Health Information Management: Integrating Information Technology ...

INFORMATION STRATEGY: AN INTRODUCTION 129
better system development and implementation practices, it will suffice to repeat
the conclusion that the implementation of IT as a process-supporting tool has
been very problematic. Many aspects of IT strategy and IT management (the
terms sometimes overlap) in health care have been intensively researched, but, as
with general strategy, there is insufficient basis to select just one proven
approach.
In health care as well as in other industries, there is a distinction between
strategy formation and strategy implementation. IT strategy and organizational
strategy should be linked, and the internal IT capabilities and characteristics
should be well developed. The importance of strategy formation should not be
underestimated: after all, a well executed flawed strategy heads down the wrong
path. Crucial are in particular the ‘concepts, ideas and definitions, that govern
how an organization views a particular IT challenge or opportunity. The
importance of foundational concepts and view…is significant’ (Glaser and Hsu
1999, p. 126). Finally, the IT strategy should be an integral, ongoing component
of the overall organizational strategy development process (see also Chapter 8).
The characteristics of strategy implementation in general and health care in
particular (complexity, alignment of heterogeneous actors, the need for a strong
vision) require specific ways of approaching strategy development. First of all,
wicked problems of organized complexity (Mason and Mitroff, 1981) have two
major implications for the design of strategy-making processes:
■
■
There must be a broader participation of affected parties, directly and
indirectly, in the decision making process.
Strategy making must be based on a wider spectrum of information gathering
from a larger number of sources.
For strategy formation in complex organizations new general criteria are needed
for the design of real world problem-solving methods (ibid.). We focus on these
methods because the content of the strategy can be very different from case to
case. These criteria are:
■
Methods need to be participative: since the relevant knowledge necessary to
solve a complex problem and also the relevant resources necessary to
implement the solution are distributed among many professional and
independent individuals, the methods must incorporate the active involvement
of (groups of) people with an interest or stake. This implies first building an
organization and network that is able to deal with sometimes dramatic
changes in both the external (new government regulations or de-regulations)
and the internal context (re-distribution of tasks, re-organizations). Second,
the personal development of the stakeholders involved should be promoted in
order to provide them with the insights, maturity and flexibility needed to
support such an organization. Third, use flexible information systems to
facilitate the necessary transformation and development process (sometimes