Impact of a data warehouse model for improved decision-making process in healthcare

The health system is one sector dealing with a deluge of complex data. Many healthcare organisations struggle to utilise these volumes of health data effectively and efficiently. Also, there are many healthcare organisations, which still have stand-alone systems, not integrated for management of information and decision-making. This shows, there is a need for an effective system to capture, collate and distribute this health data. Therefore, implementing the data warehouse concept in healthcare is potentially one of the solutions to integrate health data. Data warehousing has been used to support business intelligence and decision-making in many other sectors such as the engineering, defence and retail sectors. The research problem that is going to be addressed is, "how can data warehousing assist the decision-making process in healthcare". To address this problem the researcher has narrowed an investigation focusing on a cardiac surgery unit. This research used the cardiac surgery unit at the Prince Charles Hospital (TPCH) as the case study. The cardiac surgery unit at TPCH uses a stand-alone database of patient clinical data, which supports clinical audit, service management and research functions. However, much of the time, the interaction between the cardiac surgery unit information system with other units is minimal. There is a limited and basic two-way interaction with other clinical and administrative databases at TPCH which support decision-making processes. The aims of this research are to investigate what decision-making issues are faced by the healthcare professionals with the current information systems and how decision-making might be improved within this healthcare setting by implementing an aligned data warehouse model or models. As a part of the research the researcher will propose and develop a suitable data warehouse prototype based on the cardiac surgery unit needs and integrating the Intensive Care Unit database, Clinical Costing unit database (Transition II) and Quality and Safety unit database [electronic discharge summary (e-DS)]. The goal is to improve the current decision-making processes. The main objectives of this research are to improve access to integrated clinical and financial data, providing potentially better information for decision-making for both improved from the questionnaire and by referring to the literature, the results indicate a centralised data warehouse model for the cardiac surgery unit at this stage. A centralised data warehouse model addresses current needs and can also be upgraded to an enterprise wide warehouse model or federated data warehouse model as discussed in the many consulted publications. The data warehouse prototype was able to be developed using SAS enterprise data integration studio 4.2 and the data was analysed using SAS enterprise edition 4.3. In the final stage, the data warehouse prototype was evaluated by collecting feedback from the end users. This was achieved by using output created from the data warehouse prototype as examples of the data desired and possible in a data warehouse environment. According to the feedback collected from the end users, implementation of a data warehouse was seen to be a useful tool to inform management options, provide a more complete representation of factors related to a decision scenario and potentially reduce information product development time. However, there are many constraints exist in this research. For example the technical issues such as data incompatibilities, integration of the cardiac surgery database and e-DS database servers and also, Queensland Health information restrictions (Queensland Health information related policies, patient data confidentiality and ethics requirements), limited availability of support from IT technical staff and time restrictions. These factors have influenced the process for the warehouse model development, necessitating an incremental approach. This highlights the presence of many practical barriers to data warehousing and integration at the clinical service level. Limitations included the use of a small convenience sample of survey respondents, and a single site case report study design. As mentioned previously, the proposed data warehouse is a prototype and was developed using only four database repositories. Despite this constraint, the research demonstrates that by implementing a data warehouse at the service level, decision-making is supported and data quality issues related to access and availability can be reduced, providing many benefits. Output reports produced from the data warehouse prototype demonstrated usefulness for the improvement of decision-making in the management of clinical services, and quality and safety monitoring for better clinical care. However, in the future, the centralised model selected can be upgraded to an enterprise wide architecture by integrating with additional hospital units’ databases.

Police misconduct and crime : bad apples or systems failure?

There is a debate in the research literature whether to view police misconduct and crime as acts of individuals perceived as 'rotten apples' or as an indication of systems failure in the police force. Based on an archival analysis of court cases where police employees were prosecuted, this paper attempts to explore the extent of rotten apples versus systems failure in the police. Exploratory research of 57 prosecuted police officers in Norway indicate that there were more rotten apple cases than system failure cases. The individual failures seem to be the norm rather than the exception of ethical breaches, therefore enhancing the rotten apple theory. However as exploratory research, police crime may still be explained at the organizational level as well.

Different kinds of openings of Luhmann's systems theory: A reply to la Cour et al

Various researchers have called for an 'opening up' of Luhmann's systems theory. We take this short paper as an occasion for a critical reflection on the necessity, existence and possibilities of such an opening. We start by pointing out the inherent openness of Luhmann's theory, and, based on this, discuss three kinds of openings: the international opening, the theoretical opening and the empirical opening. With regard to the latter, we distinguish three general options of using Luhmann's theory for empirical research. Copyright © 2007 SAGE.

Organizations as distinction generating and processing systems: Niklas Luhmann's contribution to organization studies

Niklas Luhmann's theory of social systems has been widely influential in the German-speaking countries in the past few decades. However, despite its significance, particularly for organization studies, it is only very recently that Luhmann's work has attracted attention on the international stage as well. This Special Issue is in response to that. In this introductory paper, we provide a systematic overview of Luhmann's theory. Reading his work as a theory about distinction generating and processing systems, we especially highlight the following aspects: (i) Organizations are processes that come into being by permanently constructing and reconstructing themselves by means of using distinctions, which mark what is part of their realm and what not. (ii) Such an organizational process belongs to a social sphere sui generis possessing its own logic, which cannot be traced back to human actors or subjects. (iii) Organizations are a specific kind of social process characterized by a specific kind of distinction: decision, which makes up what is specifically organizational about organizations as social phenomena. We conclude by introducing the papers in this Special Issue. Copyright © 2006 SAGE.

Predictive compensation for variable network delays and packet losses in networked control systems

Networked control systems (NCSs) offer many advantages over conventional control; however, they also demonstrate challenging problems such as network-induced delay and packet losses. This paper proposes an approach of predictive compensation for simultaneous network-induced delays and packet losses. Different from the majority of existing NCS control methods, the proposed approach addresses co-design of both network and controller. It also alleviates the requirements of precise process models and full understanding of NCS network dynamics. For a series of possible sensor-to-actuator delays, the controller computes a series of corresponding redundant control values. Then, it sends out those control values in a single packet to the actuator. Once receiving the control packet, the actuator measures the actual sensor-to-actuator delay and computes the control signals from the control packet. When packet dropout occurs, the actuator utilizes past control packets to generate an appropriate control signal. The effectiveness of the approach is demonstrated through examples.

Using the work system method with freshman information systems students

Recent surveys of information technology management professionals show that understanding business domains in terms of business productivity and cost reduction potential, knowledge of different vertical industry segments and their information requirements, understanding of business processes and client-facing skills are more critical for Information Systems personnel than ever before. In an attempt to restrucuture the information systems curriculum accordingly, our view it that information systems students need to develop an appreciation for organizational work systems in order to understand the operation and significance of information systems within such work systems.

Demand for public hospital emergency department services in Australia : 2000–2001 to 2009–2010

Objective: Hospital EDs are a significant and high-profile component of Australia’s health-care system, which in recent years have experienced considerable crowding. This crowding is caused by the combination of increasing demand, throughput and output factors. The aim of the present article is to clarify trends in the use of public ED services across Australia with a view to providing an evidence basis for future policy analysis and discussion. Methods: The data for the present article have been extracted, compiled and analysed from publicly available sources for a 10 year period between 2000–2001 and 2009–2010. Results: Demand for public ED care increased by 37% over the decade, an average annual increase of 1.8% in the utilization rate per 1000 persons. There were significant differences in utilization rates and in trends in growth among states and territories that do not easily relate to general population trends alone. Conclusions: This growth in demand exceeds general population growth, and the variability between states both in utilization rates and overall trends defies immediate explanation. The growth in demand for ED services is a partial contributor to the crowding being experienced in EDs across Australia. There is a need for more detailed study, including qualitative analysis of patient motivations in order to identify the factors driving this growth in demand.

Fundamentals of process integration

Technologies and languages for integrated processes are a relatively recent innovation. Over that period many divergent waves of innovation have transformed process integration. Like sockets and distributed objects, early workflow systems ordered programming interfaces that connected the process modelling layer to any middleware. BPM systems emerged later, connecting the modelling world to middleware through components. While BPM systems increased ease of use (modelling convenience), long-standing and complex interactions involving many process instances remained di±cult to model. Enterprise Service Buses (ESBs), followed, connecting process models to heterogeneous forms of middleware. ESBs, however, generally forced modellers to choose a particular underlying middleware and to stick to it, despite their ability to connect with many forms of middleware. Furthermore ESBs encourage process integrations to be modelled on their own, logically separate from the process model. This can lead to the inability to reason about long standing conversations at the process layer. Technologies and languages for process integration generally lack formality. This has led to arbitrariness in the underlying language building blocks. Conceptual holes exist in a range of technologies and languages for process integration and this can lead to customer dissatisfaction and failure to bring integration projects to reach their potential. Standards for process integration share similar fundamental flaws to languages and technologies. Standards are also in direct competition with other standards causing a lack of clarity. Thus the area of greatest risk in a BPM project remains process integration, despite major advancements in the technology base. This research examines some fundamental aspects of communication middleware and how these fundamental building blocks of integration can be brought to the process modelling layer in a technology agnostic manner. This way process modelling can be conceptually complete without becoming stuck in a particular middleware technology. Coloured Petri nets are used to define a formal semantics for the fundamental aspects of communication middleware. They provide the means to define and model the dynamic aspects of various integration middleware. Process integration patterns are used as a tool to codify common problems to be solved. Object Role Modelling is a formal modelling technique that was used to define the syntax of a proposed process integration language. This thesis provides several contributions to the field of process integration. It proposes a framework defining the key notions of integration middleware. This framework provides a conceptual foundation upon which a process integration language could be built. The thesis defines an architecture that allows various forms of middleware to be aggregated and reasoned about at the process layer. This thesis provides a comprehensive set of process integration patterns. These constitute a benchmark for the kinds of problems a process integration language must support. The thesis proposes a process integration modelling language and a partial implementation that is able to enact the language. A process integration pilot project in a German hospital is brie°y described at the end of the thesis. The pilot is based on ideas in this thesis.

Safety enhancement of operator protection systems on self-propelled mining equipment

In the long term, with development of skill, knowledge, exposure and confidence within the engineering profession, rigorous analysis techniques have the potential to become a reliable and far more comprehensive method for design and verification of the structural adequacy of OPS, write Nimal J Perera, David P Thambiratnam and Brian Clark. This paper explores the potential to enhance operator safety of self-propelled mechanical plant subjected to roll over and impact of falling objects using the non-linear and dynamic response simulation capabilities of analytical processes to supplement quasi-static testing methods prescribed in International and Australian Codes of Practice for bolt on Operator Protection Systems (OPS) that are post fitted. The paper is based on research work carried out by the authors at the Queensland University of Technology (QUT) over a period of three years by instrumentation of prototype tests, scale model tests in the laboratory and rigorous analysis using validated Finite Element (FE) Models. The FE codes used were ABAQUS for implicit analysis and LSDYNA for explicit analysis. The rigorous analysis and dynamic simulation technique described in the paper can be used to investigate the structural response due to accident scenarios such as multiple roll over, impact of multiple objects and combinations of such events and thereby enhance the safety and performance of Roll Over and Falling Object Protection Systems (ROPS and FOPS). The analytical techniques are based on sound engineering principles and well established practice for investigation of dynamic impact on all self propelled vehicles. They are used for many other similar applications where experimental techniques are not feasible.

Cellulosic ethanol from sugarcane bagasse in Australia : exploring industry feasibility through systems analysis, techno-economic assessment and pilot plant development

Overcoming many of the constraints to early stage investment in biofuels production from sugarcane bagasse in Australia requires an understanding of the complex technical, economic and systemic challenges associated with the transition of established sugar industry structures from single product agri-businesses to new diversified multi-product biorefineries. While positive investment decisions in new infrastructure requires technically feasible solutions and the attainment of project economic investment thresholds, many other systemic factors will influence the investment decision. These factors include the interrelationships between feedstock availability and energy use, competing product alternatives, technology acceptance and perceptions of project uncertainty and risk. This thesis explores the feasibility of a new cellulosic ethanol industry in Australia based on the large sugarcane fibre (bagasse) resource available. The research explores industry feasibility from multiple angles including the challenges of integrating ethanol production into an established sugarcane processing system, scoping the economic drivers and key variables relating to bioethanol projects and considering the impact of emerging technologies in improving industry feasibility. The opportunities available from pilot scale technology demonstration are also addressed. Systems analysis techniques are used to explore the interrelationships between the existing sugarcane industry and the developing cellulosic biofuels industry. This analysis has resulted in the development of a conceptual framework for a bagassebased cellulosic ethanol industry in Australia and uses this framework to assess the uncertainty in key project factors and investment risk. The analysis showed that the fundamental issue affecting investment in a cellulosic ethanol industry from sugarcane in Australia is the uncertainty in the future price of ethanol and government support that reduces the risks associated with early stage investment is likely to be necessary to promote commercialisation of this novel technology. Comprehensive techno-economic models have been developed and used to assess the potential quantum of ethanol production from sugarcane in Australia, to assess the feasibility of a soda-based biorefinery at the Racecourse Sugar Mill in Mackay, Queensland and to assess the feasibility of reducing the cost of production of fermentable sugars from the in-planta expression of cellulases in sugarcane in Australia. These assessments show that ethanol from sugarcane in Australia has the potential to make a significant contribution to reducing Australia’s transportation fuel requirements from fossil fuels and that economically viable projects exist depending upon assumptions relating to product price, ethanol taxation arrangements and greenhouse gas emission reduction incentives. The conceptual design and development of a novel pilot scale cellulosic ethanol research and development facility is also reported in this thesis. The establishment of this facility enables the technical and economic feasibility of new technologies to be assessed in a multi-partner, collaborative environment. As a key outcome of this work, this study has delivered a facility that will enable novel cellulosic ethanol technologies to be assessed in a low investment risk environment, reducing the potential risks associated with early stage investment in commercial projects and hence promoting more rapid technology uptake. While the study has focussed on an exploration of the feasibility of a commercial cellulosic ethanol industry from sugarcane in Australia, many of the same key issues will be of relevance to other sugarcane industries throughout the world seeking diversification of revenue through the implementation of novel cellulosic ethanol technologies.

Control, performance management systems and identification processes

Is it possible to control identities using performance management systems (PMSs)? This paper explores the theoretical fusion of management accounting and identity studies, providing a synthesised view of control, PMSs and identification processes. It argues that the effective use of PMSs generates a range of obtrusive mechanistic and unobtrusive organic controls that mediate identification processes to achieve a high level of identity congruency between individuals and collectives—groups and organisations. This paper contends that mechanistic control of PMSs provides sensebreaking effects and also creates structural conditions for sensegiving in top-down identification processes. These processes encourage individuals to continue the bottom-up processes of sensemaking, enacting identity and constructing identity narratives. Over time, PMS activities and conversations periodically mediate several episode(s) of identification to connect past, current and future identities. To explore this relationship, the dual locus of control—collectives and individuals—is emphasised to explicate their interplay. This multidisciplinary approach contributes to explaining the multidirectional effects of PMSs in obtrusive as well as unobtrusive ways, in order to control the nature of collectives and individuals in organisations.

Participatory analysis of mobile diaries to inform the design of ridesharing systems

In many “user centred design” methods, participants are used as informants to provide data but they are not involved in further analysis of that data. This paper investigates a participatory analysis approach in order to identify the strengths and weaknesses of involving participants collaboratively in the requirements analysis process. Findings show that participants are able to use information that they themselves have provided to analyse requirements and to draw upon that analysis for design, producing insights and suggestions that might not have been available otherwise to the design team. The contribution of this paper is to demonstrate an example of a participatory analysis process.

Using performance management systems as identity products

This paper explores how the effective use of performance management systems (PMS) essentialises collective identities through the use of textual performances. The discursive effect of PMS operates to simplify members’ logic to allow them to understand and negotiate the complex nature of collective performance. Two case studies, drawing on a qualitative study of the implementation of PMS in two public sector organisations, point to the unique contribution of symbolic effects of one popular PMS, the balanced scorecard (BSC). Findings suggest that the BSC visualising the trajectory of achieving organisational vision through multiple perspectives, measures and linkages is a valuable identity product to achieve organisational success. The case studies also provide an analysis that contrasts aspects of the diffusion and promotion of collective identities through the use of the BSC. This demonstrates that clear direction in the identity management process is an important factor in the design and implementation of successful PMS programs. The value of this paper is to heighten recognition of the symbolic agency of PMS, as it serves as a subtle mechanism for identity management, and also to foster the collaboration of communication specialists and management accountants to achieve common organisational goals.

Revealing common attributes of organizational identities using performance measurement systems

Identity is unique, multiple and dynamic. This paper explores common attributes of organisational identities, and examines the role of performance management systems (PMSs) on revealing identity attributes. One of the influential PMSs, the balanced scorecard, is used to illustrate the arguments. A case study of a public-sector organisation suggests that PMSs now place a value on the intangible aspects of organisational life as well as the financial, periodically revealing distinctiveness, relativity, visibility, fluidity and manageability of public-sector identities that sustain their viability. This paper contributes to a multi-disciplinary approach and its practical application, demonstrating an alternative pathway to identity-making using PMSs.