Health Information Management: Integrating Information Technology ...

134 STRATEGY, IMPLEMENTATION AND EVALUATION
Based on the work of Porter, we have described strategy and distinguished it
from operational effectiveness. We have then demonstrated that there is no
agreement among practitioners, scientists and theorists as to what strategy
actually is. We have asked the question whether the health care sector deserves
special attention regarding strategy formation and implementation and have
identified several characteristics that indeed set it apart from most other types of
industry. The most important characteristics can be described by the terms
‘organized complexity’ and ‘wicked problems’. Combined with the fluidity of
the strategy concept, these characteristics confront health care managers with a
considerable challenge.
We have concluded that it is wise to be wary of simple, straightforward
recipes for the integration of health care work and IT. The strategic application
of IT in health care is primarily an effort of process improvement, organizational
development, developing a vision and culture, and a network of aligned interests,
which is able to initiate and complete the changes related to this type of
development.
DISCUSSION QUESTIONS
1 In some countries, like the UK and Denmark, the national
government has developed a strategy dedicated to the use of
information systems in hospitals. These strategies presuppose
relatively standardized approaches to the implementation and use of
these systems. What would be the preconditions for such a strategy to
be successful? Which alignment issues would be likely to occur? What
could be done to deal with these issues?
2 In countries like Sweden the health care system is run by county
councils, politically elected leaders. Would their political background
lead to different information strategies than in countries in which
individual hospitals are independent in designing their (information)
strategy? And what if these hospitals would be for-profit instead of not
for profit? Explain and argue.
3 When dealing with wicked problems, changes in one aspect
influence (many of the) other aspects and possibly are influenced
themselves again by the waves this process creates in the organization.
What influence do developments in the information systems industry,
such as the Open Source movement or digital imaging, have on
strategy development in health care organizations? Do these influences
generate new alignment issues and if so, consider which ones.
4 Standardization within the field of health care informatics is by many
considered to be a precondition for a properly functioning health care
system, allowing professionals to communicate about their patients in a
seamless way. Implementation of standards is however lagging. Design