Good Information Supports Better Healthcare - Informatics Matters

Reshaping Healthcare Organizations for 21st Century Healthcare; or "If you do what you always did, you will get what you always got"

13th March 2012

The majority of organizations in our modern commercial world are focused on delivering financial profit, they are often called "enterprises".  How does a healthcare system fit into this framework and can it, too,  be described as an enterprise?

A healthcare system will be comprised of someone who pays for the care (a government, an insurer, or the people who receive care) and a range of providers, healthcare organizations who deliver hospital care, specialist services, or more generalized healthcare services.

A healthcare system, where healthcare is publicly funded, will typically have a strategy focused around the objectives of:

  • Keeping patients well longer
  • Treating patients more effectively
  • Ensuring that patient interaction with the system is as pleasant as possible
  • Supporting healthcare workers to perform well, to learn and to build their knowledge to support care based on evidence
  • Minimizing waste

Even in a privately funded system these objectives will lead to higher profits and more satisfied stakeholders.

So, in this respect healthcare systems are a form of "enterprise". And, just as effective leaders actively consider the way that their organizations are structured, led, and managed to meet the challenges identified in their strategies, so must we consider how the "architecture" of the healthcare enterprise will support it to achieve its strategic objectives.

Transformational change and enterprise architecture

There is an old adage that goes something along the lines of "if you do what you always did, you will get what you always got".  When healthcare enterprises attempt to transition from industrial age organizations to information age enterprises they must consider not just the technology that will be required, but also how their strategy, culture, leadership, people, and organizational structure might support that development.

Often healthcare enterprises have high hopes that, by introducing computerised information systems,  and teaching people to use them, they will rapidly transform the healthcare that they provide.

Too often there is then an expectation that change will be delivered to the enterprise by the technology, the purveyors of the technology, or those entrusted with making the technology work. This expectation is always unmet and there can be a long, and often painful learning curve to the realization that 21st century tools, don't automatically lead to the knowledge-based organisation that was, perhaps, envisaged.

The issue is much broader and encompasses a range of concepts which are interconnected and interdependent. Understanding of those concepts and ideas are vital in order to achieve successful, and truly transformational, change.

Some questions that governance boards might ask Chief Executives when aspiring to transformational change

Although there are many common threads, each organisation is unique, it’s design, structure and work ethics are affected by a diverse range of local, internal and external influences. Hence there isn't a one-size-fits-all model for achieving, leading and delivering transformational change. Instead there is a range of issues that might be considered.

  • Does the organization's strategy (including the vision, mission, values, and objectives therein) reflect the degree to which transformation is necessary to deliver it? Is the strategic vision simply a better version of what we do today? Or is it so radically different that stakeholders will know that real change will be required?
  • Are the organizations and parties that are engaged in the enterprise "bought in" to the strategy? (do they feel they own it? was the strategy developed in consultation? does it resonate with the stakeholders who will support its delivery?)
  • Do the identified key performance measurements reflect how progress toward achieving the goals of the strategy is being made?
  • Are these key performance indicators given the same amount of time and discussion at meetings as purely commercial matters?
  • Does the governance and leadership structure of the enterprise work effectively with the governance and leadership of the organizations involved?
  • Are the governance and leadership effectively structured to support the transformation agenda?
  • Do the enterprise and organizational policies regarding recruitment, remuneration, knowledge retention, and staff development reflect the transformation agenda?
  • How is business as usual being managed while transformation is being led? (is the organization expecting too much, too soon, from too few?)
  • Is accountability and empowerment appropriately identified from the strategic leadership down through the hierarchy of the enterprise?

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Copyright 2012 André Snoxall.