4.6 HEALTH HUMAN RESOURCE INFORMATION SYSTEMS AFFECTING THE
4.6.2 Health Human Resource Information Systems and the Structure of an Organisation
According to Reynolds (2010), the structure of an organisation determines strategy.
The strategic opportunities for organisational change could be inadequate depending on ICT processes, access to data, scientific evidence or contextual facts, which are provided to policy and management decision-makers. These limitations to change are not random; they are structural.
Communications, either positive or negative, come into the organisation from its environment;
however, the organisation can only distinguish the varieties of messages it is structured to hear.
Conversely, when there are no organisational sub-structures which are responsible for hearing these communications on a specific set of issues, then the organisation will not hear those messages. The information may be derived from an individual in the organisation but it dissipates through the organisation because there is no structure to hear it (Reynolds, 2010).
Informed decisions taken in an organisation should be based on valid information and an
understanding of the market, including technological changes, fluctuations in economic trends or increasing competitive stressors. This means that organisational structure and policy strategy are interconnected in an iterative growth progression in which the interactional structure affects the strategy, and vice versa. Also, when an organisation uses diverse information about its ecosystem and precisely monitors strategic risks, then any emerging threats to the relationship with its environment can be avoided (Reynolds, 2010).
Figure 20: Management Decision Structure (Adapted from Reynolds, 2010) The management decision structure in Figure 20 highlights how strategic conversations connect various sub-structures on interdependent issues. Decision-making structures are able to maintain their integrity by integrating internal and external information.
Thus, an organisation needs to continually develop and adapt to the ecosystem in which the organisation exists or it will lose its “fit” with its environment (Reynolds, 2010). Events in the environment, trends and structures influence data driven decision-making, whereas design-driven decision-making focuses on mental models, organisational structures, patterns of behaviour and then environmental events.
A metaphor exists of the iceberg demonstrates leverage in shifting the mental models that inform the design or structure of a system. In the iceberg model (Fairchild, 2013), the visible ten percent of the iceberg depicts events or outcomes, which is the product of a system’s behavior. The maximum affect to change outcomes or adjust events, is by understanding the 90 percent of the iceberg is hidden from view. The iceberg model and its relevance to this study, illustrated the dynamic complexities in the KZN DOH, as events were analysed, patterns in systemic behavior examined, organisational management, information and decision-making structures evaluated and actors’ mental models explored.
Information on Environment and Future
Performance Information from Operational Management Operational
Management Participation
H R
Finance ICT
Development ICT DEVELOPMENT Consultation
H R
Finance
POLICY
Figure 21: Data to Design-Driven Decision-making Iceberg Model (Fairchild, 2013) In Figure 21, the Iceberg model was used as a tool to guide systemic thinking (Senge, 2006); in this metaphor the change proposed is from data-driven decision-making to design-driven decision making.
At the apex of the iceberg which typically we can see, are events that exist at a point in time, and which can be equated to the stocks or systemic conditions, as strong warning signs. Habitually we seek to improve events; however, intervening at or very close to an event is regarded as a place within the system that has the least leverage for change. As events occur over time, they are referred to as flows. Flows are activities that alter the level of stocks; behavior-over-time or stock-and-flow diagrams are forms of data that demonstrate a system’s behavior, its stability or volatility. In this study, the FGDs identified the event as associated with the stock or shortage of specialists, and the stock and flow were related to the recruitment of specialists, as illustrated in Figure 16 on page 38.
EVENTS
PATTERNS
MENTAL MODELS STRUCTURES What trends are there over time? Influences
anticipation
How are subsystems related? What influences patterns and relationships between parts of the system? Influences system design
Deeply ingrained assumptions, generalizations or images that influence how we understand the world and how we take action e.g. beliefs about the system, and what beliefs keep the system in
place, fundamental area of transformation
INVISIBLE VISIBLE
What is happening?
Reaction to events
Systemic behaviour over time highlights how a decrease in funding registrars training, which is demonstrated in Figure 18 on page 41, resulted in a decreased number of specialists qualifying.
Below the waterline of the iceberg are patterns of recurring events. Patterns contribute in defining whether organisational growth is sustainable or when the growth potential is approaching its
maximum. Also, patterns in systemic behaviour provide managers with data to forecast or anticipate future events and to determine whether or not interventions altered outcomes. Systemic structures such as information, management structures and actors’ mental models, are fundamental in design- driven decision-making (Burian, 2014).
According to Senge (2006, p. 5),
Mental models which are deeply ingrained assumptions, generalizations, or images, interact with how we understand the world and how we take action. As we are not consciously aware of our mental models or the effects these have on our behaviour, decision-making or choices are impacted upon.
The iceberg model allows us to explore a more comprehensive representation of the different elements that interact in the DOH context. An example of the problem currently experienced in the KZN DOH is the management decision to decrease funding for registrars’ training, resulting in the shortage of specialists. What is observed at the top of the iceberg is the event where that problem manifests. By using the iceberg model an opportunity is created to detect variables below the event level and to consider which elements influence or contribute to causing the visible event, as well as what are the patterns or trends over time.
In this research, the FG’s observations of the behavioural patterns, organisational structures, relationships and actors’ mental models were discussed, resulting in identifying the contributing factors causing the research gap, which is an increased shortage of specialists. By identifying what underlying structures may be influencing the trends, for example, HR officers’ relationships with medical staff, senior management or finance managers and how organisational structures are designed to support recruiting, appropriately qualified specialists emerged. Focusing on the structure and design of the system, outcomes can be anticipated (Fairchild, 2013). Organisational behaviour in the real world comprises time delays and feedback loops based on information received from both the internal and external environment, and system dynamics approaches are used to develop models more consistent with these realities. Forrester (2010) emphasises that information from the external
environment, for example growth, not only population growth, but also economic growth, needs to be used as leverage in policy and organisational design.
Fairchild (2013) noted that in system dynamics, stocks and flows representing accumulations for example data and information technology capacity are applied to understand the organisational behaviour. Additionally, feedback loops are used to determine dynamic behaviour for instance increasing data management performance leads to increasing motivation and thus increased skill development. Information on the underlying structure of an organisation responsible for complex behaviour can be represented by the combination of stocks, flows, and feedback loops (Fairchild, 2013).
This relevance of the iceberg model and the research findings show that the system dynamics approach proposed in this study also provided insight into the interconnectedness of these elements, the various bottlenecks in the ice-berg model, and the possible areas for improvement. One such area which was identified is the information systems in KZN.
Figure 22: Organisational Behaviour over Time (Focus Group)