Strategisk styring av IKT i helsesektoren

Abstract

This thesis looks into strategic managment of IT in the Norwegian Health Care Sector, namely the state owned hospitals. The thesis concerns the period 2002-2008, that is, it starts with the Health Reform when the ownership for hospitals passed on from the regional county level to the central government, represented by the Ministry for Health. The hospitals are organized in five regions, each with its own board of directors and it is the regional management who is responsible that national goals and strategies are implemented in the regions. The study is based on a comprehensive empirical material, based on official documents from the central budgeting process and other documents linked to that, and on interviews with 12 individual persons from different levels in the managerial pyramid, from ministry level to IT-managers in local hospitals. A lot of resources are thrown into the effort of managing IT in hospitals in the direction set by the ministry an its agency, but the effort does not pay. There is a gap between what is going on on the local level compared to the goals and strategies set by the ministry. That leads to a year by year increased demand for more and stronger management. The situation is discussed with references to Mintzbergs theory on organizations, namely to his theory about professional bureaucracies, where he anticipate conflicting interests and conflicts between the professional operational core (medical staff) and the inherent machine bureaucracy (administration). By expanding the model of the organization to a metamodel, including the strategic leadership from higher levels in the government (the ministry) and the external tecnostructure engaged (agencies, consultancies), I show that the metaorganization has a enforced tecnostructure that forces the organization in the direction of a possibly dysfunctional machine bureaucracy. Theory about information infrastructure is used to point out the complexity linked to installed base. Ciborras notion on drifting is used to explain the urge for stronger management, in fact more of same, even if it does not work. Weill/Ross framework for IT governance is referred in order to highlight the need for both horizontal and vertical alignment of goals and strategies and the managerial mechanisms needed to do so. With common IT principles and IT architecture in place, there should be no need for the intensive top-down detailed management from the Ministry or from the Directorate of Health which are the situation to-day.