This document discusses organizational structures during service-oriented architecture (SOA) implementation in a Greek healthcare organization. It first reviews literature on SOA governance frameworks and critical success factors for SOA implementation in healthcare. It then proposes and tests a new SOA governance framework, which includes elements like organizational structure, roles, policies and processes. A case study of a large Greek healthcare organization validated that each element of the proposed framework plays an important role in SOA implementation and that SOA governance is a critical success factor for integration of healthcare information systems.

1. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Organizational structures during SOA
implementation: the case of a Greek
healthcare organization.

2. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Outline
• The Importance of SOA Governance in
Healthcare
• Literature Review
• Proposed SOA Governance Framework
• Research Methodology
• Findings
• Conclusions

3. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Introduction
Healthcare IS Challenges
Patient mobility
Medical tourism
Interoperability
Security
Multiple actors with different roles
Unique medical requirements
Complex processes
Requirements for integrated care
Redesign towards patient centred
Rapid expansion of m-health
Quality management and training
Task characteristics
Testing
ComplexityGlobalization
Integration Medical Errors

4. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Security (1/2)
• Despite the sophistication of HIS a large
amount of data transmitted without
permission arises from hospitals.
• A recent report states that compromised
databases of healthcare organisations are
increasing, with 119 violations compared to
39 suffered by the financial services industry.

5. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Security (2/2)
• This phenomenon can have consequences for
healthcare:
– privacy violations,
– medical fraud,
– financial identity theft, and
– medical identity theft.

6. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Service Oriented Architecture (1/3)
• SOA supports reusability and flexibility,
• Provides interconnectivity in a more
manageable way,
• …breaks business processes into smaller
blocks of functionality (e.g. services).

7. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Service Oriented Architecture (2/3)
• SOA can:
– minimise medical errors, by providing data
exchange accurately, effectively, securely and
consistently,
– facilitate the plan to redesign HIS towards patient-
centred systems,
– transform heterogeneous and incompatible
systems in cooperating services based on
healthcare business processes.

8. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Service Oriented Architecture (3/3)
• Despite SOA benefits literature indicates that,
41% of SOA users in the Global 2000 firms
believe that:
– SOA has delivered less benefits than expected,
– 17% claim they face problems and
– will not expand SOA use
• …..applicability, efficiency and performance
are affected by various factors.

9. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
SOA Critical Success Factors (CSF)
SOA normative
literature
In depth
database
research
70 cases from
SOA in
healthcare
Literature
research
19 SOA
CSFs

10. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Top SOA CSFs in Healthcare
Governance
SOA Roadmap
Culture
Testing
Standards
Project
identification
0% 5% 10% 15% 20% 25% 30%
25%
13.8%
9.2 %
11.5%
9.2 %
9.2 %

11. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
SOA Governance
• A continuous control process that guarantees
sufficient adaptability and integrity of a SOA system in
issues like:
– capability,
– security and
– strategic business alignment.
• Its overall goal is SOA compliance of legal, technical
and intercompany regulations, respectively. In
particular, it ensures the reliable long-term operation
of an SOA.

12. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
IT Governance Frameworks & “Standards”
• There is a tendency to adopt IT Governance
Frameworks, but also a lack of a clear “winner”
amongst them.
• 834 business executives from 21 countries and
10 industries support that ISO2000 or ITIL is
referred in 28% of them, while COBIT in 12%.

13. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
IT Governance Frameworks & “Standards”
ITIL/ISO 2000
ISO 1779, 2700
Six Sigma
COBIT
PM/PMBOK
Risk IT (ISACA)
0% 5% 10% 15% 20% 25% 30%
28%
21.1%
15.1%
12.9%
12.7%
12%

14. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
IT Governance Frameworks & “Standards”
• 84 out of the 839 respondents (10%) are
healthcare executives
• …the percentages drop lower regarding their
focus on IT Governance in healthcare.

15. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
SOA Governance
• Literature review on SOA Governance:
– peer-review articles
– 5 groups of authors
– 5 models/frameworks

16. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
SOA Governance
• Focused on:
– reporting on the importance of SOA Governance,
– defining important SOA governance elements,
– analysing to the extent possible, these issues
(mainly using relative literature) and
– synthesising these issues as elements of their
proposition.
…placed on a SOA Governance concept map.

17. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Koumaditis, K., Themistocleous, M., Vassilakopoulos, G.,
Studies in Health Technology and Informatics. Vol. 190 2013. p. 204-206.

18. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
SOA Governance
• The existing models have numerous limitations,
• There is no single approach that focuses on all
necessary issues,
• Not all the models are structured in a clear
manner, with sufficient justification and detail,
• No model includes healthcare specific aspects,
• Limited testing and empirical justification.

19. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Common SOA Governance Elements
• Organisational Structures,
• Roles,
• Roadmap,
• Best Practices,
• Policies,
• SOA Governance Processes,
• SOA Governance Infrastructure,
• Metrics,
• Maturity model.

20. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Proposed SOA Governance Framework
• Grounded on common elements derived from
the normative literature (e.g. Concept map),
• Additional literature was utilized to enhance
the conceptualization,
• Healthcare specific aspects (e.g. CSFs and HIS
challenges).

21. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Proposed SOA Governance Framework
Maturity Model
Organisational
structure
Role(s)
Roadmap
Policies
Metrics
Best Practices
SOA Governance Infrastructure
SOA Governance Processes

22. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Organizational Structure
• Attributes:
– Includes a number of councils,
– Defines and abolishes governance policies,
– Obtains and maintains business objectives, standards,
best practices,
– Defines and obtains feedback from metrics,
– Trains employees,
– Communicates SOA purpose,
– Sets roadmap,
– Influences decisions on project prioritisation and
funding

23. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Organizational Structure
• Sub-elements:
– Centre-of-Excellence,
– Governance Board,
– Program Office,
– Councils-Committees.

24. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Organizational Structure
• Guidelines:
– Main governance body,
– Members from both IT and business,
– Structured in a centralized or decentralized
manner,
– Designed to compensate for the weaknesses of
the current organizational and IT structure,
– Engagement approach,
– Balanced number of structures.

25. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Organizational Structure
• Healthcare Aspects (1/2):
– Dedicated alignment structures (e.g. committees,
councils),
– Business/IT alignment goals,
– Set clear goals for all elements,
– Involve individuals with skills that can set clear
goals,
– Dedicated formal (committees, interest groups) or
informal (intranets, wikis) to control complexity,

26. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Organizational Structure
• Healthcare Aspects (2/2):
– Committees dedicated to cost control, sponsor
identification and funding,
– Dedicated structures (e.g. committees and
interest groups) to minimize risk,
– Dedicated structures (e.g. committees and
interest groups) to identify and propose
standards,
– Cultivate SOA friendly culture.

27. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Research Methodology
• Qualitative research,
• Multiple case studies,
–Large healthcare organization,
–Private Hospital,
• Semi-structured interviews,
• Various stakeholders.

28. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Findings
• SOA governance has an important role during
the integration processes for HIS integration,
• This crucial role has been reported in the
literature and was validated through this
research,
• Within the context of healthcare organizations
it appears that SOA governance is a CSF.

29. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Findings
• Each proposed SOA governance element plays
an important role during the implementation
of a SOA governance in healthcare,
• Their crucial role has been reported in the
literature and was validated through this
research.

30. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Conclusions
• Existing models on SOA governance,
• Limitation of SOA governance models,
• Proposed enhancements to SOA Governance,
• A SOA Governance Framework was proposed,
tested and verified through the practical
arena,
• Further research is required with more cases
and alternative research methods.

31. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Further Reading…
• Koumaditis K., (2016): "Governance of Service-Oriented Architecture in a Healthcare organization: A Case Study." Journal of
Information Technology Case and Application Research, Taylor & Francis Group, Volume 17, Issue 3-4, PP 130-155
• Koumaditis K., and M. Themistocleous. (2015): "Organizational structures during SOA implementation: the case of a Greek
healthcare organization." Transforming Government: People, Process and Policy, Emerald Group Publishing, 9.3 (2015): 263-
285.
• Koumaditis K., Themistocleous M., (2014), Title: “Proposing and Testing SOA Organisational Structures: a Case Study
Approach”, International Journal of Reliable and Quality E-Healthcare (IJRQEH), Vol:3, Iss.4, ISSN: 2160-9551; IGI Global.
• Konstantinos Koumaditis, Marinos Themistocleous, Paulo Rupino Da Cunha, (2013), "SOA Implementation Critical Success
Factors in Healthcare", Journal of Enterprise Information Management, Emerald Group Publishing, Vol. 26 Iss: 4

32. Koumaditis, K. and M. Themistocleous (2015). "Organizational structures during SOA implementation: the case of a Greek
healthcare organizationnull." Transforming Government: People, Process and Policy 9(3): 263-285.
Thank You !
Any Questions……