Wednesday, June 5, 2013

Transformation Framework for a Healthcare Enterprise - SDM Pulse, Summer 2013

Elizabeth Cilley Southerlan
The challenge: How to transform the Department of Defense (DoD) Military Psychological Health Enterprise (MPHE) at multiple levels of the organization into an enterprise that is capable of supporting the military’s quadruple aim of increasing readiness, reducing per capita cost, improving experience of care, and improving the health of the population. The enterprise architecting framework was chosen as the overall approach, but the specific target to which it would be applied was not determined.

The approach: Enterprise architecting offers eight “views” to use to assess the enterprise, develop an overall perspective, and foster a greater understanding of how the enterprise functions. These views are: strategy, organization, policy and external factors, information, infrastructure, knowledge, processes, and services/products (see Figure 1). This approach makes it possible to reduce the complexity of the enterprise as a whole.
Figure 1. Camp Lejeune MPHE X-Matrix.

The process: Working under the guidance and mentorship of Deborah Nightingale, Professor of the Practice at MIT’s Sociotechnical Systems Research Center, Elizabeth Cilley Southerlan, SDM ’12, decided to investigate the current state of a low-level MPHE component at Camp Lejeune, a US Marine Corps base camp in Jacksonville, NC. She then:

•    Applied holistic thinking to design, valuate, and select an optimal future state structure for an enterprise to realize its value proposition and desired behaviors;

•    Combined the results of the enterprise architecting analysis with multilevel analysis techniques to create a framework for transforming the larger, complex, multilevel MPHE;

•    Identified the dominant views of the Camp Lejeune component (organization, process, and information); the structure of the levels of the enterprise; and the interactions between the levels that could be used to understand the impact of decisions made at higher levels.

The SDM tools:
Southerlan used matrix-based techniques learned in her SDM classes (see Figures 2 and 3) to transform the information she gathered into objective data. She then combined this data with information on how levels of the DoD MPHE interact to suggest a framework for modeling potential future states of the enterprise.

The findings: The descriptive application of Southerlan’s suggested framework supported both the design and selection of a transformation plan for the overall enterprise. Nightingale and Southerlan believe that the insight gained from combining enterprise architecting tools with multilevel analysis techniques could be used to support the transformation of a complex, multilevel enterprise.

Southerlan then worked closely with research colleague Jaya Plmanabhan, SDM ‘11, to explore potential approaches that could be derived from her work to support an extension to the current enterprise architecting assessment technique.

The results:
In her thesis, Southerlan outlined the way in which the subjective information received during the as-is analysis was transformed into objective data. In her thesis investigation, the interactions between resources of the Camp Lejeune MPHE were quantified and analyzed to provide visibility to how changes made at higher levels of the complex, multilevel enterprise (the DoD MPHE) would impact the Camp Lejeune MPHE. While Southerlan used behavioral health (BH) resources and subsequent BH tasks as the quantifiable data in this application, she stated that there is potential to use different types of information as quantifiable data. For example, the metrics used by enterprises to measure performance could be considered objective data and could potentially be used to model impacts of changes made at different levels of a complex, multilevel enterprise. Southerlan recommended that when applying the framework outlined in her thesis, the dominant views of the enterprise—as determined during the enterprise architecting as-is analysis—should be used as reference to abstract objective data from the analysis. This will ensure that the data being used to model the as-is and potential future states of the enterprise have a strong presence throughout the enterprise.
Figure 2. Matrix of resources and tasks, organized by strategic group.

For a copy of Elizabeth Southerlan’s thesis, please contact SDM Industry Codirector Joan S. Rubin at

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