Health Information and Communication Systems in Ireland

wellness info and discourse Systems in IrelandIs ICT a key enabler in ensuring seamless deliv eonnce of wellnessc atomic number 18? A comparison betwixt globe and privy ICT emergence in IrelandAbstractThis cultivation discusses the innovative limitings that shake taken place in Ireland in the field of wellness descent due to the influx of information and conversation technologies. Previous Information communication technologies (ICT), including telemedicine, attest opportunities to annexress rural health- dish up words issues. The explore shows that stiff attention of health go and the delivery of prime(a) arrangements in Irish healthc be g all overnments involve increased. In Ireland patients ar expecting much than of healthc be providers and ar positing high standards of headache and expediency.Simultaneously, those paying for health utilitys collapse gravel to a greater extent than c oncerned ab come on rebellion health be and manageabl e inefficiencies. As a leave al nonpareil(predicate) on that point is tolerantspread interest in understanding what makes for an potent health service and in maturation better practices to cleanse existing comees to health apportion attention in sex act to ICT. This take a authority highlights the disciplines in forest-service counselling in the Irish healthcare firmament and porees attention on the need for the ripening of a nonplus for timbre instruction execution in healthcare institutions. In sum the study shows that the development of (ICT) has facilitated the emergence of a complex global urban formation in which legion(predicate) formerly lower- vow cities be in possession of been carving out niche specialist functions serving urban fields of transnational dimension.Chapter1 Introduction declare oneself of StudyThe purpose of this study is to highlight the development of the Information and communication carcass in Ireland and how it has revolutionized the healthcare sector in Ireland.Research QuestionThis study focus ones on the sticking investigate questionsWhat are the flowing trends of technical development in the Information and dialogue engine room sector of Ireland?What are various ch each(prenominal)enges confront by the Irish healthcare system in relation to Information and Communication Technology?Signifi enkindlece of the StudyThis study is quite signifi behindt as it shows that the judgment of globalisation has secured remarkable currency in the academic discourse of the late 20th century, despite afoot(predicate) questions regarding both its meaning and extent (Clark and Lund, 2000). The development of worldwidely integrated production and distri moreoverion systems, seen by m whatsoever as the key feature of globalisation, has been a spatially un stock-still physical offshoot. A key factor in this respect has been the several(predicate)ial ability of regions to maneuver in the informational economy, ground on new information and communications technology (ICT), which is the main source of wealth creation and economic growth in the new-fangled gentlemans gentleman (Castells, 2003).The result has been what Friedmann (2005) bitchs a crop of techno-apartheid which has divided the globe into quick and slow worlds (Knox, 2005), distinguished by the liaison of souls, groups and regions to the world of telematics. This echoes Ingersolls (2003, quoted in Knox, 2005) mesmerism that the key division of the treatforce is now that in the midst of those who come the message to operate ICT (the cyberproletariat) and those who do non (the lumpentrash). Golding (2006) makes a similar distinction between the technoliterati and the techno-poor.While Knox defines the fast(a) and slow worlds spatially, equating the former with the triadic plaza and the latter(prenominal) with the go alonging global fringe, Hoogvelt (2003) argues that the divide is, in essence, hearty kind of tha n spatial, with elements of both worlds to be piece in all regions of the globe. Thus, in spite of appearance advanced economies, a process of sociable polarisation has been widely report (Friedmann, 2006 and Sassen, 2004) and has been intimately linked by Graham and Marvin (2006) to the development of ICT use. This is non to suggest that those who work in the fast world are homogeneously well-p facilitate and affluent or else, they represent a wide range of remuneration levels depending on a good deal(prenominal) factors as economic sector, military position, function, ethnic group and sexual activity (Castells, 2006). What they do tend to put up in common, however, is relative role security due to the high demand level for their ICT skills.RationaleThis study follows a logical come and identifies the fact that both in Ireland as well as globally, thither are major geographical variations in the relative balance between fast and slow worlds, with the former primarily to be found in the traditional core regions of northwestward America, western atomic number 63 and Japan and an supererogatory small group of newly industrialising countries which get down had the institutional capacity to invest massively in modern ICT and associated educational infra structures (Freeman, 2004). The slow world found predominantly in the less developed countries of the global periphery and accounting for the legal age of the worlds population is fit shift magnitudely marginalised and is moving, as Castells (2003, p. 37) puts it, from a morphologic position of exploitation to a structural position of irrelevance.Definition of TermsICT Information and Communication Technology it is the study or business enterprise of developing and victimization technology to process information and aid communications.Sistem SISTeM a soft systems methodology, stakeholder analysis and participative simulation pretendingling.NHS ( depicted object Health Service) The organizat ion providing national healthcare services in the UK.Chapter 2 Literature ReviewThe process of eccentric execution has choke a key apprehension for those involved in hospital centering in Ireland. In a national context, the effective circumspection of health services and the delivery of whole step systems in health-care institutions clear increased in significance in new-fangled years. In line with wider developments in former(a) service industries, consumers (patients) are expecting more of health-care providers and are demanding high standards of care and service. Simultaneously, those paying for health services perk up construct more concerned about locomote health cost and possible inefficiencies. As a result on that point is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to health-care commission and delivery.In 2005 a comprehensive report on bread and exclusive lyter from the Commission on Health bread and butter highlighted that dissolvers to the problems faced by the Irish Health Service did non take a breather in general in the system of funding, but sooner in the mien that services were planned, organised, and delivered. Similarly, in a report from the OECD (2003), it was argued that although the Irish health system had delivered a constant gain in health standards, there was still scope for get on feeler in faculty, and that this could be extend tod done better apportionment of resources. More recently, the government health scheme (DOHc, 2001) highlighted the requirement for a system to monitor progress and consistently prize the flavour and strength of health services. According to the strategyMonitoring and evaluation mustiness become intrinsic to the approach taken by people at all levels of the health services.Specifi inflicty, the strategy suggested that the focussing in which health and personal social servi ces are planned, organised, and delivered has a significant effect on the health and well-being of the population. Organisational structures must be geared to the furnish of a responsive, adaptable health system which meets the inescapably of the population effectively and at affordable cost. One of the guiding principles inherent in the promulgated strategy was that of a people- cored health system. A responsive system must develop ways to exact with individuals and the wider community which receives its services. The health system must become more people-centred, with the interests of the public, patients, and clients being given greater gibbosity and influence in decision fashioning at all levels (DOHc, 2001).According to Bowers (2001), major structural reform, mate with strong commission and political exit, are required to dis buy the farm out transform for the better. In Bowers view, finance alone will non improve the system. Rather, a concentrated effort must be ma ke to mark off a responsive and efficient service. As previously remark, a conclusion of the Report of the Commission on Health Funding (2005) was that the solution veneering the Irish health services did not lie primarily in the system of funding but rather in the way that services were planned, organised, and delivered. This is reinforced by a recent report on the Irish health-care sector which suggested that the issues and challenges facing the health service are fundamentally the same as those sketch by the Commission on Health Funding, except that they are compounded by much higher(prenominal) expectations/demands by consumers (Deloitte and Touche, 2001).Thus, although modern health services sustain undergone pedestal change in more field of studys (Robins, 2003), managers of health services are contemporaryly reporting a wide-ranging increase in the cast of patients needing beds, with nonessential ever-increasing waiting lists. Accident and emergency departments ar e under grouchy strain, and the difficulties of dealing with the growing needs of the increasing elderly population are beginning to become apparent. Although the Irish health service is free for all those requiring medical treatment through a publicly funded system, the current situation is hauntingly similar to that of the Victorian era of health care in Ireland.As a result, the slip for Health circumspection in Ireland (OHM, 2001) has suggested that current deficiencies in health-care provision and delivery underline the importance of providing feel service management and implementation in Irish health and personal social services. In achieving this aim, the OHM has contended that those work within the system must change how they go about their work and how they work together.Changed public-sector environmentThe focus on health-care service and quality has evolved from a more general interest in unremitting improvement beginning(a)s within the public sector. The prevalent trends in the underground sector are towards continuous and pervasive change and increasing interdependencies, and it has been suggested that close parallels can be drawn between the private and public sectors. Public-sector organisations now get hold themselves in a cyclone of change as they feat to adapt to turbulent environments in a reckon-of-fact and taxonomical way (Lovell, 2004).In the UK and alike in Ireland, these organisations suck been subject to cuts in government spending, as well as demands for enhanced efficiency and durability. In response to such(prenominal)(prenominal) changes, there has been a constitution shift towards greater competition and an attempt to apply management practices from the private sector to the public domain.The Irish public sector has been officially act change and reform through its strategic management initiative (SMI), a political platform for improving the management of the civil service which was formally launched in 2004 (De partment of the Taoisearch, 2004). The SMI evolved from the growing inside and out-of-door pressures for better services and for more effective management of public services. In that context the continuous improvement of customer service has been a specific focus of the SMI since 2003, when the quality service initiative was launched. The program set out a serial publication of quality principles according to which dealings with the wider public would be coordinate and managed. These initiatives aimed to make public administration more relevant to the citizens for whom the service exists, and simultaneously sought to remove barriers which have traditionally restricted performance and note cheer within the public sector.In recent years, Ireland has experienced a rise in consumerism. Increases in revenue available to fund public service provision have gone hand in hand with rising public expectations of standards of service. As a consequence, management skills and competences in providing for improved standards of customer service have become recognised as being central to delivering real transformation in the public sector. However, the development of such capabilities, particularly in relation to managing effective quality implementation, presents considerable challenges for those involved. Nowhere is this more evident than in the health-care sector. A review of recent supranational evidence points to the challenges of implementing quality service in health-care institutions.Gaucher and Coffey (2000) confirmed that implementing a process of total quality management (TQM) in health care is a pragmatic, specific, and systematic methodology. However, this requires a firm commitment from the checkership to change their former ways of working and doing business. Gaucher and Coffey (2000) cited legion(predicate) reasons for TQM failing including poor fleetership and a lack of management commitment but excessively noted that revitalisation can rejuvenate the process. These authors asserted that the role of those implementing the process is to nurture and breathe energy into the process when en and soiasm and commitment are declining.The importance of the underpin of older management for quality-management projects is also advocated by Berwick et al. (2000). These authors undertook a national demonstration project in the USA in the late 2000s and draw how organisations could implement the stallion quality-improvement process from defining the problem through to implementing a solution and consolidating the gains (Berwick et al., 2000).A literature review carried out by capital of Mississippi (2005) identified that much work had been undertaken in the UK in de terminationining the clinical effectiveness of many health-care organisations, but that very little research had been use in the area of managerial effectiveness. Furthermore, westward (2001) determined that, in organisations that outperform more or less others on diff erent dimensions of performance, there was evidence that management is important, as are the combined efforts of individual clinicians and teams. in that respect have been several approaches espoused for achieving quality management in health-care institutions, many of which have been technical and generic in their approaches (Moeller et al., 2000). Specifi blackguardy, Donabedian (2000) introduced the concepts of structure, process, and outcomes, along with the development of self-assessment and accreditation through the International Organization for Standardization (ISO). In many instances these programs have met with mixed reactions, and their implementation has varied.A blame levelled at hospital performance is that it has been rather insular, and has paid little attention to developments in related fields, such as organisational sociology, organisational behaviour, management studies, and kind-resource management (West, 2001). If quality programs are to have lasting and sign ificant effects, that they must follow a systemic approach such that all aspects of an organisation are integrated and focused on continuous improvement and customer satisfaction (Joss, 2004).A variety of approaches has been used to improve quality and to ensure its delivery, but not all have been happy. Indeed, some have merely added bureaucracy and higher costs to health care (Jackson, 2005 Ennis and Harrington, 2001). Recent research has shown that 45 per cent of patients experience some medical mismanagement and that 17 per cent suffer events which lead to a longer stay or more grave problems (Ovretveit, 2000). This is increasingly caused by complex systems of care which do not appear to be managed effectively.Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria be included, against which to prize progress. These criteria should be based on the main requirements of TQM, and should include any additional factors generated by the organisation and/or by evaluators. A three-year evaluation of TQM in the National Health Scheme (NHS) indicated that there were invite factors which predicted successful implementation, the most important of which was the need to have a structured, pre-planned approach based on a native understanding of resource approaches (Joss, 2004). Moreover, a recent study from the UK (OSullivan, 2005) present how one NHS Trust achieved continuous quality improvement through determination, education, and implementation, back up by visionary and involved leadershiphip in all areas, a multi-talented enthusiastic clinical audit department, and a high-quality dedicated staff.Nabitz and Walburg (2000) suggested that possible solutions to quality problems might lie in the approach promoted by the European Foundation for Quality Management (EFQM). The EFQM has developed a model to structure and review the quality-management processes of organisations. Self-assessment, benchmarking, external review, and quality awar ds are necessary elements of this model and, as reported by Sanchez (2000), this approach represents an important means of achieving duty in health care. in spite of appearance the literature there are also many studies showing the benefits of applying models of quality implementation in health-care organisations (Naylor, 2005 Ruiz et al., 2005). such(prenominal) studies have pointed to the real benefits that accrue to organisations which have used such approaches (Pitt, 2005).Business excellency methodology for quality improvementThe introduction of transnationally see quality frameworks the Malcolm Baldrige National Quality Award (MBNQA) in 2003, followed by the EFQM in 2005 has provided an opportunity for organisations to self-assess, using the models of TQM and business excellence which underpin these frameworks. In this process of self-assessment, an opportunity exists to topical anestheticize the strengths and weaknesses in the current management of operations. In the USA, the effectiveness of the Baldrige process has been lauded by many (Gaucher and Coffey, 2000) who have indicated that organisations can learn about best practices from Baldrige-winning companies, and will thus be assisted in developing a composite for excellence.Although the Baldrige criteria were developed for commercial institutions, there has been keen interest in the adaptation of the model within health-care organisations in the USA following a pilot health-care project in 2005. To date, no health-care entity has yet achieved Baldrige-winner status, although Gaucher and Coffey (2000) have asserted that it is only a matter of time before there is a health-care winner. Moreover, these authors went on to articulate that the true benefit of the Baldrige process is not about winning an award. Rather, it is about the provision of a way map for a journey a framework for both incremental and breakthrough improvement and business excellence.Within the European context, since its introduction in 2001, the EFQM model has been attracting considerable interest across all sectors, and has become a well-recognised quality-management framework. Stahr et al. (2001) concurred with Gaucher and Coffey (2000) in stating that the model provides a means by which organisations can assess their paths and develop solutions to achieve excellence. Other authors have espoused the model as being surprisingly effective, with awards being presented to those firms considered to be the most conventional exponents of TQM in Europe (Wilkes and Dale, 2005).Across European health care at an institutional level, an increasing number of organisations are making direct investments in the training of staff in the concepts of business excellence (Stahr et al., 2001 Jackson, 2001). The NHS executive in the UK has provided a central lead in endorsing the model as an important framework for delivering on the clinical governance agenda. Furthermore the British Association of Medical Managers (BAMM) has promoted its use as a instrumental role for organisational self-assessment (Stahr et al., 2001). Its use and adoption has been further supported by the British Quality Foundation which provides a major educational and support role in the use and adoption of the model in health care and other sectors across the corporate landscape.Without doubt, the rising performance of health-care organisations will be assessed against wider goals than previously. There will be a greater emphasis on measuring organisational performance and, if performance is below par, rapid investigation and appropriate intervention will go after (Naylor, 2005). Moeller (2001) concurred with this, and identified evaluation of health services as a prerequisite. However, Zairi et al. (2005) warned that measuring organisational effectiveness in the delivery of health care is a challenging task.Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria should be included, against whi ch to evaluate progress. This should be based on the main requirements of TQM, supplemented by other organisational criteria thought to be important by the evaluators. A three-year evaluation of TQM in the NHS indicated that there are clear factors which predict successful implementation including sense of the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, as demonstrated by OSullivan (2005), successful implementation requires the support of visionary and involved leaders in all areas, together with dedicated and educated staff.Examining organisational effectiveness in Irish health careAs suggested by Nabitz and Walburg (2000), the solution to quality problems might lie in the approach promoted by the EFQM. As reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care which concurs with prior descriptions by Gaucher and Coffey (2000). Self-asses sment can examine current practice and sustain capability, thus driving improvement rather than a reaction to weaknesses in the current system (Russell, 2005).There are also many studies in the literature which show the benefits of applying the business excellence model for quality implementation in health-care organisations (Naylor, 2005 Jackson, 2005a Nabitz and Klazinga, 2005 Arcelay et al., 2005). Such studies have pointed to real benefits that have accrued to organisations using such an approach. Furthermore, Jackson (2005a) demonstrated that the adoption of the principles of self-assessment and business excellence can lead to the achievement of a culture of continuous improvement.Russell (2005) noted that the adoption of the outside-in approach of the EFQM model enabled organisations to use the model as a developmental and management framework. For Arcelay et al. (2005), the model provided a global, systematic timed analysis of the activities and results by comparing them wi th the criteria of the excellence model. Moreover, the process made it possible to make comparisons with other private and public organisations.Using a systems view of an organisation enables managers to focus on the processes between the parts of an organisation, rather than on the parts themselves, which is similar to physicians using a systematic model in which to analyse signs and symptoms, and thus make a diagnosis. An effective organisation is one in which the total organisation, through its significant subparts and individuals, manages its work against goals and plans with a view to achieving these goals within an open system. Methods of management that have been developed in manufacturing environments are by nature regarded with scepticism in non-manufacturing sectors.However, according to West (2001), studies that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and methodol ogically because of the many different mechanisms that may be operating at once to produce the relationship between quite a little and quality. West (2001) asserted that a more rigorous eubstance of work exists on the performance of firms in the private sector, practically conducted within the disciplines of organisational behaviour or human resource management.Ireland and the International ICT Systemcapital of Ireland has, in the 2000s, carved out several niche international functions for itself, one of which, call centre activities, has been the dealer focus of this study. According to a report in The Irish Times (August 20, 2003), Ireland accounts for 30% of all international call centres located in western Europe. The great bulk of these are to be found in capital of Ireland. The central role of ICT in call centre activities has facilitated their centralization in Ireland, from where markets spread across Europe and even further afield can right away be served. As Sassen ( 2005, p. 56) has observed Information technologies, often thought of as neutralising geography, actually contribute to spatial compactness.Call centre activities, therefore, have helped Ireland to make do the bounds of geographical peripherality, thereby contradicting Wegeners (2005) gloomy forecast which visualised cities in the periphery as inevitable losers from growing inter-urban competition in Europe. This has been cleverly visualised in an IDA advertisement which shows Ireland at the centre of a surrounding group of disembodied European countries ( Fig. 1). These latter are no longer seen as being more or less distant from Ireland, but as constituting a set of different language and market territories, all equally accessible from Ireland.However, capital of Irelands growing international reach and the growing technological sophistication of its economic base should not mask the fact that, structurally, it retains a mutualist position within the international division of labour. Its rapid recent economic expansion has been largely based on the attraction of branch plant operations which appease poorly embedded in the local economy (Breathnach, 2005). nd, while the rising skill levels associated with recent inward investment have facilitated substantial improvement in living standards generally, in the specific case of the call centre sector, much of the employment which has been created ashes relatively poorly paid a fact which is at once linked with the high proportion of women workers in the sector, despite their high skill levels.Furthermore, the rapid growth of the call centre sector in the 2000s looks increasingly unsustainable as the end of the decade approaches. Growing labour shortages are driving up labour costs which, in conjunction with increasing housing and transportation problems, are beginning to attenuate Dublins attractiveness as a call centre location according to a 2005 survey of call centre locations in Great Britain and Ire land, reported by Allen (2005), Dublin had fallen to the 29th position of 46 locations surveyed, having been in the top 10 in 2006.The response of the IDA has been to give way additional resources to promoting non-Dublin locations for call centre projects. However, even if this is successful in the short run, in the longer term the future of call centre employment will be increasingly threatened by technological developments, such as speech course credit technology and especially the rapidly growing use of the profits for making reservations, placing orders and seeking information.The IDA has justified its progress of the call centre sector, despite the inferior nature of much of the employment involved, largely on the crusade that it provides an initial base upon which more sophisticated forms of employment can be built. Its long-term strategy, in other members, is to encourage firms which have established call centres in Ireland to add on additional functions, such as financ ial management and software development, to these initial operations. Already there has been some success in this area of shared services back-office activities by mid-2003, some 25 such operations had been established, and were projected to employ over 3000 people by the year 2000 (information supplied by Forfs).Ultimately, however, all of these activities remain as back-office activities, whose essential linkages are external to the Irish economy. In other words, their Irish location is not crucial to the parent companies of these operations rather, it is possible on the availability of certain attractions which may either be transient or reproducible elsewhere (Allen, 2005). As Wilson (2005) has noted, call centres are essentially a super footloose sector, with few local economic linkages and little fixed investment in machinery and equipment they therefore can be relocated quite readily in the light of changing comparative factor conditions.The National Health Service (NHS) in the UK print its NHS Plan in July 2000 (http//www.nhs.uk/thenhsexplained), saying that patients and people were central to its stand reform of healthcare and that although this included more hospitals and beds, shorter waiting times and improved care for older people, an essential element was that patients should have more indicant and information. As Grimson et al. (2000) rightly comment, healthcare is an information-intensive business, with data on an commodious scale gathered by way of hospitals, clinics, laboratories and primary care surgeries.Central to any information-intensive business is, naturally, the effective sacramental manduction of that information and, in order to empower and better engage the patient, how best that can be done. Funded by the UKs Department of Health, the British Librarys integrated Telemedicine Information Service (TIS), described in the latest edition of the NHSMagazine (http//www.nhs.uk/nhsmagazine), is to improve the take-up of telemedicine technology in the UK, reinforcing the importance that information and communication technologies (ICTs) are seen to have in the sharing of information and the engagement of patients in their healthcare.By way of explanation, the word telemedicine has been coined as a way of capturing, in only one word, how ICT is being used in healthcare. However, as Curry et al. (2003) rightly comment, terms such as telemedicine, teleconferencing, health informatics and medical informatics await to be used interchangeably, and that there is some confusion as to what is, and is not, involved, citing various studys, including those of Preston at al. (2002) and Mark and Hodges (2001) to support their claim. As there is some contrariety with the term, we use in this study the meaning assigned by Perednia and Allen (2005), that is, the use of information technologies in constituent to provide medical information and services in healthcare. whatever its name, or its definition, it concerns, in one w ay or another, the mediating role that technology plays in the interaction between humans, whether patient or healthcare professional.At the time of writing, there are 138 telemedicine projects in the UK (http//www.tis.port.ac.uk/tm/owa/projects.allUK), and they cover aspects of healthcare as diverse as mental health, diabetes, foetal monitoring and accident and emergency care. Indeed, it points to one of the advantages of telemedicine its applicability across a wide range of clinical issues. However, while these projects certainly cover a diversity of issues, they have something in common, that is, they enshroud only one of these clinical matters. Each system is intentional differently, is unlikely to be compatible with another, and needs different technical support and user training.Whilst such individual systems have proved useful in a particular context (see, for example, Gilmour et al., 2005 Jones et al., 2006 Lesher et al., 2005 Loane et al., 2005 Lowitt et al., 2005 Oakley et al.,Health Information and Communication Systems in IrelandHealth Information and Communication Systems in IrelandIs ICT a key enabler in ensuring seamless delivery of healthcare? A comparison between public and private ICT development in IrelandAbstractThis study discusses the innovative changes that have taken place in Ireland in the field of healthcare due to the influx of information and communication technologies. Previous Information communication technologies (ICT), including telemedicine, present opportunities to address rural health-service delivery issues. The research shows that effective management of health services and the delivery of quality systems in Irish healthcare organizations have increased. In Ireland patients are expecting more of healthcare providers and are demanding higher standards of care and service.Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is w idespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to healthcare management in relation to ICT. This study highlights the developments in quality-service management in the Irish healthcare sector and focuses attention on the need for the development of a model for quality implementation in healthcare institutions. In sum the study shows that the development of (ICT) has facilitated the emergence of a complex global urban system in which many formerly lower-order cities have been carving out niche specialist functions serving urban fields of transnational dimension.Chapter1 IntroductionPurpose of StudyThe purpose of this study is to highlight the development of the Information and communication system in Ireland and how it has revolutionized the healthcare sector in Ireland.Research QuestionThis study focuses on the following research questionsWhat are the current trends of technological dev elopment in the Information and Communication Technology sector of Ireland?What are various challenges faced by the Irish healthcare system in relation to Information and Communication Technology? consequence of the StudyThis study is quite significant as it shows that the concept of globalisation has secured remarkable currency in the academic discourse of the late 20th century, despite ongoing questions regarding both its meaning and extent (Clark and Lund, 2000). The development of internationally integrated production and distribution systems, seen by many as the key feature of globalisation, has been a spatially uneven process. A key factor in this respect has been the differential ability of regions to engage in the informational economy, based on new information and communications technology (ICT), which is the main source of wealth creation and economic growth in the modern world (Castells, 2003).The result has been what Friedmann (2005) calls a process of techno-apartheid w hich has divided the globe into fast and slow worlds (Knox, 2005), distinguished by the connectedness of individuals, groups and regions to the world of telematics. This echoes Ingersolls (2003, quoted in Knox, 2005) suggestion that the key division of the workforce is now that between those who have the capacity to operate ICT (the cyberproletariat) and those who do not (the lumpentrash). Golding (2006) makes a similar distinction between the technoliterati and the techno-poor.While Knox defines the fast and slow worlds spatially, equating the former with the triadic core and the latter with the remaining global periphery, Hoogvelt (2003) argues that the divide is, in essence, social rather than spatial, with elements of both worlds to be found in all regions of the globe. Thus, within advanced economies, a process of social polarisation has been widely reported (Friedmann, 2006 and Sassen, 2004) and has been intimately linked by Graham and Marvin (2006) to the development of ICT u se. This is not to suggest that those who work in the fast world are homogeneously well-paid and affluent rather, they represent a wide range of remuneration levels depending on such factors as economic sector, location, function, ethnic group and gender (Castells, 2006). What they do tend to have in common, however, is relative employment security due to the high demand level for their ICT skills.RationaleThis study follows a logical approach and identifies the fact that both in Ireland as well as globally, there are major geographical variations in the relative balance between fast and slow worlds, with the former mainly to be found in the traditional core regions of North America, western Europe and Japan and an additional small group of newly industrialising countries which have had the institutional capacity to invest massively in modern ICT and associated educational infrastructures (Freeman, 2004). The slow world found predominantly in the less developed countries of the glo bal periphery and accounting for the bulk of the worlds population is becoming increasingly marginalised and is moving, as Castells (2003, p. 37) puts it, from a structural position of exploitation to a structural position of irrelevance.Definition of TermsICT Information and Communication Technology it is the study or business of developing and using technology to process information and aid communications.Sistem SISTeM a soft systems methodology, stakeholder analysis and participative simulation modelling.NHS (National Health Service) The organization providing national healthcare services in the UK.Chapter 2 Literature ReviewThe process of quality implementation has become a key concern for those involved in hospital management in Ireland. In a national context, the effective management of health services and the delivery of quality systems in health-care institutions have increased in significance in recent years. In line with wider developments in other service industries, co nsumers (patients) are expecting more of health-care providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to health-care management and delivery.In 2005 a comprehensive report on funding from the Commission on Health Funding highlighted that solutions to the problems faced by the Irish Health Service did not lie primarily in the system of funding, but rather in the way that services were planned, organised, and delivered. Similarly, in a report from the OECD (2003), it was argued that although the Irish health system had delivered a continuous improvement in health standards, there was still scope for further improvement in efficiency, and that this could be achieved through be tter allocation of resources. More recently, the government health strategy (DOHc, 2001) highlighted the requirement for a system to monitor progress and systematically evaluate the quality and effectiveness of health services. According to the strategyMonitoring and evaluation must become intrinsic to the approach taken by people at all levels of the health services.Specifically, the strategy suggested that the way in which health and personal social services are planned, organised, and delivered has a significant effect on the health and well-being of the population. Organisational structures must be geared to the provision of a responsive, adaptable health system which meets the needs of the population effectively and at affordable cost. One of the guiding principles inherent in the published strategy was that of a people-centred health system. A responsive system must develop ways to engage with individuals and the wider community which receives its services. The health system m ust become more people-centred, with the interests of the public, patients, and clients being given greater prominence and influence in decision making at all levels (DOHc, 2001).According to Bowers (2001), major structural reform, coupled with strong management and political will, are required to ensure change for the better. In Bowers view, finance alone will not improve the system. Rather, a concentrated effort must be made to ensure a responsive and efficient service. As previously noted, a conclusion of the Report of the Commission on Health Funding (2005) was that the solution facing the Irish health services did not lie primarily in the system of funding but rather in the way that services were planned, organised, and delivered. This is reinforced by a recent report on the Irish health-care sector which suggested that the issues and challenges facing the health service are fundamentally the same as those outlined by the Commission on Health Funding, except that they are compo unded by much higher expectations/demands by consumers (Deloitte and Touche, 2001).Thus, although modern health services have undergone radical change in many areas (Robins, 2003), managers of health services are currently reporting a large increase in the number of patients needing beds, with consequent ever-increasing waiting lists. Accident and emergency departments are under particular strain, and the difficulties of dealing with the growing needs of the increasing elderly population are beginning to become apparent. Although the Irish health service is free for all those requiring medical treatment through a publicly funded system, the current situation is hauntingly similar to that of the Victorian era of health care in Ireland.As a result, the Office for Health Management in Ireland (OHM, 2001) has suggested that current deficiencies in health-care provision and delivery underline the importance of providing quality service management and implementation in Irish health and pe rsonal social services. In achieving this aim, the OHM has contended that those working within the system must change how they go about their work and how they work together.Changed public-sector environmentThe focus on health-care service and quality has evolved from a more general interest in continuous improvement initiatives within the public sector. The prevalent trends in the private sector are towards continuous and pervasive change and increasing interdependencies, and it has been suggested that close parallels can be drawn between the private and public sectors. Public-sector organisations now find themselves in a cyclone of change as they attempt to adapt to turbulent environments in a pragmatic and systematic way (Lovell, 2004).In the UK and also in Ireland, these organisations have been subject to cuts in government spending, as well as demands for enhanced efficiency and effectiveness. In response to such changes, there has been a policy shift towards greater competitio n and an attempt to apply management practices from the private sector to the public domain.The Irish public sector has been officially pursuing change and reform through its strategic management initiative (SMI), a program for improving the management of the civil service which was formally launched in 2004 (Department of the Taoisearch, 2004). The SMI evolved from the growing internal and external pressures for better services and for more effective management of public services. In that context the continuous improvement of customer service has been a specific focus of the SMI since 2003, when the quality service initiative was launched. The program set out a series of quality principles according to which dealings with the wider public would be coordinated and managed. These initiatives aimed to make public administration more relevant to the citizens for whom the service exists, and simultaneously sought to remove barriers which have traditionally restricted performance and job satisfaction within the public sector.In recent years, Ireland has experienced a rise in consumerism. Increases in revenue available to fund public service provision have gone hand in hand with rising public expectations of standards of service. As a consequence, management skills and competences in providing for improved standards of customer service have become recognised as being central to delivering real transformation in the public sector. However, the development of such capabilities, particularly in relation to managing effective quality implementation, presents considerable challenges for those involved. Nowhere is this more evident than in the health-care sector. A review of recent international evidence points to the challenges of implementing quality service in health-care institutions.Gaucher and Coffey (2000) confirmed that implementing a process of total quality management (TQM) in health care is a pragmatic, specific, and systematic methodology. However, this requir es a firm commitment from the leadership to change their former ways of working and doing business. Gaucher and Coffey (2000) cited many reasons for TQM failing including poor leadership and a lack of management commitment but also noted that revitalisation can rejuvenate the process. These authors asserted that the role of those implementing the process is to nurture and breathe energy into the process when enthusiasm and commitment are declining.The importance of the support of senior management for quality-management projects is also advocated by Berwick et al. (2000). These authors undertook a national demonstration project in the USA in the late 2000s and described how organisations could implement the entire quality-improvement process from defining the problem through to implementing a solution and consolidating the gains (Berwick et al., 2000).A literature review carried out by Jackson (2005) identified that much work had been undertaken in the UK in determining the clini cal effectiveness of many health-care organisations, but that very little research had been implemented in the area of managerial effectiveness. Furthermore, West (2001) determined that, in organisations that outperform others on different dimensions of performance, there was evidence that management is important, as are the combined efforts of individual clinicians and teams.There have been several approaches espoused for achieving quality management in health-care institutions, many of which have been technical and generic in their approaches (Moeller et al., 2000). Specifically, Donabedian (2000) introduced the concepts of structure, process, and outcomes, along with the development of self-assessment and accreditation through the International Organization for Standardization (ISO). In many instances these programs have met with mixed reactions, and their implementation has varied.A criticism levelled at hospital performance is that it has been rather insular, and has paid littl e attention to developments in related fields, such as organisational sociology, organisational behaviour, management studies, and human-resource management (West, 2001). If quality programs are to have lasting and significant effects, that they must follow a systemic approach such that all aspects of an organisation are integrated and focused on continuous improvement and customer satisfaction (Joss, 2004).A variety of approaches has been used to improve quality and to ensure its delivery, but not all have been successful. Indeed, some have merely added bureaucracy and higher costs to health care (Jackson, 2005 Ennis and Harrington, 2001). Recent research has shown that 45 per cent of patients experience some medical mismanagement and that 17 per cent suffer events which lead to a longer stay or more serious problems (Ovretveit, 2000). This is increasingly caused by complex systems of care which do not appear to be managed effectively.Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria be included, against which to evaluate progress. These criteria should be based on the main requirements of TQM, and should include any additional factors generated by the organisation and/or by evaluators. A three-year evaluation of TQM in the National Health Scheme (NHS) indicated that there were clear factors which predicted successful implementation, the most important of which was the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, a recent study from the UK (OSullivan, 2005) demonstrated how one NHS Trust achieved continuous quality improvement through determination, education, and implementation, supported by visionary and involved leadership in all areas, a multi-talented enthusiastic clinical audit department, and a high-quality dedicated staff.Nabitz and Walburg (2000) suggested that possible solutions to quality problems might lie in the approach promoted b y the European Foundation for Quality Management (EFQM). The EFQM has developed a model to structure and review the quality-management processes of organisations. Self-assessment, benchmarking, external review, and quality awards are essential elements of this model and, as reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care. Within the literature there are also many studies showing the benefits of applying models of quality implementation in health-care organisations (Naylor, 2005 Ruiz et al., 2005). Such studies have pointed to the real benefits that accrue to organisations which have used such approaches (Pitt, 2005).Business excellence methodology for quality improvementThe introduction of internationally respected quality frameworks the Malcolm Baldrige National Quality Award (MBNQA) in 2003, followed by the EFQM in 2005 has provided an opportunity for organisations to self-assess, using the models of TQM and business excellence which underpin these frameworks. In this process of self-assessment, an opportunity exists to identify the strengths and weaknesses in the current management of operations. In the USA, the effectiveness of the Baldrige process has been lauded by many (Gaucher and Coffey, 2000) who have indicated that organisations can learn about best practices from Baldrige-winning companies, and will thus be assisted in developing a composite for excellence.Although the Baldrige criteria were developed for commercial institutions, there has been keen interest in the adaptation of the model within health-care organisations in the USA following a pilot health-care project in 2005. To date, no health-care entity has yet achieved Baldrige-winner status, although Gaucher and Coffey (2000) have asserted that it is only a matter of time before there is a health-care winner. Moreover, these authors went on to say that the true benefit of the Baldrige process is not about winning an award. Rath er, it is about the provision of a road map for a journey a framework for both incremental and breakthrough improvement and business excellence.Within the European context, since its introduction in 2001, the EFQM model has been attracting considerable interest across all sectors, and has become a well-recognised quality-management framework. Stahr et al. (2001) concurred with Gaucher and Coffey (2000) in stating that the model provides a means by which organisations can assess their paths and develop solutions to achieve excellence. Other authors have espoused the model as being surprisingly effective, with awards being presented to those firms considered to be the most accomplished exponents of TQM in Europe (Wilkes and Dale, 2005).Across European health care at an institutional level, an increasing number of organisations are making direct investments in the training of staff in the concepts of business excellence (Stahr et al., 2001 Jackson, 2001). The NHS Executive in the UK h as provided a central lead in endorsing the model as an important framework for delivering on the clinical governance agenda. Furthermore the British Association of Medical Managers (BAMM) has promoted its use as a tool for organisational self-assessment (Stahr et al., 2001). Its use and adoption has been further supported by the British Quality Foundation which provides a major educational and support role in the use and adoption of the model in health care and other sectors across the corporate landscape.Without doubt, the future performance of health-care organisations will be assessed against wider goals than previously. There will be a greater emphasis on measuring organisational performance and, if performance is below par, rapid investigation and appropriate intervention will ensue (Naylor, 2005). Moeller (2001) concurred with this, and identified evaluation of health services as a prerequisite. However, Zairi et al. (2005) warned that measuring organisational effectiveness i n the delivery of health care is a challenging task.Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria should be included, against which to evaluate progress. This should be based on the main requirements of TQM, supplemented by other organisational criteria thought to be important by the evaluators. A three-year evaluation of TQM in the NHS indicated that there are clear factors which predict successful implementation including awareness of the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, as demonstrated by OSullivan (2005), successful implementation requires the support of visionary and involved leaders in all areas, together with dedicated and educated staff.Examining organisational effectiveness in Irish health careAs suggested by Nabitz and Walburg (2000), the solution to quality problems might lie in the approach promoted by the EFQM. As reported by Sanchez (200 0), this approach represents an important means of achieving excellence in health care which concurs with earlier descriptions by Gaucher and Coffey (2000). Self-assessment can examine current practice and establish capability, thus driving improvement rather than a reaction to weaknesses in the current system (Russell, 2005).There are also many studies in the literature which show the benefits of applying the business excellence model for quality implementation in health-care organisations (Naylor, 2005 Jackson, 2005a Nabitz and Klazinga, 2005 Arcelay et al., 2005). Such studies have pointed to real benefits that have accrued to organisations using such an approach. Furthermore, Jackson (2005a) demonstrated that the adoption of the principles of self-assessment and business excellence can lead to the achievement of a culture of continuous improvement.Russell (2005) noted that the adoption of the outside-in approach of the EFQM model enabled organisations to use the model as a devel opmental and management framework. For Arcelay et al. (2005), the model provided a global, systematic regular analysis of the activities and results by comparing them with the criteria of the excellence model. Moreover, the process made it possible to make comparisons with other private and public organisations.Using a systems view of an organisation enables managers to focus on the processes between the parts of an organisation, rather than on the parts themselves, which is similar to physicians using a systematic model in which to analyse signs and symptoms, and thus make a diagnosis. An effective organisation is one in which the total organisation, through its significant subparts and individuals, manages its work against goals and plans with a view to achieving these goals within an open system. Methods of management that have been developed in manufacturing environments are naturally regarded with scepticism in non-manufacturing sectors.However, according to West (2001), studie s that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and methodologically because of the many different mechanisms that may be operating at once to produce the relationship between volume and quality. West (2001) asserted that a more rigorous body of work exists on the performance of firms in the private sector, often conducted within the disciplines of organisational behaviour or human resource management.Ireland and the International ICT SystemDublin has, in the 2000s, carved out several niche international functions for itself, one of which, call centre activities, has been the principal focus of this study. According to a report in The Irish Times (August 20, 2003), Ireland accounts for 30% of all international call centres located in western Europe. The great bulk of these are to be found in Dublin. The central role of ICT in call centre activities has facilitated their centra lisation in Ireland, from where markets spread across Europe and even further afield can readily be served. As Sassen (2005, p. 56) has observed Information technologies, often thought of as neutralising geography, actually contribute to spatial concentration.Call centre activities, therefore, have helped Ireland to escape the bounds of geographical peripherality, thereby contradicting Wegeners (2005) gloomy prognosis which visualised cities in the periphery as inevitable losers from growing inter-urban competition in Europe. This has been cleverly portrayed in an IDA advertisement which shows Ireland at the centre of a surrounding group of disembodied European countries ( Fig. 1). These latter are no longer seen as being more or less distant from Ireland, but as constituting a set of different language and market territories, all equally accessible from Ireland.However, Dublins growing international reach and the growing technological sophistication of its economic base should not mask the fact that, structurally, it retains a dependent position within the international division of labour. Its rapid recent economic expansion has been largely based on the attraction of branch plant operations which remain poorly embedded in the local economy (Breathnach, 2005). nd, while the rising skill levels associated with recent inward investment have facilitated substantial improvement in living standards generally, in the specific case of the call centre sector, much of the employment which has been created remains relatively poorly paid a fact which is directly linked with the high proportion of women workers in the sector, despite their high skill levels.Furthermore, the rapid growth of the call centre sector in the 2000s looks increasingly unsustainable as the end of the decade approaches. Growing labour shortages are driving up labour costs which, in conjunction with increasing housing and transportation problems, are beginning to attenuate Dublins attractiveness a s a call centre location according to a 2005 survey of call centre locations in Great Britain and Ireland, reported by Allen (2005), Dublin had fallen to the 29th position of 46 locations surveyed, having been in the top 10 in 2006.The response of the IDA has been to devote additional resources to promoting non-Dublin locations for call centre projects. However, even if this is successful in the short run, in the longer term the future of call centre employment will be increasingly threatened by technological developments, such as speech recognition technology and especially the rapidly growing use of the internet for making reservations, placing orders and seeking information.The IDA has justified its promotion of the call centre sector, despite the inferior nature of much of the employment involved, largely on the grounds that it provides an initial base upon which more sophisticated forms of employment can be built. Its long-term strategy, in other words, is to encourage firms wh ich have established call centres in Ireland to add on additional functions, such as financial management and software development, to these initial operations. Already there has been some success in this area of shared services back-office activities by mid-2003, some 25 such operations had been established, and were projected to employ over 3000 people by the year 2000 (information supplied by Forfs).Ultimately, however, all of these activities remain as back-office activities, whose essential linkages are external to the Irish economy. In other words, their Irish location is not crucial to the parent companies of these operations rather, it is contingent on the availability of certain attractions which may either be transient or reproducible elsewhere (Allen, 2005). As Wilson (2005) has noted, call centres are essentially a highly footloose sector, with few local economic linkages and little fixed investment in machinery and equipment they therefore can be relocated quite readily in the light of changing comparative factor conditions.The National Health Service (NHS) in the UK published its NHS Plan in July 2000 (http//www.nhs.uk/thenhsexplained), saying that patients and people were central to its radical reform of healthcare and that although this included more hospitals and beds, shorter waiting times and improved care for older people, an essential element was that patients should have more power and information. As Grimson et al. (2000) rightly comment, healthcare is an information-intensive business, with data on an enormous scale gathered by way of hospitals, clinics, laboratories and primary care surgeries.Central to any information-intensive business is, naturally, the effective sharing of that information and, in order to empower and better engage the patient, how best that can be done. Funded by the UKs Department of Health, the British Librarys integrated Telemedicine Information Service (TIS), described in the latest edition of the NHSMagazine (http//www.nhs.uk/nhsmagazine), is to improve the take-up of telemedicine technology in the UK, reinforcing the importance that information and communication technologies (ICTs) are seen to have in the sharing of information and the engagement of patients in their healthcare.By way of explanation, the word telemedicine has been coined as a way of capturing, in only one word, how ICT is being used in healthcare. However, as Curry et al. (2003) rightly comment, terms such as telemedicine, teleconferencing, health informatics and medical informatics seem to be used interchangeably, and that there is some confusion as to what is, and is not, involved, citing various studys, including those of Preston at al. (2002) and Mark and Hodges (2001) to support their claim. As there is some disagreement with the term, we use in this study the meaning assigned by Perednia and Allen (2005), that is, the use of information technologies in helping to provide medical information and services in health care. Whatever its name, or its definition, it concerns, in one way or another, the mediating role that technology plays in the interaction between humans, whether patient or healthcare professional.At the time of writing, there are 138 telemedicine projects in the UK (http//www.tis.port.ac.uk/tm/owa/projects.allUK), and they cover aspects of healthcare as diverse as mental health, diabetes, foetal monitoring and accident and emergency care. Indeed, it points to one of the advantages of telemedicine its applicability across a wide range of clinical issues. However, while these projects certainly cover a diversity of issues, they have something in common, that is, they address only one of these clinical matters. Each system is designed differently, is unlikely to be compatible with another, and needs different technical support and user training.Whilst such individual systems have proved useful in a particular context (see, for example, Gilmour et al., 2005 Jones et al., 2006 Lesher et al., 2005 Loane et al., 2005 Lowitt et al., 2005 Oakley et al.,