The critical success factor approach to strategic alignment: seeking a trail from a health organization's goals to its management information infrastructure.

The critical success factor (CSF) approach is a technique that will aid health administrators, planners and managers to identify, specify and sort among the most relevant and critical factors determining an organization's survival and success. Following a top-down management perspective, this paper discusses the CSF methodology as a strategic information management process comprising several important phases: (i) understanding the external factors such as the organization's industry, market and environment; (ii) achieving strong support and championship from top management; (iii) encouraging the proactive involvement of management and staff in generic CSF identification; (iv) educating and directing the participation of staff members in CSF verification and further refinement of generic CSFs into specific CSFs; and (v) aggregating, prioritizing and translating activity-related CSFs into organizational information requirements for the design of the organization's management information infrastructure. The implementation of this CSF approach is illustrated in the context of a British Columbia community hospital, with insights provided into key issues for future health researchers and practitioners.     

Health care leadership in the public interest

Successful institutional leaders articulate a sense of organizational purpose and mission, and establish and maintain an organizational culture that fits with that purpose, while anticipating and responding to external and internal dynamics that will affect the organization's capacity to meet its role. In health care, the organizational purpose is necessarily directed to the broader community, and the dynamics that must be anticipated include not only technological and economic change, but also changes in public attitudes and expectations. In order for the institution to thrive over time, it must both be near the front of the curve of those changes while protecting and preserving excellence in its core activities. The key to effective leadership in health care organizations is effective two-way communication with internal constituencies, with the organization's communities, and with the broader public policy process. Health care leaders must take a more active role in responding to their communities' health needs and in shaping public policy toward health care.     

The Role of Community Health Information Networks in Disease Management

A Community Health Information Network (CHIN) is a web-based net of computer systems which allows the electronic exchange of clinical, financial and administrative information among unaffiliated healthcare entities in order to improve the efficiency and delivery of healthcare in the community. It achieves this through a combination of services, products and technology.One field of application in which CHINs can be very effective is disease management; the aim of disease management is to align patient, provider and payer interests in order to enhance quality of care and cost savings. CHINs can be used to effectively and efficiently implement disease management programmes through linking disease management systems (i.e. computerised disease management programmes) with other information systems. The application of CHINs in the implementation of disease management programmes has many benefits including shared data, internal communication, external communication, value-added applications, bonding and marketing presence. However, there are also problems and pitfalls of an architectural and ‘emotional’ nature. Architectural problems relate to legacy system incompatibility, legacy functionality, external data representation, communications disparity, distributed governance, flexibility versus homogeneity, confidentiality, and size and scalability. Emotional problems include personal barriers, community and ethnic cultural issues, and suspicion between the various levels of care involved in an information exchange process.Many examples of operational CHINs can be found on the Internet. Although many challenges lie ahead for patients, healthcare providers and healthcare organisations in this field, these examples show that the use of CHINs will influence medical and healthcare practice in a positive way, especially in terms of disease management.     

Strategic performance measurement systems: next step after dashboards

This article has summarized work being done at the leading edge of strategic performance measurement. Initiatives that today seem ivory-towerish tomorrow may represent the mainstream. Compared with the organizations profiled here, other health systems may be smaller, be less automated, or lack expertise in statistics and graphic presentation. Such differences should not prevent any hospital, medical group, HMO, or integrated delivery system from embracing in its own way the essential aspects of strategic performance measurement: Developing--as the cornerstone for measurement--a clear mission, vision, and strategy based on the organization's core values, core competencies, and customer expectations. Developing high-level performance measures of the organization's current performance and progress toward its strategic vision. Cascading measures throughout the entire organization, from the governing board and senior management down to operating clinical and administrative units. Expanding measures beyond internal operations to include measures of community or population health, systemwide measures along the continuum of care, and environmental scanning of key external trends. Using measurement actively throughout the organization to drive strategic planning and continuous improvement. Such efforts are not an "add-on" to busy board and executive agendas; they are an integral part of them. When measures on performance reports are reflective of organizational reality--like the speed and compass gauges on a jetliner's instrument panel--knowledgeable leaders will use them with ease. Even such complex constructs as spider diagrams, says Dr. Berman, are putty in a board's hands when the measures are pertinent and directors are educated about them. "They're useful decision-making tools because they're easy for our board members and managers to understand," he sums up. "They provide a snapshot of our organization."     

Developing countries' health expenditure information: what exists and what is needed?

In the past decade, the scarcity of financial resources for the health sector has increasingly led countries to take stock of national health resources used, review allocation patterns, assess the efficiency of existing resource use, and study health financing options. The primary difficulties in undertaking these analyses have been 1) the lack of information on health expenditures and 2) not using existing information to improve the planning and management of health sector resources. The principle sources of available health expenditure information are reported by organizations such as the World Bank, WHO, UNICEF and OECD. Special studies and non-routine information are a second major source of information. This existing data has a number of difficulties, including being sporadic, inconsistency, inclusion of only national level public expenditure, high opportunity and maintenance costs, quantitative and qualitative differences across countries, and validity and interpretability problems. Reliable health expenditure data would be useful not only for in-country, national purposes, but also for cross-national comparisons and for development agencies. Country uses of health expenditure data include policy formulation and planning and management, while international uses would facilitate examination of cross-national comparisons, reviews of existing programmes and identification of funding priorities. Collaborative efforts between countries and international development agencies, as well as between agencies, are needed to establish guidelines for health expenditure data sets. This development must ensure that the resulting information is of direct benefit to countries, as well as to agencies. Results of such collaborative efforts may include a set of standardized methodologies and tools; standardized national health accounts for developing countries; and training to enhance national capabilities to actively use the information. The opportunities for such collaboration are unique with the issuance of the World Development Report 1993, to build on this work in clearly identifying what is needed and proposing a standardized data set and the tools necessary to regularly and economically gather such data.     

Collecting data along the continuum of prevention and care: a Continuous Quality Improvement approach

For the past 14 years, a team of applied social scientists and system analysts has worked with a wide variety of Community- Based Organizations (CBO's), other grassroots agencies and networks, and Medical Center departments to support resource, program, staff and data development and evaluation for hospital- and community-based programs and agencies serving HIV at-risk and affected populations. A by-product of this work has been the development, elaboration and refinement of an approach to Continuous Quality Improvement (CQI) which is appropriate for diverse community-based providers and agencies. A key component of our CQI system involves the installation of a sophisticated relational database management and reporting system (DBMS) which is used to collect, analyze, and report data in an iterative process to provide feedback among the evaluators, agency administration and staff. The database system is designed for two purposes: (1) to support the agency's administrative internal and external reporting requirements; (2) to support the development of practice driven health services and early intervention research. The body of work has fostered a unique opportunity for the development of exploratory service-driven research which serves both administrative and research needs.     

Informed strategy. Information managers should play a key role in determining an organization's direction

Hospital chief executive officers need to set directions for their facilities' information systems, and information professionals need to play a more direct role in strategic planning, according to speakers at the Computers in Healthcare Conference last May. To implement effective information systems, chief information officers must be closely connected with the organization's capital budgeting and strategic budgeting process. A key strategic role for information systems managers is to educate organization personnel in the use of information technology. As demands placed on information systems increase, improving end users' skill level is the best way to take the pressure off. Information managers must create systems that respond to changes in healthcare, including the trend toward outpatient care. The information requirements for strategic planning include an external assessment and an internal assessment. Managers should strive to create information systems capable of answering strategic questions concerning patients, payers, practice patterns, and other key issues. Information systems also must provide data that allow managers to assess strategic decisions. They should also give top managers access to information that will help them identify and pursue broad new goals and directions.     

The CIO and IRM (information resources management) alliance: maneuvering for the competitive edge in hospital information management

In 1986, Johns noted that "The hospital industry was caught unprepared for the external demands and information needs required in a case-mix reimbursement environment." Lack of a data-processing philosophy and inattention to external forces were cited as having hampered technology upgrade and integration of financial and clinical databases. The intervening years have witnessed a growth of information dissemination in the health care industry concerning information value and resource management. The frequency of appearance of articles on information management in the professional literature and the number of workshops and professional meetings addressing the topic attest to the current visibility of the information resource. Despite this flurry of interest, the industry has not developed its own models of information resources management nor validated its information evolution with accepted management information systems models. While interest in health care information resource management exists, understanding of the complex issues in this area has not developed as one would expect. While there are a myriad of reasons for this, a contributing factor is the lack of a research foundation for development and application of theory and models. Even though various graduate programs exist in medical informatics and biomedical computing, few concentrate on the study of health information resource management from an organizational perspective. Because of this, academic research in the area has been minimal. The scarcity of graduate-level programs has also meant that few individuals have been educated to deal with the challenges of managing the many disparate functional activities associated with health care information resource management. Due to a variety of internal and external forces, extreme demands were placed on the hospital information resource during the past decade.(ABSTRACT TRUNCATED AT 250 WORDS)     

The reformation of information technology

During the last twenty years there have been major changes in European health services in the need for information, technology and the information user. The need for information for management purposes has been highlighted by the shift away from running institutions to providing health care for defined populations, and the diminution in financial growth available to health services. To provide comprehensive care in the current financial climate there is a requirement for relevant and timely information about the patients being treated, the population from which they come and the cost and effectiveness of the treatment being provided. Major changes have occurred in both the software and hardware available for information technology (IT) applications. Modern technology cannot only process statistical data but also acquire, process, store and disseminate vocal, pictorial, textual and numerical information. Among applications of interest to health service managers are quantitative data systems, planning systems, text management systems and communications both within the organization and with other organisations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of a Novel Electronic Genetic Screening and Clinical Decision Support Tool in Prenatal Clinical Settings

“The Pregnancy and Health Profile” (PHP) is a free prenatal genetic screening and clinical decision support (CDS) software tool for prenatal providers. PHP collects family health history (FHH) during intake and provides point-of-care risk assessment for providers and education for patients. This pilot study evaluated patient and provider responses to PHP and effects of using PHP in practice. PHP was implemented in four clinics. Surveys assessed provider confidence and knowledge and patient and provider satisfaction with PHP. Data on the implementation process were obtained through semi-structured interviews with administrators. Quantitative survey data were analyzed using Chi square test, Fisher’s exact test, paired t tests, and multivariate logistic regression. Open-ended survey questions and interviews were analyzed using qualitative thematic analysis. Of the 83 % (513/618) of patients that provided feedback, 97 % felt PHP was easy to use and 98 % easy to understand. Thirty percent (21/71) of participating physicians completed both pre- and post-implementation feedback surveys [13 obstetricians (OBs) and 8 family medicine physicians (FPs)]. Confidence in managing genetic risks significantly improved for OBs on 2/6 measures (p values ≤0.001) but not for FPs. Physician knowledge did not significantly change. Providers reported value in added patient engagement and reported mixed feedback about the CDS report. We identified key steps, resources, and staff support required to implement PHP in a clinical setting. To our knowledge, this study is the first to report on the integration of patient-completed, electronically captured and CDS-enabled FHH software into primary prenatal practice. PHP is acceptable to patients and providers. Key to successful implementation in the future will be customization options and interoperability with electronic health records.     

Issues management: the other side of strategic planning

Most health services organizations follow a strategic planning model that emphasizes organizational changes to adapt to the environment. This limited view overlooks the possibility of changing the environment to better suit the organization's goals. Health services leaders in particular are concerned because they have not been effectively engaged in dealing with external policy matters. A strategic issues management system provides an integrated approach to this responsibility and can be established by expanding current strategic management activities. Additional resources will be required for new analyses and interpretations and for more intense interaction with stakeholders, but these costs will be significantly less than the benefits realized from operation of an effective strategic issues management system.     

The evolution of external quality evaluation: observations from the Joint Commission on Accreditation of Healthcare Organizations.

The Joint Commission on Accreditation of Healthcare Organizations, the oldest health care accrediting body in the world, currently accredits almost 20000 organizations in the USA. Although continuing to be professionally-sponsored, accreditation's rapid growth in recent years has been driven by the external users of accreditation--government, purchasers, and public--rather than by the original users, the professionals themselves. This experience in the USA suggests that over time successful external quality evaluation mechanisms throughout the world will involve representatives of the public, purchasers, and government in establishing standards and setting policies. Without this involvement, these stakeholders are unlikely to find the mechanisms credible in addressing their needs, and will seek alternatives--adding cost and duplication to the external quality evaluation system. Successful mechanisms are also likely to provide more detailed information about an organization's performance to the public, purchasers, and the government, while creating evaluation processes that provide for innovation and support improvement in efficiency, as well as quality, through incorporation of aspects of the Baldrige and European Foundation for Quality Management approaches to organizational excellence. Finally, successful evaluation mechanisms are likely to create a special focus on the safety of care, incorporating aspects of the International Organization for Standardization's ISO 9000 approach to quality management. While the specific nature, priority, and timing of these changes will differ from country to country, they are likely to influence the evolution of external quality evaluation throughout the world. External evaluation of health care organizations' quality holds great promise, but its long-term success depends on responding to all those who will want to depend on it.     

Planning for successful outcomes in the new millennium

The complexity of the health care environment will increase in the next millennium. Organizations must adopt an approach of selecting outcomes management solutions that are focused on data capture, analysis, and comparative reviews and reporting. They must decisively and creatively implement, in a phased approach, integrated solutions from existing robust systems, while considering future systems targeted for implementation. Outcomes management solutions must be integrated with the organization's information systems strategic plan. The successful organization must be able to turn business-critical data into information that supports both business and clinical decision-making activities. In short, health care organizations will have to become information-driven.     

我国纵向型区域医疗联合体的进展与挑战

纵向型区域医疗联合体是纵向整合型卫生服务体系的组织形式,对于实现区域医疗卫生服务整体效能最大化,使有限的卫生投入发挥最大效益,具有重要意义。本文综述了国内在纵向型区域医疗联合体方面的实践和进展,目前绝大部分的模式主要是通过医疗机构自身联合或行政手段支撑,外部政策支持不足,进展阻力较大。发现主要存在外部行政区划分割造成的体制性环境限制,外部运行机制性配套政策支撑不具协同性,各层级医疗机构纵向协作内在动力不足等问题,群众对于创新服务体系的组织形式缺乏理解和认同,区域卫生信息网络化滞后等。建议政府作为主要推动者,开展医联体顶层政策设计;在顶层政策设计下完善外部运行机制的各项配套政策;完善医联体运行的内部治理和外部评价机制;提高基层服务能力,提高患者对基层医疗卫生机构的认同感和信任度;对县域纵向整合型服务体系作出统筹的制度安排。     

Perceived quality of management information and the influence of overspending penalties in the NHS.

The information needs of managers have changed considerably since the introduction of the internal market and many NHS units have invested in new management information systems to enhance the organization's performance. The characteristics of good quality information include accuracy, timeliness and comprehension. Information for management control also benefits from participation between the provider and the user. There are behavioural implications of using information as a control device and managers must internalize the financial objectives of the organization, usually expressed in budget reports. Failure to meet targets must attract penalties that will influence the managers' behaviour. They must respond to the information provided if control is to be exercised. This paper gives the results of a study into managers' perceptions of the adequacy and usefulness of financial information and the impact of penalties for overspending. It concludes that the financial information currently provided fails to meet many of the criteria of good quality information. Any perceived penalty for failing to attain budget-related goals is better than none, and there is little distinction between an overt reprimand and the ultimate sanction of dismissal.     

What is the appropriate health policy content in a program curriculum?

Faculties of graduate health administration programs have considerable flexibility in applying curriculum guidelines established by the Accrediting Commission on Education for Health Services Administration (ACEHSA) to help achieve their self-determined missions. When a program's mission includes preparing graduates for eventual careers at the strategic levels of healthcare organizations, specific health policy content is appropriate. In determining this curriculum content, faculties can be guided by the need to prepare graduates to accomplish three policy-related activities that are vital to successful strategic management: 1. comprehend and understand relevant governmental health policy aspects of a healthcare organization's external environment, including assessing the impact of these aspects of the environment on the organization; 2. lead strategic responses to the challenges and opportunities emanating from the governmentalhealth policy aspects of an organization's external environment; and 3. participate in shaping, to the organization's benefit, the governmental health policy aspects of its external environment. Curriculum design options for providing this content are discussed.     

Determinants of a merger in a publicly-funded health system: a political-economy perspective

This article reports the results of a case study, spanning a period of 10 years, of the merger of two hospitals in a publicly-funded health system. A political economy model was used to analyse the determinants of the merger. Results show that external political economy factors, mainly pressure from the state to rationalize health services and the organization's needs to acquire critical resources, significantly contributed to the merger decision. At the internal political economy level, groups and individual strategies also played a determinant role. Our study suggests that merger in the public sector may not necessarily result from efficiency motives.     

Preparing for the JCAHO survey

In summary, the future success of a health care organization's ability to meet changing JCAHO standards will be dependent on the integration of information throughout the organization. The growing demand for reliable and accessible data for all levels of staff has become a daily need in health care. One of the key questions that will be posed by future JCAHO surveyors will center on current abilities to integrate and send information from a variety of sources to those who need the data within the organization. Many organizations are planning and implementing strategic plans to create linkages between existing information systems and further the overall systems knowledge of all staff.     

Product-line management defined

PLM will have a significant impact on an organization's mission, management philosophy, marketing plan, and most definitely, day-to-day operations. PLM offers an alternative to traditional management approaches for the medical record department and the health care industry as a whole. The medical record professional should understand PLM both as a hospital wide structure and as an internal structure used to maximize departmental productivity and use of resources.     

The role of environmental health in disaster management: a qualitative study of Australian experiences

Even though environmental health is widely considered to be an integral component of disaster management, limited research on this topic has been conducted. Using a qualitative approach, the authors conducted in-depth interviews of practitioners in Queensland, Australia, to explore the role of environmental health in disaster management and determine how those internal and external to the profession perceive this role. The major themes that emerged described a process in which the "view of health" is socially constructed, and this process is instrumental in shaping perception of the environmental health role in disaster management. The authors also found that the role of environmental health in disaster management is experiencing renegotiation due to a complex process of challenging the socially constructed view of health, raising the profile of the profession, and achieving increased representation in disaster management. Ultimately, increased recognition and a heightened profile of environmental health will result in a more effective disaster management system and will carry over into day-to-day activities.