Lecture 11 : SSM case creating an information strategy

IE 398 - Lecture 11 1

Lecture 11 : SSM case creating an information strategy

• Merging an acute and a small hospital in NHS

• The situation and insights for the SSM process

• Organization of the SSM implementation

• Finding out and modeling

• Information needs analysis

• Lessons for SSMSpring 2010


Merging an acute and a small hospital in NHS

• NHS : provides health care nationally• “from cradle to grave”, hence a large

organization, very wide spectrum and heavily involved in expertise and variety of services

• attempts to improve efficiency and effectiveness by introducing the “internal market” concept in 90’s

• District authorities as purchasers of health services from autonomous Trusts

• Contracts for an agreed sum of money

Spring 2010



• Trusts had to think more seriously about their information systems – as quality, timeliness and costs matter

• Acute hospital : large teaching organization to deliver a range of services to patients – referred to it by GP’s or– entering to it as result of accidents and emergencies

• developes services and match them to its capabilities in time

Spring 2010



• An acute hospital, The Royal Victoria Infirmary and, the rather small Hexham General Hospital

• A new big hospital at two distant sites to negotiate for a “contract” and commit to it

• IS needs were initially intended to be met simply by computer system purchases without much consideration given to analyzing and scoping the use

Spring 2010


The situation and insights for the SSM process

• The new Information Officer saw the need for a new IS strategy

• Purposeful activities had to play the key role in developing such a strategy

• Not to be directly undertaken by IT specialists

• SSM was seen very suitable to this end• Six months period to develop a proposal

for the strategySpring 2010

IE 398 - Lecture 11 6Spring 2010


The situation and insights for the SSM process

• Facilitators : The Information Officer, a senior management consultant, and P.Checkland

• The first two were (according to Checkland) natural systems thinkers

• P. Checkland’s ideas at the outset: – Activity models only for major hospital activities– Discuss information needs based upon these models– Compare present information support with the needs elicited in

the above– Re-formulate strategy

• Needed only “primary task” models, as thinking in-depth would go beyond the IS functionality and would not find much chance of application within reasonable time

Spring 2010


Organization of the SSM implementation

• Staff to be arranged in a number of small sized teams in each of the two hospitals

• Examine core purpose, activities and info needs of several functions (surgery, medicine, nursing, theathres, business,..)

• A joint workshop every month of team representatives with the three facilitators

• Project team members would keep on carrying their routine tasks as usual with no exception

Spring 2010




• project was to be slipped quietly into the day-to-day activity of the two hospitals

• Launched by the CEO of the acute hospital in a meeting of about 100 people

• strategy was emphasized to emerge from the group and not from the management

• CEO’s involvement demonstrated that the study was taken seriously by the Trust

• three facilitators explained the work to do Spring 2010



• Checkland prepared, at several levels, generic models relevant to acute hospital operation

• This was a choice made specific to this situation• IS would be shaped to serve taking the current

hospital organization as given • Analysis two and three were skipped, since the

study addressed an explicit question in this particular situation

• Generic activity models would be enriched by considering and engaging in debates over the accounts of CATWOE and 3E’s

Spring 2010


A generic model that would be relevant to any acute hospital, was initially constructed. Its Root Definition was:

A system, operating under a range of external influences, which, in the light of a strategy based on its capabilities and costs, delivers services defined in 'contracts' with purchasers within the context of NHS norms and policies, that service delivery itself contributing to the ongoing development of its strategy for service provision. C those receiving hospital services, purchasers

A hospital professionals

T need for acute services need for acute services met

W acute services can best be provided by an organization dedicated to developing and delivering such services

O hospital management board; NHS executive

E NHS structures and norms, the purchaser-provider split

E1, efficacy demonstrable delivery of a portfolio of services of suitable quality

E2, efficiency minimum use of resources (expressible in money and time)

E3, effectivenes

s

satisfaction of patients treated, purchasers, the NHS executive, contributions to hospital reputation (i.e. contributions to long-term viability]

Finding out and modeling

Spring 2010



Finding out and modeling• a low resolution activity diagram for a generic

acute hospital• activities 2-5 are expanded are collectively

under the external influences in activity 1• monitoring against plans and “contracts” versus

monitor the overall activity system from 3E’s perspective

• A higher resolution model of each activity essentially needed to assess information needs

Spring 2010



Finding out and modeling• primary task form preserved in the diagram of

higher resolution• CATWOE for a generic service S in the detailed

diagram C Patients, ancillary support services

A Providers of clinical service

T Need for service S need for service S met

W The capability and organization for professional provision of service S is available and appropriate

O Senior hospital managers, including doctors

E NHS norms, hospital organization structure; contract requirements

E1, efficacy demonstrable delivery of a service of suitable quality

E2, efficiency minimum use of resources (expressible in money and time)

E3, effectiveness

satisfaction of the serviced people, meet negotiated contractual clauses for particular service

Spring 2010


Finding out and modeling

• Detailed diagramming was taken further only by one more step for some of the activities

• experience indicates, beyond three levels of detail -starting from the overall organization at the

topmost level- is useless

• Stop at the level where most problematical features lie

Spring 2010


Information needs analysis• activity models helped structuring discussions

and not taken as would-be descriptions• Rather than the usual inquiry for the activities

and their linkages, they took– what information should be available to someone

doing this activity?– what is available at present?– what information is generated by doing this activity?– to whom should it go?

• Gaps and opportunities not revealed directly by models, but emerged from discussion and debate

Spring 2010


Activities from the

How the activity

Measures of Information Information

support Information gaps

and

model -----------------------

----

is done--------------------

performance---------------

needed--------------

provided by-----------------

---

opportunities ----------------------

4.1.4 and 4.1.5

Receive request for Letter, phone call Speed with

which Patient's details, Patient

Automatic generation of

service, and accept the request is clinical

condition, administration

letters to patient and

patient handled and history system (PAS) referrer

Contract situation

Up-to-date contract

situation

Table 4.1 An illustration of the kind of chart used for information analysis

Spring 2010


Table 4.1 An illustration of the kind of chart used for information analysis (cont.d)

Activities from the How the activity

Measures of

Information

Information support

Information gaps and

model --------------------------

is done--------------------

performance-------------

needed-------------

provided by----------------------

opportunities ----------------------

4.1.6

Diagnose problem Consider history Medical audit

Case notes Case notes often missing

Examine patient Results from Much duplication of

Conduct investigations recording of patient's

investigations details

Delays in receiving test

results

Spring 2010



Activities from the How the activity

Measures of

Information

Information support


model --------------------------

is done--------------------


needed-------------

provided by----------------------

opportunities ----------------------4.1.7

Treat patient Conduct proce- Medical audit

Availability of Theatre booking Systems not available at

dures/operations Facilities, theatres,

system ward level

Prescribe drugs anesthetics, etc.

Drug effects and

interactions

Spring 2010



Activities from the

How the activity Measures of

Information

Information support


model --------------------------

is done--------------------


needed-------------

provided by----------------------

opportunities ----------------------

4.1.8

Discharge patient Discharge summary Speed with

Post-treatment test

PAS Links to ongoing providers

Discharge letter which produced

results of care

Availability of Automatic generation of

discharge facilities

discharge summaries and

Coding letters Support for Read coding

Spring 2010


Lessons for SSM• “..grasping of SSM is much easier in a live

situation than in a classroom.”• such a methodology which feels natural can

help to counter the feeling among the members of a large complex organization, of no definite course to follow and no knowledge of direction

• group working on nursing services appreciated CATWOE as they considered “hospital contract manager” in addition to the “patients” in C, among the victims or beneficiaries

Spring 2010


Documents

Lecture 11 : SSM case creating an information strategy