Tackling failures, complexity and integration in (re)engineering health systems
•
2 likes•1,175 views
This thesis proposes using an Enterprise Engineering Paradigm to help design performant, innovative and sustainable health systems. The document outlines the research methodology, which follows a Design Science Research Methodology. A literature review covers definitions of health systems and approaches like reductionism vs. holism. The theoretical foundations section explains concepts from enterprise engineering, enterprise architecture, enterprise governance and enterprise ontology. A proposed solution applies methods from the Enterprise Engineering Paradigm to analyze and improve the Belgian health system. The demonstration section presents two case studies. The findings relate the work to enterprise engineering theory and the health domain. The conclusions state that the Enterprise Engineering Paradigm prevents failures in strategic initiatives. Future work involves expanding and repeating the approach.
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (17)
Similar to Tackling failures, complexity and integration in (re)engineering health systems
Similar to Tackling failures, complexity and integration in (re)engineering health systems (20)
Recently uploaded
Recently uploaded (20)
Tackling failures, complexity and integration in (re)engineering health systems
- 1. a thesis submitted for the degree of Master of Enterprise Architecture Raphaël Wouters June 2014 Towards engineering performant, innovative and sustainable health systems
- 2. Agenda • Introduction • Research Methodology • Literature Review • Theoretical Foundations • Proposed Solution • Demonstration • Conclusions link
- 3. Agenda • Introduction • Research Methodology • Literature Review • Theoretical Foundations • Proposed Solution • Demonstration • Conclusions
- 4. Introduction Aging Populations Chronic Diseases Power/Influence shifts Technological Advances Rising Costs Inefficiencies Irregular Quality Unequal Access
- 5. Problem & Motivation Health services - Many change drivers (transformational & incremental) - Rarely formal/approved/accomplished health reforms - Methodology, metaphors, governance and management style & other “best practices” from secondary sector Current approaches don’t seem to be (adequately) implementing these changes Isn’t there a better way?
- 6. Research Questions How to (re)design performant, innovative and sustainable health systems? RQ1. What is the contribution of the Enterprise Engineering Paradigm to the integrated design of performant, innovative and sustainable health systems? RQ2. How can we objectively assess, compare an draft health system reform proposals conform the disciplines in the Enterprise Engineering Paradigm?
- 7. Agenda • Introduction • Research Methodology • Literature Review • Theoretical Foundations • Proposed Solution • Demonstration • Conclusions
- 8. Research Methodology DSRM (Hevner, et al., 2004) DSRM Process Model (Peffers, et al., 2008)
- 9. Objectives of the Solution Organizational change evaluation Descriptive Fragmented Heterogeneous Prescriptive Holistic Integrated ?
- 10. Agenda • Introduction • Research Methodology • Literature Review • Theoretical Foundations • Proposed Solution • Demonstration • Conclusions
- 11. Literature Review Definition of a Health System “All organizations, people and actions whose primary intent is to promote, restore or maintain health.” World Health Organization, 2000
- 12. Reductionism vs. Holism “Reductionism breaks things into parts and attempts to deal with each part in isolation. […] in organizational and societal settings, however, it has not been plain sailing and struggled primarily because it misunderstands the nature of human beings (yet it remains a dominant wisdom).” - Flood, 1999 Holism: the whole is primary and greater than the sum of its parts and indicates emergence
- 13. Problem Dissolving “To dissolve a problem is to redesign the system or its environment so the problem is eliminated and cannot reappear.” – Russel Ackoff
- 14. Management vs. Governance Management deals with executing activities Governance deals with guiding those activities (adequacy, correctness) “[…] focus on outcomes is not an effective way to improve a process or activity.” – Deming, 1986
- 16. Other Approaches PDCA Lean Thinking Six Sigma tVM
- 17. Agenda • Introduction • Research Methodology • Literature Review • Theoretical Foundations • Proposed Solution • Demonstration • Conclusions
- 18. Enterprise Engineering “The whole Body of Knowledge regarding development, implementation and operational use of enterprises, as well as its practical application.” - Dietz, 2006 Generic goals - Intellectual manageability - Organizational concinnity - Social devotion
- 19. Enterprise Architecture “Reduction of enterprise complexity by addressing strategic objectives and areas of concern, and converting them into coherent/consistent set of enterprise design principles and standards.” - Dietz, 2008 & Hoogervorst, 2009
- 20. Enterprise Architecture Reference Context Hoogervorst, 2013-2014
- 21. Enterprise Governance “The organizational capacity for devising and steering change.” – Hoogervorst, 2009
- 22. Enterprise Ontology Captures complexity of enterprises and focuses on implementation-independent essence. Difficulty of comprehending structural-functionalistic aspects of enterprises is greatly reduced.
- 23. Generic System Development Process Dietz, 2006
- 24. Agenda • Introduction • Research Methodology • Literature Review • Theoretical Foundations • Proposed Solution • Demonstration • Conclusions
- 25. Proposed Solution Quantification Methods Analysis Techniques Enterprise Engineering Paradigm Improvement Methods Enterprise Engineering Enterprise Governance Enterprise Ontology Ask why five times Demand/Supply/Variation analysis Patient Journey Mapping Clinical Pathway Analysis Process Mining (!) Patient Stories/Profiles Service-Oriented Analysis Demand, Experience, Costing Health Cost-Benefit Analysis tVM’s “Purpose, Measure, Method” Inter-transactional redesign NS Theory Lean thinking
- 26. Agenda • Introduction • Research Methodology • Literature Review • Theoretical Foundations • Proposed Solution • Demonstration • Conclusions
- 27. Belgian Health System Global challenges, and: - expected staff shortage - power balance shift - lack of adequacy (screening/prevention, pathologies) - surgery safety - overconsumption
- 28. Reform Proposals
- 29. Reform & Anecdotal Scenarios Case A – Medication Reconciliation Case B – Primary Care Subsystem
- 30. Case Approaches Introduction Problem Analysis Proposed Solution Application & Results
- 31. Agenda • Introduction • Research Methodology • Literature Review • Theoretical Foundations • Proposed Solution • Demonstration • Conclusions
- 32. Findings Relation to theory - steep learning curve and emergence of EE discipline - not all activities are transaction-based - understandable, but after adaptation period - desire for (unattainable) fully codified method Relation to domain - strong pull towards financing/expenditure - public availability and scarcity of up-to-date/reliable data
- 33. Conclusions EEP & compatible techniques/methods prevents failures in strategic initiative implementations: - solid foundational theory and methodology - different and unified approach - integrates several enterprise aspects coherently and consistently - applied at different health system levels
- 34. Future Work - improve and extend EO modeling phase - improve design phase (domains, aspects, models) - integrate BoK of “Business Process Engineering” - expand scope, e.g. integrate with social/welfare - expand scope, e.g. by adding or segregating other health services/care clusters - repeat application to other reform proposals (national and European level)
- 35. Thank you!
Editor's Notes
- Results and capability to produce them are fundamentally different aspects