Health Information Management: Integrating Information Technology ...

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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
130 STRATEGY, IMPLEMENTATION AND EVALUATION ■ ■ ■ supporting it, sometimes provoking it, sometimes enabling it). Fourth, unleash the creativity of the professionals by providing them with the (IT) tools that allow them to contribute to desired strategic outcomes, without squeezing them in a top-down approach. Methods need to be adversarial: in complex problems, the best judgement on the assumptions embedded in certain opinions or choices is rendered in the context of opposition. Doubt is the guarantor of mature decisions. To enable this, fostering a culture of openness and critical discussion throughout the organization, including top management is necessary. Individual and/or group coaching can support this. Permanent evaluation of strategies and projects will also improve transparency and provide opportunities to deal with new developments. Methods need to be integrative: a unified set of assumptions and a coherent plan of action are needed to guide effective strategy formation. Participation and the adversarial process tend to differentiate and expand the knowledge base. Something else is needed to bring this diverse but relevant knowledge together in the form of a total picture, which can be the basis for day-to-day decision making. This implies permanently building and maintaining coalitions in order to create the basis for coordinated action by the organization. In the professional context of hospitals, maintaining support for strategy implementation is at least as important as the strategy formation itself. Also, focusing on long-term outcomes of the combinations of organizational development and information technology is necessary. This is a management responsibility (top-down). However, getting results requires constant tinkering on the implementation level, which may create bewilderment and distrust in the organization. <strong>Management</strong> should realize that integrative also means that the strategy should be borne by the organization instead of accepted, thus creating the basis for dealing with the confusion of the actual implementation. Last but not least, methods must be managerial mind supporting: most problem-solving methods and computer aids focus on ‘decision support systems’, that is, on systems that provide guidance for choosing a particular course of action to solve a particular problem. Problems of organized complexity however, are ongoing, ill structured and generally ‘wicked’. The choice of the individual courses of action is only part of the manager’s need. More important is the insight into the nature of complexity and to formulate concepts and world-views for coping with it. It is the manager’s thinking process and his mind that needs to be supported. This implies that leadership and leadership development, not just for and by top management, are essential to allow health care providing organizations to address the challenges of this decade. Deliberate management development programmes combined with intensive (external) training programmes will prepare managers to develop personalities which are able to deal with the sometimes bewildering complexity of the sector (education through—international—
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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
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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
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IMPLEMENTING INFORMATION SYSTEMS 17
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IMPLEMENTING INFORMATION SYSTEMS 18
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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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