MAST: the organisational aspects
Lise Kvistgaard
Odense University Hospital
Denmark
Berlin, May 2010
What is an organisation?
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A consciously coordinated social unity
With clear boundaries
Targets certain goals
Members have defined roles
Level 1
Level 2
Level 2
Level 3
Level 3
Level 3
Level 3
10/04/2015
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Although some large health
organisations may look like this…
Characteristics of health
care organisations
• High level of complexity
• Dynamic environment - many
activities at the same time
• Interdependence between units
or people on a number of levels
• Many professions work together
• Often difficult to single out the
result of one organisational
change for measuring,
• Many processes occur
simultaneously
Telemedicine in health
care organisations
Important decision: should the new technology be adapted to the
organisation, or should the organisation be adapted to the technology?
• Impact on organisations at the structural level
• Impact on work flow
– Impact on distribution of work between professions
– Impact on distribution of work between units in an
organisation
– Impact on distribution of work between organisations
– Impact on geographical distribution of health care services
• Impact on organisations at the cultural level
Implementing new
technology
…into health care systems:
a 3 piece puzzle in which the pieces continuously
need to adjust to each other in order to obtain
optimum fit:
• Clinical work
• Organisation of health care
• The technology
– Should organisational culture be considered the fourth
piece?
How to evaluate organisational
aspects of telemedicine
Topics - an overview
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Process
Structure
Management
Culture
Process: topics and
outcomes (1)
• Workflow
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Number of patients treated
Number of procedures performed
Time spent on each stage in the work flow
Referral times
Bed days
• Staff, training and resources
– Changes in work distribution between professions
(task shifting)
– Changes in staff requirement
– Time spent on training
– Changes in hours spent on each stage in the
work flow
Process: topics and
outcomes (2)
• Interaction and communication
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Amount of electronic communication
Changes in information and reporting systems
Changes in face to face patient communications
Changes in the way medical staff communicate
Changes in the way medical staff cooperate
• Methods for data collection:
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systematic literature review
Interviews (single or focus groups)
questionnaires
observation
surveys
statistical studies
Structure: topics and
outcomes
• Spread of technology,
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Changes in the number of units offering treatment
Number of organisational units set up especially for telemedicine
Changes in organisation of generalist and specialist tasks
Changes in geographical spread
Time spent on travel, staff or patients
• Economy (this topic was covered in the previous presentation)
Methods for data collection:
– systematic literature review
– questionnaires
– surveys
Management: Topics and
outcomes (1)
• Management style
– Changes in leadership style
– Changes in managers´ span of control
Level 1
Level 2
Level 3
Level 2
Level 3
Level 3
Level 3
Management: Topics and
outcomes (2)
• -Or a different structure?
Methods for data collection:
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systematic literature review
Questionnaires
Interviews
surveys
Culture: topics and
outcomes
• Attitude and culture
– Staff attitudes towards telemedicine applications
– Staff experience with telemedicine applications
– Impact on organisational culture
• Instruments for measuring:
– Interviews (single or focus groups)
– surveys
– observation
Data collection on
organisational aspects
• Frequently situation specific data are needed
• Often primary studies must be carried out
• Existing studies are often based on very small
samples
• The evaluation of the organisational aspects of a
particular telemedicine device may require various
methods:
– descriptions (of structure, processes and workflow)
– quantitative methods (for instance changes in number of
bed days and changes in referral times)
– qualitative methods (attitudes and experience)
Description of organisational
aspects of telemedicine in the
literature1
Important: Literature review indicates no consensus regarding the use of
particular outcome measures or data collection instruments
• Generally, evaluations of organisation aspects of
implementing new medical technology are few
and far between
• For interventions applying telemedicine solutions,
descriptions are sometimes found, mostly when the
application affects the organisation at a structural
level
Examples of relevant outcome measures in the
existing literature
• Referral times
• Length of stay
Description of organisational
aspects of telemedicine in the
literature (2)
Recommendations based on the literary
review
• It is useful to identify stages in the workflow process
and explore the time needed to complete them
• Cost estimation can be made on the basis of this
• Hospital stay data (bed days, referral times, etc) are
widely used in assessing outcomes
Example: the
organisational aspect
• Description of the organisational change
– Method: interview
• Description of the advantages and disadvantages
of the new organisation
– Method: interviews with staff and management,
questionnaire
• Task shifting and time spent
– Method: observation and registration, collection and
analysis of hospital data
• Changes in patient flow
– Method: collect and analyze hospital data
Hints for starting an assessment
of a telemedicine application
• The implementation of the telemedicine
solutions will often affect organisational
structures
• Although a systematic literature review
should be carried out, don't be too
optimistic about the results
• Be prepared to carry out your own primary
studies on the organisational aspects
• Be pragmatic and consider which data are
relevant as basis for decision making in
each case
Questions?