The Soft Information
Systems and Technologies Methodology (SISTeM©):
A Contingency Approach to Integrated Decision Making and Development
Chris Atkinson
Brunel University
UK
SISTeM’s Philosophical Underpinning
Beyond ‘Hard’ rationalism & ‘Soft’ interpretivism to:
‘Actor Network Theory
Integrated networks of humans and non-humans
Bruno Latour & Michelle Callon
SISTeM - Cycle 2
Overall Process
Migrating form Cycle 1
Modelling the change and the process of change
Deciding on the Change and the process of change
Realising the Change
SISTeM CYCLES 1 & 2
Tools and Techniques for both Cycles
Relevant Systems and
Schematics of Relevant Systems
‘A human/machine system to MANAGE individual Departmental, Speciality and Locality services, providing care to individual and groups of patients within the Trust's own, or in other settings.’
‘A clinical human/machine information system to enhance patient care in the community’
The Stages of the
Soft Systems Methodology
Hybrid Matrix Models
The Stages of the
Soft Systems Methodology
Conceptual and Expressive Models
SISTeM Tools and Techniques
Cycles 1& 2
THE RADIOTHERAPY PATIENT TREATMENT SLOT ALLOCATION
DECISION (CYCLE 1), ROOT DEFINTIONS, CATWOE ANALYSIS
Decision: Radiotherapy machine slot allocation process is required.
Original Issue
It is increasingly difficult to carry out the allocation of patients, their assessments and the degree of urgency for treatment to slots in radiotherapy machines as a result of an increase in the number of machines, teams and patients referred.
Relevant System: A patient treatment, to radiotherapy machine slot allocation system
Development Root Definition: Human/Machine Slot Allocation System
A slot management human/machine activity system owned by the clinical team and operated by slot manager and IS that apportions a patient, their referral and assessment to a (series) of slots within radio therapy machines (and their teams) in line with the treatment sets down by the consultant radiotherapist and oncologist clinical assessment and degree of urgency.
CATWOE Analysis
Customer(s): Radiotherapy Teams, Patients, Consultants,GPs, Radiotherapy machines Hospital and GP information systems
Actors: Slot Allocation Manager, Slot allocation Information System
Patient, GP
Transformation: Patient in need of radiotherapy treatment slot TO
Patients allocated to radiotherapy machine slots and team for treatment
Worldview: An efficient slot allocation, in line with assessment and degree of urgency is an important contributor to patient care and equity in machine/team resource allocation
Owner: Slot allocation manager - process, Director IS&T
Environment: Patients referred, Consultants, GPs, radiotherapy machines, teams
THE RADIOTHERAPY PATIENT TREATMENT SLOT ALLOCATION PROCESS INFORMATION MACHINE ACTIVITY
1. RECEIVE a referral of a patient, following a clinical assessment by an Oncologist and - from within PHT, peripheral clinic or other and Radiotherapy Consultants decision and treatment.
NOTIFY Radiotherapy of the referral of Patient X
OPEN Access to patient referral details and Radiotherapy Consultant's
decision on treatments.
2 REVIEW each referral and their clinical requirements in terms of - degree of urgency, type of treatment and number of treatment slots required, diagnosis, patient availability, need for further investigations
PROVIDE Patient personal details, name, address, DOB, sex, age, hospital number, NHS number, none availability dates for patient
PROVIDE Name of Oncologist, place, time of assessment,
PROVIDE Clinical assessment of each patient - diagnosis, site, stage, treatment pattern and dosage, urgency - radical, palliative, pre-op/other.
RATIFY Patient/consultant details with PMI
PROVIDE Details of test and investigations carried out, results, missing tests.
NOTIFY Oncologist of test result not received - ACCESS Test results, via OCS
PROVIDE Details of currant morbidity state of patient
ACCESS Patient records, relevant to currant episode of care.
PRESENT Contract allocation of patient and HRG
Machine Root Definition: Patient Radiotherapy Machine Slot Allocation Information System
A Radiotherapy Patient Treatment Slot Allocation Information System, operated by the slot allocation manager and owned by the Director of Information that enables the patient to be allocated to slot in the radiotherapy machines by:
Providing Information about the patient
Receiving notification of a referral
Presenting information about the test and investigations
Present details of diagnosis, site, fractions required, stage, urgency,
Provide accrual of referrals on a daily weekly basis
Create overview of machine slots over next year, and their allocated status
Capture degree of urgency and details of treatment pattern and type of machine suitable.
Schedule of machine availability - slots open/closed
Capture allocation of machine slots for the fractions required
Notify patient, GP (or other referee) of times and treatment and capture confirmation of intention to attend
Download slot allocations into radiotherapy machine, planner, simulator treatment
Accrue slots allocated on the matrix for the numbers of fractions prescribed along with patient details and when these have been undertaken
Process Simulation
Simulation Slot Allocation Human/machine Activity System
Human Capability Root Definition : Patient Radiotherapy Machine Slot Allocation Allocation Manager System
A Radiotherapy Patient Treatment Slot Allocation System, undertaken by the slot allocation manager and owned Clinical Team that enables the patient to be allocated to slot in the radiotherapy machines by:
Receive patient referral
Review each patient referral
Asses patient’s treatment needs - care and urgency
Know the current and future slot usage and availability against each machine and clinical team.
Allocate a patient to slots in the machines, reconciling individual patient treatments needs, the current ongoing patient cohort needs and machine and team availability
Ratify patient availability for slots allocated and adjust if required.
Input ratified patients and their slots into the treatment machines
Ensure treatment teams appreciate slot allocates and work load and are available
Manage slot allocation process, and improve its efficiency, efficacy and effectiveness
Human Psychosocial Root Definition: Patient Radiotherapy Machine Slot Allocation Allocation Manager System
A Radiotherapy Patient Treatment Slot Allocation System human cultural system
Empathise with each patient’s human, care and treatment needs
Appreciate the utility of the slot allocation information system and ensure its deployment
Appreciate professionally significance of clinical diagnosis and treatment by the consultants
Appreciate ramifications of the diagnosis for the patient
Appreciate the ramifications of each allocation for a patient and their family
Seek for the patient the most efficacious slot allocation and team utilisation
Seek the most effective and efficient utilisation of machine and radiotherapy team resources
Diligently enter slot allocations into the machine and notify teams appropriately
Keep radiotherapy teams ‘sweet’
Manage slot allocation process, and improve its efficiency, efficacy and effectiveness
SISTeM Underpinning Philosophical Framework
From Hard Rationalism and
Soft Interpretivism to:
Actor-Network Theory
The Actantial-Relational Epistemology of Latour and Callon
SISTeM and
Actor Network Theory
ANT within SISTeM in Practice:
SISTeM as a non-human actor translated into a problem-solving actor network (PSAN) and enacted by it.
SISTeM translates and mobilises other actors in the PSAN.
SISTeM models based on the human/machine actor network.
Outcome of SISTeM are interventions in or mobilisation of new organisational actor networks through incorporation.
SISTeM facilitates the traversing by the PSAN and wider organisational network of obligatory passage points.
The Soft
Information Systems and Technologies Methodology
SISTeM is a methodology that aims to address issues in areas of psychosocial, informational and technological concern by activating in the network of people and technologies involved an integrated action based learning cycle, which is ideally never-ending.
It will enable them to decide upon, envisage and realise the human/machine changes they have chosen to address their problem situation.
(Atkinson 1999 after Checkland 1981)