1. Lessons learned from IT-projects in the health care sector In search of excellence

2. The researcher Daniel Andersson Dept. Innovation and Medical Informatics, IMI Karolinska Universitetssjukhuset daniel.andersson@karolinska.se

3. Research background The health care sector in Sweden –Spends a lot of financial resources on IT –Has fallen behind in comparison with other countries/branches in the industrial world –Is only using the opportunities that IT brings about to a small extent –The IT-systems is characterized by isolated islands which can’t communicate

4. Research background The health care sector in Sweden Coordination and an overall grip is lacking on both the local, regional and national levels It is said that every county council, has between 400 to 800 applications in their business Applications are structured differently and uses different terms and conceptual definitions

5. Research background Objectives All patient information shall follow the patient independently of his or her geographical location Increase the overall productivity, efficiency and effectiveness by bringing the care into line with the patients needs developing new treatment, collaboration and organizational forms

6. Problem areas? A decentralized health care system The organization of the health care system –Large number of principals with responsibility The principals economical prerequisites Lack of IT-competence on the management level Weak order competence

7. Problem areas? The protection against intrusions on personal integrity and official secrets legislation regarding patient information The health care personnel's various needs and prerequisites Current IT-systems and regulations

8. Problem description Study IT-projects within the health care sector Get a deeper understanding about –the broken care process –the prerequisites to enable IT to: facilitate information exchange increase the availability to information increase the productivity, effectiveness and efficiency

9. Research aim Give the readers a deeper understanding regarding –technical and organizational problem areas –pitfalls and critical success factors Enable the development of successful strategies and action plans to enable the goal of establishing a common national IT-infrastructure for nursing and care

10. Research apporach National level Regional level Local level International level Article 1 Article 2 Article 3 Article 4, 5 Tid

11. Research design Data-gathering methods –Semi-structured interviews, Participative observations, Document analysis Grounded Theory Methodology –Reducing raw data into concepts (categories) –Developed and integrate categories into theory by coding data, memos and diagramming Theoretical approach: Principle of duality, Game Theory, Discretionary behaviour, Bounded rationality

12. Research Questions The central research question: –How shall governments manage the process of building a common national process-oriented IT- infrastructure for nursing and care. Centralization vs. decentralization

13. Other Questions –What role does a decentralized health care system play when it comes to establishing an national IT-infrastructure for nursing and care? –Which are the critical success-factors developing new IT-systems supporting nursing and care? –What characterizes successful innovations related to IT in the health care system?

14. The local perspective Emergency care process

15. OrtAVDÖvr AVD Op/AnAVARöntgenAkuten 1 2 Akutbe- dömning 11.400 Undersöka 8414 Operation 387 Undersöka Utreda Behandla Utreda Behandla 2 Operation 173 40 54086 650 2 9.800 Operation 357 333 162 410 2 36 0 Operation 63 54 324 Utreda Behandla Take Care HOPATake CareRISTake Care Acute orthopaedic process

18. Other Questions –Conflicts of interests Public – private interests –Threat of increasing insight Fear of loosing one’s job –...