High Performing Hospital Enterprise Architecture: Insights from a Multi-method Exploratory Case

The US healthcare system is a critical infrastructure grappling with as much as 16% of the GDP in its expenditures and unsatisfactory outcomes, and undergoing considerable public scrutiny. High ranking officials have both singled out the US healthcare system as the most expensive and among the least effective in the developed world. Hospitals hoping to find “The Toyota Way” so as to rid themselves of waste through lean and six sigma improvement initiatives, have mostly focused in applying tools at a process level, rather than adopting an enterprise perspective and understanding the full breadth of their socio-technical complexity. This paper adopts a systems thinking approach in describing a leading Boston hospital’s enterprise architecture through a multi-method exploratory case. The initial exploratory question proposed by hospital senior leadership was “How to speed patient flow in the Emergency Department?”, however as results became available, the scope was expanded to include the whole hospital enterprise. Both qualitative and quantitative data evidence were collected through a variety of methods, namely observation, archival records, documentation, and interviews. Analysis includes techniques consistent with the grounded theory approach, as well as more traditional quantitative data analysis. Hospital enterprise performance is hypothesized to be related to hospital enterprise architecture, and an alternative hospital enterprise architecture is proposed as well as future work.