engineering performant, innovative and sustainable health systems - an integrated approach
TRANSCRIPT
Engineering performant, innovative and sustainable health systemsresearch and master thesis submitted for the degree of Executive Master of Enterprise and IT Architecture
Raphael WoutersEnterprise Architect & Consultant [email protected] linkedin.com/in/raphaelwouters @raphaelwouters
Health System Change DriversAging PopulationsChronic DiseasesPower/Influence shiftsTechnological AdvancesTackling ComplexityRising CostsInefficienciesIrregular QualityUnequal AccessCoverageetc…
Problem & MotivationHealth services- Many change drivers, both transformational and
incremental- Rarely formal, approved or 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?
Research QuestionsHow can we (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?
Research MethodologyDSRM (Hevner, et al., 2004) DSRM Process Model (Peffers, et al., 2008)
Objectives of the SolutionOrganizational change evaluation
DescriptiveFragmentedHeterogeneous
PrescriptiveHolisticIntegrated
?
Definition of a Health System
“All organizations, people and actions whose primary intent is to promote, restore or maintain health.”
– World Health Organization, 2000
Mechanistic vs. Organismic Viewpoint“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).”
– Robert L. Flood, 1999
Problem Dissolving
“To dissolve a problem is to redesign the system or its environment so that the problem is eliminated and cannot reappear.”
– Dr. Russel Ackoff
Classical Approaches
PDCA
Lean Thinking
Six Sigma
tVM
Choosing a Method, Technique or Tool- Who invented it and in what timeframe? - What was their frame of reference and their entailed
convictions? - Why was this invented, what problem did they (try) to
solve?- Do we have that same problem? - Did they succeed, and was it due to the application? - What type of statements and trade-offs are made and are
they (still) true? - Does it work and is it repeatable in our context?
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
http://www.ee-institute.org
Enterprise OntologyCaptures complexity of enterprises and focuses on implementation-independent essenceDifficulty of comprehending structural-functionalistic aspects of enterprises is greatly reduced
Theoretical Foundations
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
Enterprise Architecture Reference Context
Hoogervorst, 2013-2014
Enterprise Governance“The organizational capacity for devising and steering change.” – Hoogervorst, 2009
Management vs. GovernanceManagement deals with executing activitiesGovernance deals with steering and guiding change
“[…] focus on outcomes is not an effective way to improve a process or
activity.” – Deming, 1986
Generic System Development Process
Dietz, 2006
Enterprise Engineering Manifesto
Seven Postulates1. Unity & Integration2. Enterprises as Socio-Technical Systems3. Functional vs. Constructional Perspectives4. The Essence of Organizations5. Operationalization of the Enterprise6. Enterprise Architecture & Principles7. Enterprise Governance
http://www.ciaonetwork.org/publications/EEManifesto.pdf
Proposed Solution
QuantificationMethods
AnalysisTechniques
Enterprise Engineering
Paradigm
ImprovementMethods
Enterprise EngineeringEnterprise GovernanceEnterprise Ontology
Ask why five timesDemand/Supply/Variation analysisPatient Journey MappingClinical Pathway AnalysisProcess Mining (!)Patient Stories/ProfilesService-Oriented Analysis…
Demand, Experience, CostingHealth Cost-Benefit Analysis (QALY)tVM’s “Purpose, Measure, Method”…
Inter-transactional redesignNormalized Systems TheoryLean thinking, e.g. tVM…
Demonstration in the Belgian Health System
Prof. Lieven Annemans
(Health Economist)
Belgian Health System – Some Reform Proposals
Case XCase C – IEP Reforms
Book Reform Proposals Anecdotal Scenarios
Case A – Medication Reconciliation
Case B – Primary Care Subsystem
Case Approach1. Introduction2. Problem Analysis3. Proposed Solution4. Application & Results
Case Example – Scenario
Case Example – Architecture Principles
Case Example – Ontological Model
FindingsRelation to theory- steep learning curve into Enterprise Engineering
paradigm - emergence of the Enterprise Engineering discipline- not all activities are transaction-based (e.g. emergent)- understandable, but after adaptation period- desire for (unattainable) fully codified method
Relation to domain- strong pull towards financing and expenditure context- public availability and scarcity of up-to-date and
reliable data
ConclusionsThe Enterprise Engineering Paradigm together with compatible techniques, tools and methods helps to prevent failures in strategic initiative implementations- solid foundational theory and
methodology- different and unified approach- integrates several enterprise aspects and
activities coherently and consistently- can be applied at different (health) system
levels- just-in-time, just enough detail +
attractive ROME
Future Work- improve and extend Enterprise Ontology
modelling- 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
(local, national and European level)
Thank you!