Towards high performing hospital enterprise systems: an empirical and literature based design framework

Abstract

Our understanding of enterprise systems (ES) is gradually evolving towards a sense of design which leverages multidisciplinary bodies of knowledge that may bolster hybrid research designs and together further the characterisation of ES operation and performance. This article aims to contribute towards ES design theory with its hospital enterprise systems design (HESD) framework, which reflects a rich multidisciplinary literature and two in-depth hospital empirical cases from the US and UK. In doing so it leverages systems thinking principles and traditionally disparate bodies of knowledge to bolster the theoretical evolution and foundation of ES. A total of seven core ES design elements are identified and characterised with 24 main categories and 53 subcategories. In addition, it builds on recent work which suggests that hospital enterprises are comprised of multiple internal ES configurations which may generate different levels of performance. Multiple sources of evidence were collected including electronic medical records, 54 recorded interviews, observation, and internal documents. Both in-depth cases compare and contrast higher and lower performing ES configurations. Following literal replication across in-depth cases, this article concludes that hospital performance can be improved through an enriched understanding of hospital ES design.

Keywords:

• design
• enterprise systems
• framework
• longitudinal literature review
• multi-method exploratory cases
• performance
• systems thinking

Acknowledgements

The author wants to recognise many helpful discussions with members of MIT’s ESD faculty and with Dr Maria Fradinho, an instructor at Harvard Medical School, and fourth year OB/GYN medical resident at the Beth Israel Deaconess Medical Center (note: Boston Hospital included in this article is not the BIDMC). Additionally, the author thanks Dr Dan Livengood for proof reading this article.