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.

Is the correlation between business and IT strategy yesterday’s struggle?

I have, on several occasions, written about the correlation between the corporate business vision and strategy, and the IT strategy. How one forms the other and how clinical IT can transform the healthcare system. OUH has a clear research profile in its development plan (strategy) towards 2014, with exact goals and intentions. This should be apparent in the IT strategy as well, where certain paragraphs should address the research goals, and as to how IT can support this with solutions that bring the hospital closer to realizing said goals.

A sound theoretical model as basis for your work is the Strategic Alignment Model (SAM) which the University of Aarhus teaches in one of the courses in which I’m the examiner.

However, is it actually as simple as I sometimes imply? Something says it is not. Hospitals are often run according to operational settings, and because of this, strategy needs to be adjusted continually to prevent downtime in operation, decrease in quality or that everything simply stops due to unsuccessful IT initiatives in which effect cannot be measured before (maybe) 2-4 years.

I read an article in Computerworld regarding IT strategy where the managing director of Delta presents his strategy through 16 slides. This made me consider if you, as the theory has it, can plan and adjust continually or if the complete connection between business and IT strategy is more of a theoretical concept than a practical option. The truth is none of the above - simple as that – but then what?

Raf Cammarano suggests an answer in his article ”Why Business-IT Alignment is Yesterdays’ War” to what it is that is so difficult. He argues furthermore that instead of correlation you have to aim for synchronization. The difference, as I perceive it, is that correlation is more static while synchronization is an ongoing process, where one initiative or a new direction in the business strategy results in an immediate IT strategy adjustment. In the 16 slides presented by Delta this organic approach is the simpler one. It becomes, however, imperative that you ensure that everything isn’t always in play. Lucid goals and visions and a defined framework must be maintained to avoid perpetual leniency.

Raf Cammarano mentions a line of points that preclude seamless correlation (alignment). These are:

”Unfortunately there are four types of lag that make it almost impossible for IT Departments to stay synchronized with the organization:

• Stimulus lag: the delay between the business changing course and IT finding out about it
• Response lag: the delay between IT finding out about the change and deciding what to do about it
• Execution lag: the delay between IT deciding what to do and actually doing it.
• Results lag: the delay between IT completing what it needed to do, and the business seeing the results.

 In an ideal world there would be no lag and IT would be perfectly synchronized with the rest of the organization. Although we don't live in such a world, CIOs should nonetheless aim to reduce each of these lags as close to zero as possible.”

However, my point is not to cancel the discussion of business versus IT. On the contrary, it is more important than ever and we need to consider this more often than every three years, when the business releases a new strategy.

If this does not happen then the whole correlation will vanish and IT becomes short sighted and operation oriented, losing planning, correlation, synchronization and strategy in the process.

Centre for Innovative Medical Technologies, CIMT

I have previously written a post about benefit management of IT projects in the health sector. One area that traditionally have not had the great attention when large and small IT projects ended and went into operation in the hospitals I've worked on. From an economic point of view, among other things, this is not appropriate because the business case that was the basis for the project will never be realized, and thus it is unclear whether the project actually creates the benefit or the value that you expect.

In addition you misses the learning of the work done with the business cases as estimates and project plans are never evaluated and assessed by practice. 

They are, in other words, theoretical goals that never gets a working life or a  conclusion.

Benefit management does not happen because, as described above, occurs because you do not evaluate, assess or analysis the of projects. Therefore there will be no evidence of a technology in a particular area or speciality, at a particular group of patients with a particular skill group (s), etc. ., Does the technology create the value, change or effect that you anticipate? You just don’t know…

Here I am not talking about the IT-related effect. No it is the clinical effect that is interesting in this context.  What does the technology to patient care, quality, organization, management, waiting time, patient satisfaction, processes, treatments? and so on. To put it bluntly, we just don’t know.

In a health care system that so much is evidence-based, and where research goes hand in hand with the daily clinic, it's scary that there is so little research and evaluation of the technologies we are introducing.

That brings me to my real point. I have very peripherally involved myself in the work on the establishment of a Centre for innovative medical technologies(CIMT). This centre will focus research on the impact innovative technologies have on the clinical area.

The centre is a virtual construction between University Hospital and University of Southern Denmark. As The ministry of science, Innovation and higher education write on the Department's website:

Today there are only a limited scientific evidence of efficacy and effectiveness of innovative medical technologies. This fact is also recognized by the European Commission as one of the possible explanations for the lack of market penetration and large-scale implementation of telemedicine solutions. This led in 2009 to the start of work on the establishment of a European evaluation model and the subsequent establishment of large scale documentation projects.

University Hospital has been a key player in this work and want to promote the development, testing and implementation of innovative medical technologies, and the evidence of the effects and consequences of these.

And CIMT writes: Center for Innovative Medical Technology - also known as CIMT - is a new research and innovation center for Odense University Hospital (University Hospital) and University of Southern Denmark (SDU). founding of CIMT formalize the existing cooperation between the two institutions and creates the basis for stronger collaboration through a strong common research focusing on the use of medical technology. CIMT should also ensure increased visibility of research and innovation efforts in Southern Denmark in Denmark and internationally.

I welcome this initiative. It is time to take digital solutions, innovative technologies, IT and welfare  technologies into the evidence-based course. It is never too late and there will be room to make a difference, perhaps even worldwide.