A Case for an EA Approach

By | September 12, 2012

Here is my case for an EA Approach.  I was on a walk with my wife and our dog the other day and our conversation led to some of the problems we encounter at work.  My wife is a Registered Nurse at a large acute care hospital.  She has an amazing wealth of experience caring for very sick people.  She told me about a problem on her ward and how the implemented resolution failed to deliver the expected results.  This problem has nothing to do with information technology and everything to do with enterprise architecture (or in this case lack of EA).

Problem:

Washing hands is a mandatory safety practice for all medical professionals.  It is a very simple way to limit the spread of infection from patient to caregiver to patient.  The configuration of the nursing ward my wife worked on had the sinks at one end of a corridor of patient rooms.  Each time a nurse had to wash their hands, they had to walk the length of the corridor and then back to a patient’s room.  This was time consuming and inefficient for the nurses who are already run off their feet on every shift.

Solution:

The hospital installed sinks at multiple locations along the length of the corridor so that the travel time between hand washing and patient care was shortened.  The intended outcome was to improve efficiency for the nurses by having sinks close to where their patients are located.

Outcome:

Today, nurses have sinks close to where they care for their patients but the sinks require a supply of antibacterial soap and paper towels.  The new problem, from the nurses’ perspective, is that the soap and paper dispensers are not being filled in a timely manner because hospital management have not provided more time and/or resources to housekeeping staff to ensure the sinks are stocked.   The result is that nurses come to a sink to wash their hands and there is no soap and/or towels.  Nurses then need to find soap and towels and refill the sink supplies.  This means that highly trained nurses, who should be caring for patients, are now doing the work of the housekeeping staff causing delays in patient care.  Also the hospital has added a risk that hand washes are missed or not done thoroughly due to lack of supplies.  Failure to consider all factors of the original problem led to implementing a solution that did not resolve the problem of delayed patient care.

Add a Holistic View:

My wife’s story makes a case for taking an enterprise architecture approach to problem resolution and solution implementation.   The hospital recognized a problem and came up with a solution.  But, they failed to take an enterprise approach to understand the full implications of the problem and what the long term requirements for sustaining the optimal solution would be.  Adding an Enterprise Architecture step between Problem and Solution will always generate better outcomes.  Here is a simple approach that I use to help better understand a problem before coming up with a solution.  Clive Finklestein taught me this “Rapid EA Delivery” approach in the 2007:

  1. Start with the Zachman Framework  – using “What, How, Where, Who, When, Why” to understand the problem
  2. Make lists for each of “What, How, Where, Who, When, Why” related to the problem
  3. Create Matrices between the lists and note any relationships (What vs How, What vs Where, What vs Who, etc)
  4. Analyze the relationships noted in Step 3 to fully understand the problem
  5. Brainstorm solutions and then create lists for each solution which helps show if there are issues with the solution
  6. Select a solution to implement and ensure time is set aside to monitor the new implementation to ensure it is meeting expectations

In the nursing sink scenario, adding more sinks made sense.  What was missing was understanding the operational costs of keeping a larger number of sinks cleaned and supplied. If the matrix analysis approach had been used, this issue would have come up before any installation of new sinks and funding would have been allocated to the project.  I will post some sample matrices in a subsequent blog post to show you how simple and effective this technique is.

As always, I look forward to your comments and feedback.

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5 thoughts on “A Case for an EA Approach

  1. Rabih

    It’s weird you mentioned that right now. In a couple of days, you’ll be living in a place where they thought (at some point at least) that they can solve all the problems by having “more” of everything.

    I was shocked one time to know that one organization (not AUS btw 🙂 ) bought a million dollar (literally!) server for an Oracle database that can go on a server that is 10 times cheaper at least!!..

    Going back to “sinks”, I remember visiting a wealthy family some time ago with my much younger brother (around 12 at that time) and he couldn’t stop himself from commenting loudly on the fact that the visitors’ bathroom had 3 BIG sinks!.. Why would they have 3 big sinks? simply because they can! 🙂

    RT

    Reply
    1. Leo de Sousa Post author

      Rabih, thank you for your comments. In today’s economic conditions, I am sure that the instances of spending because you can will be severely reduced. Looking forward to joining you soon.

      Reply
  2. Mark

    A similar situation came to prominence in the UK a few years ago after several cases of “superbugs” (patient illness caused by not-clean-enough hospital wards and staff [and visitors!]) were highlighted in the national press. This wasn’t caused by a lack of sinks per se, but one related cause was identified as hand hygiene of everyone in hospitals – staff, patients and visitors alike. The solution didn’t involve more sinks (that would have been fairly expensive to implement throughout the UK) but to place hand sanitiser gel dispensers liberally throughout all the hospitals, especially next to doors in and out of wards, for the use of both medical staff and visitors. The nursing staff also often carry mini-dispensers with them to use as they walk around (and obviously still use existing sinks to wash their hands with water when appropriate). This (amongst other measures) helped to greatly reduce the incidents of superbugs. Obviously from an EA point of view, this creates new supply chain requirements, but it also means that expensive infrastructure changes were minimized. I think it’s a good example of a (relatively) simple solution devised by looking at the problem’s root cause directly, rather than using the current solution as a starting point.

    Reply
    1. Leo de Sousa Post author

      Thank you Mark for providing another great example. If we can tell these stories, perhaps Enterprise Architecture can be seen as a strategic practice instead of an IT initiative.

      Reply
  3. Emeric Nectoux

    Hi Leo,

    I won’t argue on the method described above… This is basic, so to say (no offense 😉 ). When reading your article, my first reaction was to react on the economical aspect of this situation. But finally, I will more focus on the decision making process that lead to this “un-efficient solution” that was put in place. This is, to me, revealing a crazy “old fashion management style”: “Houston, we have a problem, give me the solution. Now!” Shoot and forget.

    This is really where (on decision maker level) the change management has to operate. Of course, I am not saying that we should discuss, argue on “what to do” during a year period to solve the “sink issue”, but at least… take a step back, remove your head from the rabbit-hole and think. Maybe that the main idea would be not to approach the whole thing like a problem, but more like “what should we improve to avoid our patient to die from nosocomial infection”. A bit a more holistic approach indeed (I don’t want to be gross here). Unfortunately, until this conscious choice is not taken by decision maker, you (and I as EA) be seen as ineffiencient “pain-in-the-ass” people who are making the company loosing money by willing to think before acting.

    I might sound a bit pesimistic, but don’t get me wrong here, I am not. What is important in such case is first: to show that the thinking process won’t take much more time than the shoot and forget one. Second, show the business case. Then, back to the economical situation, check if we can afford such improvement.

    Cheers!
    /Emeric

    Reply

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