The Soft Information Systems and Technologies Methodology (SISTeM ):

Transcription

1 The Soft Information Systems and Technologies Methodology (SISTeM ): A Contingency Approach to Integrated Decision Making and Development Chris Atkinson Brunel University UK

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3 SISTeM s Philosophical Underpinning Beyond Hard rationalism & Soft interpretivism to: Actor Network Theory Integrated networks of humans and non-humans Bruno Latour & Michelle Callon

4 SISTeM - Cycle 2 Overall Process Migrating form Cycle 1 Modelling the change and the process of change Deciding on the Change and the process of change Realising the Change

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7 SISTeM CYCLES 1 & 2 Relevant Systems and Tools and Techniques for both Cycles Schematics of Relevant Systems A human/machine system to MANAGE individual Departmental, Speciality and Locality services, providing care to individual and groups of patients within the Trust's own, or in other settings. A clinical human/machine information system to enhance patient care in the community

8 The Stages of the Soft Systems Methodology Hybrid Matrix Models

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11 The Stages of the Soft Systems Methodology Conceptual and Expressive Models SISTeM Tools and Techniques Cycles 1& 2 THE RADIOTHERAPY PATIENT TREATMENT SLOT ALLOCATION DECISION (CYCLE 1), ROOT DEFINTIONS, CATWOE ANALYSIS Decision: Radiotherapy machine slot allocation process is required. Original Issue It is increasingly difficult to carry out the allocation of patients, their assessments and the degree of urgency for treatment to slots in radiotherapy machines as a result of an increase in the number of machines, teams and patients referred. Relevant System: A patient treatment, to radiotherapy machine slot allocation system Development Root Definition: Human/Machine Slot Allocation System A slot management human/machine activity system owned by the clinical team and operated by slot manager and IS that apportions a patient, their referral and assessment to a (series) of slots within radio therapy machines (and their teams) in line with the treatment sets down by the consultant radiotherapist and oncologist clinical assessment and degree of urgency. CATWOE Analysis Customer(s): Radiotherapy Teams, Patients, Consultants,GPs, Radiotherapy machines Hospital and GP information systems Actors: Slot Allocation Manager, Slot allocation Information System Patient, GP

12 Transformation: Patient in need of radiotherapy treatment slot TO Patients allocated to radiotherapy machine slots and team for treatment Worldview: An efficient slot allocation, in line with assessment and degree of urgency is an important contributor to patient care and equity in machine/team resource allocation Owner: Slot allocation manager - process, Director IS&T Environment: Patients referred, Consultants, GPs, radiotherapy machines, teams THE RADIOTHERAPY PATIENT TREATMENT SLOT ALLOCATION PROCESS INFORMATION MACHINE ACTIVITY 1. RECEIVE a referral of a patient, following a clinical assessment by an Oncologist and - from within PHT, peripheral clinic or other and Radiotherapy Consultants decision and treatment. NOTIFY Radiotherapy of the referral of Patient X OPEN Access to patient referral details and Radiotherapy Consultant's decision on treatments. 2 REVIEW each referral and their clinical requirements in terms of - degree of urgency, type of treatment and number of treatment slots required, diagnosis, patient availability, need for further investigations PROVIDE Patient personal details, name, address, DOB, sex, age, hospital number, NHS number, none availability dates for patient

13 PROVIDE Name of Oncologist, place, time of assessment, PROVIDE Clinical assessment of each patient - diagnosis, site, stage, treatment pattern and dosage, urgency - radical, palliative, pre-op/other. RATIFY Patient/consultant details with PMI PROVIDE Details of test and investigations carried out, results, missing tests. NOTIFY Oncologist of test result not received - ACCESS Test results, via OCS PROVIDE Details of currant morbidity state of patient ACCESS Patient records, relevant to currant episode of care. PRESENT Contract allocation of patient and HRG

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16 Machine Root Definition: Patient Radiotherapy Machine Slot Allocation Information System A Radiotherapy Patient Treatment Slot Allocation Information System, operated by the slot allocation manager and owned by the Director of Information that enables the patient to be allocated to slot in the radiotherapy machines by:

17 Providing Information about the patient Receiving notification of a referral Presenting information about the test and investigations Present details of diagnosis, site, fractions required, stage, urgency, Provide accrual of referrals on a daily weekly basis Create overview of machine slots over next year, and their allocated status Capture degree of urgency and details of treatment pattern and type of machine suitable. Schedule of machine availability - slots open/closed Capture allocation of machine slots for the fractions required Notify patient, GP (or other referee) of times and treatment and capture confirmation of intention to attend Download slot allocations into radiotherapy machine, planner, simulator treatment Accrue slots allocated on the matrix for the numbers of fractions prescribed along with patient details and when these have been undertaken Process Simulation Simulation Slot Allocation Human/machine Activity System

18 Human Capability Root Definition : Patient Radiotherapy Machine Slot Allocation Allocation Manager System A Radiotherapy Patient Treatment Slot Allocation System, undertaken by the slot allocation manager and owned Clinical Team that enables the patient to be allocated to slot in the radiotherapy machines by: Receive patient referral Review each patient referral Asses patient s treatment needs - care and urgency Know the current and future slot usage and availability against each machine and clinical team. Allocate a patient to slots in the machines, reconciling individual patient treatments needs, the current ongoing patient cohort needs and machine and team availability Ratify patient availability for slots allocated and adjust if required. Input ratified patients and their slots into the treatment machines Ensure treatment teams appreciate slot allocates and work load and are available Manage slot allocation process, and improve its efficiency, efficacy and effectiveness Human Psychosocial Root Definition: Patient Radiotherapy Machine Slot Allocation Allocation Manager System A Radiotherapy Patient Treatment Slot Allocation System human cultural system Empathise with each patient s human, care and treatment needs Appreciate the utility of the slot allocation information system and ensure its deployment Appreciate professionally significance of clinical diagnosis and treatment by the consultants Appreciate ramifications of the diagnosis for the patient Appreciate the ramifications of each allocation for a patient and their family Seek for the patient the most efficacious slot allocation and team utilisation Seek the most effective and efficient utilisation of machine and radiotherapy team resources Diligently enter slot allocations into the machine and notify teams appropriately Keep radiotherapy teams sweet

19 Manage slot allocation process, and improve its efficiency, efficacy and effectiveness SISTeM Underpinning Philosophical Framework From Hard Rationalism and Soft Interpretivism to: Actor-Network Theory The Actantial-Relational Epistemology of Latour and Callon SISTeM and Actor Network Theory ANT within SISTeM in Practice: SISTeM as a non-human actor translated into a problem-solving actor network (PSAN) and enacted by it. SISTeM translates and mobilises other actors in the PSAN. SISTeM models based on the human/machine actor network. Outcome of SISTeM are interventions in or mobilisation of new organisational actor networks through incorporation. SISTeM facilitates the traversing by the PSAN and wider organisational network of obligatory passage points.

20 The Soft Information Systems and Technologies Methodology SISTeM is a methodology that aims to address issues in areas of psychosocial, informational and technological concern by activating in the network of people and technologies involved an integrated action based learning cycle, which is ideally never-ending. It will enable them to decide upon, envisage and realise the human/machine changes they have chosen to address their problem situation. (Atkinson 1999 after Checkland 1981)