2. 2
2003 M.D. (First-Class Honors) (Ramathibodi)
2009 M.S. in Health Informatics (U of MN)
2011 Ph.D. in Health Informatics (U of MN)
2012 Certified HL7 CDA Specialist
• Lecturer, Department of Community Medicine, Ramathibodi
• Deputy Executive Director for Informatics (CIO/CMIO), Chakri
Naruebodindra Medical Institute, Ramathibodi
nawanan.the@mahidol.ac.th
http://groups.google.com/group/ThaiHealthIT
Research interests:
• EHRs & health IT applications in clinical settings
• Health IT adoption & eHealth development
• Health informatics education & workforce development
Introduction
6. 6
Context for Strategic IT Management
The sailboat image source: Uwe Kils via http://en.wikipedia.org/wiki/Sailing
The destination
The boat
The sailor(s) &
people on board
The tailwind The headwind
The direction
The speed
The past journey
The sea
The sail
The current location
7. Class Exercise: Part 1
Knowing Your Context
Group discussion: ใน รพ.ของท่าน ปัจจัยที่น่าจะมีผล
ต่อการนํา IT มาใช้ และการบริหารจัดการ IT มีอะไรบ้าง
และมีความสําคัญอย่างไร?
ทุกโรงพยาบาลในตัวอย่างเป็นโรงพยาบาลสมมติ รายละเอียดต่างๆ ไม่ได้อ้างอิงข้อเท็จจริง
11. 11
Context
The sailboat image source: Uwe Kils via Wikimedia Commons
The destination
The boat
The sailor(s) &
people on board
The tailwind The headwind
The direction
The speed
The past journey
The sea
The sail
The current location
12. 12
Destination & Direction
• Vision
• Mission
• Strategic goals & business strategies
ประเด็นพิจารณา
• Specific
• Measurable
• Achievable
• Relevant/Realistic/Resourced
• Time-bound
19. 19
4 Quadrants of Hospital IT
Strategic
Operational
ClinicalAdministrative
20. 20
• Business
Intelligence
• Data Mining/
Utilization
• MIS
• Research
Informatics
• E‐learning
• CDSS
• HIE
• CPOE
• PACS
• EHRs
Enterprise
Resource
Planning (ERP)
• Finance
• Materials
• HR
• ADT
• HIS
• LIS
• RIS
Strategic
Operational
ClinicalAdministrative
Position may vary based on local context
4 Ways IT Can Support Hospitals
21. 21
IT As A Strategic Advantage
Resources/
capabilities
Valuable ?
Non-Substitutable?
Rare ?
Inimitable ?
No
Competitive
Disadvantage
Yes
No
Competitive
necessity
No
Competitive
parity
Yes
Yes
No
Preemptive
advantage
Yes
Sustainable
competitive
advantage
From a teaching slide by Nelson F. Granados, 2006 at University of Minnesota Carlson School of Management
22. Class Exercise: Part 3
Knowing Your IT Environment
Group discussion: วิจารณ์ว่า IT environment ของ
รพ. ต่อไปนี้ อยู่ใน Quadrant ใด และอยู่จุดใดใน
Competitive advantage model
29. 29
Hospital B
• โรงพยาบาลเอกชน 200 เตียง
• Vision: เป็นโรงพยาบาล High Tech High Touch ชั้นนําของประเทศ
• IT Environment
– HIS มี MPI, ADT, EHRs, CPOE แต่ยังมี CDSS จํากัด ระบบ HIS ช่วยลด
waiting time และเพิ่มประสิทธิภาพการบริการอย่างเต็มที่
– มีระบบลูกค้าสัมพันธ์ (CRM) ที่ effective มาก โดยเป็น standard out-of-the-
box implementation เป็นส่วนใหญ่
• People
– บุคลากรมีอายุเฉลี่ย 37 ปี (range 20-57) แผนก IT เข้มแข็ง
– แพทย์ไม่ค่อยมี interaction กับบุคลากรอื่น, รายได้เป็นแรงดึงดูดหลัก
– ผู้บริหารได้รับการยอมรับจากบุคลากรทุกวิชาชีพว่ามีวิสัยทัศน์และบริหารงานได้ดี
30. 30
Hospital C
• โรงพยาบาลมหาวิทยาลัย 900 เตียง
• Vision: เป็นโรงพยาบาลชั้นนําของภูมิภาคเอเชียที่มีความเป็นเลิศในด้านบริการ การศึกษา
และวิจัย
• IT Environment
– เป็น รพ.แรกๆ ที่มี HIS ซึ่งพัฒนาเอง และต่อยอดจาก MPI, ADT ไปสู่ CPOE (แต่ยัง
ขาด CDSS) ระบบ HIS เข้ากับ workflow ของ รพ. เป็นอย่างดี ยังใช้เทคโนโลยีเมื่อ
20 ปีก่อน เป็นหลัก มีระบบ ERP ที่ทันสมัย เข้ากับ รพ.
• People
– บุคลากรมีอายุเฉลี่ย 40 ปี (range 20-65), แผนก IT มีทั้งบุคลากรใหม่และที่เคย
พัฒนาระบบ HIS ตั้งแต่แรกเริ่ม
– แพทย์มีความเป็นตัวของตัวเองสูง, มักทํางานเอกชนด้วย, มี turn-over rate สูง
– พยาบาลและวิชาชีพอื่นมักมองว่าแพทย์คืออภิสิทธิ์ชน และมีเรื่องถกเถียงกันบ่อยๆ
31. 31
Context
The sailboat image source: Uwe Kils via Wikimedia Commons
The destination
The boat
The sailor(s) &
people on board
The tailwind The headwind
The direction
The speed
The past journey
The sea
The sail
The current location
32. 32
“The Boat”
• Size
• Resources
• Structures
• Work Processes
• Facilities/Geography
• Etc.
33. 33
“The Sea”
• Target customers
• Local competitiveness
• Relationship of hospital to local players
• Inter-organizational collaboration
• IT market environment
• National/international trend
• Regulations
• Standard of care
• Etc.
39. 39
IT As A Strategic Advantage
Resources/
capabilities
Valuable ?
Non-Substitutable?
Rare ?
Inimitable ?
No
Competitive
Disadvantage
Yes
No
Competitive
necessity
No
Competitive
parity
Yes
Yes
No
Preemptive
advantage
Yes
Sustainable
competitive
advantage
From a teaching slide by Nelson F. Granados, 2006 at University of Minnesota Carlson School of Management
40. 40
4 Quadrants of Hospital IT
Strategic
Operational
ClinicalAdministrative
41. 41
IT & Strategic Management
Vision (Goal)
Mission (Purpose)
Business Strategies
IT Strategies
42. Class Exercise: Part 6
Creating IT Strategy
Group discussion: เสนอ 1-2 IT strategies และ IT
projects ที่จะนําพา รพ. ไปสู่ vision ที่ตั้งไว้
47. How will we secure
our most important
financial and non‐
financial resources?
At what process do
we need to excel
to fulfill our
customer
expectations?
How will we sustain
our ability to improve?
How can we be
recognized as
the incubator of
change agents?
Deliver integrated
healthcare across
professions & care levels
Expose trainees to
relevant healthcare
needs of the public
Improve healthcare
process through
health systems
research
Improve educational
process through
medical education
research
Be a health professional
school for transformative
learning
Be a socially-responsive
health research institute
Be an innovative model
of integrated healthcare
Utilize
open-innovation
to enhance
research
Align research with healthcare
delivery & operations
Deliver
competency-based
transformative education
Provide
continuity of close
supervision
Engage
communities
47
Internationalize
educational, research
and healthcare processes
Build a
happy
workplace
Be certified/accredited
by educational and
healthcare standards
Utilize KM
to systematically
handle opportunities
for improvement
Increase research
funding from grant
agencies
Increase
investment returns
from organizational
assets
Sustain
healthcare
revenues
Use government
budgets
effectively
Sustain
public
donations
Enhance image
& visibility
though effective
public relations
Develop & Manage
workforce effectively
& efficiently
Build enabling
healthcare &
administrative
IT environment
Build state-of-the-art
learning resources
Financial capital:
Non‐financial capital:
Educational process: Research process:
Provide high-quality
healthcare &
remarkable customer
experiences
Healthcare process:
Learning and growth:
Goal: Ramathibodi becomes a medical institute that is publicly perceived as
“The Incubator of Change Agents for Desirable Health Systems (in BE2565)”
Customer:
As of 2014-4-1
Streamline
research
management
processes
50. 50
IT Project Management
• A project: “a temporary endeavor undertaken to
accomplish a unique purpose”
• Project management: “the application of
knowledge, skills, tools, and techniques to
project activities in order to meet or exceed
project requirements”
Marchewka (2006)
51. 51
The Project Management
Body of Knowledge (PMBOK®)
Marchewka (2006)
1. Project Integration Management
2. Project Scope Management
3. Project Time Management
4. Project Cost Management
5. Project Quality Management
6. Project Human Resources Management
7. Project Communications Management
8. Project Risk Management
9. Project Procurement Management
52. Class Exercise: Part 7
The Importance of Project Management
Group discussion: ถ้าขาด Project Management
ที่เหมาะสม จะเกิดอะไรขึ้นได้บ้างกับ IT Projects?
(What can go wrong with the IT projects?)
55. 55
The CHAOS Report
The Standish Group (1995)
Among the IT projects studied:
• 31% were cancelled before completion
• 53% were completed but over budget, over schedule, and
did not meet original specifications.
57. 57
New Top Ten Factors for IT Project Success
Marchewka (2006)
Rank Success Factor
1 Executive Support
2 User Involvement
3 Experienced Project Manager
4 Clear Business Objectives
5 Minimized Scope
6 Standard Software Infrastructure
7 Firm Basic Requirements
8 Formal Methodology
9 Reliable Estimates
10 Other
Table 1.3 Source: Extreme Chaos. The Standish Group International, Inc. 2001.
http://www.standishgroup.com/sample_research/index.php
67. 67
Measurable Organizational Value (MOV)
Marchewka (2006)
• The project’s goal
• Measure of success
• Must be measurable
• Provides value to the organization
• Must be agreed upon
• Must be verifiable at the end of the project
• Guides the project throughout its life cycle
• Should align with the organization’s strategy and goals
69. 69
A Good Project Goal
Marchewka (2006)
“Our goal is to land a man on the
moon and return him safely
to the earth by the end of the decade.”
John F. Kennedy (1961)
70. 70
Metrics: Financial
Marchewka (2006)
• Payback Period = Initial Investment
Net Cash Flow
• Breakeven Point = Initial Investment
Net Profit Margin
• Project ROI = (Total Expected Benefits - Total Expected Costs)
Total Expected Costs
71. 71
Metrics: Scoring Method
Marchewka
(2006)
Criterion Weight Alternative A Alternative B Alternative C
Financial
ROI 15% 2 4 10
Payback 10% 3 5 10
Net Present Value (NPV) 15% 2 4 10
Organizational
Alignment with strategic
objectives 10% 3 5 8
Likelihood of achieving
project’s MOV 10% 2 6 9
Project
Availability of skilled
team members 5% 5 5 4
Maintainability 5% 4 6 7
Time to develop 5% 5 7 6
Risk 5% 3 5 5
External
Customer satisfaction 10% 2 4 9
Increased market share 10% 2 5 8
Total Score 100% 2.65 4.85 8.50
Notes: Risk scores have a reverse scale – i.e., higher scores for risk imply lower levels of risk
92. 92
Project Risk Management
Risk Strategies
• Accept/ignore
• Avoid completely
• Reduce risk
likelihood or impact
• Transfer risk to
someone else (e.g.
insurance)
Marchewka (2006)
Risk = f(likelihood x impact)
93. Class Exercise: Part 11
Risk Assessment
Group discussion: ระบุ risks สําคัญๆ ที่อาจเกิดขึ้นใน
ระหว่างการดําเนิน IT Project ที่เสนอ และวิธีจัดการ
risks เหล่านั้น
94. 94
Gartner’s Sourcing Life Cycle
Sourcing Strategy
Identification
Criteria development
Organization fit
Selection process
Partnership opportunities
Governance model
Metrics
Payment models
Terms and conditions
Provision
for changes
Relationship
Performance
assessment
Goals: reach business
objectives, efficiency,
quality, innovation
Transition
Evaluation and Selection
Contract
Development
Sourcing
Management
Alignment
Organization assessment
Core competencies
Market scan
Make‐or‐buy decisions
Risk analysis
Strategic Tactical
From a teaching slide by Nelson F. Granados, 2006
95. 95
IT Outsourcing Decision Tree
Does service offer
competitive advantage?
Is external delivery
reliable and lower cost?
Keep Internal
Keep Internal
OUTSOURCE!
Yes
No
Yes
No
From a teaching slide by Nelson F. Granados, 2006
96. 96
IT Outsourcing Decision Tree:
Ramathibodi’s Case
Does service offer
competitive advantage?
Is external delivery
reliable and lower cost?
Keep Internal
Keep Internal
OUTSOURCE!
Yes
No
Yes
No
Core HIS, CPOE
Strategic advantages
• Agility due to local workflow accommodations
• Secondary data utilization (research, QI)
• Roadmap to national leader in informatics
External delivery unreliable
• Non‐Core HIS,
External delivery higher cost
• ERP maintenance/ongoing
customization
ERP initial
implementation,
PACS, RIS,
Departmental
systems,
IT Training
97. 97
Gartner Hype Cycle
Image source: Jeremy Kemp via http://en.wikipedia.org/wiki/Hype_cycle
http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp
99. Class Exercise: Part 12
Change Management
Group discussion: เสนอวิธีบริหารการเปลี่ยนแปลง
ใน user แต่ละกลุ่มใน Rogers’ Adoption Curve
100. 100
Unified Theory of Acceptance and Use
of Technology (UTAUT)
Venkatesh et al. (2003)
Performance
Expectancy
Effort
Expectancy
Use
Behavior
Social
Influence
Facilitating
Conditions
Behavioral
Intention
Gender Age Experience
Voluntariness
of Use
Usefulness
Ease of Use
Social Norm
& Opinions
IT Support
101. 101
Adoption Strategies:
“The Tipping Point” Version
The Three Rules of Epidemics
• The Law of the Few
– Connectors
– Mavens
– Salesmen
• The Stickiness Factor
• The Power of Context
Gladwell (2000)
Ease of Use
Social Norm
& Opinions
IT Support
Change Agents
Opinion Leaders
Super‐Users
Champions
102. 102
Factors Related to Hospital IT Adoption
• Communications of project plans & progresses
• Workflow considerations
• Management support of IT projects
• Common visions
• Shared commitment
• Multidisciplinary user involvement
• Project management
• Training
• Innovativeness
• Organizational learning
Theera-Ampornpunt (2009) [Unpublished]
105. 105
The KM Aspect of Project Management
Image source: Senoo et al. (2007) http://dx.doi.org/10.1108/14601060710776725
Nonaka SECI Model
During
Implementation,
Near Go-Live &
Post Go-Live
After Action
Review (AAR) /
Postmortem
Meeting,
Project Evaluation
Before & After
Project Kick-off,
During Project
Planning
During
Implementation,
Near Go-Live
Training
112. 112
Some Thoughts
• People-Process-Technology
• First, Do No Harm
• Embrace Change
• Murphy’s Law
–Everything that can go wrong will go wrong
(and if there is a worse time for something
to go wrong, it will happen then)
113. 113
Some Thoughts
• You Can Never Prepare Enough
• The Biggest Failure After Any Crisis is
the Failure to Learn
• Failures Are Opportunities in Disguise
• A Tale of Two Departments: It’s All
About the Attitude!
114. 114
Some Thoughts
• Remember Murphy’s Law, Or It Will Remind You
Itself!
• Manage People First, Before Managing Work, Money,
or Computers
• Recognize Values of “Special People”
• Calm Your Fears of Change
• Put Patients First
• Communicate! Communicate! Communicate!
• Good Communication Pays Off