Operational and Implementation Problems - Coursework Example

? Operational and Implementation Problems in IT Systems in Children’s Services Health care facilities face many operational challenges, somerelating to the sheer logistical incapacity to handle the work flowing though the systems and the others relating to the manner in which the systems run. Modern business concepts necessitate the use of information systems to improve work efficiency and improve performance assessment process. Children healthcare services are not exempt to these challenges and issues. In fact, in many Western nations, the facilities tending to the needs of children clog with work and experience high levels of operational inefficiencies. In addition, the implementation of technological innovations to the referral and performance assessment process is yet to achieve satisfactory results. The current information systems are just as prone to the errors as with the earlier systems, a situation many analysts think should inspire broad changes and reforms with the overarching aim of correcting it and making the systems more efficient. This paper discusses problems in referral and assessment services in children’s healthcare facilities and makes recommendations for smoother running of the systems. Introduction Health care systems the world over are seeking to ‘modernize’ their health care systems even further. Modernization is a broad term referring to the process of automation, by the use of advanced technology in the day-to-day operations at the health care establishments. Over the past decade, aggressive improvements in health facilities with regard to technology have been taking place. Many hospitals now make use of electronic patient records, electronic scheduling of appointments, e-prescription, and improvement in broadband communication networks across the national health care systems (MedPAC, 2004). Arguably, technology has changed the state of health care for the better, and its benefits and ability to enhance the quality of health care provision is indisputable. While the reports on the impact on the use of technology in healthcare systems have been nothing but favourable, particular facets of the automated systems continue to arouse much debate and inspire dialogue from analysts in the health care systems, in particular assessment and referral processes in children’s facilities. According to research from a few years ago, technology currently in use in assessment and referral processes in children’s health care facilities is highly ineffective, error prone, wrongly used and incapable of delivering on its expectation. This report analyses problems facing healthcare facilities serving children with regard to their assessment and referral processes. Healthcare System Design The healthcare information system belongs in a broader context of the health care system structure. Many factors, evidently affects its operation and efficiency, from the origination to its operation and use of the information it generates. Below is a diagram of a healthcare information system according to the World Health Organization (WHO) (Lippeveld & Sauerborn, 2005), the diagram elucidates the defining role the management plays in the design and implementation of new healthcare information systems. From the management, it is apparent that the management oversees the supply of resources to use in establishing the new information systems, and lays a foundation for the kind of output they expect from the systems. Problems in Computerised Healthcare Systems serving Children Broadhurst et al. (2010) claims that the existing initial assessment systems for children’s services exhibit deep flaws and acute malfunctions. Medical institutions continually face situations where they have to deal with more patients than they have capacity for; consequently, meeting the right performance standards becomes a distant reality. For instance, the process of classifying incoming referral information happens in a sloppy and haphazard manner, and with little informational backing. Because of flawed manual classification systems, many cases are wrongly categorised and the children to whom the cases pertain suffer as a result. In addition, Broadhurst et al. (2010) highlights the fact that the demands of data input from the referrals makes the conducting of some of the key steps in the process unattainable. For instance, critical face-to-face time with the young patients is lost. This illicit combination of negative factors exacerbates the problems associable with referral systems. Additionally, the problems make the people running the systems assume a less favourable outlook of the automated systems, which does great disservice to the children the systems apparently serve (Broadhurst et al, 2010). In addition, the problems in serving children in public referral centres calls for an urgent upgrade of the systems to meet pressing demands while keeping an appreciable level of performance for the health care centres. Automated internal audit systems have done little to alleviate the problems facing workers operating the automated information systems. IT-based internal audit systems have put a wedge between the worker facilitating the service and the person receiving the service, while creating numerous complications in operations and data management for the persons involved. According to Broadhurst et al. (2009), Integrated Children’s System (ICS) systems, which are believed to embody the spirit of internal audit systems, have failed in their mandate as performance assessment tools, and in reverse, inhibit the process of quality performance in the health care centres. In particular, the study showed that the systems increased the chances for hard to notice errors. Existing referral systems also face accusations of being hostile and unwelcoming of staff feedback. In addition, the workers often have to overwork themselves and take blame and threats of demotion for errors in the systems. The unhealthy management practice is responsible for the concealment of errors by the staff to avoid unfavourable management action. Internal inspection and performance measurement system only seem to exacerbate the situation of the workers and overburden them further though undue work pressures. Conceivably, the audit systems fail miserably in their role in assessment and performance evaluation in the health care facilities. IT Implementation Approach in Hospital Establishments According to the analysis by Broadhurst et al (2009), the design of the current information systems have obvious and glaring flaws, and lack a functional human-machine interface to make them fitting for their purpose. Part of the process towards redesigning new information systems is identifying the reasons for failure in the previous one. In this case, the existing technologically enhanced systems are highly error prone, and the management staff especially inhibitory to continuous improvement process through the indiscriminate assignment of blame to employees even for faults resulting purely from the use of the system. The observation is echoes concerns raised in a report by Heeks and Salazar (1999), which revealed that the emphasis on the technical aspects of the technological systems at the expense of the organizational structure and social aspects were inevitably doomed for failure. The level of malfunction present in the current IT system implores stakeholders to step in and help develop new systems that incorporate broader structural outlooks and ensure that the needs and goals of putting those systems become a reality. Although supporters of the current information systems claim that, the systems offer increased levels of safety, research by Broadhurst et al. (2009) clearly suggests otherwise, and with credible evidence. For example, the current assessment systems have demanding audit regiments, which lower the potency of the information systems, one of the many factors, which make the calls for improvement of new and more effective information systems more pronounced. Another flaw in the implementation process of the existing system is attributable to the lack of proper retraining of the staff charged with operating the new systems. In addition, most of the existing systems conspicuously exclude the input of the user in the design, for instance, the opinions of the affected staff and the end users, which explain some of the reasons for the inefficiency in the systems with regard to their operations. From the research on the inefficiency of the current computerised systems, the pressure from the senior staff in the creation of the system usually results in unrealistic and impractical demands on the users of the systems, especially the staff, whose performance measurement is with regard to strict and non-negotiable evaluation criteria for which the systems may fall short. For instance, the workers have to classify and input numerous data from manually filled sheets into the computerised system, a hurried system that results in numerous errors in the use of the computerised systems. With this in mind, it is imperative that subsequent design of the information systems should take into consideration the probability of making errors, by developing an easy to use system with internal mechanism to detect errors as soon as they are apparent. Such measures can help restore confidence in the new information system and stem the downgrade in the service delivered through the computerised systems in health care facilities. Conclusions The common management practice of inconsiderately punishing employees for mistakes done within their area of responsibility is a huge impediment to progress and efficiency of referral processes in children’s health care facilities. The added inefficiency of the internal assessment systems also contributes largely to this disconcerting trend. The problems in management of the referral and assessment systems spills into the quality of service accorded to the end-users, who often suffer neglect and wrongful treatment as a result. In addition, the assessment systems themselves carry serious inherent flaws, and the audits and assessments are often rushed and imprecise, concentrating on some areas deemed more important and ignoring most of the other areas requiring detailed audit. Despite heavy technological investments in IT services for children health care facilities, some of the agendas the systems sought to resolve by replacing traditional manual systems persist. The incidences of errors remain worryingly high. Analysts suggest that the baffling occurrence many be as a direct result of poor implementation methodology of the technological referral and assessment systems, which were implemented without careful assessment of the design requirements of the systems for the health facilities. While not dismissing the use of technology in modern governance, the analysts call for a re-examination of the factors critical to the implementation of a successful information system for health care facilities. Recommendations Kaye et al. (2004) claims that for technological changes to have a positive impact in the health care systems, the leadership also needs to adjust accordingly, in what is aptly referred to as ‘innovative leadership’. While Kaye et al. (2004) emphasizes the importance of involving the top leadership in designing healthcare systems, the researchers are quick to accentuate the importance of collaborating with stakeholders in the field so that the issues relating to the running of the facilities are addressed comprehensively. Ignoring the needs and practicalities facing the staff and the beneficiaries of the systems are a major reason for the failure of the systems in the first place. Shaw and Stahl (2008) propose that continuous improvement form part of the automation process in the health care facilities. Through regular review and improvement, the systems will grow in efficiency and quality of service. In addition, it is crucial that health care systems have solid standards on which to base their technology advancements. The current piecemeal implementation of technology gravely understates the importance of concrete technology and therefore leads to less commitment to ensure that they work as expected (Shaw & Stahl, 2008). References Broadhurst, K, Wastell, D, White, S, Hall, C, Peckover, S, Thompson, K, Pithouse, A and Davey, D. (2010). Performing ‘Initial Assessment’: Identifying the Latent Conditions for Error at the Front-Door of Local Authority Children’s Services. British Journal of Social Work, 40(2), 352-370. Heeks, R, and Salazar, M. (1999). Why Health Care Information Systems Succeed or Fail. Institute for Development Policy and Management. P.5. Retrieved on April 14, 2012 from http://unpan1.un.org/intradoc/groups/public/documents/nispacee/unpan015482.pdf Kaye, R, Kokia, E, Shalev, V, Idar, D and Chinitz, D. (2010). Barriers and Success Factors in Health Information Technology: A practitioner’s perspective. Journal of Management and Marketing in Healthcare. Vol. 3(2), 163-175. DOI: 1179/175330310X1273657773 2764 Retrieved on April 14, 2012 from http://www.maccabi-research.org/res/pdf/ Barriers.pdf Lippeveld, T, and Sauerborn, R. (2004). A framework for designing health care information systems. WHO. Retrieved on April 14, 2012 from http://whqlibdoc.who.int/publications/2000/9241561998_(chp2).pdf MedPAC. (2004). Information technology in healthcare. MedPAC. Retrieved on April 14, 2012 from http://www.medpac.gov/publications%5Ccongressional_reports%5C June04_ch7.pdf Shaw, M and Stahl, B. (2008). Quality assurance based healthcare information system design. Americas Conference on Information Systems, ON, Canada 14th – 17th. Retrieved on April 15, 2012 from http://www.cse.dmu.ac.uk/~bstahl/publications/2008_ healthcare_qa_amcis.pdf Read More