Health Information Management: Integrating Information Technology ...

INFORMATION STRATEGY: AN INTRODUCTION 127
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interaction between powerful interests that are unlikely to enter into fully
cooperative arrangements.
Societal constraints. Social, organizational and political constraints and
capabilities, as well as technological ones, are central to both the feasibility
and the desirability of solutions.
For those practising in health care, many of the characteristics of complexity will
be very recognizable. Why is this important? Not because it is useful to classify
health care as ‘more complex’ than other types of industry. There is no benefit in
a competition in complexity. It is useful however to recognize many problems in
health care as wicked problems, because this will help the health care
practitioner in developing approaches to his (strategic) problems and it will
provide directions (see the next section, p. 136).
Looking at Porter’s answer to the ‘What is strategy?’ question, there may be
another reason why the hospital industry may actually differ from other
industries. For managers of hospitals, the liberty to choose a different position is
in many countries severely limited because of budgetary and other restraints.
Quite the opposite, governments and the public opinion in many countries strive
for the same quality of care for everybody, regardless of income, age or place of
residence. The context, in other words, does not allow health care managers
much freedom to design their own goals. On the contrary, there are many
incentives to be the same. If we follow Porter’s reasoning, this inevitably leads to
a focus on operational effectiveness and a best practice culture concentrating on
standard individual activities and not on aligning some of these activities into a
unique service or product not available elsewhere. If the unravelling and
redistribution of (information handling) tasks (see Chapter 5), requires such an
integration of individual activities, i.e. change beyond operational effectiveness,
strategy development in health care organizations may be seriously hampered.
Maybe this explains why there is so little literature on strategy for hospitals, at
least in the European context, as opposed to literature on hospital management
(focus on operational effectiveness). Certainly, literature comparing strategy
approaches on the hospital level in Europe is rare (McKee and Healy 2002).
A final issue differentiates health care from many other industries and heavily
influences the abilities of health care providing organizations to develop and
implement strategies. In Chapters 2 and 3, we described the tensions between
traditional characteristics of medical work and the (potential) impact of
technology. As most highly trained professionals, medical professionals and IT
have a problematic relationship. IT enables codification of medical knowledge,
transparency in medical treatments, standardization of work processes and new
ways of collaboration with less qualified professionals (task redistribution), all of
which have a direct impact on the professional autonomy and identity of medical
professionals. IT, in other words, has the real potential to affect the professional
and economic position of medical professionals: the development of the patient—
doctor (1:1) relationship into a patient—health care team (1: many) relationship