Are the new hospitals in Denmark really really super?

The press has named the new hospitals in Denmark to super hospitals. It is a very ambitious word - super – to be using and it rests heavily on everyone's shoulders to deliver on these high expectations. However, is it actually super hospitals we are building? Let us first define what the word actually means super.

According http://www.denstoredanske.dk/ means SUPER following:

super, (lat. 'above'), Latin and international prefix denoting location, extent or amount, see. superpower, which is a particularly powerful superpower; is also used with reinforcing intention in everyday terms like super good.

We are dealing with a concept that can be compared to top-notch and great (maybe even unique according Gyldendals dictionary. Super has a reinforcing effect and it increases a given value of the word it attaches to. As in the example above, then super good, is better than just good. Let us take two examples

The first is from space:

nova (from Lat. (stella) nova 'new (star)', feminine form of novus 'new'), star whose brightness in a matter of days, from a thousand to a million times greater. During months, for slow novas years, the brightness decreases gradually to a normal for the star.

A supernova is a stellar explosion that briefly outshines an entire galaxy, radiating as much energy as the Sun or any ordinary star is expected to emit over its entire life span, before fading from view over several weeks or months.

This first is a slow increase in intensity and brightness to eventually return to its original strength. A supernova is a doomsday explosion in a short time that can outshine an entire galaxy. See that is truly super.

The second example is the word man and superman. Superman is characterized by the fact that he has (super) powers, x-ray vision, is invulnerable, can manipulate time and has a super moral that helps him, he fights evil and saves the world again and again. Superman is not any man - no, he is a superman because of his superb qualities.

So a super hospital must be something much more than just a hospital. But as with Superman and his forces, sight, etc., what characterizes a super hospital and are we actually going to build them or are we building minimally improved hospitals that does not deserve the title of super. I can often be in doubt. Especially because the press in Denmark has focused on the lack of founds, the decrease in the amount of beds and overall quality in all the hospital construction projects. I guess the politicians are right, when they say that you cannot judge the future hospitals superpowers by the amount of beds. The clinical area will change much within the next 8 years, so to talk about the design, architecture and the correlation to the future healthcare delivery is just not possible.

But then it is also obvious that the argument goes both ways – you do not know the healthcare sector of the future – and therefore you do not know if your future hospital will be super!

The only real fact is, that the hospital will be new, shining, white, single patient rooms etc. But if super is new way of delivering healthcare, new ways technologies that supports the healthcare of tomorrow – you don’t know. Super in that equation is new as in a new building – the rest is pure speculation.

So what is a super hospital is the million dollar question that everybody assumes they know – but none articulate it in detail. The. Expert Committee has identified areas they believe characterizes a super hospital. You must increase the hospital operation efficiency by 8 per cent , build single man patient rooms, increase productivity and convert treatment towards more day surgery, thereby allowing the closure of almost 20 per cent beds. Very practical but probably not the full picture of a super hospital

New OUH's vision is trying to define the super hospital, but if you are going a step deeper: what characterizes it in detail - no one knows - but everybody says it - super!

It would be interesting, now that politicians are the fathers of the super hospitals', to hear their views on what is a super hospital for them? And also what is it for the patients, the employees and of course the general Dane – we are paying for the party through taxes and we expect a super hospital. I guess we all fail if super is not defined.  It is difficult – maybe it is because it is not super at all.

What is a super hospital for you?

Leadership mindsets for IT success

I have recently started teaching University students in IT, Communication and Organization. Basically it is a subject regarding basis IT skills (What is cloud computing, how is the internet designed etc) and secondly it’s about strategy and aligning IT with business objectives. As I have previously mentioned in this blog I find the subject of IT and business fascinating, and I hope to at least empower my students with the knowledge about how it can be done and how hard it actually are to achieve.

Anyway, during my research for the class. I came by a very interesting and accessible little piece regarding the leadership mindsets in business. The article is written by Professor Donald Marchand and Professor Joe Peppard and was released in The European Business Review in March-April 2014 issue.

What I like about the article is, that it focuses the main points and arguments in a short form and in the end; it points the reader to the future by some practical advice.

The authors main point in the article is basically that with different mindsets on IT and information within the business, the role of IT will change: "…these differences in mindsets and thus perceived roles and responsibilities of senior managers and CIOs, the implications for how information recourses, IT, and knowledge are managed in the company will differ.. dramatically."

So the mindset of senior management and the CIO will affect how the company will use and regard IT investments. No new knowledge in that. However, the article suggest a Matrix where the business manager roles on on Axis and the CIO on the other.

http://www.europeanbusinessreview.com/?p=302

An excellent matrix, that gives the necessary input to a discussion on how we regard IT today and where would we like to be. A strategic talk about IT and business.

In the end, the authors suggest two key questions that should be explored during the strategic discussions senior management and IT have. They are as follows:

Where are your group or business unit management teams and CIOs today in terms of mindsets, behavior, and shared language?

Where should your business unit management teams and CIO be in the future related to the strategic management of information, IT and knowledge resources.

I can only recommend the small 4 page article to all management teams – both business and IT – It’s a great start for further elaboration and discussion on how will we regard and ultimatly use IT in our business to gain for example a competitive advantage.

The planning of IT – is it a necessary evil ?

What if you are in charge of a centralised IT department with infrastructure architects, solution architects, business consultants, account managers etc. And lets say the company is huge and has large departments all over the world. Again lets imagine that the departments are in charge of implementing and administration of the It systems for the entire organisation. So they have, so to speak, divided the systems and projects among themselves leaving the centralised IT department with architectural consulting and Infrastructure as their only areas of responsibility. To govern the IT they have established a kind of Architecture board, where decisions of a strategic level are made as well of decisions of how and which projects to proceed and fund. An important board that if respected and used have the ability to align the decentralised organisation in and around a common business strategy.

I guess with the above organisation,  IT is closer to the business it is supposed to support, it might get the process of funding to run more smooth, because the local management knows exactly where it hurts. It is very agile and can react to imminent issues that may arise as small or medium business can do. The problem, or positive people would say challenges, are of course, to align all the IT initiatives, IT management and operations, IT projects and the overall IT planning process, of the organization as a whole.

When power and decision making are decentralised people tend to decide and use that power. Often not for the greater good of the whole organisation and not for the long term planning – actions are often isolated decisions based on local knowledge, local challenges and therefore short term IT planning.

So no system or organisation is perfect – but maybe we have a solution where we can have both local knowledge and business integration at the same time as long term strategic IT planning.

It is called Enterprise architecture – and it fucking rocks if it is implemented and respected by all the participants in the organization. The video below quickly explains the concept of enterprise architecture way better than I can, so please take four minutes to watch it.

I am certified in TOGAF 9.1 Enterprise Architecture and that is just one out of a handful methodologies regarding enterprise architecture.  The real issue with the TOGAF framework or more precise the Architecture development method (ADM)

The open Group (opengroup.org)

is to gain enough speed in the administrative process, that implementing EA will not result in a standstill of the IT within the business.  If that happens, the business units will just circumvent the EA processes and acquire the IT themselves. The more the individual departments operate on their own – the more short termed and individual are the IT planning – but then again it is closer to the business needs. On the other hand the more centralised IT is planned, the more administrative and bureaucratic everything can tend to be and then it will of course be further away from the eminent business challenges.

I guess I don’t have the answer except that short and long term planning is necessary. The TOGAF EA is a great way to handle it – It just need all to respect the processes established and it needs to be tailored to the organisation it is supposed to support – otherwise the resources are lost and we might even be further away than when we started to plan for IT in the first place.

By the way - good people will leave in all the parts of the organization if you do not respect the craft of doing IT properly. Especially the enterprise architects will not tolerate that business and IT is done with no planning and with a little or no respect to strategies, business needs and the processes that have proven best. TOGAF calls that capability based planning - how the overall EA capability of the organization is established and maintained -  don't ever ignore that in your organisation either.

There is no such thing as a pilot in the healthcare sector

I often wonder why IT projects within the healthcare sector, always takes a lot of time or end up so big, that the project management cannot handle them and the project schedule is delayed.

Often in IT projects there are a clear understanding of the business case, the goals and purpose of the system. But people never the less does not talk about what a pilot is for and why they have chosen that particular method and for example not a lab test instead. In healthcare there are no such things as a pilot, because we need to focus on patient security and a high quality of the delivered treatment. Pilots with less functionality or even simulated data flows, do not go well within that paradigm.

In my time in IT management in a big university hospital I heard more than the opposite doctors and nurses argue, that a pilot project would be ok, but not until that integration or that functionality is implemented as well. If project management give in, the project is growing and the pilot will not start until the entire system is in place, and that can take a lot of time. Low hanging fruit slowly ascends into the three tops so to speak, and are harder to reach.

Projects in the healthcare sector can be illustrated with one of my personal favourite Gifs. Everything is lined up, the field is well described and marked, the goal is clear and in sight and you has even implemented some organizational and functional routines to help the system into implementation. But quick the project gets to big and crashes half way towards a milestone.

 
I guess one way to solve the above paradox is to really understand and communicate the purpose of the pilot and not let the project grow out of its initial scope. Furthermore, always make it clear, that the system after ending the pilot might get shut down, so you will not make severe adjustments for a lot of money on a system that might not be implemented fully within the organization.

So my I guess my point is, that be careful with your health IT projects, get it aligned exactly with the business needs and don’t overdue the functionality. Keep the fruit low and don’t let perfect be the enemy of good.

The power of simplicity - a way of looking at Requirements

Based on the clinical concepts of the New University Hospital and decisions about design and architecture we can identify a range of functional requirements that describe future processes, working methods etc on New University Hospital. Decisions for example that we build single person patient rooms single rooms or the establishment of cluster pharmacies will also require a wide range of requirements for future solutions.

From these functional requirements we then can identify a number of IT requirements that will make us able to solve or meet the functional requirements. These IT requirements can be assembled in IT solutions that solve one or usually more functional requirements. In other words, it reflects the clinical concepts and architecture and design requirements for future hospital - IT solutions ensure that these can be realized.

The following is an example where the kitchen and food logistics concept and the choice of making local floor kitchens around the hospital will cause the food to be transported from the central kitchen out to the floor kitchens. Here it is prepared and served on trays to patients. The Central kitchen staff therefore requires that they can monitor the food temperature from leaving the central kitchen to arrival in the floor kitchen. This is referred to as they want to monitor if the "temperature chain is broken." This can be solved in many ways, and one of them is to install censors in the crates which food is stored in. Data on temperature must be collected in an IT system, and to be given an alarm if the temperature rises to an agreed level and therefore the temperature chain is broken. Functional requirements from the central kitchen about securing healthy food that are always cold ends with an IT solution or an expansion of existing solution, so it is possible to continuously monitor the temperature of the food and give a warning if the temperature rises above a defined level.

The method is rather easy to understand, to communicate and it ensures that we always focuses on the business requirements and not start with IT. I guess a simple, understandable and effective method is always preferred in a busy schedule. It works for us at least.

Benefit Management may save us all!

I just read a thesis from the University of Aarhus, about harvesting value in IT projects. The students named the area as Benefit Management (profit realization), and is a highly relevant and general area that many organizations should prioritize. Particularly in the health sector.!

I've often wondered that in such a research-heavy and evidence-based system such as health care sector, how can you introduce New Technology, new processes around technology and new skills among staff, without knowing the evidence or just the effect on productivity or perhaps quality.?

Currently there are deployed  IT in the Danish health like in a pace not seen before. In Region Southern Denmark the regional project portfolio consist of more than 50 large and small projects, so spending millions and billions on a national level - and what do we get out of it? Well to put it bluntly we often don’t know!

Benefits management is defined in the book "Benefits Management – How to increase the business value of your IT projects" written by Ward, J. & Daniel, E. 2012 as:

“The process of organizing and managing such that the potential benefits arising from the use of IT are actually realized” (page 8)

Benefits Management is all about identifying and harvesting the value that a given project has the potential to realize. Currently projects are not initiated in Region of Southern Denmark without having drawn up a business case. But how will the projects be prioritized towards each other? And do we work adequately with identifying the value a given project may realize. Maybe – but probably not.

But when the system, technology or equipment is implemented, how is it ensured that the gains that were identified in the business case is realized. ? There may have been a tendency not to make this impact assessment, evaluation, or otherwise measure whether what you thought you got out of a project. Traditionally, the value collected are invisible deep within the operation of the organization. The point is that we often do not know what the value is and therefore we cannot harvest it.


I guess benefit management has two major objectives. One is on a macro project management level to harvest the value on a organizational level. It could be to increase the effectiveness with 2 pct. or to reduce adverse events. The other is on a local level, where the individual ward or department can identify their special benefits from the implementation and then try to work towards those when implementing the system. Done right it may help on the projects implementation success rate on a local scale, because the receiving users take responsibility on the implementation and the goals/benefits regarding it.

In my organization we have used the Himss IT value suite. In short it is a framework to identify the following:

•    How do we know Health IT works?
•    How does Health IT improve patient care?
•    Can others duplicate the type of value others have achieved?

The framework is suitable both on the managerial/organisational level but also on the local level, where a discussion with the headline “what is a successful implementation in our ward” the main issue.

Benefit management is and must be our focus otherwise we invest, implement, learn and reinvest in the dark. To know the impact is crucial also because only then are we able to share our experience and help others in their efforts.

It took two very talented, hard-working and well-prepared students to get my eyes to the problem again. (I gave them the grade 12 for the rest). They introduced me to the field on an academic and structured way. The road is paved with endless amounts of benefits and value of digitization - we all have an obligation to pursue these unyielding, and the courage to harvest them  in a proper and professional manner.

Ward and Daniel is a great book by the way – and I highly recommend it.

A full automated, double loop medication process in action – awesome expierence

In our project there is I clear line between the choice of less beds,  a fixed amount of m2 and an 8 pct efficiency increase, to new solutions that will help the hospital to operate in the new environment. The best is of course a solution, that will meet those requirements and increase the overall quality of the care delivered. IT has a tremendous role in that equation. So instead of talking about an increase in beds or m2, the discourse is and must be about new solutions because the constrains are fixed.

Last week I was in France – Annecy to visit a hospital that was build a couple of years ago. On the IT side the wards, patient rooms, EHR, RIS/PAS etc we were quite up to speed. They did not have anything revolutionary installed, and they to had a lot of patient terminals that no clinician used. But then I realised they did not have any big medicine rooms on the actual ward only a small area with acute medicine. So that intrigued me, because New OUH will be build that way.

We were then allowed to visit their pharmacy and there I got a huge surprise. Everything was automated, every drug was tracked and medicine was delivered to the ward automatically based on the data the doctor ordered in the EHR. For the first time a saw the whole process automated and it was a great success.

An Italian firm had delivered the robots (I guess they are better on healthcare robots than on trains) and the system seems to run smoothly.

Pill pick robot and unit dosed medicine

So

1. Robot that cuts medicine from the blister packs into one unit packets
2. Robot that counts the units to ensure they are all there
3. Robot that packs the units in separate bags withs barcodes and RFID
4. Robot that stores the units
5. EHR registers medicine prescribed and send data to pill pick robot
6. Pill Pick robot then picks the units and packs them for the individual patient and bind them together
7. The medicine is then shipped to the ward by a tube system

The above is not a futuristic vision – it is real and in operation in France. It will save m2, increase efficiency and tremendously decrease the amount of adverse events due to errors in the medication process. What’s there not to like for a future digital, “small” and efficient hospital.?

Ownership of healthcare data is an irrelevant discussion

I have just been in Finland for the annual conference in healthcare IT where I did a speech on “From the structural reform to new hospitals projects”. It was a great experience, and the conference had over a 1000 participants and a great vendor area. On day two I was invited to participate on a expert panel arranged by the Finnish health ministry, who are finalising the national ehealth strategy.

The expert panel consisted of a group of very influential people including the CEO of Himss Stephen Lieber, Hal Wolf former of Kaiser, Hans Nielsen Hauge of Norway, Uwe Biddrus of Himss. We should comment and influence the final draft. I am rather proud to be accepted in that crowd and we did our best to comment and discuss the content and the direction the strategy described.

It is a very ambitious strategy, where municipalities, social services, hospitals, general practitioners are all covered in and end to end continuum of care strategy. I found it inspiring and the big challenge now will be to get it flying, coordinated and actually implemented within the Finnish system.

When we discussed the strategy, we landed on the subject on who will own the health data. It is the patients data, and the patient will in the future generate a lot more for themselves – we have seen a fraction on that with fitbit etc.

In the future the patient will probably meet the healthcare system with a huge amount of self-collected data, and say here you go, use it to cure me and to personalize my treatment. After a while Hal Wolf directed the conversation towards the issue, that it is not about who owns the data (strictly a legal issues) – It is who have access to the data. I think the first legal question shouts down the discussion more often that it opens it up – so the shift in paradigm was a very welcome gesture from a very knowledgeable man. In the end it is all about access and nothing more actually.

We need knowledge and information to be able to coordinate the care and bring healthcare towards personalised and integrated care. It took me a trip to Finland to truly realise that.


By the way. Finland stands on the brink on something great - I guess the magnificent vendor area is a sign to that. Investments will be huge and we should all help and look north - because a change in healthcare might come from that direction sooner than we know it.

Book Review: The Phoenix Project: A Novel About IT, DevOps , and Helping Your Business Win

First published in danish here

I would like to recommend you a book on IT operations . It is written as a novel, but contains significant learning points and academic elements that are relevant. The book is written in an attractive and readable language, with many all-action sections where IT operations often are compared to war-like situations or American action movies. I have several times been thinking my time in the military, when the authors are talking about crashes in IT systems. For example, the IT operations chief speaks to his section leaders on a massive crash in the payroll system and then a crash in the SAN:

 

 First, the events that led to the SAN and payroll failure on Thuesday may not happen again. What started off as a medium-sized payroll failure snowballed into a massive friendly-fire SAN incident. “ s. 78.  

 

 One is tempted to shout hell yea - Oorah . (Expression from the Marines) when reading these passages in the book.

 

At the same time I often find myself smiling of recognizable elements in the small incidents portrayed in the book. These episodes are easy to relate to from my own time in an IT operations organization. This makes the book relevant and funny in its own light consenting shape.

 The book starts with the main character Bill Palmer being promoted two levels in the IT department of a large manufacturing company that produces car parts. Bill is a former Marine and a sergeant and hence the book's explicit big hero. He goes from being head of section in a smaller section with 6 employees to become Head of the entire IT operation. Meanwhile, a number of large business critical projects are delayed - especially the Phoenix project (part of the title of the book), which is a 2 -year delay, 20 million dollars big project to reverse the decline of the Company Bill is employed in. In addition, IT operations in the enterprise are characterized by their daily effort to fix a large number of issues and they have no overview of what the employees actually spend their time on.

The book's major theme is described fairly accurately on page 53 where Bill Palmer himself describes the issues that the IT department faces. The following may also be well regarded in a general perspective on the industry, and therefore the book's messages are often relevant and recognizable.

The plot is simple: First, you take an urgent date-driven project, where the shipment date cannot be delayed because of external commitments made to Wall Street or customers. Then you add a bunch of developers who use up all the time in the schedule, leaving no time for testing or operations deployment. And because no one is willing to slip the deployment date, everyone after Development has to take outrageous and unacceptable shortcuts to hit the date.

The results are never pretty. Usually, the software product is so unstable and unusable that even the people who were screaming for it end up saying that it’s not worth shipping. And it’s always IT Operations who still has to stay up all night, rebooting servers hourly to compensate for crappy code, doing whatever heroics are required to hide from the rest of the world just how bad things really are.( s.53)

Bill Palmer and his two section leaders are in the first part of the book thrown in one big IT crash after another, an external security audit and several issues that only a few of their employees  can solve (bottlenecks ) . After those issues Bill Palmer meets Eric Reid who has previously worked in the production at one of the factories and has now been offered a seat on the board. Erik Reid is Bill Palmer's savior and he introduces a number of tools that Bill can use to get a handle on his organization and production. Erik explains his method in a sort of hippie / Buddhism kind of way:

”The First Way helps us understand how to create fast flow of work as it moves from Development into IT Operations, because that's what's between the business and the customer. The Second Way shows us how to shorten and amplify feedback loops, so we can fix quality at the source and avoid rework. And the Third Way shows us how to create a culture that simultaneously fosters experimentation, learning from failure, and understanding that repetition and practice are the prerequisites to mastery." S. 91

Bill Palmer works subsequent to correct the IT department, aligns IT with business, ensure good and u bureaucratic processes and distribute work equally among the employees. He tries to identify and address bottlenecks and minimize unplanned work (read emergency breakdowns and project tasks) , to work in a structured , strategic and coherent end-to -end process. All the walls eventually are patched with Kanban boards and LEAN concepts are flying freely through the air. All very nice when he succeeds, but the portrayal of the book seems a little saved, and almost too easily managed and to happy.

The book is also a little archetypal in its character sketches. Bill our biggest hero, Patty is a change manager who love (long and complex) procedures, Wes is operationsmanager with everything that belongs to the subject. He yells before thinking it through , he 's a little overweight and loves technology more than people , John is the IT Security Officer and Bren 's IT nerd , magician , WizKid or some sort of Yoda doing everything in the IT department. Virtually nothing work in the IT department at the beginning of the book, and it cannot be fixed without Brent helps. When Brent works, he goes like in a trance-like state, manipulate code in an intuitive and incomprehensible way. (“You do not need to see his identification ... These are not the droids you're looking for ...).

In other passages in the book, the person depictions is little archetypal and ordinary, but that makes them on the other hand very recognizable from the real world. It is partly amusing but also instructive in terms of how to get people with different backgrounds and perspectives to work together.

Implementation of Eric Reid's three ways runs more smoothly in the book than it probably would in reality. There's just nothing that is that bad and that rapidly becoming well. But if you can ignore this, then the content of the book is still relevant. The book does not deal with human or cultural elements of such major changes, which is probably a major gap.

I think the book is excellent and I would recommend it to everyone in the IT industry. The book also provides an accessible insight into the engine room of an IT department, and illustrates the importance of getting an IT strategy, prioritization of IT projects and the selection of projects coordinated and consolidated with the business vision and goals.

On this basis alone, the book should be read by managers, department and section managers and development staff in companies, which are all dependent on IT to achieve their business goals.

The Phoenix Project: A Novel About IT, DevOps , and Helping Your Business Win
All page references are based on the Kindle version with an upright angle.

Videoclip: Nyt OUH and SDU meets the users of the New University Hospital

Yesterday Syddansk Universitet and Nyt OUH invited interested citizens to look and hear about our great and huge project. It was a great success and people had a lot of question to their future hospital, future neighbour and future workplace. Below are links to some media clips about the meeting (in Danish).

Book review: Enterprise Architecture As Strategy

Was first published in danish here

I have previously written about the IT industry as a place were empty words and promises lives well, and it is not entirely wrong. But when you are in an evidence-based health system, as I am, so will half intelligent methods/model and as we say in Denmark, sometimes long-haired solutions not supported by either the boardroom or among clinicians, not result in praise. Clinicians require evidence , and if they does not, then it might be because clinical practice has not been changed, we still deliver healthcare as we always have done and then there is no clinical effect. Power to paper and nothing more.  So it is only when the clinicians want to discuss the change of healthcare, our IT system is having an effect.  But then I bought the book :

 Enterprise Architecture As strategy , Creating a Foundation for Business Execution (2006 )

where recommendations and conclusions are based on 15 years of study ( started in 1995) , and more than 200 companies participated , so perhaps there is something conclusive and robust in this book's recommendations . This makes it, if nothing else, extremely interesting in a IT contexts , as this kind of thoroughness is not seen often in our line of work.

 The book I have read in the summer and it's about enterprise architecture . Not as a technical discipline, but as a managerial approach to strategy development. The book was written in 2006 by Jeanne W. Ross ( Principal Research Scientist. MIT ), Peter Weil ( director of CISR and MIT Sloan Senior Research Scientist ) and David C. Robertson ( Professor to IMD International).

The book describes how a company (hospital) create their Foundation for Business Execution . So a company's ability to execute / implement its key processes in a qualitatively high and reliable level . For this to happen, Ross, Weil and Robertson identifies three main areas a company must go through. You have to define and work with the following :

•     Operating Model (OM)
•     Enterprise Architecture (EA)
•     IT engagement model

Operating model is defined as : " ...the necessary level of business process integration and standardization for delivering goods and services to customers” (s. 8).. In other words, OM reflects the vision and strategy as a company's top management has decided . The claim in the book is that OM will influence and thus provide a framework and direction for prioritizing IT efforts in the future.

 Enterprise Architecture (EA ) is defined as : "The organizing logic for business processes and IT infrastructure reflecting the integration and standardization requirements of the company’s operating model (p. 47). EA should describe the relationship between the key processes in a company with systems and data. The two areas IT and business are closely related , and the authors of the book emphasizes the importance of the IT solutions support business strategy. To facilitate the understanding of EA work they introduce a so-called core diagram representing an overall view of the architecture , with key processes, systems and data that support the selected Operation Model is shown.

 IT engagement model is defined as : "” the system of governance mechanisms assuring that business and It projects achieve both local and company-wide objectives” (s. 118-119) . So a system of governance mechanisms , to ensure that projects achieve local and overall business objectives. Are you thinking Benefit Management - well you are not entirely wrong.

 In addition to individual passages in the book that has a, for a Dane, a too straightforward message: " we know best " and " do as we recommend , then it will go well in life ," then the book is well documented and in a language that is fluent and understandable. The book does not bury you deep in technical terms, but focuses on the managerial and strategic planning of IT and EA , as well as how it can be seen in the context of a business strategy . The book is intended for IT managers who are interested in a method that shapes and frames their plan to align IT efforts and architecture , but it will also turn to students as the book's theoretical underpinnings are solid and well documented.

 I would like to recommend the book, and with its 234 pages, it is a fast read for most people. I think it gives a breath of fresh air , introduce new ways and is probably close to something we in the IT industry , will  call evidence-based . If nothing then only for that reason. Read the book - We owe it to patients, families and especially clinicians. The services and systems IT delivers , should at least be as evidence-based as those services our clinic supplies.

 Enterprise Architecture as Strategy : Creating a Foundation for Business Execution Jeanne W. Ross, Peter Weill , and David Robertson, 2006 , Harvard Business School Press

HIMSS Continuity of Care Maturity Model - an importent patient focus acros the continium of care

In a few weeks Himss is announcing the European model of HIMSS Continuity of Care Maturity Model: Transforming Health through Effective Usage of Interoperability and Analytics in Nice in the start of April at WOHIT.

Himss is renowned for its maturity model EMRAM within the hospital sector, where 7 stages defines the maturity of digitalization within the hospital. The Nordic countries and maybe Denmark in particular have always focused on the patients journey.The entire continuum of care from the GP, to the hospital, municipality, pharmacy etc. Denmark has a widespread digital landscape that shares data as messages between the participants with the patient in the centre.  The Continuity of Care Maturity Model will address exactly that, and more importantly it will drive change into a focus around the patient and not the Hospital. You could call the new maturity model a patient centred model!

I have participated in the project of developing the model with Himss analytics as the project manager. It has been fun and very rewarding to work closely with other healthcare partners across Europe, but also to develop something different, something new and substantial important for the health services and organisations across the European Union.

The above sounds like a little flamboyant, but a maturity model is important. Not that it matters if you get a 5, 6 or 7 in an isolated perspective, but the model and the eagerness to achieve greatness will drive the business, the hospitals and partners in a certain direction. It will be a driver of change, and the model will point the direction and set out the goals – so of course it is important, that it is designed properly. Data shows in the US, that the higher grade you have in the EMRAM the greater your hospital will be within quality metrics end efficiency. So it is ultimately not about the digitalization, the grade or us bragging in the bar late at night about my hospital being EMRAM 6 or even 7! – it is and always will be about cutting costs and improving quality – it is about the patient and nothing more actually. 

I truly believe Continuity of Care Maturity Model will in the future be a factor in that equation.

Himss on the model:

HIMSS Europe is presenting the Continuity of Care Maturity Model, that evaluates various aspects of delivering continual care covering both capabilities at organization and pan-organization levels. The Model will measure the readiness of an organization to deliver continuity of care as well as the maturity of a healthcare system in the continuity of care delivery. There will only be a global model but regional specifications are possible within the model’s framework.

The model has been designed by HIMSS Europe in collaboration with a pan-European workgroup including country teams from Spain, the Netherlands and the Nordics. It comprises 32 individuals representing regional and national health authorities, strategic planning organizations, CIOs of groups or regions, industry and HIMSS consultants.

Understanding How Business Goals Drive IT Goals

Sometimes great things happen to you, and yesterday I ran into an article by the very interesting name: “Understanding How Business Goals Drive IT Goals”. It is written by IT governance institute (ITGITM) which is a non-profit, independent research entity that provides guidance for the global
business community on issues related to the governance of IT assets.

In the introduction they write:

In today’s complex and constantly changing business world, IT’s alignment to the business and IT governance are high on the agenda of executive management. Strategic planning based on the alignment of IT goals to business goals is a key component in business/IT alignment. It is important that an enterprise start with a clear view of its mission and a thorough definition of its supporting strategy and business goals. This then needs to be translated into goals for the IT department, which are the basis for the IT strategy. Finally, the supporting IT processes must be carefully planned to translate the IT strategy into action. For these planning efforts, enterprises may be looking for guidance to identify the set of important business goals and IT goals, and how they interrelate.

The article goes on and describes a set of top ten business goals and how they relate to a set of IT goals. It gives you a great input on how to work with translating business goals and work with them when you are in a management position and desperately needs that next IT strategy for your business and IT department. The list can inspire you on how the business and IT correlates and it goes very nicely with the Strategic alignment model I have described in my blog.

The article goes on and describes in detail business goals for certain business areas as for example: “Manufacturing and Pharmaceuticals Sector” or “Government, Utilities and Healthcare Sector”

I must say when looking at the list for healthcare I like what I see. The five first is:

1. Maintain the security (confidentiality, integrity and availability) of information and processing infrastructure. Operational
2. Align the IT strategy to the business strategy. Corporate
3. Make sure that IT services are reliable and secure. User
4. Ensure IT compliance with laws and regulations. Corporate
5. Translate business functional and control requirements into effective and efficient automated solutions. User

And that is a great crosswalk between operational goals and development and new initiatives (goals). Looking at Nyt OUH and our coming hospital to be, we have two major constrains or goals set by the state. 20 pct fewer beds and therefor an increase in ambulatory production and a 8 pct efficiency increase. The 8 pct is about 400 mill dkr, which must be found year one after the new hospital is in use.  I guess number 2 and 5 in the above list addresses that issue.

How can IT, new equipment and digital solutions help the hospital succeed and reach those goals?.

If, lets say 40 pct of the 400 mill is supposed to be harvested by new innovative IT solutions, then it is time to discuss how it is done. We need a well defined process and a method, that will bring us closer to the right solutions.

It takes time, money and resources to choose, implement and operate those solutions – We need to make the right choices, so our money is spent wisely and in accordance to our business goals – otherwise it is IT for ITs sake – and that will not necessarily generate more efficiency or reduce the number of beds we need.

Never let perfect be the enemy of good

I attended Himss 14 in Orlando last week. I participated in the Nordic ehealth exchange program, which I found was a great success. We discussed in the Nordic group on which strategy to implement within our countries, regions or hospitals. Best of breed or best of suite. Let me tell you, nothing is easy within the healthcare IT sector and that question especially fuelled a lively debate between my Nordic colleagues. A representative from Kaiser Permanente introduced the term “Integrated suite approach”, where I guess the best of both worlds unite into a seamless integrated platform for the individual clinician.  Utopia or reality? Well I like the term and it is probably that rather pragmatic approach we all take, because no suite can handle it all and silo best of breed needs integration.

Besides the above I learned through a short status from Island (all countries gave one) that they have decentralised databases and by a quick calculation – they have a fragmented EHR landscape with approximately 1 DB pr 23.000 inhabitants.! I guess it is not easy even for small countries.

But as a general learning point we all are battling with the same issues. Less founding, more elderly and conical patients – You all know the song. When you try to fix the problems and do better every day for the good of the patients one thing is certain. Small steps where you test, learn, correct, test etc is crucial. We tend to fix everything in one project and the risk it introduces is just enormously. As one said –

Never let the perfect be the enemy of good.

I guess it is correct when you do business process improvements either by IT or other means of change. In Odense we are building a hospital on a bare field, and even though we can start all over, we also have to work with legacy systems, old habits and organisational forms and local desires. But maybe we are in a unique position to really try the business process re engineering? We are going to try a total different approach on our way of delivering logistics.

I hope it is for the better for I know it will never be entirely perfect.

Thank you all my Nordic colleagues for an intriguing 3 days in Orlando. We can do much on our own, but even more together – And the Nordics are in front – let us keep that way. My only regret is that I did not engage with other participants as much as I should have done - I guess it is my loss.. but hey..see you all next year.
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Read more: Is the correlation between business and IT strategy yesterday’s struggle?
Read more: Centre for Innovative Medical Technologies, CIMT