Lecture 11 : SSM case creating an information strategy

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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 SSM

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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
  90s
• District authorities as purchasers of health
  services from autonomous Trusts
• Contracts for an agreed sum of money

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Merging an acute and a small hospital in NHS

• 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 GPs or
• entering to it as result of accidents and
  emergencies
• developes services and match them to its
  capabilities in time

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Merging an acute and a small hospital in NHS

• 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

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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
  strategy

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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. Checklands 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

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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

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Organization of the SSM implementation

• 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
• CEOs involvement demonstrated that the study was
  taken seriously by the Trust
• three facilitators explained the work to do

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Organization of the SSM implementation

• 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 3Es

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Finding out and modeling
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, effectiveness satisfaction of patients treated, purchasers, the NHS executive, contributions to hospital reputation (i.e. contributions to long-term viability
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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 3Es
  perspective
• A higher resolution model of each activity
  essentially needed to assess information needs

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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
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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

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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

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

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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 Case notes often missing
Examine patient Results from Results from Much duplication of
Conduct investigations investigations recording of patient's
investigations details
Delays in receiving test
results
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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 ----------------------
4.1.7
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
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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 ----------------------
4.1.8
Discharge patient Discharge summary Speed with 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
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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

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