Lecture 11 : SSM case
creating an information strategy
• a case study in IS: merging two hospitals
• the situation and insights for the SSM
process
• organisation of the SSM implementation
• finding out and modeling
• information needs analysis
• lessons for SSM
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merging a large acute hospital and a
small hospital in NHS
• NHS provides health-care nationally, “from cradle to
grave”
– hence it is a very large organisation,
– with wide spectrum and heavily involved in
expertise and a variety of services
• difficulties in funding have increased over time
• attempts are made in the 90’s to improve efficiency
and effectiveness by introducing the internal
market concept:
– district authorities are to act as purchasers of health services
and buy from providers who are autonomous Trusts
– according to nonbinding contracts for an agreed sum of money
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• Trusts had to think more seriously about their information
systems – as quality, timeliness and costs matter
• an acute hospital, The Royal Victoria Infirmary and the
smaller Hexham General Hospital are to merge as a
trust at two distant sites
• an acute hospital is a large teaching organisation that
delivers a range of services to patients who
– are referred to it by GP’s or
– enter as result of accidents and emergencies
• the merger warrants new and effective IT and IS
systems
• these needs were initially thought to simply require new
computer purchases without much consideration given to
analyzing and scoping the use
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the situation and insights for the SSM process
• the new Information Officer saw the need for a
new IS strategy and assembled a group of
facilitators
• SSM was seen as suitable by the IO to this end
• purposeful activity models had to play the key
role in developing such a strategy
• research would have to be carried out by about
40 groups of hospital professionals, not by IT or
IS specialists such as
– doctors
– nurses
– accountants etc.
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organisation of the SSM implementation
• each group would be assigned a function that takes
place at two sites and examine the core purpose,
activities and information needs such as:
–
–
–
–
–
surgery
medicine
nursing
theathres
business..
• team members would keep on carrying their routine
tasks as usual with no exception
• a strategy was to be developed within six months, so the
information strategy would be based on the current
pattern of activities
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• facilitators were: the Information Officer, a senior
management consultant, and P.Checkland
• a joint workshop every month of team
representatives with the three facilitators would
meet to discuss proress and problems
• Checkland’s ideas at the outset were:
– construct activity models only for major hospital activities
– discuss information needs based upon these models
– compare present information support with the needs elicited in
the above
– re-formulate strategy
• needed only “primary task” models, as thinking
in-depth would not find much chance of
application within reasonable time
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• project was to be integrated into the dayto-day activity of the two hospitals
• the project was launched by the CEO of
the acute hospital in a meeting of about
100 people
• strategy was emphasized to emerge from
the group and not from the management
• CEO’s involvement demonstrated that the
study was taken seriously by the Trust
• three facilitators explained the work to do
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• Checkland prepared, at several levels, generic
models relevant to acute hospital operation
• this was a choice made specific to this situation
• IS would be shaped to serve taking the current
hospital organisation as given
• analysis two and three were skipped, since the
study addressed an explicit question in this
particular situation
• generic activity models would be enriched by
considering and engaging in debates over the
accounts of CATWOE and 3E’s
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finding out and modelling
A generic model that would be relevant to any acute hospital, was
initially constructed. Its Root Definition was:
A system, operating under a range of external influences, which, in
the light of a strategy based on its capabilities and costs, delivers
services defined in 'contracts' with purchasers within the context of
NHS norms and policies, that service delivery itself contributing to
the ongoing development of its strategy for service provision.
C
those receiving hospital services, purchasers
A
hospital professionals
T
need for acute services  need for acute services met
W
acute services can best be provided by an organization dedicated to developing and delivering such
services
O
hospital management board; NHS executive
E
NHS structures and norms, the purchaser-provider split
E1, efficacy
demonstrable delivery of a portfolio of services of suitable quality
E2, efficiency
minimum use of resources (expressible in money and time)
E 3,
effectiveness
satisfaction of patients treated, purchasers, the NHS executive, contributions to hospital reputation (i.e.
contributions to long-term viability]
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• this is a low resolution activity model for a
generic acute hospital
• in this model, activities 2-5 are expanded
collectively under the external influences in
activity 1
• there is an inner feedback loop from 5 to 2 which
monitors against plans and “contracts” versus
monitoring the overall activity system from
3E’s perspective
• a higher resolution model of each activity is
essentially needed to assess information needs
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• primary task form is preserved in the higher resolution model
• CATWOE for a generic service S in the detailed diagram
C
Patients, ancillary support services
A
Providers of clinical service
T
Need for service S  need for service S met
W
The capability and organization for professional provision of service S is available
and appropriate
O
Senior hospital managers, including doctors
E
NHS norms, hospital organization structure; contract requirements
E1, efficacy
demonstrable delivery of a service of suitable quality
E2, efficiency
minimum use of resources (expressible in money and time)
E3, effectiveness
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satisfaction of the serviced people, meet negotiated contractual clauses for
particular service
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• more detailed modelling was taken further
only by one more step for some of the
activities
• experience indicates that modelling
beyond three levels of detail -starting from the
overall organization at the topmost level- is often not
useful
• the rule is to stop at the level where most
problematical features lie
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information needs analysis
• generic models helped to underline the point that SSM
models were useful to structure discussions and were
not descriptions of real-world examples
• rather than the usual inquiry for the activities and their
linkages, they helped to answer questions like,
– what information should be available to someone doing this
activity?
– what is available at present?
– what information is generated by doing this activity?
– to whom should it go?
• gaps and opportunities not revealed directly by models,
emerged from discussion and debate
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Table 4.1 An illustration of the kind of chart
used for information analysis
Activities from the
How the activity
model
is done
--------------------------- --------------------
Measures of
Information
Information
support
performance
---------------
needed
--------------
provided by
opportunities
-------------------- ----------------------
Information gaps and
4.1.4 and 4.1.5
Receive request for
Letter, phone call
Speed with which Patient's details,
Patient
Automatic generation
of
service, and accept
the request is
clinical condition, administration
letters to patient and
patient
handled
and history
referrer
Contract situation
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system (PAS)
Up-to-date contract
situation
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Table 4.1 An illustration of the kind of chart
used for information analysis (cont.d)
Activities from the
How the activity
Measures of
model
-------------------------4.1.6
is done
--------------------
performance needed
-------------------------
Diagnose problem
Consider history
Medical
audit
Information
Information support
Information gaps and
provided by
----------------------
opportunities
----------------------
Case notes
Case notes often missing
Examine patient
Results from
Much duplication of
Conduct
investigations
recording of patient's
investigations
details
Delays in receiving test
results
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Table 4.1 An illustration of the kind of chart
used for information analysis (cont.d)
Activities from the
How the activity
Measures of
model
-------------------------4.1.7
is done
--------------------
performance needed
-------------------------
Treat patient
Conduct proce-
Information
Information support
Information gaps and
provided by
----------------------
opportunities
----------------------
Medical audit Availability of
dures/operations
Facilities,
theatres,
Prescribe drugs
anesthetics, etc.
Theatre booking
Systems not available
at
system
ward level
Drug effects and
interactions
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Table 4.1 An illustration of the kind of chart
used for information analysis (cont.d)
Activities from the
How the activity
Measures of
Information
Information support
Information gaps and
provided by
----------------------
opportunities
----------------------
model
is done
-------------------------- -------------------4.1.8
performance needed
-------------------------
Discharge patient
Speed with
Post-treatment
test
which
produced
results
of care
Availability of
discharge facilities
Coding
Automatic generation of
discharge summaries and
letters
Support for Read coding
Discharge summary
Discharge letter
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PAS
Links to ongoing
providers
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lessons for SSM
• lack of knowledge was not a problem: “..grasping of SSM
is much easier in a live situation than in a classroom.”
• such a methodology which feels natural can help to
counter the feeling among the members of a large
complex organisation of no definite course to follow and
no knowledge of direction
• group working on nursing services appreciated
CATWOE as they considered “hospital contract
manager” in addition to the “patients” in C, among the
victims or beneficiaries:
– nurses provide service according to the contract
– this came counter to nurses’ professionalism
• the project was a good example of the LUMAS model
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