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ES Implementations in healthcare , Ambitions , Cycles , Approaches. Christiaan Katsma & Ton Spil. Agenda. Dynamics of the ES Implementation process Suitability of agile or incremental approaches Inspection of 5 cases in healthcare Results Discussion .
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Christiaan Katsma & Ton Spil
Dynamics of the ES Implementation process
Suitability of agile or incremental approaches
Inspection of 5 cases in healthcare
Parr & Shanks (2001)
ES Implementations traditionally are executed in a staged approach.
Current Web applications, SOA, SAAS,.. based projects often use more incremental or agile approaches
In the last century the incremental and agile implementation of ES was explained and described (Fichman & Moses, 1998; Stender 1999)
But the monolithic technology behind the ERP systems at first prohibited actual incremental implementation approaches.
the answer will usually be no. “
Information System oriented approach
Currently we see an initial trend (Mezaros & Aston, 2007; Karim et all; 2007) for system implementers to gradually come up with cyclical implementation approaches.
In the perspective of implementation time and cycle usage these approaches more and more come close to the agile philosophy (Alleman, 2002)
Configure & Rollout
Onward & Upward
What is the current state of implementing ES packages using cyclical or incremental approaches?
5 cases of ES implementations in the Netherlands in Hospitals.
Different ambition and maturity levels
Qualitative & longitudinal approach (started 2004)
Interviews with at least three different “roles”in the project (Consultant, Healthcare professional, (Top) Manager)
The specific distinction between the flexible care processes on the one hand and the structured and repeating operational hospital management processes, like purchasing and controlling (Merode et al., 2004).
This distinction was/is seen as impeding and complicating the implementation process. (end of the 90’s).
We currently see that this typical characteristic is becoming a foundation for cyclical implementation efforts.
Based on the MIT Alignment model and its developments (Venkatraman, Scott Morgan, Yetton et al.) we distinguish three ambition levels for ES implementations
IT driven Replacement (IDR)
Package enabled Reengineering (PER)
Human driven renewal (HDR)
We observe an increase in the use of cyclical approaches resulting in what we call macro dynamics at work in four out of the five hospitals studied.
Macro dynamics means that the hospitals start drifting in either their ambition level, implementation approach or even both.
Within the limitations of 5 cases we conclude that such a drift in most cases leads to implementation problems if not aligned within one implementation cycle.
On the other hand persistence in ambition level and implementation approach results in a positive perception of the implementation project and its results.
Functionalistic approaches still dominate in the ES domain
Only one hospital adopts a mere IT- Driven Replacement ambition. (compared to 5 years ago the healthcare domain is advancing to proces reengineering in the care processes.
Humand driven renewal still is lacking as phenomena in the ES domain.
There is great dificulty in the cases to be consistent in the adopted approach and ambition level.
Changes within one cycle do not show good implementation results. Changes between cycles show moderate to good results
This makes us question: