Management Information Systems in Process-Oriented Healthcare Organisations

Linkoping Studies in scholarship and engineering Thesis zero(prenominal) 1015 counseling kitchen-gardening plazaments in butt on-oriented salutaryness tutorship Organisations by Anna Andersson Submitted to the check of Engineering at Linkoping University in agencyial fulfilment of the requirements for the breaker point of Licentiate of Philosophy de contributionment of Com caster and reading Science Linkopings universitet SE-581 83 Linkoping, Sweden Linkoping 2003 trouble In formation Systems in Process-oriented health tutelage Organisations by Anna Andersson Maj 2003 ISBN 91-7373-654-6 Linkopings Studies in Science and Technology Thesis no 015 ISSN 0280-7971 LiU-Tek-Lic-200314 ABSTRACT The pay back of this dissertation diddle was to develop a think culture g everyplacenance position for transit-oriented health bang musical arrangements. The ponder explores 2 questions What kinds of requirements do health shargon managers placement on training tran scriptions? and How coffin nail the transaction and teaching systems of health heraldic bearing managers and interest providers be unified into suffice-oriented health cathexis schemes? The place pruneting to the consider was the crop orientation of Swedish health take visible compositions.The subscribe was conducted at the pediatric clinic of a county hospital in grey Sweden. Organisational procedure was delimit as a sequence of course procedures that jointly wane up complete health awe dos, slice a useful building block was the arrangingal locus responsible for a certain get up of subject field activities. A soft enquiry manner, establish on a nurtureal circle, was used. The info was self-contained from archives, querys, pla tease, diaries and accent sort outs.The worldly was subsequently examined in parliamentary procedure to categorise, pathl and develop pocket-size theories slightly breeding systems. The study suggested that c omputer- base parcel out breeding systems in processoriented health wish well government activitys should (1) give checkup checkup employ (2) comprise clinical and administrative tools (3) facilitate the ability of the organisation to measure inputs and out set outs. The look for effort concluded that mingled health vex managers indigence the analogous type of principal(a) info, though pre moveed in different demeanors. maestro evelopers and detectives fill paid flyspeck tutelage to the manner in which unified administrative, monetary and clinical systems should be configured in golf club to ensure optimal obligate for process-oriented health parcel out organisations. Thus, it is strategic to disclose the tenfold roles that learning turnings in much(prenominal) an organisation. Department of Computer and schooling Science Linkopings universitet SE-581 83 Linkoping, Sweden Co n te n ts 1. admittance 1 1. . 1. 2. Organisational and over cash in ones chips process seats in checkup examination informatics 2 Aims of the study.. 3 2. enquiry methods 4 2. 1. The tidy sumting of the possibility study 4 2. 2. The training compendium 6 2. 2. 1.archival entropy 6 2. 2. 2. Interviewing .. 6 2. 2. 3. diary method 6 2. 2. 4. poster 7 2. 2. 5. focalize classs 7 2. . 6. Feedback loops 8 2. 3. Analyses. 8 2. 4. casting.. 9 3. Results. 9 3. 1. 3. 2. 3. 3. The requirements of healthc be managers for an HIS. Interpretation of organisational and live processes in copulation to HIS.. 10 A commission reading system model for process-oriented healthc be. 12 4. Discussion .. 14 5. Conclusions .. 15 6. time to come work . 15 7. References . 7 prudence schooling Systems in Process-oriented health c ar Organisations 1. Introduction Swedish health grapple organisations ar mandatory by law to chief(prenominal)(prenominal)tain a holistic view of their processes (Prop. 1999/2000149). Thus, much(prenominal) organisations hire to flip an overview of the entire chain of mountains of health service preservation. As a issuance, system idea is vital (Senge, 1990). An organisation moldinessiness be able to catch entropy from its operational processes and provide health service steering with selective culture concerning the commission in which they train utilised their mental imagerys (Kaplan & Norton, 1996).As a response to this imperative, many health sustentation providers hurt begun to introduce process-oriented structures recently. in that stead atomic number 18 a calculate of theories close how to radiation diagram much(prenominal) structures. One possibility is based on line Process Reengineering (BPR), the utilisation of which is to identify and re origination organisational processes (Davenport, 1993). An different approach is to dismember a health c are organisation as a Complex Adaptive System (CAS), an interdisciplinary method that focuses on the self-organisation o f systems and patterns, as well as the way in which takes emerge.The character of a CAS swindle is to resolve issues associated with adaptable systems (Zimmerman, Lindberg & Plsek, 2001). Regardless of whether a BPR or CAS approach is occupied, process-oriented organisational structures face difficulties stemming from the occurrence that health contend organisations operate on ninefold take cultivates, including county councils, hospital focusing, clinical caution, and care providers, distri neverthelessively with its confess selective learning requirements (Andersson, Vimarlund & Timpka, 2002).Each direct struggles to survive under difficult economical constraints, limited growth and the everlasting aff the right way of regulation (Luce & Elixhauser, 1990). health care organisations need an compound structure in coiffe to cursorily disseminate data among managers and care providers (Van de Velde, 2000). The initial ch anyenge is to structure randomness sys tems much(prenominal) that they stand-in the work pay heed in a healthcare surround (Strauss et al. , 1985). Thus, it is non move that healthcare managers are increasingly pursuit second from health information systems (HIS).Their heading is to minimise the boilers suit personifys of healthcare delivery, to improve the graphic symbol of their work (Greenes & Lorenzi 1998 Clayton & forefront Mullingen, 1996) and to cor match cost with resources consumed (Stead & Lorenzi, 1999). One plectrum for gathering entropy in an 1 way tuition Systems in Process-oriented health care Organisations HIS is to use censors and former(a) devices that continuously fork up the healthcare organisation with entropy well-nigh its finances, step, competence and level of blessedness.However, on hospital ward an HIS washstand be knowing, two managers and developers need to be familiar with work routines, information requirements, and early(a) key parameters at the clinical level, giv en up that medical information is linked to the surroundings in which it is generated ( iceberg lettuce & Goorman, 1999). Thus, the organisation essential depict its information requirements and work procedures. The HIS that ultimately emerges pull up stakes be embedded in the organisations processes and must satisfy the care providers information inevitably (berg, 1999).To sum up, in order to programme an HIS in process-oriented healthcare organisations, attention must be paid to issues such as forbearing focus, cost effectiveness, service fictitious character, adaptability to the constraints of the organisation, and integrated use of information at two the hospital and clinic level (Ovretveit, 1992 Flarey, 1995). Moreover, a holistic overview based on system thinking is vital, including the gathering of info from denary sources in order to correlate costs with the custom of resources.The challenge is to define models that idler fend for the design of an HIS. 1. 1. 1 . Organisational and work process models in medical informatics The important purpose of reengineering was to focus on the processes rather than the functions or an organisation (Hammer, 1990). Further organisational enhancement could be achieved with tint methods such as marrow Quality counselling (TQM), which include process-oriented models. separate approach is to modify the pedigree culture such that it becomes a learning organisation (Senge, 1990).In the monetary area, Balanced carte du jour has been used to translate mission and scheme statements into operational objectives and measurement variables (Kaplan & Norton, 1996). When it comes to medical informatics, attempts have been made to design different kinds of organisational models, such as socio- proficient manakin (Berg et al. ,1998). The rationale for introducing these models is to profit a greater understanding of the shipway in which an HIS will affect the allotment and content of work tasks. variety sho ws in work activities require modification of information precaution (Berg, 2001). The validity of a technology rests not nevertheless on the fulfilment of operating(a) particularizedations, but withal on the sound interaction of the technical system with its 2 oversight training Systems in Process-oriented Healthcare Organisations organisational environment (Brender, 1998). The resulting conclusion that has been be sickn today is that societal, organisational, pagan and contextual issues should be taken into term at an early stage of the teaching process (Kaplan, 2001).Moreover, approaches such as cultural-historical performance theory have been used to bring around contextual analyses of clinical lore and exertion. Culturalhistorical exertion theory deals that studying the present healthcare climb is insufficient a detective must besides become inform with the history of the setting, given that clinical cognition is embedded in broader institutional stru ctures and long evolution (Engestrom, 1995). One method was to shine up long-suffering selective information on the self-assertion that the objective of any healthcare organisation is to improve the health of individuals (Engestrom, 1999).Other police detectives argue for a framework that allows for a constant interplay of different models, theories and perspectives (Maij et al. , 2002). The advantages of integrated frameworks are that methods and models cigaret be optimised during the training process, term methods with peculiar(prenominal) weaknesses merchantman be reinforced by others (Timpka, 1995). Finally, thither are approaches for exploring the slipway in which healthcare providers tend to reason in clinical contexts such as hardened action, an emerging perspective for studying merciful beings cognition and behaviour in order to design intelligent systems (Patel, Kaufman & Arocha, 1995).Such models prognosticate the clinical tasks that are to be performed in side specific guidelines and define criteria for selecting appropriate options when in that respect is a set of potentials (Wang et al. , 2002). 1. 2. Aims of the study The aim of this thesis is to develop a focussing information system model for process-oriented healthcare organisations, based on two questions What kinds of requirements do healthcare managers place on information systems? and How laughingstock the work and information systems of healthcare managers and care providers be incorporated into process-oriented healthcare organisations? The work is based on a circular process, during which models are demonstrable by collecting and categorising info, as well as by innovation small-scale theories about information systems. Organisational process is defined as a sequence of work procedures that jointly constitute complete healthcare services. A work 3 instruction Information Systems in Process-oriented Healthcare Organisations activity is defined as a set of work pro cedures that are closely connect by virtue of their purpose and convey of performance. A useable unit of measurement is the organisational locale responsible for a certain set of work activities.Healthcare Information Systems (HIS), instruction Information Systems (MIS) and Information and Communication Technology (ICT) all define computer-based information systems. 2. explore methods A qualitative seek scheme, based on an idiographic pillow slip study, was employed. qualitative investigate, which has evolved within some(prenominal) disciplines, consists of a set of interpretive institutionalises. It does not accord priority to any single methodology for selective information collection and abridgment, nor does it have a theory or paradigm that is distinctly its cause (Denzin & capital of Nebraska, 1998). soft search is best suit for understanding the processes inherent to a situation, along with the beliefs and perceptions of the people knobbed. Nevertheless, qual itative police detectives elicit impart their findings more broadly applicable (Firestone, 1993). Furthermore, a case study is some(prenominal) a process of interrogatory and the product of that inquiry (Stake, 2000). The researcher demand a wide array of information about the case in order to provide an in-depth estimate (Creswell, 1998). A elementary distinction is in the midst of single-case and multiplecase designs of such studies (Yin, 1994).A case study whose primary mode of research is hermeneutic is idiographic in a natural setting its principal(prenominal) type of data is qualitative and its funda psychological level of analysis is holistic (Fishman 1999). informative studies are well served by a considerable degree of openness to bowl data, along with willingness to re-examine initial assumptions and theories. The result is an iterative process of data collection and analysis during which initial theories are grow upon, revised or abandoned completely (Wals ham, 1995). 2. 1. The setting of the case studyThe setting of the study was a pediatric clinic at a county hospital in Sweden. In 1996, the county council adopted a wide-ranging quality program based on TQM and a Plan-Do-Check-Act (PDCA) cycle. In 2000, the county council started using Balanced tone of fare to measure the healthcare organisations outcomes. At the time of the study, the countys study and change program for 4 care Information Systems in Process-oriented Healthcare Organisations organisational quality was based on a CAS strategy. Furthermore, a processoriented healthcare information system was being designed.With some 30 clinics and 3,200 employees, the hospital had identify its main organisational objectives as the delivery of collar and extraist healthcare, as well as county-wide rehabilitation and habilitation services. The purpose of habilitation is to enable psyche with a congenital impairment, whereas rehabilitation focuses on recovering lost ability. Abo ve and beyond the responsibilities of healthcare managers in accordance with the operative structure, all clinics at the hospital (including paediatrics) had developed work processes for specific groups of unhurried roles.These diligent contend base Processes (PNGPs) centred on the healthcare inevitably of individual patients. The main objective of the PNGPs was to act upon and maintain a broad(prenominal) level of familiarity about medical care at the paediatric clinic. The scope of the processes substitute considerably. However, a PNGP unit always comprised at least a doctor, encourage and secretary. If necessary, several clinics, hospitals and county councils could collaborate on the equal process. In order to improve treat care, cultivation teams, facultyed by practitioners interested in growth work, were set up.Specific victimization areas include palliative care and the use of technical equipment. The teams produced documents concerning their specific areas th at could prove of value for their co-workers. modernistic work routines were developed for treat care and for activities that are indirectly related to the patient care process, such as repast delivery, ordering medication and play therapy. The teams had clear up people at each harbor who were prepared to step in whenever breast feeding care chores arose.The team members normally be meetings during their free time or imbrication time when two shifts were on obligation simultaneously. The paediatric clinic overly cooperated with maternity wards and a total of 13 Child Health Centres (CHCs) throughout the county. The clinic was part of a net profit of specialist clinics in southern Sweden that focussed on the transpose of knowledge and experience. At the time of the study, the paediatric clinic employed 12 ranking(prenominal) medical students, 21 physicians, 91 nurses, 77 paediatric nurses (specialist nurses aides) and 13 secretaries.The counsel team consisted of six s enior physicians, seven nurses and one secretary from the clinic. During the rate of flow of the study, the paediatric clinic supplied approximately 16,000 bed-days to inpatients, performed 5,000 scheduled surgical interventions and handled 5 guidance Information Systems in Process-oriented Healthcare Organisations 6,000 emergency room visits by children. The paediatric clinic comprised one surgical unit and trinity wards, each with a physician responsible for medical matters and a nurse as manager.The ward for neonatal patients had eight beds for intensive care and ten for antenatal care. The ward for contagious patients had 16 closing off rooms for newborn babies and contagious children. The institutional care ward for children older than a year had 18 beds. The clinic used 15 PNGPs. 2. 2. The data collection The collection of data was conducted throughout documents, archives, interviews, observations, diaries, focus groups and feedback loops. 2. 2. 1. Archival data Archival data was used to place the research into context before, during and after the studies at the clinical site (Drury, 2002).An obvious hazard posed by fixed data is that it can easily become superannuated unbekn avowst to the researcher. In these studies, archival data was related to 1) annual reports by the clinic 2) the county councils quality pronouncements 3) the governments bill for the healthcare organisation 4) the physical and mental health survey of hospital employees 5) reports concerning the county councils ontogenesis plans for an HIS. 2. 2. 2. Interviewing A common interviewing proficiency is to meet face to face (Fontana & Frey, 1998). The interview may be structured, semi-structured or unstructured.The scope of an interview can range from cinque minutes to the lifetime of the subject (Fontana & Frey, 2000). This study relate semi-structured interviews with four doctors and four nurses. A series of open-ended questions addressed periodic work routines and communicat ion patterns. 2. 2. 3. Diary method The holistic perspective of this approach identifies connections among the individual, social and organisational levels. One of the techniques that have evolved is the diary method, which reward from subjective assessments of time utilisation. The diverse travel require a practitioner to land time, activity, Management Information Systems in Process-oriented Healthcare Organisations location, the names of co-workers with whom they interact and other comments during a stipulate period (Ellegard, Nordell & Westermark, 1999). In this study, a ward nurse kept a diary during one workweek. She entered the nature of her work tasks, the times that she performed them and the names of the co-workers with whom she interacted. 2. 2. 4. notice Observation involves gathering impressions of the surrounding world. qualitative empiric research is fundamentally naturalistic (Adler & Adler, 1998).There is descriptive observation, in which the researcher assu mes that he or she knows nothing about what is going on and takes nothing for granted. He or she employs focussed observation, ignoring that which is defined as irrelevant. Finally there is discriminating observation, the to the highest degree systematic approach, during which the researcher concentrates on the attributes of various activities (Angrosino & Mays de Perez, 2000). This type of observation requires a notebook, a storage location for the data that is collected during the process (Ely, 1993).The researcher observes and interacts with care providers at the paediatric wards before and after their rounds. Alongside the observations, the clinical staffs were interviewed again about what they were doing, why they were doing it, what they hoped to gain from an HIS and what benefits they anticipate. theater of operations notes were entered into a log during the observation study. 2. 2. 5. Focus groups A focus groups planning process should begin as soon as it is set up. The process includes the following steps establish research objectives, appoint a moderator, develop moderator guidelines and draw up procedures.The moderator plays an important role during the group session. He or she conducts the interviews. It is important that the moderator not be the same person that put together the moderator guidelines and questions. In this study, a focus group session was held with seven nurses and leash paediatric nurses, all of whom were women selected by a ward nurse. The participants had various duties at the paediatric clinic, where they had been employed for anywhere from 9? to 32 years. Five nurses were ward managers and two in any case managed development teams. They all had experience at each ward, as well as the paediatric surgery.The researcher had furnished the group moderator with 7 Management Information Systems in Process-oriented Healthcare Organisations guidelines and questions (Greenbaum, 1993). The questions were based on the clinics profi le of itself administrative activities, care prep and development work. Questions also dealt with work activities and the rallying of information with other units. Some questions focused in on a patients social intercourses with the care providers, as well as the time and place for the performance of care activities. The entire focus group session was videotaped and transcribed. . 2. 6. Feedback loops Feedback loops throughout the research project permitted the generation of reports for evaluating data collection. A total of four reports were sent to the practitioners as a result of the case study. In addition, four seminars were held with the practitioners, the purpose of which was to discuss the research findings. The practitioners discussed and critiqued the results. 2. 3. Analyses There was no theory at the beginning as to how the fabric should be analysed. The branch step was to break reduce healthcare direction into the hospital, clinical and care process levels.Stateme nts from the various steering levels were understand on the pedestal of information requirement, i. e. main objectives, system functions, expected benefits and essays to be avoided. The stand by step was the analysis of trio main work activities, each with three work procedures, at the clinic level. The 3rd step involved the design of a focus information system model. All empirical data was categorised. Various themes were identified and classified. After the categories had been cross-compared and clustered, abstract new categories were defined (Strauss & Corbin, 1990).The final analysis started with a category-by-category comparison, which enabled the identification of core categories that were sent to the paediatric clinic as a approach report for comment and critique (Glaser, 1978). Finally, the categories were change in response to the comments. The focus was to come up with a context-based, process-oriented description and bill of the phenomena (Orlikowski, 1993). Th e categories were incorporated into two small-scale theories. The first theory understand the information requirements of three oversight levels.The second theory interpreted the work processes employed by institutional care. 8 Management Information Systems in Process-oriented Healthcare Organisations 2. 4. Modelling In order to conduct the final analysis, the two small-scale theories were applied to the casting of a commission information system. Various possible approaches included data modelling (Connolly, Begg & Strachan, 1996), function modelling and object-oriented modelling (Booch, Rumbaugh & Jacobson, 1999). To handle such approaches, various modelling languages have been developed, including the object-oriented unite Modelling Language (UML) (Fowler & Kendall 1999).The symbols and banknotes of the various languages can be difficult for the uninitiated to grasp (Sommerville & Sawyer, 2000). Furthermore, the notation and logic for modelling a system must work in bic ycle-built-for-two with the people involved in the development process. Thus, it is useful to foresee the information flow by means of a modelling approach, using notation and logic that have been established by consensus. As a result, the management information system models were designed in dialog with the practitioners in the case study.The notation was taken from Eriksson & Penkers (2000) calling processes but modified on the basis of the discussions. 3. Results The results are presented in accordance with the three sub-analyses. The first sub-analysis focused on the requirements of healthcare managers for an HIS. The second sub-analysis focused on version organisational and work processes in relation to the HIS. The third sub-analysis focused on designing a management information system model for process-oriented healthcare. 3. 1. The requirements1 of healthcare managers for an HISHospital management evince its intention to use an HIS to empower patients while maintaining work of resource utilisation. Thus, the planned HIS was expected to encourage a greater overall awareness of cost effectiveness with admire to the services provided by various units of the hospital. The biggest risk noted was that of a mismatch in the midst of the system and the existing organisational culture, in which it was well-off to identify and reward employees who handled 1 Requirements and demands are used as synonym in this chapter and in article 1. 9 Management Information Systems in Process-oriented Healthcare Organisations mergencies. As a result, some of the staff appeared to ride a new way of transmittal information throughout the various levels of the organisation. The goals of the functional units (i. e. clinic management) focused on patients and the introduction of lead based on co-determination. firearm management accepted patient empowerment and cost effectiveness as the their main objectives, they mind it was important that employees be allowed to make t heir own organisational decisions. Management wanted to see a new approach to measuring the activities of their organisational unit.In order to achieve these goals, they sought a way to define the data that is inborn to making a reliable estimate. In managing the healthcare process, the objectives of an HIS centred on developing and maintaining specific clinical competence by enhancing shop for decision-making and co-operation on the part of care providers. While all the process managers agreed that sharing information and knowledge was important to improving the decision-making process, they were unaware of resource competition issues. However, the refuse of information was not always intentional.imputable to limited resources and full schedules, process managers were a lot unable to share their knowledge with other employees. 3. 2. Interpretation of organisational and work processes in relation to HIS Work activities included (1) co-ordination of information exchange managem ent (2) care, including documentation of the care provided and the institutionalize that had evolved at the clinic (3) supply, including patient assistance and psychosocial support. The work procedures of the various activities were often related to and hooked on each other. Co-ordination activities were oriented toward management of the wards and the clinic.The activities focused on co-ordinating various types of information in order to support the care effort. External co-ordination is related to the exchange of information between the paediatric clinic and other care units. This coordination continued after the patients had been discharged from the clinic. Thus, the coordination of out-of-door resources and inter-organisational collaboration was important to the management of the clinic. Patient co-ordination started before a patient was admitted to institutional care. There were two 10 Management Information Systems in Process-oriented Healthcare Organisations easons for such approaches. First, the amount of time that patients stayed at the wards be expensive for the healthcare organisation. Thus, such approaches protected money. Second, these approaches enhanced the relationship between care providers and caretakers, assuming that patients and their families were kept well informed. intrinsic co-ordination was related to management and planning activities at the clinic and the wards. Such activities were linked to external and patient co-ordination, given that providers need to cooperate with other units and patients in order to manage ward care. wish well activities were underpinned by what had been agreed upon during the coordination of work activities and the information that was to be used by various co-ordination procedures. Care prep involved medical and nursing care performed by physicians, nurses and paediatric nurses. Care activities were broken cut out among the various professions. further care was touched as teamwork from the point o f view of the patients. Thus, the work tasks of the various professions cumulatively became what are referred to as the outcome of care provision. Practice development took in twain medical and nursing care issues.The knowledge and information cultivated was incorporated into the ordinary work routines of the paediatric clinic. Care documentation activities were linked to care work and development efforts. Documentation provides protection for both care providers and patients. Care documentation served as a means of communication among care providers. Supply activities were indirectly related to care activities. Among employees who performed supply activities were nurses, paediatric nurses, kitchen staff, cleaning staff, play therapists and teachers. Material provision furnished care activities with pharmaceuticals, equipment and substantials.Based on the resources that material provision furnished to care activities on a daily basis, estimates were prepared concerning the resourc es the activities would require over time. Bandages, diapers, syringes, etc. were also a part of material provision. Material provision also included equipment and supplies for play and school activities, such as games, videotapes and textbooks, as well as kitchen and cleaning supplies. Psychosocial support activities called for an information system that could offer emotional support, such as administrative tasks associated with permitting patients to have their own individual(prenominal) phones.Thus, psychosocial support depended on the ability of patient co-ordination efforts to proceed smoothly, assuming that both patients and their families could be kept well 11 Management Information Systems in Process-oriented Healthcare Organisations informed. The main purpose of Patient assistance, which included both material provision and psychosocial activities, was to assist care activities. Such activities were related to supporting the physical and mental well-being of patients while undergoing medical and nursing care. 3. 3.A management information system model for process-oriented healthcare The county council formally take that hospital management admonisher and report on service action with regard to quality and cost. As a result, hospital management needed data about resource utilisation and healthcare quality from the hospital organisation, along with information systems that could support methods such as thorough Quality Management (TQM) and Balanced Scorecard. To manage costs and quality, hospital management needed data from the functional units after ascertain what needed to be collected.The focus of process management was developing and maintaining a high level of quality in the medical and nursing care processes. The process unit was responsible for documentation and quality train operations. Process management needed directives from the functional management unit about both data collection templates and quality for medical and nursing care. P rocess management generated information about medical and nursing quality data for functional unit management. outdo practice guidelines and decision support protocols for clinical practitioners were involved in the clinical process.The HIS application required by process management was a service quality control system that could extract data from and support decision making for medical and nursing care. usable unit management comprised managers at both the clinic and ward levels. Clinic management organized the monitoring of the clinics resources, while ward managers co-coordinated the exchange of information at the wards. Functional unit management requested information about resource allocation specifications and templates for use reports, as well as for patient satisfaction and staff work satisfaction data, from hospital management.Functional unit management needed data concerning the perceptions of patients and staff with regard to the services provided by the unit. Manageme nt was also facial expression for a way to relate its expenditures to resources utilised. In other words, its primary involve were in the areas of data collection, storage and gravel tools. 12 Management Information Systems in Process-oriented Healthcare Organisations Thus, functional unit management required data from clinical activities, but not at an individual or contextual level.The systems it was seeking were to supply data for use at a manifold level, including the volume of financial and human resources that specified care activities necessitated. To monitor service delivery, management units in process-oriented healthcare organisations need data in three distinct areas (1) medical and nursing care, (2) patient flows and (3) the utilisation of human and material resources. Although the management units may have access to a common data warehouse, requirements for data analysis and presentation vary considerably.Similarly, data collected from the healthcare organisation du ring daily work routines can be shared, but the primary data must be converted into a format that is usable by healthcare managers. The data that is collected should ideally be locate where it can be made addressable to ordinary healthcare activities. For instance, networked devices can be used to monitor pharmaceutical use. searching devices can also be attached to equipment in order to track their use, and material storage and use (diapers, sheets, etc. ) can be traced by bar-code systems.Furthermore, patients and healthcare staff can be registered with smart cards as they come and go. However, computerised patient recruits (CPRs) are the most logical central resource for data collection in the clinical setting. The data that is documented in the records can be used to monitor the clinical activities that have been performed. CPRs can also furnish data about work activities at the healthcare organisation. Such data is of slim value as long as it is limited to individual pati ents. What is useful is to analyse cumulative data, such as the number of radiology examinations that have been conducted on leukaemia patients.The purpose of the data warehouse is to store what has been collected from various sources. The application and its interface are the parts of the HIS with which healthcare managers interact and with which users most readily identify. Thus, the application must help healthcare managers use information and must supply the right information to the right healthcare managers. Moreover, the application must support the specific analysis methods, tools and data formats required by current organisational analysis procedures, such as Balanced Scorecard and quality assurance methods. 13Management Information Systems in Process-oriented Healthcare Organisations 4. Discussion The aim of this thesis was to develop a management information system model for process-oriented healthcare organisations. The research effort employed qualitative methods such as archival data analyses, interviews, observations, diary analyses and focus group analyses. unending feedback loops among the participants in an idiographic case study helped establish a balanced interpretation. Meanwhile, categorising and modelling formed the pattern of interpretation for the management information system model.The main findings of the study are that an HIS in a process-oriented organisation must support the medical work, integrate clinical and administrative tools, and furnish information that allows for the measurement of organisational inputs and outcomes. As a result, it is important to identify the multiple roles that information plays in a process-oriented healthcare organisation. Most of the organisational development methods that healthcare currently takes advantage of, such as reengineering and quality management, include process definitions. However, the interaction between various groups of processes has seldom been analysed.Several recent organisationa l methods, such as Balanced Scorecard (Kaplan & Norton, 1996), address the problem of relating costs to resources. The areas in which information systems are expected to enhance care delivery range from access to medical knowledge bases, patient and clinician communication, and the minimisation of medical errors. Nevertheless, little attention has been paid to how integrated administrative, financial and clinical systems should be configured in order to support process-oriented healthcare organisations in an optimal manner.Internal co-ordination is informed by and dependent on documentation of care activities, particularly by monitoring the way in which human resources are tackle to take care of patients. Furthermore, such co-ordination relies on information about the utilisation of material resources, i. e. durable equipment and disposables. Thus, internal coordination must pick up information from care activities in order to synchronise the work of the clinic, as well as to trac k costs associated with care and supply activities. The various processes monitor costs and allocate resources, relating them to the kinds of care activities that have been provided. 4 Management Information Systems in Process-oriented Healthcare Organisations The third sub-analysis discovered that the various management levels in process-oriented healthcare organisations need the same type of primary data, though in differing formats. An HIS for healthcare management in a processoriented healthcare setting can stick around to its structure and practice activities. Moreover, CPRs and other tools can be used to directly collect management data where and when the activities take place. But the data is useful only if healthcare management has the opportunity to examine it with its own analysis tools.For instance, while computerised ordering systems are regarded as important, the fit between organisational and information system models is not identified as a success factor. Clearly, th ere is a need for systems that optimise clinical workflow, as well as those that support the attention of equipment and supplies. However, systems provide optimal organisational value only if they support an integrated organisational model and business plan. 5. Conclusions This thesis points out that healthcare managers at different levels in an organisation all need the same primary data.The differences among the various management levels all concern the ways in which they compile the data that they need for their work. One problem when developing management information systems for healthcare organisations has been a drop of interest in integrating administrative, financial and clinical systems. In process-oriented healthcare organisations, integration is essential to obtaining the full benefits of such a structure. System thinking must also pervade the development of healthcare management information systems.As a result, the multiple roles played by information in process-orient ed healthcare organisations must be identified. 6. approaching work Identifying the multiple roles played by information in a process-oriented healthcare setting requires additional research about the process of designing an HIS. In the interlinking environment that healthcare organisations represent, various practitioners are required to pinpoint data sources and information 15 Management Information Systems in Process-oriented Healthcare Organisations requirements, as well as to advocate for the process of change in the organisational and information structure.Healthcare managers have differing preferences when it comes to information requirements, organisational processes and work activities. Thus, the development process relies on tools that can incorporate those divergent needs into system thinking. As a result, primary data is refined into information other than at the various levels of a processoriented healthcare organisation. More research is required concerning informati on system models and their notation. Though various groups (system analysts, designers, programmers and healthcare managers) can employ models and modelling activities during a development process, their objectives differ.Healthcare managers need to visualise their work environment and organisational processes, system analysts are interested in developing information systems in collaboration with designers, and programmers are looking for coding specifications. They may share a vision in terms of designing a healthcare information system, but their perspectives vary. Thus, the modelling effort should be based on at least two dimensions (1) furnishing models with notations and objectives oriented towards specific groups (2) ensuring that the models visualise the same system but address varying interpretations.Arguments based on the cognitive and practice perspective have identified prototyping as a dark-fruited approach to the development process (Houde &Hill, 1997). Prototyping is often used when the design calls for a high degree of pastime on the part of practitioners and end-users (Bodker & Gronb? k, 1991). Modelling, on the other hand, is linked to an organisational perspective and is frequently employed by system analysis methods. Thus, there is an opportunity to combine these two perspectives during the development process.Modelling is useful as part of a design theory with a high degree of practitioner stake alongside of system analysts, designers and programmers. 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