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This paper delves into the complexities of integrating heterogeneous systems within healthcare institutions, emphasizing the necessity of embracing imperfection. It discusses the impact of external drivers on integration and the interplay between order and disorder in clinical settings. The transition from E-government to M-government is explored, along with the challenges and opportunities presented by wearable medical devices. The concept of dissolving system boundaries and fostering creative disorder is analyzed in the context of emerging healthcare practices. The shift from management to governance is examined, drawing on the transaction-driven view of organizations. The paper also highlights the significance of information and knowledge sharing in evolving communities of practice, emphasizing the role of rough prototyping in user-driven innovation. Real-time monitoring technologies and collaborative efforts among regulators, service providers, and users are discussed as integral aspects of improving service provision and performance evaluation in healthcare settings.
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Beyond Integration: the uses of disorder Stephen Little, Open University
The Slight Surprise of Integration • The seduction of a simplistic formulation of the problem • The Organizing Vision in Information Systems Innovation • Swanson & Ramiller 1997 • The intimate relationship between order and disorder • Orders and Their Others: On the Constitution of Universalities in Medical Work • Berg & Timmermans 2000 • The depth of the research behind the paper • A Patchwork Planet: Integration and Cooperation in Hospitals • Ellingsen & Monteiro 2003
Context of Current Practice • Seamless integration • Misleading illusion • Imperfection as necessity • Hospital example • Collection of interacting heterogeneous systems within institutional container(s) • External drivers for integration • Internalised message • Deterioration of functionality for clinical users • Metatechnical view • Institutional-organisational-task level interactions
Context of Emerging Practice • Dissolving the container • Dissolution of system boundaries • Frustrated integration versus creative disorder • Distributed health care • Wearable medical monitors/devices • E commerce to M commerce • MANET Mobile Ad-hoc NETworks • Class 3 & 4 radio frequency smart tags • E government to M government • UK Intelligent Infrastructure Systems • real time monitoring and surveillance of movement • biometrics • CCTV plus appeals for mobile phone video • Except where police action is involved
Managing Disorder • Management ------ Governance • Williamson (1975) and transaction driven view of organisation • governance replacing management • disintermediation and re-intermediation • Microsoft ----------- OSF • Cathedral --------- Bazaar Raymond E.S. (2001) • Information Sharing ---------- Knowledge Sharing • hierarchies ---------------------- distributed Communities of Practice
Rough Prototyping 2001: user pull • Community Monitoring of Policy and Performance • http://www.newnet.org.uk/neat/ • Regulators, service providers and users collaborating on the monitoring of service provision • GPS • digital video • digital still • WAP
Monitoring Performance http://www.newnet.org.uk/neat/monitor/default.htm • real-time monitoring of transport services from within the community
Embracing Disorder: Closing the Loop • The technologies which have enabled military and managerial surveillance of distributed resources also, paradoxically, enable the communities so scrutinised to develop their own distributed strategies and patterns of relationships with external parties • Little & Grieco (2003) • New paradigm for codesign • bottom-up and networked response, • feedback loop from those on the receiving end of decisions • IS driven and enabled feedback from user/customer/public to both owner/provider and government/regulator
