We recently organized a workshop at BiZZdesign for enterprise architects in healthcare. A mixed group, from hospitals and other healthcare providers. In the workshop, various issues were discussed. We want to highlight some of these topics in this blog.
First, there is the maturity of the architectural practice in healthcare institutions. Prior to the workshop, the participants had completed a quick scan that provides a first insight into this maturity, in different areas taken from management approaches such as COBIT. The graph below gives a fairly representative example of an outcome. Without going into detail on the measurement and scales (the typical maturity levels of 1-5) , there are a couple of things we notice.
Many architecture groups in healthcare organizations are struggling with the communication with the rest of the organization. In healthcare, the patient cure and care processes are the center of focus, and the information is seen as relatively unimportant by most healthcare professionals and managers. This makes it difficult for architecture groups to gain recognition from both the organization at large and from management in particular. In organizations like banks, insurers or government agencies, where large parts of the primary process are ‘inside’ the information systems, the perception of architecture is different.
We also see that the responsibilities for architecture are often not assigned properly. That has to do with the previous point, but also with the organization structures in healthcare. The relatively autonomous role of physicians in hospitals makes centralized decision-making on information- and IT-related issues difficult to organize. Vested interests and specific local needs clash with the general goals of effective and efficient information systems across the organization.
Nevertheless, many healthcare organizations have engaged in the professional development of their internal architecture practice, increasingly using tools and establishing clear policies and procedures. The latter also has its risks: if the organization’s understanding of the value of architecture is still lacking, instituting procedures and standards may evoke the image of the ‘architectural police’. It is therefore important to grow the maturity of your architectural practice in different areas and aspects at the same time.
A second theme of the workshop was the essential role of information in healthcare. Information flows have become the ‘circulatory system’ of the organization. Many organizations, however, lack a clear overview and do not pay adequate management attention to information. Fragmentation of data in silos, inconsistencies, unclear responsibilities, privacy sensitivity, complexity and a large number of external information flows are just some of the issues that make this a growing problem. In the workshop, we discussed various complementary solutions:
- Data governance to organize responsibilities and quality assurance;
- Master data management to bridge across silos and ensure consistent data quality;
- Metadata management to capture ‘data about data’ such as origin, history, accuracy, accountability and access control;
- Business intelligence and data warehousing to distill management reports and trends from large amounts of data.
In particular, the increased reporting pressure from the government, insurers and regulators makes good management information paramount. This is really an issue for the boardroom, given the serious risks involved. In the Netherlands, recent publicity about substantial fines for hospitals and physicians because of inaccurate invoicing, and the refusal by accountants to approve the financial statements of healthcare organizations clearly show the need for improvement in this area. The complexity of the healthcare system in the Netherlands and many other countries makes this a challenging task.
A useful way to start with EA in a healthcare organization is to use a reference model. In the Netherlands, three reference models (for cure, long-term care and mental healthcare) have been developed by the community and are increasingly adopted in practice.
Finally, we learned that architects with some background in and affinity with healthcare find it easier to bridge the gap between the EA discipline and the primary operation of healthcare. It helps in the communication with the nursing staff and doctors if they have the feeling that the architect understands what healthcare is about.