In addition to a strategic intents described above and in addition to the methodology developed by Epic and the program management of Sundhedsplatformen, an additional measure has been put in place to ensure the realization of the potential and the benefits promised by the new HIT.
This section reviews so-called ‘benefit realization concept’ (Implementering i bund - Koncept for Gevinstrealisering i Sundhedsplatformen Bilagssamling), which contains a detailed analysis of the expected results of the implementation. The analysis is done approximately halfway between the project initiation in January 2014 and the first go-live at Herlev Hospital in May 2016.
“The Benefit-realization-concept is dealing with the combined realization of economical, qualitative and patient-experienced benefits in treatment following implementation and
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use of Sundhedsplatformen. The concept defines the overall frame and principles for how the benefit realization is to be conducted and in appendixes it lists the initiatives that are to operationalize the concept.” (p.3)
The need to focus on benefit realization in broad terms is based on the conviction that it is inadequate to ensure the outcome of the program merely in financial terms. In order to be a success the benefits realized in the program must include workflows and
processes, which is only possible through concrete changes in hospitals and hospital departments. “Only when employees work in a different way, will changes happen.” (p.4) The responsibility of changes is placed with two primary groups. Department managers and middle-managers are responsible for implementing the actual changes and hospital management and regional leadership (Koncernledelse) is identified as responsible for managing the processes. The benefit realization is essentially a question of leadership.
In order to support the change process driving the benefit realization four areas are identified;
Introduction: A solid introduction to the ideas [of Sundhedsplatformen]
Clear goals and plans: Determination of clear goals, communication, plans and deadlines
Help / tools: Establishing data based help (it-based tools), enabling measurement of individual indicators
Education: Education of department- and middle-managers
Tying the various elements together is the focus on data-driven management, though which it should e.g. be possible to determine / measure if initiatives have the desired effect. In the model below taken from the ‘benefit realization concept’ it is clear how a strict hierarchical structure and increasing levels of detail in data is seen as the way to ensure success.
106 Figure 4.6: Benefit realization of Sundhedsplatformen
The model illustrates the use of indicators at various management levels. In the ‘benefit realization concept’ it is emphasized that feedback should be possible between the levels in the hierarchy. The model however is clearly structured in a traditional
hierarchy, characterized by command and control and scientific management thinking.
While this is not entirely surprising, considering it is a public sector organization and as such logically rounded by the bureaucratic structures in the public sector, it is in stark contrast to the practice of intensive involvement of clinical staff e.g. though the 500-clinician meeting and the ITX lab-tests. It would seem that the concept assumes that successful implementation is merely a question of describing, instructing and monitoring well enough and then to allow for feedback, mostly in order for it to appear to be
trustworthy.
Summary
As mentioned above one of the characteristics of the case of Sundhedsplatformen is the enormity of the project. The number of people involved. The timespan involved. The scope of the change and the potential implications to the future users. In the most hectic phases, program director Gitte Fangel, described the project as resembling whitewater rafting, leaving only room for crude maneuvering once things have been set in motion, because of the complexity and scale of internal and external forces causing the project to move forward or downstream. It is notable how the distinction between
Regional leadership level
Monthly measurement of progress and status overview, used for overall controlling and follow-up vis-à-vis hospital direction and IT organization
Hospital management
Monthly / weekly measurement of progress and status overview, used for overall controlling and follow-up on department management
Department management
Weekly measurement of progress and analysis to be used as development and change tool in the actual change management and benefit realization overview, used for overall controlling and follow-up on department management
Data driven change management and realization of benefits
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the episodic or continuous organizational change to a wide extent has dissolved.
Distinctions between planned and unplanned and between episodic and continuous blurs as the project progresses. As noted in the literature review the umbrella construct of Organizational Change and Development (OCD) appears better suited to describe the ongoing situation. One of the consequences of the scale of the project has been that it has been virtually impossible for any individual to get a detailed understanding of the project. Some have had significant knowledge about details and other an overview at a higher level. Messages to stakeholders from Sundhedsplatformen have by necessity been at certain level of abstraction, in order to be understandable to a wider audience.
And if the devil is in the detail, this has due to the complexity rarely if ever been brought to the attention of the wider organization.
The perhaps most important conclusion to be drawn from the overview of context and content of Sundhedsplatformen is that the pre-history of Sundhedsplatformen does not just goes back to the signing of the contract in 2013 or even to the first meeting
between the regions about the project in 2011. For clinical staff at the hospitals the history of organizational change extents decades back influenced by a steady flow of strategies and visions for the area. Anybody working in hospitals will have been exposed to local hospital realization of visions from authorities. While it might be thought, that this would have caused a ‘change fatigue’ in the organization, causing upfront resistance to Sundhedsplatformen, the analysis in the next chapter illustrates the reaction to pending change is not that simple. As explained in several interviews – this time it is different.
The case however also reveals what appears to be an inherent conflict between open and involving approach to work on the project and the demand to demonstrate
accountability. On the one hand clinicians have been invited in, at virtually all stages in the project to test, give feedback and validate content and processes. The core team working to transform the generic core system of EPIC into a solution specifically
designed to the Danish condition all have clinical background, which e.g. means that the people working on the anesthetics module of Sundhedsplatformen actually had clinical experience from anesthetics. This is in contrast to the command and control approach introduced in the ‘benefit realization concept’ which to a wide extent foresees the post implementation reality of hospitals being required to been run within tight budgets and being able to continuously to account for status on key measuring points.
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5 - Analysis
1. Introduction to analysis 2. Categorization of themes 3. Thematic analysis
a. Sensemaking b. Positioning
c. Scripting the future d. Culture
4. Recurring patterns – the Anticipation Cycle 5. Anticipating organizational change