5 Meeting the challenge Int
Page 96 and 97: STARTING POINTS 81 ‘gender, race,
Page 98 and 99: STARTING POINTS 83 Now, imagine an
Page 100 and 101: STARTING POINTS 85 organization,
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 114 and 115: DESIGNING INTERACTIONS 99 the way t
Page 116 and 117: DESIGNING INTERACTIONS 101 1 Identi
Page 118 and 119: DESIGNING INTERACTIONS 103 the deve
Page 120 and 121: DESIGNING INTERACTIONS 105 communic
Page 122 and 123: DESIGNING INTERACTIONS 107 Figure 6
Page 124 and 125: DESIGNING INTERACTIONS 109 ■ Figu
Page 126 and 127: DESIGNING INTERACTIONS 111 measurem
Page 132 and 133: DESIGNING INTERACTIONS 117 Covell D
Page 134 and 135: Part II Information strategy, imple
Page 136 and 137: INFORMATION STRATEGY: AN INTRODUCTI
Page 152 and 153: Chapter 8 Developing the informatio
Page 154 and 155: STRATEGY, IMPLEMENTATION AND EVALUA
Page 172 and 173: Guidelines for information system d
Page 180 and 181: Chapter 9 Implementing information
Page 182 and 183: IMPLEMENTING INFORMATION SYSTEMS 16
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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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