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Biomedical subjects

G Southon

Publications and source records attributed to G Southon.

12 recordsLinked to original sources
PubMed1999

Lessons from a failed information systems initiative: issues for complex organisations.

Organisational issues are now recognised as key factors in the effective use of information technology (IT). This paper extends our knowledge of these issues for large complex distributed organisations. It is based on an analysis of the failure of a large IT system selected by a major state public health service for Statewide implementation. The system selected was well proven overseas, was implemented through a pilot process, yet was withdrawn because it did not meet requirements. The issues which are dealt with include the nature of the organisation and its interaction with the implementation strategy, the nature of decision-making, the contrast between the incentives and perspectives at different levels, ownership of the program, management of skills and the impact of instability and complexity. The option of decentralised IT management is raised and the advantages of common systems discussed. A proposal is ventured for managing such developments while maintaining essential commonality. The paper demonstrates that the environment of large complex distributed organisations introduces a complex of issues that are not normally considered in implementation strategy.

Attitude to Computers↗
PubMed1999

IT, change and evaluation: an overview of the role of evaluation in health services.

Effective evaluation is important for appropriate deployment and use of information technology, especially in the current environment of changing health services. However, the broad range of roles and environments in which technology is used challenges traditional evaluation approaches. As technology has progressed, these roles have developed to the extent that information technology is now often playing a very complex role in health service organisations. In such cases there are many uncertainties in decisionmaking that are difficult to address with traditional formal evaluation techniques. There is a need to recognise and work with more complex, socially constructed decisionmaking process relying substantially on a variety of human judgements. The need for this recognition is demonstrated by exploring the difference in our ability to analyse a range of different systems, considering the role of complexity, uncertainty, theory, change and control. There is the need, then, for evaluation processes to complement these social decisionmaking processes, rather than to replace them. The nature of these processes needs to be effectively understood to enable the most appropriate types of evaluations to be undertaken. A number of different scenarios are explored to demonstrate the types of roles that evaluation may need to take.

Decision Making, Organizational↗
PubMed1999

Empowerment and the performance of health services.

Addresses the issue of empowerment and its possible role in promoting the effectiveness of health services. Empowerment represents the ability of people within organisations to use their own initiative to further organisational interests. However, despite its apparent simplicity, the concept turns out to be quite complex and to have unanticipated implications. We explore some of these implications in health service organisations, and their consequences for health policy. Our conclusion is that many health policies may well act to degrade the empowerment of health service workers, and hence the performance of health service organisations.

Conflict, Psychological↗
PubMed1998

The end of professionalism?

Increasingly questions are being raised about the ability of many current health reforms to address the challenges that are facing health systems. We investigate this situation by exploring the role of professionalism in the delivery of health services. In contrast to the dominant approach of considering professionalism as a social phenomenon, professionalism is considered as primarily a task-related phenomenon. The characteristics of the task are identified as being high levels of uncertainty and complexity. These characteristics are shown to lead naturally to the key social features that typify professionalism. Hence, the close link between professionalism and the nature of the task is argued. However, health reforms threaten professionalism. They have been based on considerable dissatisfaction with the performance of professionals as well as the emergence of a number of new challenges. In addition, the reforms have been developed without significant consideration of the central role that professionalism has played, and reformers have adopted a simplified view of the task. Thus, the centrality of professionalism has intrinsically been downgraded. However, this simplification can be shown to be inconsistent with the realities and complexities of health service provision, and thus the downgrading of professionalism is unwarranted. This inconsistency generates many of the conflicts and contradictions being reported. The future of health service reform depends on an effective understanding of the nature of the task, recognition of the central role of professionalism and the development of professional and organisational structures that support each other.

Health Care Reform↗
PubMed1998

People and organizational aspects of medical informatics.

Positive outcomes come to health care organizations that are doing the right things well, that is, their organizational strategies are aligned with their environments and they are executing those strategies well. Likewise, the informatics strategies must also be aligned with the organization's strategies. Without this congruence, informatics does not have the potential to have a substantial positive impact on the overall organizational outcomes. The execution of the informatics strategies must also be exemplary; however, the change processes required for achieving the desired informatics and organizational outcome goals are demanding and complicated. Implementing them in extremely complex organizations that operate on a 7-day by 24 hour basis is not easy. However, we are constantly learning more about complex change processes and the ways we can better manage them to improve our needed informatics outcomes. The challenge is to build upon the existing research base to more us even further ahead.

Humans↗
PubMed1996

Health service structures, management and professional practice: beyond clinical management.

At the heart of the operation of the health system is the relationship between managers and the various professionals who provide clinical services. While there is an inherent conflict between these two groups, this conflict has been avoided in the past by the managers playing a supporting rather than a controlling role. However, the current demands of cost-control are placing managers and professionals into direct conflict; a situation that many organisations are addressing by putting clinicians into management roles. This measure has had initial success in some situations, but it is argued that this success will be limited because clinical departments are not able to address many of the broader issues that affect the performance of health services. This paper proposes an alternative approach that will enable these broader issues to be effectively addressed, and also reduce the structural conflict.

Australia↗
PubMed1996

The clinical learning environment.

This paper presents a brief review of the attributes of effective learning environments in clinical settings. Recent studies articulate the perceived importance of social and organizational factors as determinants of learning. Differences are evident among hospitals and among departments within hospitals with regard to the quality of the learning environment they offer. These differences are reflected in the orientation towards teaching and learning, the level of autonomy, variety and workload, and the quality of supervision and social support. Differences are also evident in the type and quality of opportunities for practice of important skills and in the availability of educational resources. These factors are perceived as major determinants of the effectiveness of learning in clinical settings. The implications for clinical teachers and administrators are discussed. The authors argue that emphasis should be given to the creation of supportive and well-organized learning environments in clinical settings. This may require a great emphasis on the role of clinical teachers as designers of opportunities for learning and managers of learning resources.

Clinical Competence↗
PubMed1994

The impact of strategic conflict on the management of information technology in a hospital.

This case study examines the management of information technology in a public teaching hospital. The technology is divided into two major classes: central, mainly administrative systems; and local clinical systems. This split is an outcome of the strategic conflict between the goals of efficiency and effectiveness as pursued by administrators and clinicians respectively. Without resolving this conflict it would be very difficult to develop an integrated information system for this hospital.

Conflict, Psychological↗
PubMed1994

Professional autonomy and accountability. A critique of current health reforms and an alternative proposal.

Many countries have become increasingly concerned about the cost of health services, and the issue is considered to be a crisis in the United States. There are many factors that influence the performance of health service professionals, and they all need to be taken into account in reforming the industry. Accountability is important, but it must be compatible with the underlying character of health service delivery. A long-term programme needs to be developed to provide the environment in which professionals can work most effectively. This requires a greater emphasis on professionally-based processes that promote performance and provide accountability.

Health Care Reform↗
PubMedDate not supplied

Antecedents of the people and organizational aspects of medical informatics: review of the literature.

People and organizational issues are critical in both implementing medical informatics systems and in dealing with the altered organizations that new systems often create. The people and organizational issues area--like medical informatics itself--is a blend of many disciplines. The academic disciplines of psychology, sociology, social psychology, social anthropology, organizational behavior and organizational development, management, and cognitive sciences are rich with research with significant potential to ease the introduction and on-going use of information technology in today's complex health systems. These academic areas contribute research data and core information for better understanding of such issues as the importance of and processes for creating future direction; managing a complex change process; effective strategies for involving individuals and groups in the informatics effort; and effectively managing the altered organization. This article reviews the behavioral and business referent disciplines that can potentially contribute to improved implementations and on-going management of change in the medical informatics arena.

Attitude to Computers↗