TED Talk – Rotomskiene – Role of Stakeholders
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Innovation and Sustainability in the National Implementations of e-Health: an International Perspective on the Role of Stakeholders.

Innovation and Sustainability in the National Implementations of e-Health: an International Perspective on the Role of Stakeholders.

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  • Innovation – within this context means delivering new approaches in healthcare delivery – not being centred around the healthcare providers, but the patient. <br /> Sustainability – here means that deployed healthcare information systems are used by those they were intended to be used and delivering positive patient outcomes in terms of and ultimatelly – patient outcomes. <br /> National implementations – there are many success stories on how one or another IS was implemented within the boundaries of one healthcare organisation, the challenges yet begin when various IS have to be integrated accross organisational boundaries. <br /> e-Health – the term was introduced by the European Commission in 2004 to place a more focused attention to the process of ICT deployment in healthcare sector. <br />
  • However, certain conditions have to be met in terms who and how (at which level) has to be involved. <br />
  • Research was delivered as part of a longitudial case study research combined with on-site participant observation for 1 year and large number of expert interviews. <br />
  • I don‘t think anything can argue about this. <br /> And this is one of the main reasons we all are here. <br />
  • Starting with the EU Action Plan 2004 and ending with the most recent one - eHealth Action Plan 2012-2020: Innovative healthcare for the 21st century supporting current EU Agenda Europe 2020. <br /> And national e-Health development strategies in each of the EU member states. <br />
  • Number of studies: <br /> a study delivered by the Royal Academy of Engineering and The British Computer Society (2004), <br /> Oxford University/Computer Weekly survey (2010) or <br /> the Standish Group (2004, 2011) indicate that every year there will be around $81 billion spent for cancelled / failed software projects. <br /> There are no similar data available on success rates of healthcare IS projects specifically, however there is growing body of evidence suggesting that failure rates here might be even higher. <br /> Well, irrespective of the precise amount, it is clear that the price tag associated with IT project failures is unacceptably high. Both financial and in broader terms. <br />
  • Literature review suggests lack of qualitative research which will deliver new insights in this respect. <br /> Or they are not very well communicated or listened to by the practitionares. A contribution to close these gaps. <br />
  • Or the <br />

TED Talk – Rotomskiene – Role of Stakeholders TED Talk – Rotomskiene – Role of Stakeholders Presentation Transcript

  • Innovation and Sustainability in the National Implementations of e-Health: an International Perspective on the Role of Stakeholders Dr. Rasa Rotomskiene Mykolas Romeris University, Vilnius, Lithuania STS Roundtable, 2-5 October, 2013 Boston This research was partly funded by the European Social Fund under the Global Grant measure under the Project „Integrated Transformations of eHealth Development: the Perspective of Stakeholder Networks“.
  • The main statement of this research Stakeholder engagement does create the conditions under which national programmes for the introduction of ICT in healthcare sector lead to improvement and innovation in patient care and to sustainability of organisational change.
  • Main research object The national process of ICT implementation in healthcare sector and the strategies used for related changes to be transferred and embedded within a workplace level (a comparative analysis of the UK (English and Welsh) experience).
  • Main focus of this research: • to deliver new insights in relation to the national delivery of eHealth (integrated information systems in the healthcare sector); and • explaining the conditions under which national programmes for introduction of ICT lead (or fail to lead) to improvement and innovation in patient care and to sustainability of organisational change.
  • Key findings: • ICT implementation in healthcare is more socioorganisational process than a technical one; • patient-focused approaches of healthcare delivery require changes in work organisation and in an overall delivery of healthcare services; • stakeholder engagement in the process of ICT implementation in healthcare has multi-dimensional effects and can offer the potential to improve change effectiveness and sustainability; • the way stakeholder engagement is undertaken has an ultimate role for achieving innovation in patient care and sustainability of organisational change.
  • Relevance of the research (1) • growing importance of ICT in human life including public policy domains and the delivery of public services.
  • Relevance of the research (2) • Nationally integrated eHealth infrastructure and information systems are now viewed as key enablers for safe, efficient, high quality, patient-centred and seamlessly delivered healthcare.
  • Relevance of the research (3) • yet high failure rates of complex ICT projects often lead to wasted public finance investments and failed processes in a highly risk-sensitive environment such as healthcare.
  • Relevance of the research (4) • practitioners and academics alike still know little about what mechanisms are effective and which factors influence IS process innovations.
  • Relevance of the research (5) • this research extends the growing knowledge of the new direction of IS research with its new and empirically grounded insights on the importance that the stakeholders can play in the (national) processes of eHealth developments.
  • Findings from the case studies: England The implementation process (key features leading to failure): - A top-down change implementation approach; - A technocratic view towards ICT-led organisational change; - Unbalanced power of large IT suppliers and management consultants and the NHS; - ‘Big bang’ approach / ‘Rip and replace’ strategy; and - Lack of stakeholder engagement.
  • Key obstacles: England • • • • • • • • • • • • Delivered IS were difficult or not possible to use; Resistance to change by the staff in the NHS; Lack of local change ownership and commitment by the stakeholders; Lack of real expectations and deadlines; IT suppliers trying to hide their difficulties; Hindered conditions to become an ‘intelligent client’; The process is led by large IT companies rather than the needs of the NHS; Disappearing locally accumulated knowledge and skills; Hindered NHS’ capabilities to innovate; Service fragmentation instead of cooperation / integration; IT failures hurting patient care; No value for money.
  • Findings from the case studies: Wales The implementation process (key features leading to success): •A bottom-up incremental change implementation approach, where the national programme (the national coordinating body) works as a change management organisation providing a platform for stakeholder cooperation; •Multi-level organisational communication with the NHS Wales and stakeholder engagement; •An extensive involvement of end users into the delivery of service improvement projects (path-finder pilot projects).
  • Findings from Wales: the contribution stakeholder engagement can make: • • • • • • • • • stakeholder engagement improves change communication; improves change receptivity; increases change ownership / commitment towards change; improves internal cooperation; increases trust; enables crossing organisational boundaries; creates conditions for organisational learning; contributes to cooperation / quality of healthcare; contributes towards sustainability of achieved changes in healthcare delivery.
  • Diagram 1. The Conceptual framework of the national eHealth development
  • Technical deployment of ICTs & Stakeholder engagement
  • Management of organisational change & Stakeholder engagement
  • Stakeholder engagement (stakeholder management tool & nature of response; ladder of stakeholder engagement (Friedman & Miles, 2006: 162)
  •     11. Delegated power   10. Partnership   Jodint decision-making power over specific  projects Multi-way dialogue, e.g.  joint ventures Some decision-making power afforded to  stakeholders over specific projects Multi-way dialogue, e.g.  strategic alliance 9. Collaboration   8. Involvement   Stakeholders provide conditional  support; it conditions are not met  support is removed. The organization  decides the extent of conformity 7. Negotiation   Organization has the right to decide.  Stakeholders can advice.  6. Consultation Appease the stakeholder   5. Placation Stakeholders can hear and be heard,  but have no assurance of being heeded  by the organization   4. Explaining   Multi-way dialogue, e.g. board  representation Minority representation of stakeholders in  decision-making process Multi-way dialogue, e.g.  constructive dialogue Multi-way dialogue, e.g.  reactive: bargaining Two-way dialogue, e.g.  questionnaires, interviews,  focus groups, task forces,  advisory panels Educate stakeholders Two-way dialogue, e.g.  workshops Educate stakeholders One-way dialogue, e.g. verified  corporate social reports 3. Informing   2. Therapy   1. Manipulation „Cure“ stakeholders of their  ignorance and preconceived beliefs „Misleading“ stakeholders, attempting to  change stakeholder expectations One-way dialogue, e.g.  briefing sessions, leaflets,  magazines, newsletters, green  glossy social corporate  reports, or other publications
  • Theoretical research results (in brief) The research has identified the link between the stakeholder engagement and innovation and sustainability in patient care and organisational change in relation to the national eHealth development processes and identified the reasons why this happens.
  • Recommendations for practitioners: • viewing stakeholders (first of all the end user) as a valuable resource; • involving clinicians and especially the end users’ of planned health information systems at the outset of the service improvement projects, • undertake an incremental implementation process with an extensive multi-dimensional stakeholder engagement (taking into account the width and multi-level nature of the institutional context of a national health service) at every stage of agreeing eHealth national implementation strategy and undertaking service improvement projects, • facilitating stakeholder (user) empowering and organisational learning in overall, but retaining control over the entire implementation process.
  • Key findings (1): 1. As revealed by the theory review and the empirical evidence delivered by this research, there are significant limitations in current IS research: •for a long time there was an over-reliance on the functionalist paradigm in IS research, where social process models of IT-induced change have remained rare in the literature; •in this way this piece of research has provided additional new empirically grounded evidence, which in the scientific discussions support the position of IS research aiming to expose the shortcomings of the yet predominant technical/functionalist paradigm and to offer new alternatives corresponding better to the contemporary needs of the society (evolutionary and organisational change models such as ‘integrated socio-technical’ approaches started to emerge emphasizing ‘social learning’ and ‘orchestrated organisational change’).
  • Key findings (2) 2. This piece of research has brought additional evidence that the involvement of stakeholders within clinical contexts of organisational change might have even greater importance than in other sectors. This happens for a number of reasons: •Firstly, underlying causes of power and influence of healthcare organisations are linked to the specifics of ‘professional bureaucracies’ (Mintzberg, 1979) (medical staff, administrative staff, managers or IT specialists and others; hybrid roles (Fitzgerald et al., 2006); •Secondly, the environment and policy context in which healthcare is operating are very complex and involve many challenges, and where the national implementation of eHealth additionally puts its own requirements. Therefore to achieve effective problem solving, it is necessary to involve in the process as many necessary stakeholders as possible.
  • Key findings (3) 3. From the two in-depth empirical case studies new insights in relation to ICT implementation in healthcare sector were revealed: •Evidence was found that innovations in relation to the national processes of eHealth development were or had the potential to become both disruptive and sustaining, but in both cases an additional complexity was added by the multi-level nature of the national process as such and especially the multiplicity of players, their interests and ability (or inability by some) to influence the process or exercise their own power; •eHealth implementations usually call for major changes in the way healthcare has previously been delivered. ‘Patient at the centre’ and ‘patient centred-care’ require an effective working across organisational and professional boundaries.
  • Key findings (4) 4. Empirically grounded findings have provided additional evidence to support and broaden the position of Davidson (2006), aiming to strengthen the aspect of dynamism of the Technological Frames of Reference concept (TFR) (Orlikowski and Gash, 1994, Orlikowski, 2000) as a theory framework through which ICT development and use in organisations can be analysed: •the findings of this research suggest that stakeholder theory in general and stakeholder engagement in particular has the power to integrate both the IT project management and organisational change perspectives of technology-led change, and deliver new insights regarding innovation and organisational change sustainability in healthcare sector: stakeholder engagement has the potential to contribute to change communication, change receptivity, change ownership and commitment towards change, internal (within the healthcare sector) cooperation and trust, as well as to the ability of crossing organisational and professional boundaries, improve organisational learning.
  • Key findings (4) • contribute to the capacity to innovate, the quality of healthcare and sustainability in organisational change – the main aspects that were derived from empirical research as being among the main obstacles in the national deployment of eHealth solutions; • Moreover, by taking an interpretive rather than a positivist stance towards ICT-led organisational change (Orlikowski and Baroudi, 1991, Orlikowski & Yates, 2006, Davidson, 2004), the research suggests that stakeholder engagement highly contributes towards the interpretive process of organisational change. The main suggestion of this research is that multi-level continuous stakeholder engagement is an effective intervention strategy aimed at overcoming incongruence and has the potential to result in frame alignment and improve organisation outcomes. Moreover it also is able to account for a more dynamic perspective of frame change as an ongoing interpretive process, triggered by variety of organisational circumstances in time (Davidson, 2006, Simmon & Lovegrove, 2005);
  • Key findings (5) 5. At the same time, user / stakeholder engagement as such does not always lead to successful project / process outcomes. Certain conditions on how to involve stakeholders to achieve innovation in patient care and sustainability in organisational have to be met: •Regarding the levels of stakeholder engagement and management identified by Friedman & Miles (2006: 162), levels 9 (collaboration) – 11 (delegated power) are most suitable in relation to the engagement of end users in the national process of eHealth development. •Several aspects were derived from the empirical data, which contribute to a more effective stakeholder engagement in a national process of eHealth development: - such as viewing stakeholders as a valuable resource, - involving clinicians and especially the end users’ of planned health information systems at the outset of the service improvement projects,
  • Key findings (5) - undertake an incremental implementation process with an extensive multi-dimensional stakeholder engagement (taking into account the width and multi-level nature of the institutional context of a national health service) at every stage of agreeing eHealth national implementation strategy and undertaking service improvement projects, - facilitating stakeholder (user) empowering and organisational learning in overall, but retaining control over the entire implementation process. • The role of the national coordinating body (such as the national programme) mainly should focus on creating a platform of stakeholder interaction and organisational learning for the entire national health service by facilitating internal cooperation, providing strategic direction, reducing risk and dependency on IT suppliers and breaking professional and organisational boundaries by stakeholder empowering, but at the same time retaining control over the process.
  • Key findings (5) • Only then stakeholder engagement may result improved change communication, increased change receptivity, change ownership and commitment towards change, internal cooperation and trust, ability to cross organisational and professional boundaries, stakeholder engagement and organisational learning / innovation / quality of healthcare and sustainability in organisational change that actually contribute to the innovation in patient care and sustainability of organisational change and therefore an overall quality of patient care.
  • THANK YOU FOR YOUR ATTENTION Dr. Rasa Rotomskiene Mykolas Romeris University, Vilnius, Lithuania E-mail: rjuciute@mruni.eu Phone: +370 612 48 391 This research was partly funded by the European Social Fund under the Global Grant measure under the Project „Integrated Transformations of eHealth Development: the Perspective of Stakeholder Networks“.