Examples of Various Observed Anomalies Identified Within the Public Swedish Health-Care Sector – A more commonly orientated summary of a five years research and development work regarding information systems and organisation
This article (or preprint not yet completed due to the retirement of one of the authors) is a more commonly orientated summary of some of the two authors' findings during a five years engagement (or research and development work) within the public Swedish health-care sector.
Particular so about research results from Skaraborgs Sjukhus, i.e. the four hospitals that are located in Falköping, Lidköping, Mariestad and Skövde with approximate 4 500 employees. Our engagement, in this case, was at first concerning the yearly questionnaire surveys remitted to all employees regarding work and work conditions. That is, the so-called co-workers' questionnaire surveys, as have been and still, are practised within e.g. all Swedish public hospital (as well as also within many other private and public sectors). This research and development work gradually, more or less, forced us to scrutinise the organisation of these four hospitals in some specific ways. Such scrutinising was necessary for at least two reasons.
Firstly, this was needed due to one of the authors more than forty years experiences within the automotive and manufacturing industry. Among other things, we had already developed and used a specific method for some questionnaires surveys, which required detailed control out of each operator's work and workplace, as well as taking advantage of auxiliary information like e.g. both real-life and schematic layouts, individuals and workgroups geographical positions therein. This approach was needed to, gain an in-depth, understanding of each particular production system. For example, one merit is that we have earlier, using this specific method, been able to link subjective information with more hard facts, i.e. it has been proved possible to for us to amalgamate operators' perception with the e.g. production system design (i.e. a particular sort of complementary data collection have been at hand for all og our questionnaire surveys).
Secondly, this was also needed to make sense out of our similar efforts to apply this specific method for the public health-care sector (albeit, modified to suit Skaraborgs Sjukhus). And, while we were carrying out preliminary interviews as well as collecting auxiliary information, we had already (during the very initiation of the engagement dealt with here) started to be somewhat perplexed by some various anomalies gradually identified. Especially so for how the information regarding the organisation was differing between the information found in various information systems that were practised and also by anomalies with the information identified by quite other sources. Since one of our overarching aims was to, so to say, grasp the geographical aspects of Skaraborgs Sjukhus.
That is, to relate organisational issues to already established information to gain a proper overarching understanding that made sense for our analytical purposes. This independent on if such information happened to be hiding in an information system or if such information eventually was more or less evident using e.g. sings and naming of various parts of the building facilities (as a help for both of the employees as well as to the patients). Our earlier experiences, from the automotive and manufacturing industry, had most certainly underlined the importance of trying to establish what may be denoted as a "consistent semantic network".
At least was such a network needed for our analytical purposes. In fact, it proved necessary to carry out extensive inventories of all of the rooms (respectively room numbers, room denotation, etc.) for all of the approximately 35 000 rooms used. It was necessary for us to compare these particular findings with the information found in some information systems. Information systems that were used for e.g. administration of salaries within the four hospitals, calling of patients, the health-care region of Västra Götaland with numerous hospitals used for managing of information to patients in a more overarching (domestic) perspective and thus overarching sense, etc.
For example, the nomenclature practised within the four hospitals proved to be fragmented, inconsistent, incompatible, not well thought-out, etc. Moreover, the core medical health-care services managed by one public service (by Skaraborg Sjukhus) was not at all congruent with another public service, which was responsible for the building facilities (Västfastigheter) (two incompatible logics). It was, as a consequence, e.g. impossible to provide us with any list of names and number of employees the organisational units. In fact, it was even impossible to designate the parts of the appropriate building facilitates to the responsible organisational unit. Among other things, because the rent for the premises was invoiced as a lump sum on a yearly base between these two public services, this without any such information (such information was as said just non-existent). It is such anomalies, and partly the necessary measures suggested as remedies, that this article will address.
A comment: Note that a, for us and rather obviously for others, annoying was the above mentioned lack of a so-called consistent semantic network (the denotations in various administrative information systems used were featuring several inconsistencies like, abbreviations, shortenings, synonyms etc.) (such facts became obvious for us, and these anomalies ought to be remedied in the future). However, some constructive remedies are also illustrated, as was proved possible to bring forward by means of our practices of a combine data-collection and data-analyze approach (i.e. cross-reference procedures by computer technique and various manual efforts like re-configuration of customized print-outs on paper, which were cut up and reorganized manually by e.g. glue and scissors).
creation of a consisted semantic network
restructuring of information systems
Swedish health-care sector
vital preconditions for hospital design
certain cognitive aspects of work