STRENGTHS AND WEAKNESSES

(Second part)

The graphic representation (Fig.4)is based on the analysis of the flows existing among the elements conventionally denominated “modules” or “sub-systems”, coinciding with certain company management activities (e.g.: order management);
_ “sub-modules”, activities supporting certain modules (tender management, resolution management)
_ “parties outside the company” with which this regularly exchanges information (suppliers, medical practitioners, other healthcare enterprises, Regional Authority and Ministry of Health); _ “key modules”, management activities which, owing to the number and significance of the information they gather and summarise, prove to be crucial “hinges” for the circulation and integration of the flows. Although, on one side, this distinction facilitates the planning of individual sub-systems, on the other it emphasises the need for an overall reference picture that may be referred to in order to ensure their indispensable integration.
The guidelines to be adopted for the planning may be summarised as follows:
. Centrality of the user as a prerequisite for an actual integration and for information correctness;
. Operating autonomy of individual services/structures, whilst avoiding the formation of computer “islands” without any connections;
. Operating integration among the various existing sub-systems; . Modularity of the application solution, to guarantee opening and flexibility on one side and the need for a gradual realisation on the other;
. Involvement of the operators within the various levels of responsibility;
. Management sub-system fully supplied by the data coming from the management (healthcare and administrative) information system, but at the same time specifically aimed at carrying out a management control function.
An integrated information system should make available and categorise the factual information and knowledge of problems (that is statistical and epidemiological information for a recognition and clarification of the quality and quantity features of specific problems under investigation) and the procedural knowledge of problems (information and knowledge as to how a problem can be solved, by modelling and analysing its causes and consequences, and as to how the objectives can be defined and action organised to achieve certain desired results) (10).
The following picture represents a typical flow of data and information for the management of a problem, starting from its first report up to the shared definition of a standardised procedure or of a plan hypothesis.(Fig 5)
The problem management route, from its first report, is facilitated through the methodological support provided by the already mentioned information and knowledge of a factual and procedural type: statistical and epidemiological data; problem identification; identification of action.
In picture 5, special significance is borne by the information on corporate strategies and policies (including corporate mission, triennial plan and annual programme), which contribute to the evaluation of the degree of feasibility of any action, its consistency with what has already been scheduled and the synergies that can be activated among the various estimated lines of action. For the definition and development of an integrated information system, it is necessary to identify the typology of actors within the healthcare system: these are to be deemed starting points and receivers of data, information and knowledge. (fig.6).
In addition to the suppliers of the Healthcare Units, a crucial role is played by the State, the Regional Authorities and the Local Authorities, the training bodies (schools and universities), the companies supplying products, technologies and services to the healthcare system and, above all, to families and to people, who interact with the Healthcare Units to express their needs.

4. The Corporate Healthcare Information System (SISA)

The General Management, in support of the typical activities of strategic government, avails itself of organisational structures, which are an integral part of the system comprising support, evaluation, control, research and development functions related to the processes of the whole corporate organisation. Among such functions is the Corporate Healthcare Information System (SISA), provided for by the legislator with the Legislative Decree 229-99 and subsequently enforced at a regional level by the various A.S.L. units (11).

Mission
1) Ensure that healthcare and non-healthcare operators, employees and contract co-operators of the National Health Service, carry out their activities with the aid of telematic and computer systems capable of optimising the effectiveness of their performance.
2) Guarantee that information represents the connective tissue of the organisation, through the integrability, transparency and accessibility of data.
3) Protect and keep confidential the data records of the Enterprise. 4) Manage the databank required for the preparation of statistical data sheets.

Chief Functions
1) Realise an integrated and homogeneous healthcare and administrative information system aimed at:
- Knowing the healthcare history of individual citizens and managing with a full knowledge of the facts the phases of the disease of any Enterprise user, whilst meeting the secrecy requirements of the person concerned;
- Supporting and integrating hospital, specialist and territorial medical activities.
- Facilitating citizens’ access to and interaction with healthcare structures;
- Supporting all management activities carried out by the healthcare
Departments or by the Districts and by the various organisations operating within the Enterprise;
- Mitigating the burden of bureaucratical duties, improving and simplifying internal productive processes and reducing overall costs;
2)Identifying, based on the scheduled objectives and on the requirements of the management involved, data processing and computer automation projects to carry out the required activities, as well as data processing and computer capacity improvement projects, by identifying the objectives to be pursued, the performance modalities, related timing and costs and a synthesis of the cost/benefit ratio. Submitting the projects in question to the General Manager, through the executives involved.
3)Managing the implementation of the approved projects, by pursuing all the relevant aspects thereof.
4)Systematically monitoring, in conjunction with the individual staff members in charge, the state of automation of the company activities and of the existing data processing and computer facilities, in order to evaluate their effectiveness, efficiency and flexibility, so as to establish whether any specific action is required.
5)Preparing and submitting to the General Manager the Information System policies that need to be adopted, with special reference to the choices involving data processing and computer capacity, to the choices concerning system, language and facility standardisation, to the resort to customisable packages or to totally proprietary solutions, and to the criteria to be followed in resorting to suppliers.
6)Determining the technical standard for the supply contracts and taking part in the technical evaluation of the offers received from potential suppliers, thus working in conjunction with the Local Superintendency and General Affairs Office U.O.s [Operating Units].
7)Practically handling the relations with hardware and software suppliers, by ensuring prompt compliance with contractual terms and by providing documentation of the activity carried out, also to support the processes relating to Administrative Management, Management Control and General Affairs.
8)Managing regular and occasional relations with external bodies (Ministry, Regional Authority, University, other NHS facilities, etc.), which may contribute to the achievement of the mission. 9)Activating experimental management projects, also aimed at obtaining specific contributions provided for at a national or local level.
10)Above all methodically harmonising SISA’s performance with the various Department Managers, in order for its activity to prove consistent with the area of responsibility of such Departments and for any action relating to the information and computer system to prove integrated with and parallel to the activities such Managers are in charge of. The functions listed above may be supplemented in harmony with the development of the organisation system and in agreement with the expanded mission of this Regulation.

Organisation
The Information System Service is organised according to the following activities:
- Computer System
- Information Flows

a) Computer System (S.T.)
The S.T. interacts with all the organisation levels within the Enterprise, to:
- Handle the operation of hardware equipment in the territorial workstations (terminals, personal computers, Intranet, modems, etc.).
- Provide assistance and handle involved staff members’ training covering the employment of data processing and /or computer equipment for their activity.
- Handle the operation of the Data Processing Centre (CED) and of data backups on existing servers;
- Manage the Intranet;
- Ensure the availability of human resources for emergency data loading activity.

b) Information Flows (F.1)
In order to ensure that decision-making processes are fully conscious and reliable, it puts at the disposal of all organisation levels a monitoring system covering all the required activities, in order to have available a databank that can be used in time at acceptable costs, offering facilitated access and a logic organisation of the information which is of a relational nature (relational database), though the establishment of a Data Warehouse. Furthermore it interacts with the Ministry of Health and with regional authorities for the transmission of all the requested activity data.

Chief Responsibilities
1) Attainment of scheduled results for each project.
2) Total cost of data processing and computer services: - starting from the stage relating to the evaluation of the purchase request made by the facilities involved, in order to integrate this with the overall data processing-information system project; - and ending with the stage relating to the management of technical assistance contracts covering hardware no longer under warranty.

Organization
1) Internal management of allocated human resources is aimed at the creation of experts in the fields relating to the chief processes required for the Enterprise operativeness (processes for the supply of hospital services, healthcare service access processes, processes for the supply of territorial services, resource acquisition processes, etc.).
2) Any actions carried out on information and computer systems are characterised by the ability to: - guarantee a process-related and not a facility-related approach; - ensure full involvement of the hierarchical line involved (which as rule takes upon itself responsibility for the project); - guarantee the involvement of the staff that is to be in charge of the activities in question; - test the proposals that have been put forward.
3) For the largest users (the Districts, the Central Processing Unit or CPU) the system provides for the creation of operating units devoted to providing these services to such users. The related staff is only physically based at the user’s premises, whereas from a hierarchical and operational point of view it reports to the Information System Service.
The operativeness of these staff members must take into account the users’ requirements. Please find below a possible graphic representation limited to SISA only (fig. 7).

(to be continued)

Ubaldo Comite
Professore a contratto
Cattedra di Organizzazione Aziendale
Università della Calabria