This business report has been commissioned by St Mary’s Hospital, an NHS Trust hospital on the Isle of Wight. It discusses the existing IS strategies being implemented by the hospital and gives a background history on the strategies which have preceded it. The report aims to evaluate the successfulness of the current strategy and suggests future strategic options which could be considered to improve the future productiveness and cost effectiveness of the Hospital. It concludes that the original strategy which St Mary’s implemented for its SIS system was flawed and discusses the reasons behind this, including problems could have been avoided.
The report also suggests that introducing either Outsourcing or adopting an E-business outlook would help the hospital overcome many of its problems. Finally the report looks at comments made by manager of St Mary’s on the subject of the use of SISP in the public sector and shows that SISP is still a valuable tool for such an organisation. Introduction The UK National Health Service (NHS) is possibly the most important organisation in Great Britain and has, since 1948 provided quality (mostly) free health care to the people, paid for through general taxation and national insurance payments (Hackney and McBride, 2002). It has seen many changes since its inception and continues to evolve with our ever changing society.
St Mary’s Hospital on the Isle of Wight is one of hundreds of district hospitals in the UK. It provides general medicinal and nursing services, and also offers many specialist services to patients both on the Island itself and in the surrounding Wessex mainland area. In addition to this, St Mary’s provides “diagnostic imaging, laboratory, ambulance, pharmacy and therapy services” (Hackney and McBride, 2002) and is an NHS Trust.
All of the health care in the UK is now provided by such Trusts – each of which has independent control over managerial and financial decisions from a budget granted from the Government each year. This system has led to a need for value for money services to be a priority in order that the most patients can be treated in the least amount of time with a high quality of service and with the least amount of money spent – it is naturally, very difficult to satisfy every factor. This is where Information Systems can help; by refining the every day processes of the hospitals and calculating ‘costs’ for these processes and treatments as and when they happen.
The problem with IS implementation in hospitals however is due to the lack of standardisation on a national scale. The government and NHS offer advice and standards for hospitals to meet but do not specify any particular systems for use. These independent hospitals’ IS strategies are shaped by the additional funding provided by national initiatives and the partial central funding offered by new developments and pilot schemes (Jones, 2001).
NHS hospitals’ IS implementations rarely meet the requirements for which they were originally designed. Various problems such as interdepartmental differences in data collection, information overload, data duplication, incorrect usage of systems, lack of training and simply the fact that the hospitals are in general, short-staffed and under funded. It is not surprising then, that these information systems are not developed effectively.
This report discusses the case of St Mary’s Hospital in 3 parts: In the first section this report discusses the key influences and elements on the production of St Mary’s IS strategy, and how it has implemented this strategy. The success of this current strategy and its methods for implementation are evaluated. The second section of this report produces two different strategies which could be implemented in order to improve on the current strategy being employed at St Mary’s. The report makes recommendations on which strategy should be implemented. Finally the report discusses the theoretical basis for the use of business frameworks and concepts in designing strategies for public sector organisations.
Analysis of the Existing IS Strategy Introduction Like so many other NHS institutions, St Mary’s relies heavily on computerised technology in order to function successfully on a day to day basis. In particular, “The treatment of a patient in hospital requires the support of a wide variety of information systems…. These information systems will support the flow of clinical, administrative and financial data” (Hackney and McBride, 2002).
This exchanging of data can help streamline the processing of patients as well as reducing wrong diagnoses and waiting times. The data may include patient identification, medical records, images of scans and x-rays as well as listing the procedures which are due to be performed or have already taken place for the patient. One system controlling data exchange could greatly enhance the work of the staff in the hospital but although such systems are planned for, they do not always work in practice with many departments choosing their own IT systems separately, leading to more confusion.
Dr Jonathan Kay, of the Oxford Radcliffe Hospital, in a study of Electronic Patient Records (EPRs) explains that, ”Many departments have chosen systems which are best of breeds, but this makes it difficult for a clinician to have one source of access to all.” (CSW Health, 2003). St Mary’s Hospital set up an information strategy group in 1990, the purpose of which was to report on the hospitals IS needs at that time. It was decided that St Mary’s needed to become independent and fully “self sufficient in information and it supporting technology” (Hackney and McBride, 2002). For this to happen it was
St Mary’s IS Strategy “IS strategy is demand oriented, focusing on information and system requirements in meeting business objectives….. The IT strategy, on the other hand, is supply oriented and concerned with specifying the technology as to how to deliver these applications.” (Hackney et al, 2000) Key influences Many separate bodies had influence over the IS strategy of St Mary’s Hospital. Most important of all were the actual staff of the hospital that would be using the systems – they were represented by an in house information department which produced the various proposals. Initially the Regional Health Board had control over the allocation of funding and approval of investment in the Hospital though this later changed with the advent of NHS trusts. Project proposals were required to be submitted to each of these governing bodies for each individual project planned for St Mary’s.
National Government also had a strong influence over the development of the IS strategy of St Mary’s since white papers produced at the time of the planning (‘Working with Patients'(1989) and ‘The Health of the Nation'(1992)) resulted in a rethinking of the demands of the system being proposed. Key Elements The original strategy proposed by the IS team at St Mary’s called for “the phased implementation of an integrated hospital information system” (Hackney and McBride, 2002) and that St Mary’s should be “self sufficient in information and its supporting technology” (Hackney and McBride, 2002). In order to implement the integrated Hospital Information System (HIS) the first proposals asked for a dedicated computer room, a Local Area Network (LAN) and Nurse Information and Patient Administration systems (NIS and PAS).
The LAN was a central feature for the program as it is the backbone of the HIS where every service should interlink enabling information to be transferable between each individual system. A case mix system was suggested to enable the costing of individual clinical procedures and the PAS system enabled the patient’s records to be kept and transferred throughout the hospital. An IT room was thought to be required for the housing of PC systems relating to the running of the hospital and a training centre was also planned, which would take up the space of an old ward. It was also planned for the HIS to be linked to GP surgeries in the local area.
Strategy Implementation In 1991 St Mary’s submitted a business IS plan to Wessex region. The bid asked for a hospital wide network, a system for information transfer and a dedicated computer suite. The bid was amended, on the wishes of Wessex region so that the IT suite and network were submitted as two separate bids. One year later Wessex region granted ï¿½21M for the introduction of a new system to replace the current PAS setup. St Mary’s had to resubmit its initial report in order to receive a share in this money.