Information technology is pivotal in helping organizations maintain a reliable mechanism of enhancing information governance within healthcare settings. Unfortunately, many of the available healthcare information systems fail at the implementation phase (Johnson & Zhang, 2005). This paper discusses the key factors contributing to these failures. Besides, it analyzes the leadership team’s reaction to the failures in a bid to offer recommendations of some of the best practices that any organization can adopt to avoid such failures in the future by suggesting how health care leaders can use project metrics and portfolio management to ensure efficiency and effectiveness. The paper also analyzes government interventions into health care businesses to ensure that health care and patient information are secure by minimizing information breaches and technology failures. Finally, the study offers a personal position on whether health care providers should either develop a custom application or select a proprietary system to help with information system failures in the healthcare settings. This discussion is done with reference to failures in of patients’ records, which are computer-based in HCR Manor Care and healthcare IT projects at Health Integrated Service Center.
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Factors contributing to the failure of information health care information systems
According to Kaplan (2000), healthcare information systems in the US have a failure rate of 50 percent. Various scholars describe the reasons why this failure takes place in a comprehensive manner. For example, Johnson, and Zhang (2005) cite the failure to incorporate staff such as clinicians in the process of development of human-computer interfaces as a mega contributing factor for the breakdown of many IT infrastructures. Many information systems in healthcare settings are also influenced negatively by inadequate technical support together with maintenance challenges upon implementation of information systems. At HCR Manor Care and Health Integrated Service Center, other contributing factors include poor collaboration between various representatives of information system service providers and stakeholders within the health care bases (Baron et al., 2007). In spite of this wealth of information on bottlenecks, which result in the failure of information systems in these organizations, many information systems within healthcare settings are still failing.
For HCR Manor Care and Health Integrated Service Center, failure of IT systems originates from a number of IT projects implementation-related challenges. Breakdown of healthcare IT systems including those for HCR Manor Care and Health Integrated Service Center involves an overrun by time constraints, under-delivery of services, and failure of the systems to accomplish the anticipated results. Research on the malfunction of different organizations’ IT systems reveal common findings that more than half of all IT projects implemented in healthcare settings face the challenges of being over-budgeted or
being completed when they are too late (Baron et al., 2007). Common breakdown challenges experienced at the two organizations include cancellation and delays of the IT projects’ software. These challenges afflict organizations either at the level of the national system, regional, or even in the delivery of ancillary services.
Full implementation of computer-based patient records requires the entire user to have ample skill and knowledge of the operation of the systems for them to deliver their expectations: increased efficiency and quality of service. Insufficient training resulted in influencing the outcomes of implementation processes for IT healthcare systems at HCR Manor Care. For instance, before nurses and other practitioners had completely learned how to use such systems, they considered the new approach as time-consuming and tiresome. Introducing new systems also entails alteration of the normal way of doing work at organizations. For HCR Manor Care and Health Integrated Service Center, this challenge manifested itself in the form of the general unwillingness of people to adapt and/or embrace new technology. Failed IT systems lack the necessary security to protect patients’ data. This has the implication of breaching the privacy and protection of patients’ information.
Leadership Reaction to Failure
In health care settings, leadership is vital. It is crucial for the success of any organization (Lussier & Achua, 2004). Leadership functions to inspire people to work collectively to achieve specific goals within an organization. Leadership is an organizational practice that not only influences people (employees) but also leaders in a manner that ensures that organizational objectives are achieved through change. For HCR Manor Care and Health Integrated Service Center, leadership failed to integrate people and leaders to influence organizational objectives, missions, and other organizational stakeholders who were affected by the failure. Even with the failed IT systems, leadership failed to accomplish its purpose: to involve people in seeking solutions to issues that may affect the performance of an organization. This perhaps reveals why there has been an immense scholarly interest in how leaders must relate with persons in charge of IT infrastructure in organizations across all sectors including healthcare to ensure organizational success.
HCR Manor Care and Health Integrated reacted to the breakdown by seeking to understand why seemingly effective and reliable IT infrastructure would fail yet many resources had been committed to its development and implementation. The purpose of leadership in any organization is to avail new ideas and innovations. It also ensures that people abide by values that encourage the growth of an organization through the integration of organizational behavior. Leadership plays four main functions within an organization. These are leading, guiding, setting up, and managing (Lussier & Achua, 2004). These functions are accomplished in the context of a clear understanding of the roles that leaders and people in charge of IT systems must play to enhance the success of the systems in achieving their preset objectives. Unfortunately, HCR Manor Care and Health Integrated could only attribute the failure to poor design. They failed to pay attention to the roles that people could have played to enhance the success of the IT systems.
IT systems in healthcare settings are meant to handle immense data ranging from patients’ records, medication supplies, logistics management, finance, and even inventories among others. This architectural requirement for IT systems in health care raises the question of whether an organization should deploy proprietary systems or custom systems. Proprietary systems are often copyrighted. Consequently, compliance with any software application with the source code is necessary. This means that compliance with copyright restrictions is mandatory when deploying them in healthcare settings. Accordingly, it becomes hard to tailor-make IT platforms within an organization to suit the specific needs of the organization. Based on this rationale, it is necessary for the organization to develop customized IT applications so that they can have total control of their infrastructure especially when it is necessary to develop unique and new threat-aware systems. This strategy is perhaps important in the era of the increased incidences of cybercrime.
The development of customized applications in the healthcare of HCR Manor Care and Health Integrated is also vital since proprietary systems have demerits, which may influence negatively the efficiency and effectiveness of an organization. For instance, when an organization chooses to execute its functions by deploying the existing applications, it encounters the problem of using long-lived applications (Baron et al., 2007). Proprietary applications have the drawback of having undergone and/or continue to undergo an evolution process so that compatibility emerges as a major issue that an organization will have to address constantly. Comparatively, custom applications are often new, meaning they have the advantage of deploying the most recent technology already evaluated and proven for efficiency.
Although challenges associated with the implementation of IT infrastructures in health care settings are similar in many aspects, it is important to address problems in healthcare IT implementation in different paradigms. This practice would ensure that technical difficulties such as the incapacity to handle large and complex amounts of data required for processing within healthcare facilities are resolved in a specialized manner. This way, systems can be developed such that they minimize the complexity of infrastructural design, and yet solve the possible drawbacks, which contribute to failure. In line with this recommendation, Johnson and Zhang (2005) maintain that the implementation of IT in healthcare demands deployment of standards, which are well defined to enhance interoperability together with ensuring that technologies, which are deployed are highly compliant with various legal requirements. Indeed, it is important for health organizations’ IT systems to have the capability to generate a myriad of reports for various health plans.
For HCR Manor Care and Health Integrated, IT systems failure occurred at different levels. To ensure that this does not happen again, it is recommended to have flexibility in IT systems to support different organizations ranging from a single office to an organization having regional or nationally integrated networks for service delivery to be put in place. Avison and Young (2007) support this recommendation by further arguing that flexible IT infrastructures are credible for enhancing cost reduction. In fact, it leads to improved workflow besides guaranteeing better and quality care while still facilitating ease of communication and organizational collaboration.
Scrutiny of failures of IT projects and infrastructure in health care organizations leads to a consensus that IT in healthcare may fail because of financial, social, cultural, and even managerial challenges similar to other organizations operating in other sectors. To address these problems, it is recommended for organizations in the healthcare sector to consider embracing organizational, cognitive, behavioral, and social factors in the formulation of policies to drive IT infrastructural development strategy. Kaplan and Shaw (2004) support this recommendation by claiming that healthcare organizations need to define the procedure and approaches that are deployed to disseminate and/or design the systems of evaluation of success by clearly defining the people who characterize success together with how it is achieved.
How health care leaders can use project metrics and portfolio management to ensure operational efficiency and effectiveness
Any problem with IT systems starts from the formulation of the strategy to its implementation and then a failure in its functionality. Leaders can use project metrics and portfolio management to enhance authorization, identification, IT project control, and management of all IT programs and related work to enhance the achievement of organizational strategic goals. For healthcare organizations, the achievement of strategic goals entails the delivery of better healthcare through reliable healthcare IT infrastructure (Kaplan, 2000). Project portfolio management is important, especially in a healthcare organization. It helps in the resolution of governance issues that may lead to the failure of IT infrastructure within a healthcare organization. Project portfolio management approaches are useful for healthcare organizations’ leaders since they facilitate leaders to align organizational IT projects with capabilities together with the priorities of an organization seeking to enhance the efficiency and effectiveness of its service delivery networks.
Through the top-down governance methodology of enhancing the design of IT projects, leaders can effectively determine the projects, which are likely to succeed to deliver the desired outputs. Indeed, organizations seeking to utilize IT as an intervention for enhancing their service delivery need to implement only the projects, which are feasible both in the short-run and in the long run (Brown, 2009). For example, through project portfolio management, it is also possible to establish the criteria for the selection and ranking of various IT project proposals. This strategy aids in the process of selection of appropriate IT project tasks, which blend with a myriad of technologies that are most effective and possess lesser probabilities of failure. Through embracing a project management portfolio, project works can also be mapped within specific applications residing within a given portfolio.
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Organizations including those operating in the healthcare sector implement various projects including IT projects to increase their effectiveness and efficiency in their operations. Hence, all executives must work harmoniously with all counterparts within their line of organizational business to determine the most effective way of utilizing organizational resources, which are normally finite (Brown, 2009). For example, when such projects are IT-based, transparency, equal participation in the making of vital decisions especially on the necessary operation of the infrastructure, collaboration, and clear communication of the desired IT value must be made to avoid instances of failure of IT systems. This underlines the significance of project portfolio management by leaders within healthcare organizations to aid in the proper management of the process of development, design, and implementation of IT systems.
Government intervention in healthcare business
Government intervenes in the business of the healthcare organizations through the formulation and implementation of policies that ensure better service delivery to all people amid their demographic and social-economic differences. This step is done through the development of public health policies that are implemented through public health and healthcare agencies. These agencies are constitutionally mandated to perform tasks such as maintenance of the functionality of the information systems in their areas of focus, prompt service delivery, enhancing accessibility to vaccines and other medical products, governance and leadership, availing sufficient financing, and monitoring the performance of health service workforce (Handler et al., 2001, p. 1237).
Government intervention through public healthcare agencies also facilitates the achievement of roles and functions of promotion of health knowledge to the areas of interest for different organizations especially in the delivery of quality evidence-based healthcare services. For instance, this compound role is critical in enhancing the success and achievement of the missions and objectives of the department of health not only within federal states but also in entire America. This goal calls for the development and integration of tools for fostering surveillance of health systems including the IT systems to ensure compliance with the established standards of healthcare (Kaplan, 2000). The goal of the government is to ensure that people receive quality care right from diagnosis and maintenance of records to medication. Where technology that is enhanced through IT infrastructure is deployed to realize the functions that are central to any healthcare organization’s operations, the government has the chief responsibility of evaluating the effectiveness and reliability of the systems in ensuring quality healthcare to all citizens who are served by an organization in the healthcare sector.
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