Introduction
Defining Framework Constructs
PACS Maturity Concepts
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Level 1: PACS infrastructure
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Level 2: PACS process
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Level 3: clinical process capability
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Level 4: integrated managed innovation
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Level 5: optimized enterprise PACS chain
Concepts on Business/IT Alignment
Multi-factorial PACS Performance
PISA Framework
Methods and Material
Framework Development Process
Pilot Sites
Number of beds | Yearly exams | Capacity of radiologist (FTE) | PACS vendor | Experience with PACS (years) | |
---|---|---|---|---|---|
Hospital A | 360 | 78,146 | 4.5 | Care-stream | 6 |
Hospital B | 900 | 200,000 | 12.5 | Agfa | 5.5 |
Results
Data and Measurement
Hospital A | Hospital B | All pilot respondents | |||||
---|---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Mean | SD |
M
| |
Organizational dimension 1: strategy and policy | |||||||
Maturity level 3 Q1 | 4.50 | 1.29 | 3.25 | 1.26 |
3.88
| 1.36 | 3.50 |
Maturity level 3 Q2 | 3.75 | 1.50 | 4.25 | 0.96 | 4.00 | 1.20 | 3.50 |
Maturity level 4 Q1 | 4.25 | 0.96 | 3.00 | 1.83 | 3.63 | 1.51 | 4.00 |
Maturity level 4 Q2 | 6.75 | 0.50 | 6.00 | 1.41 |
6.38
| 1.06 | 7.00 |
Maturity level 5 Q1 | 3.50 | 1.00 | 4.50 | 2.52 | 4.00 | 1.85 | 4.00 |
Maturity level 5 Q2 | 3.75 | 1.89 | 3.00 | 0.82 | 3.38 | 1.41 | 3.50 |
Organizational dimension 2: organization and processes | |||||||
Maturity level 3 Q1 | 4.50 | 2.38 | 3.50 | 1.73 | 4.00 | 2.00 | 4.50 |
Maturity level 3 Q2 | 2.00 | 0.82 | 1.25 | 0.50 |
1.63
| 0.74 | 1.50 |
Maturity level 4 Q1 | 1.50 | 0.58 | 3.75 | 0.50 | 2.63 | 1.30 | 2.50 |
Maturity level 4 Q2 | 5.25 | 1.50 | 5.50 | 0.58 |
5.38
| 1.06 | 5.50 |
Maturity level 5 Q1 | 1.25 | 0.50 | 1.00 | 0.00 | 1.13 | 0.35 | 1.00 |
Maturity level 5 Q2 | 4.75 | 1.71 | 4.50 | 1.73 |
4.63
| 1.60 | 5.00 |
Organizational dimension 3: monitoring and control | |||||||
Maturity level 3 Q1 | 4.00 | 0.82 | 3.75 | 1.71 | 3.88 | 1.25 | 4.00 |
Maturity level 3 Q2 | 3.50 | 1.00 | 3.25 | 0.96 | 3.38 | 0.92 | 4.00 |
Maturity level 4 Q1 | 4.67 | 1.15 | 2.25 | 1.26 | 3.29 | 1.70 | 4.00 |
Maturity level 4 Q2 | 2.75 | 1.50 | 3.75 | 1.26 | 3.25 | 1.39 | 4.00 |
Maturity level 5 Q1 | 4.75 | 0.96 | 3.25 | 2.22 | 4.00 | 1.77 | 4.00 |
Maturity level 5 Q2 | 3.75 | 1.26 | 4.00 | 1.83 | 3.88 | 1.46 | 4.00 |
Organizational dimension 4: information technology | |||||||
Maturity level 3 Q1 | 5.25 | 0.50 | 5.75 | 1.26 | 5.50 | 0.93 | 5.50 |
Maturity level 3 Q2 | 5.50 | 1.29 | 4.75 | 2.63 | 5.13 | 1.96 | 5.50 |
Maturity level 4 Q1 | 4.75 | 0.96 | 5.50 | 1.00 | 5.13 | 0.99 | 5.50 |
Maturity level 4 Q2 | 5.50 | 1.00 | 2.75 | 2.06 | 4.13 | 2.10 | 5.00 |
Maturity level 5 Q1 | 5.00 | 1.00 | 5.00 | 0.82 |
5.00
| 0.82 | 5.00 |
Maturity level 5 Q2 | 3.50 | 1.29 | 3.50 | 1.91 | 3.50 | 1.51 | 3.50 |
Organizational dimension 5: people and culture | |||||||
Maturity level 3 Q1 | 3.00 | 1.41 | 4.25 | 2.22 | 3.63 | 1.85 | 4.00 |
Maturity level 3 Q1 | 4.50 | 1.00 | 2.50 | 1.29 | 3.50 | 1.51 | 3.50 |
Maturity level 4 Q2 | 3.25 | 1.71 | 5.00 | 2.00 | 4.13 | 1.96 | 4.50 |
Maturity level 4 Q2 | 3.25 | 1.26 | 4.75 | 1.89 | 4.00 | 1.69 | 4.00 |
Maturity level 5 Q1 | 4.25 | 0.96 | 5.00 | 0.82 |
4.63
| 0.92 | 5.00 |
Maturity level 5 Q2 | 3.00 | 1.83 | 5.00 | 1.41 | 4.00 | 1.85 | 4.50 |
Hospital A | Hospital B | All pilot respondents | |||||||
---|---|---|---|---|---|---|---|---|---|
Mean | SD |
M
| Mean | SD |
M
| Mean | SD |
M
| |
Clinical contribution | |||||||||
C1 | 5.50 | 1.29 | 5.50 | 4.50 | 0.00 | 4.50 | 5.17 | 1.17 | 5.00 |
C2 | 6.25 | 0.50 | 6.00 | 7.00 | 0.00 | 7.00 |
6.63
|
0.52
| 7.00 |
C3 | 4.33 | 2.08 | 5.00 | 5.25 | 1.71 | 5.50 | 4.86 | 1.77 | 5.00 |
C4 | 5.33 | 0.58 | 5.00 | 6.50 | 0.00 | 6.50 | 5.80 | 0.84 | 6.00 |
Organizational efficiency | |||||||||
O1 | 4.75 | 0.96 | 4.50 | 5.00 | 0.00 | 5.00 | 4.86 | 0.69 | 5.00 |
O2 | 3.00 | 1.41 | 3.00 | 6.33 | 0.58 | 6.00 | 5.00 | 2.00 | 6.00 |
Service construct | |||||||||
S1 | 4.50 | 1.00 | 5.00 | 6.00 | 0.00 | 6.00 | 5.25 | 1.04 | 5.50 |
S2 | 5.25 | 0.50 | 5.00 | 2.25 | 0.96 | 2.50 | 3.75 | 1.75 | 4.00 |
S3 | 5.25 | 0.50 | 5.00 | 5.75 | 0.50 | 6.00 | 5.50 | 0.53 | 5.50 |
S4 | 6.00 | 0.00 | 6.00 | 5.75 | 0.50 | 6.00 | 5.86 | 0.38 | 6.00 |
Technical information system | |||||||||
T1 | 4.50 | 1.91 | 4.00 | 5.25 | 2.87 | 6.50 | 4.88 | 2.30 | 5.50 |
T2 | 5.50 | 1.29 | 5.50 | 6.50 | 0.58 | 6.50 | 6.00 | 1.07 | 6.00 |
T3 | 5.50 | 1.29 | 5.50 | 5.00 | 0.82 | 5.00 | 5.25 | 1.04 | 5.00 |
Instrument Refinement
Number | Dimension | Type of modification | Impact on model |
---|---|---|---|
1 | Strategy and policy | ML3Q1 was interchanged with ML4Q2 based on perceived complexity. In its new position ML4Q2 was reworded following recommendations of the respondents | Better fit of model and ordered complexity |
2 | Organization and processes | ML5Q2 was interchanged with ML3Q2 based on perceived complexity of the statement | Better fit of model and ordered complexity |
3 | Organization and processes | Statement ML4Q2 was reworded to fit the complexity of maturity level 4 based on comments of one of the respondents | Statement ML4Q2 better fits maturity level 4 and follows increased complexity |
4 | Information technology | Statement ML5Q1 was reworded to fit the complexity of maturity level 5 | Statement ML5Q1 better fits maturity level 4 and follows increased complexity |
5 | People and culture | Statement ML5Q1 was reworded to fit the complexity of maturity level 5 | Statement ML5Q1 better fits maturity level 5 and follows increased complexity |
6 | PACS performance | Answer categories of performance metric C2 (see “Appendix”) have been rescaled | Results in better distribution of scores |
Measuring PACS Maturity and Alignment
Hospital | S&P | O&P | M&C | IT | P&C |
α
|
β
|
---|---|---|---|---|---|---|---|
A (as-is) | 308 | 229 | 317 | 344 | 273 | 115 | 5.1 |
B (as-is) | 294 | 270 | 266 | 333 | 349 | 83 | 5.5 |
A (to-be) | 381 | 358 | 376 | 389 | 363 | 31 | – |
B (to-be) | 399 | 406 | 393 | 409 | 386 | 23 | – |
Our hospital has a clear local orientation towards operations with respect to PACS. Strategy and policy on a regional, cross-enterprise level is currently missing….
Application in Practice
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As a first step, assess the maturity, alignment, and performance state of the current deployed PACS (“as-is”) and also a “to-be” situation should be determined using the PACS maturity model—and survey—involving multiple stakeholders (e.g., radiologists, technologists and PACS administrator, etc.).
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A second step concerns performing a fit-gap analysis in determining if the current PACS maturity level is either a precursor for the to-be situation or the desired maturity level “leaps” over intermediary stages. Hence, at this stage, decision makers need to be decided whether the improvement roadmap follows an incremental improvement process (stages follow one another by definition), radical changes (i.e., introducing radical changes to processes and not following the logic of monotonous sequential development), or a hybrid combination of the two. This decision implies—in terms of strategic direction—if the hospital structure and PACS process focus and/or persist on a previously chosen paths by retaining current strategies and structures.
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In the third and final step, we suggest to set out all improvement activities and make deliberate investments that are required in order to achieve the desired level of PACS maturity and alignment. For this purpose, a set of measurements can be defined which are organized into projects that take into account the risks involved, investment costs, critical success factors, and benefits. In the course of the execution of all (hospital-wide) activities, the level of alignment between the five organizational dimensions should be monitored in managing similarities, overlap, and synergy between the improvement projects in order to realize strategic objectives and optimal deployment of PACS.