A STRATEGIC ALIGNMENT MODEL FOR IT FLEXIBILITY AND DYNAMIC CAPABILITIES: TOWARD AN ASSESSMENT TOOL

The Dynamic Capabilities View (DCV) has emerged as an influential theoretical and management framework in modern IS research. However, despite the view\u27s significant contributions, its strength and core focus are essentially in its use for historical firm performance explanation. Furthermore, valuable contributions have been made by several researchers in order to extend the DCV to fit the constantly changing IT environments and other imperative drivers for competitive performance. Nevertheless, to our knowledge, no DCV extension has been developed which allows firms to assess their current state of maturity and to derive imperative steps for further performance enhancement. To fill this gap, this article develops a strategic alignment model for IT flexibility and dynamic capabilities and empirically validates proposed hypotheses using correlation and regression analyses on a sample of 322 international firms. Findings suggest that there is a positive relationship between a firm’s degree of alignment of IT flexibility and dynamic capability dimensions – defined as the degree of balance between all dimensions – and competitive firm performance. Alignment can, therefore, be seen as an important condition that significantly influences a firm’s competitive advantage in constantly changing environments. The proposed framework helps firms assess and improve their IT flexibility and dynamic capabilities. Results are discussed, while theoretical and practical implications are highlighted, concluding with suggestions for future research

Evolutionistic or revolutionary paths? A PACS maturity model for strategic situational planning.

PURPOSE: While many hospitals are re-evaluating their current Picture Archiving and Communication System (PACS), few have a mature strategy for PACS deployment. Furthermore, strategies for implementation, strategic and situational planning methods for the evolution of PACS maturity are scarce in the scientific literature. Consequently, in this paper we propose a strategic planning method for PACS deployment. This method builds upon a PACS maturity model (PMM), based on the elaboration of the strategic alignment concept and the maturity growth path concept previously developed in the PACS domain. METHODS: First, we review the literature on strategic planning for information systems and information technology and PACS maturity. Secondly, the PMM is extended by applying four different strategic perspectives of the Strategic Alignment Framework whereupon two types of growth paths (evolutionistic and revolutionary) are applied that focus on a roadmap for PMM. This roadmap builds a path to get from one level of maturity and evolve to the next. RESULTS: An extended method for PACS strategic planning is developed. This method defines eight distinctive strategies for PACS strategic situational planning that allow decision- makers in hospitals to decide which approach best suits their hospitals' current situation and future ambition and what in principle is needed to evolve through the different maturity levels. CONCLUSIONS: The proposed method allows hospitals to strategically plan for PACS maturation. It is situational in that the required investments and activities depend on the alignment between the hospital strategy and the selected growth path. The inclusion of both strategic alignment and maturity growth path concepts make the planning method rigorous, and provide a framework for further empirical research and clinical practice. (aut. ref.

Picture archiving and communication systems in the South African public healthcare environment : a suitable structure and guidelines to assist implementation and optimisation

Thesis (MScEng)-- Stellenbosch University, 2013.ENGLISH ABSTRACT: South Africa has a great number of patients and not enough medical expertise to attend to their patient needs. The South African Department of Health (DoH) has recognised the potential benefit of the Picture Archiving and Communication System (PACS) to address the health needs of rural patients who do not have access to specialised medical care. PACS allows specialist remote access to patient information to assist the diagnosis and treatment process remotely. South African healthcare institutions have been implementing PACS for over a decade, in an attempt to address the health needs of rural patients that do not have access to specialised medical care. Despite numerous deployment attempts, and the DoH’s support for PACS, the system is not operating successfully in South Africa. PACS was chosen due to its proven success as an appropriate technical system in most international hospitals of first and third- world countries (van Wetering, 2008) (Horri, 2010). However, specifications, guidelines and best practice operational methods for the appropriate PACS technical structure are lacking in South African literature and in governmental strategies. Additionally, there are no guidelines for implementation or support for hospital decision makers to manage the system and enterprise change. The purpose of this thesis is to (a) define a PACS technical and operational structure suited for the South African public healthcare environment and, (b) to develop guidelines for implementation and optimisation of PACS for managing the system and the enterprise change and progressively reach the defined structure. A combination of literature research, field observations and focus group discussions led to the understanding of the current (“As-Is”) PACS healthcare delivery system in South Africa and its barriers. Three types of PACS structures were found to be currently available: a DICOM-only image management system; a vendor supplied PACS; and a super-PACS. It was found that currently very few PACS systems in South Africa are operational and integrated with other healthcare institutions. This was due to a combination of factors: a) the complex, long chain of interdependent process steps and domains; b) vendor imposed limitations and propriety data formats; in combination with c) a lack of governing standards to ensure integration of digital PACS systems within the healthcare delivery environment; and lastly d) key decision makers lack the expert knowledge necessary to make informed decisions to deploy and manage PACS optimally. Further research led to establishing the (“To-Be”) PACS technical and operational structure suited for the South African public healthcare environment. Research has shown that the suited PACS technical and operational structure is a hospital-owned PACS system, free from vendor-imposed limits. The system consists of two databases, one with patient information and the other with patient images. The two databases are integrated by a hospital-owned server, which accesses the separate data files by means of patient identity keys. The requirements for the PACS implementation and optimisation guidelines for managing the system and the enterprise change to progressively reach the defined structure were developed. Different Enterprise Architectural Frameworks, as improvement and optimisation guidelines, were considered and compared in accordance with the requirements established. A maturity model (MM) was deemed as the appropriate framework to offer guidelines for managing PACS implementation and optimisation in the public medical sector of South Africa. After establishing that the available MMs were not sufficient in process or technical system detail, a new MM was developed for the deployment and maturation of PACS. The study was validated by means of usability study, user acceptance and goal checking, through focus group discussion and expert review. Users found the model to be a suitable deployment and optimisation guide, as well as a strategic planning tool. Verification was achieved by means of requirement analysis and consistency checking through the focus group discussions. It was found that it is needed to define a PACS technical and operational structure is suited for the South African public healthcare environment and that the guidelines for implementation and optimisation of PACS for managing the system and the enterprise needs to change to reach the defined structure functional. Implementing the use of PACS MM to reach the defined structure in South Africa will assist in improving healthcare delivery in South Africa and improving PACS system operation.AFRIKAANSE OPSOMMING: Suid-Afrika het 'n groot aantal pasiënte en nie genoeg mediese kundiges om aan hul pasiënt behoeftes te voorsien nie. Die Suid-Afrikaanse Departement van Gesondheid (DvG) erken die potensiële voordeel van ‘n Foto Argief en Kommunikasie Stelsel (PACS) om die gesondheidsbehoeftes van alle Suid-Afrikaners aan te spreek – tot die landelike pasiënte wat nie toegang tot gespesialiseerde mediese sorg het nie. PACS laat spesialiste toe om toegang te kry tot afgeleë pasiënt inligting, en daardeur fasiliteer dit die diagnose- en behandelingsproses. Suid-Afrikaanse gesondheidsorginstellings poog al vir meer as ‘n dekade om PACS te implementeer, om daardeur die gesondheidsbehoeftes van landelike pasiënte wat nie toegang tot gespesialiseerde mediese sorg het nie, aan te spreek. Ten spyte van talle ontplooiings pogings, en die DvG se steun vir PACS, is die stelsel steeds nie suksesvol in Suid-Afrika nie. PACS is gekies as ‘n oplossing, as gevolg van die sisteem se bewese sukses as 'n geskikte tegniese stelsel in meeste internasionale hospitale in eerste en derde wêreld lande (van Wetering, 2008) (Horri, 2010). Suid-Afrikaanse regering strategie en literatuur het egter ‘n gebrek aan spesifikasies, riglyne en beste- praktyk operasionele metodes vir die toepaslike PACS tegniese struktuur. Benewens is daar geen riglyne vir die implementering en ondersteuning van die stelsel en die onderneming se verandering vir hospitaal besluitnemers nie. Die doel van hierdie tesis is om (a) 'n PACS tegniese en operasionele struktuur, geskik vir die Suid-Afrikaanse openbare gesondheidsorg omgewing te definieer, en (b) riglyne vir die implementering en afronding van PACS vir die bestuur van die stelsel en die onderneming se verandering teen doel om progressief die gedefinieerde struktuur te bereik. 'n Kombinasie van literatuur navorsing, veldwaarnemings en fokusgroepbesprekings het gelei tot die begrip van die huidige ("as- is") PACS gesondheidsorg proses in Suid-Afrika en die hindernisse daarvan. Drie tipes PACS strukture is tans beskikbaar in SA: 'n DICOM (net-mediese- beelde) beheer stelsel, 'n verkoper verskafde PACS, en 'n super-PACS. Deur uitgebreide navorsing is daar gevind dat baie min PACS stelsels in Suid-Afrika tans operasioneel en geïntegreer is met ander gesondheidsorg instellings. Dit was te danke aan 'n kombinasie van faktore: a) die kompleks, lang ketting van interafhanklike proses stappe en gebiede; b) ondernemer opgelê beperkings en ordentlikheid data formate; in kombinasie met c) 'n gebrek aan beheer standaarde integrasie van digitale PACS stelsels om te verseker binne die lewering van gesondheidsorg-omgewing, en laastens d) sleutel besluitnemers nie die deskundige kennis wat nodig is om ingeligte besluite te sit en te bestuur PACS optimaal te benut. Verdere navorsing het gelei tot die vestigting van die geskikde("to-be") PACS tegniese en operasionele struktuur, vir die Suid-Afrikaanse openbare gesondheidsorg omgewing. Die geskik PACS tegniese en operasionele struktuur bestaan uit ‘n hospitaal-besitde PACS stelsel, vry van ondernemer-opgelegde grense. Die stelsel bestaan uit twee databasisse, een met 'n pasiënt inligting en die ander met dei pasiënte se mediese beelde. Die twee databasisse geïntegreer deur 'n hospitaal-besitde-rekenaarbediener, wat toegang tot die afsonderlike data lêers het deur middel van die unieke pasiënt nommers. Die vereistes vir die PACS implementering en afrondings riglyne, vir die bestuur van die stelsel en die ondernemings veranderinge, is ontwikkel. Verskillende ondernimings argitektuur raamwerke is oorweeg en vergelyking in terme van hulle vermoe om aan die gesigde vereistes et voldoen. As ‘n resultaat is die volwassenheid model (MM) beskou as die toepaslike raamwerk om riglyne vir die bestuur van PACS implementering en afronding in die openbare mediese sektor van Suid-Afrika te bied. Na die beskikbare MMs geasseseer was en nie voldoende bewys is, was 'n nuwe MM ontwikkel vir die implementeering en afronding van PACS. Die studie was gevalideer deur middel van die bruikbaarheid studie, gebruikers aanvaarding en doelwit asseseering, deur middel van fokusgroep besprekings en kundige oorsig. Gebruikers het gevind dat die model geskikte as implementeerings en afrondings gids, sowel as 'n geskikte strategiese beplanning hulpmiddel is. Verifikasie is bereik deur middel van vereiste-ontleding en konsekwentheid analiseering deur die fokusgroep besprekings en spesifikasie analise. Die PACS tegniese en operasionele struktuur wat definieer was, is geskik vir die Suid-Afrikaanse openbare gesondheidsorg omgewing en dat die riglyne vir die implementering en afronding van PACS funksioneel is . Die implementering en gebruik van die gedefinieerde struktuur deur mideel van die PACS MM in Suid-Afrika, sal help in die verbetering van gesondheidsorg dienslewering en die verbetering van PACS stelsel operasie

Sistemas de gestão integrados: desenvolvimento de um modelo para avaliação do nível de maturidade

Tese de doutoramento do Programa Doutoral em Engenharia Industrial e de SistemasIntegração é definida como “o ato ou processo de tornar inteiro” e sistema como “arranjo de elementos interrelacionados e interatuantes, tais como processos que utilizam vários recursos de modo a atingir objetivos predefinidos”. As organizações humanas despendem uma grande quantidade de trabalho a desafiar um dos conceitos mais básicos da física: a entropia. A “ponta do iceberg” visível desta guerra intestina contra a tendência das organizações para a desordem são os sistemas de gestão. Os sistemas de gestão mais reportados a coexistirem num Sistema de Gestão Integrado (SGI) são o Sistema de Gestão da Qualidade (SGQ), implementado segundo a norma ISO 9001, o Sistema de Gestão Ambiental (SGA), implementado segundo a norma ISO 14001 e o Sistema de Gestão de Segurança e Saúde no Trabalho (SGSST), implementado segundo a norma OHSAS 18001. O objetivo do trabalho realizado foi o de analisar o fenómeno da integração de sistemas de gestão, identificar áreas de investigação abertas, propor soluções para colmatá-las, nomeadamente através do desenvolvimento de um modelo que permita avaliar a maturidade de um SGI. Como ponto de partida, a revisão bibliográfica efetuada procedeu ao levantamento de todas as questões abordadas pela literatura científica relacionada com a integração de sistemas e com modelos de maturidade e, a partir da caracterização do estado-da-arte, identificou as áreas para as quais ainda não há respostas ou onde, apesar de já existirem, as mesmas são de natureza difusa. Constatou-se que a integração de sistemas de gestão é um fenómeno caracterizado pelo número elevado de variáveis envolvidas, nomeadamente, a estratégia utilizada, o processo de implementação, a tipologia de auditorias e o nível de integração atingido, entre outras. A revisão bibliográfica inicial permitiu também o desenvolvimento de questionários, que se revelou a principal metodologia de investigação adotada. O recurso a metodologias alternativas na análise de resultados confirmou a relação existente entre as motivações iniciais para implementação de um SGI e os benefícios daí resultantes. A clarificação da posição do SGQ num contexto de integração, identificando as várias posições que este subsistema pode assumir, contribuiu com informação crítica para a gestão de topo, focando o sucesso do processo de integração. O contributo final desta tese consubstanciou-se na elaboração de um modelo de maturidade que permite avaliar a maturidade de um SGI assente em dois componentes: o back office e o front office. Esta tarefa permitiu que outros contributos fossem também possíveis, nomeadamente, a realização de uma macro-análise ao fenómeno da integração de sistemas de gestão a nível mundial, ao desenvolvimento de indicadores macro e à avaliação da sua assertividade por comparação com outros indicadores baseados em diferentes fontes. A natureza diversa da pesquisa bibliográfica realizada permitiu também a identificação de conceitos externos ao processo de integração, mas cuja adoção permite um acréscimo à maturidade dos SGIs. Tópicos como a avaliação e gestão do ciclo de vida, a macroergonomia, a sustentabilidade e a responsabilidade social foram identificados como coadjuvantes para uma integração mais profunda, contribuindo para um SGI com maior maturidade. O desenvolvimento de indicadores macro para avaliação da dispersão a nível mundial dos SGIs permitiu concluir que a sua evolução, durante o período temporal de 1999 a 2011, se traduz num acréscimo acentuado em todas as macro regiões consideradas. A nível nacional, as empresas que desenvolveram um SGI situam-se, principalmente, nas regiões Norte, Centro e de Lisboa sendo a tipologia de SGI mais adotada aquela na qual estão integrados os SGQ, SGA e SGSST. Os resultados do questionário dirigido aos peritos permitiram distinguir empresas com um alto nível de integração. A utilização das mesmas ferramentas e metodologias organizacionais em cada subsistema e o alinhamento de objetivos, bem como o facto de a empresa monitorizar os seus processos com base em indicadores integrados são evidências de um nível de integração máximo. No modelo de maturidade desenvolvido é possível constatar que três variáveis dão um contributo superior às restantes para a variável latente “Maturidade do SGI”. São elas a visão integrada revelada pela gestão de topo, a classificação do nível de integração atingido e a tipologia de auditorias realizadas.Integration is defined as “the act or process of making whole or entire” and System defined as “an interrelated elements array, such as processes, using several resources to achieve set goals”. Human organizations take a lot of work in order to defy basic physics laws namely entropy. The visible “iceberg peak” of this subtle war against organizations disorder trend are the management systems. The most commonly reported subsystems combined into a single Integrated Management System (IMS) are the Quality Management System (QMS) implemented according ISO 9001 standard, the Environmental Management System (EMS) implemented according ISO 14001 standard and the Occupational Health and Safety Management System (OHSMS) implemented according OHSAS 18001 standard. The main objective of this thesis is to analyse all management systems integration phenomenon, to identify open research paths and to present solutions, namely, through a model development aiming at IMS maturity assessment. The thorough literature review undertaken, focused on open questions identification related to IMS and maturity models, depicted some unanswered questions, some with diffuse answers and some questions never made. The initial literature review allowed the development of the surveys focused on the organizations and on the selected academic and industry experts being this methodology the thesis corner stone. A back office and front office based maturity model development assessing IMS was the ultimate contribution from this thesis. This contribution, on its own, and sustained on multi-methodological tasks, allowed some other contributions, namely, the macro analysis of the management systems integration phenomenon worldwide, macro-indicators development and their evaluation by comparison with other indicators based on different sources. Some alternative methodologies adopted on results analysis contributed on some issues raised by several authors, namely, by confirming the relation between IMS implementation initial motivation and the benefits collected afterwards. Additionally, the QMS reposition after the integration process was assessed and three main strategies were identified. This identification enables top management with crucial information aiming at an integration successful process. Literature review allowed also external concepts identification that relates to IMS maturity. Topics like life cycle management and assessment, macroergonomics, sustainability and social accountability should be taken into account, enabling a deeper integration, and a more mature IMS. The results promoted several critical success factors identification that should be considered when integrating management subsystems. Some characteristics intrinsically related to high integration level organizations and low integration level organizations were identified. It was possible to conclude that management systems integration phenomenon is characterized by the high number of variables involved. The adopted strategy, the implementation process, the audit typology, the IMS typology, the motivation, the benefits, the obstacles and the achieved integration level are among those variables. Through macro-indicators development aiming the IMS dispersion worldwide analysis one may conclude that they evolved positively and increased in number during the time period between 1999 and 2011. At a national level, it is possible to conclude that the organizations that developed an IMS are mostly located at the North, Centre and Lisbon regions. The integrated QMS, EMS and OHSMS is the IMS typology mostly adopted. The results collected from the survey among academic and industry experts allowed the identification of high integration level organizations. According to these results, the development and adoption of the same tools and methodologies by each subsystem and objectives alignment, processes monitoring based in integrated indicators are evidences of a maximum integration level. The maturity model final version allows the conclusion that three variables contribute the mostly to the “IMS Maturity” latent variable. Those variables are the integrated vision by top management, the integration level classification and the audit typology. External concepts and the eight excellence management pillars relate also to the IMS maturity

Modelo de Maturidade para a Gestão dos Sistemas de Informação Hospitalares

Neste projeto de doutoramento, foi desenvolvido um Modelo de Maturidade abrangente denominado HISMM (Hospital Information System Maturity Model), que incorpora os principais Fatores de Influência dos Sistemas de Informação Hospitalares (SIH). A conceção do HISMM, seguiu duas abordagens metodológicas, nomeadamente a Revisão Sistemática de Literatura (RSL) e o Design Science Reserach (DSR). Numa primeira fase, realizou-se uma abrangente RSL. Posteriormente, foi realizado um inquérito por questionário que contou com a participação de vários especialistas de STI da área da saúde, e que possibilitou a conceção de uma primeira versão do Modelo. Finalmente, na perspetiva de validar o Modelo inicialmente proposto, foram encetadas entrevistas a um conjunto restrito de importantes Gestores de SIH Portugueses