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The Creation of Inter-Organizational IT Governance for Social Welfare and
Healthcare IT – Lessons from a Case
Tomi Dahlberg
Institute for Advanced Management Systems Research (IAMSR)
Åbo Akademi University, ICT House, Joukahainengatan 3-5A, FI-20520
Turku, Finland
and
Aalto University School of Business, Runeberginkatu 22-24, FI-00100, Helsinki Finland
E-mail: [email protected]
Abstract
Abstract. Social welfare and healthcare professionals consider their services fragmented, which impacts also IT
deployment. They also face the question, whether to cooperate with other organisations in IT. Needs to cooperate and to
organise cooperation have increased with the ever wider IT deployment. Governance of IT helps in this by defining the
responsibilities of cooperating organisations. Improved data sharing, pooling of developments and purchases are
among envisioned benefits. This article depicts the theoretical basis of inter-organizational IT governance arrangements
against the background of a case engaging over 100 organisations. The lessons of the case, including a survey involving
68 experts, suggest that perceived need to cooperate with concrete benefits and governance principles are necessary to
establish inter-organizational IT governance. The findings of this research augment the knowledge base of IT
governance with constructs taken from resource-based view (RBV), transaction cost economics (TCE) and social
network theories.
Keywords: Social Welfare IT, Healthcare IT, IT Governance, Inter-organizational IT Governance, Voluntary interorganizational IT Governance, Networked IT Governance, Resource Based View (RBV), Transaction Cost Economics
(TCE), Social Network Theory, Case Research
Reference to this paper should be made as follows: Dahlberg, T. (201X) ‘The creation of inter-organizational IT
governance for social welfare and healthcare IT – lessons from a case’, Int. J. Networking and Virtual Organisations,
Vol. 1x, No. x, pp.xxx–xxx.
Biographical notes: Tomi Dahlberg is a Professor of Information Systems (act) at the Abo Akademi University, Turku,
Finland. Prior to this he has been a Senior Research Fellow, Research Director, Visiting Professor and Professor of IS at
the universities of Turku, Jyväskylä and Aalto from 2000 to 2014. He worked in the positions of CEO, CIO and CTO in
software industry, banking, telecom operator and nanotechnology industries from 1984 to 2009 and after that has worked
as an executive consultant and mentor for his own company and as a board professional. He received his Ph.D. in
Information Systems Science (Econ.) from Aalto University Business School in 1991. His current research interests
focus on inter-organizational IT governance, governance of data, CIO profession and payment services, especially
mobile payments.
This paper is a revised and expanded version of a paper entitled ‘Perceived need to cooperate in the creation of interorganizational IT governance for social welfare and healthcare IT services – a case study’ presented at the Fifth WellBeing in the Information Society (WIS2014) Conference in Turku, Finland, 18–20 August 2014. That paper was
awarded the best paper nomination of WIS2014.
1. INTRODUCTION AND BACKGOUND
How to arrange and provide healthcare and social welfare services to citizens? How to deploy IT to
enable and support this? These questions are pondered in most countries of the world. Demographic
changes and constantly rising costs of healthcare and social welfare services motivate such
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considerations. Demographic changes alone with longer life expectancies and lower birth rates create
serious challenges to economies. Population aging is a global phenomenon whereas birth-rate decrease
is more typical for developed economies, such as the country of the study, Finland (OECD, 2014a).
The proportion of citizens over 65 years was 18.1% in 2012, which was the 7th highest among OECD
countries (OECD, 2014a). The OECD average was 15.1%. OECD estimates that by 2050 the
proportion of “silver economy” citizens will grow to 27.1% in Finland, and to 25,2% for the OECD
average (OECD, 2014b). The numbers of citizens with disabilities that need support, such as diabetes,
serious allergies or memory problems, have also increased in developed economies (Hovenga, 2013).
Wintley-Jensen (2013) listed critical challenges for the EU countries by 2025. The GDP proportion
of health and social care will increase with 4 - 8 %. The headcount of work force will shrink and the
dependency ratio (proportion of citizens not in the labour force) will drop from its previous 1:4
towards 1:2.
How do countries respond to such challenges? The concept of super-aged society describes
societies where the proportion of citizens over 65 years exceeds 25% [23]. This concept also describes
an approach that aims to turn challenges caused by demographic changes into opportunities for
economic growth. Similar ideas have been presented within EU (e.g. EU Summit, 2015). It is deemed
impossible to solve the challenges created by the growing demand of social welfare and healthcare
services by only providing more services. It is necessary to promote healthier life-styles, to encourage
citizens to monitor their wellbeing, and to increase preventive care and self-services. Moreover, we
should develop services, which make it possible to live safely at home even when a citizen is frail or
disabled. Tighter coopeation between social welfare and healthcare is called for to increase services’
impact (Obi et al. 2013, EU Summit, 2015]. Empowerments through active aging, new work
arrangements, and better inclusion in the society are also among the suggested solutions.
Each country with local organizations bears the service responsibility. Ideas presented above have
to be integrated into existing national service systems. Finland, similar to a few other countries, has
created a national strategy to renew the system of arranging and providing healthcare and social
welfare services. Two latest national governments have prioritized this reform among the key
objectives in their plan of action. To guide the reform the Ministry of Social Affairs and Health has
published documents such as “Social Welfare and Healthcare Service Strategy 2020”, “Increase
Purposeful Usage of Social Welfare and Healthcare Information” and “Support Project of Planning
and Documenting National Enterprise Architecture for Social Welfare and Healthcare Services”.
These documents state that it is necessary to transform care and institution centric services more into
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prevention and outside-institution services, and from professional into citizen centric care practices.
They also describe how basic healthcare, specialized medical care, and social welfare services have
been organized into separate service systems. Healthcare service systems are organized into three
levels from national to local, and the social welfare system into two. The approximately 320
municipalities of the country provide basic healthcare services. They have established 20 healthcare
districts to coordinate the arrangement of basic healthcare services. All healthcare districts provide
basic healthcare services, which compete with municipal service providers. Every healthcare district
belongs to one of the five special catchment areas organized around university hospitals, which
provide specialized medical care services. Municipalities represent the local level and national
organizations the country level in social welfare services. According to the mentioned documents
there are inefficiencies due to silos, fragmentation and overlapping activities. The reorganization of
the three service systems under one unified system with significantly tighter integration between
social welfare and healthcare services is the key feature of the reform. (Author’s note: the abovementioned documents are publicly available in local languages from the home page of the Ministry.
This reform and the case constitute only the background for this article. Due to these reasons these
documents have been discarded from References.)
How is IT and especially IT governance related to the above-described phenomena? IT is
considered as one of the key means to support healthcare and social welfare reforms in developed
economies (EU Summit, 2015). Similarly, the opportunities of the super-aged society are seen to arise
primarily from the deployment of IT (Obi et al., 2013). Furthermore, the above discussed need to
increase cooperation between social welfare and healthcare organizations requires the same from their
IT.
Governance of IT is one of the means to organize IT cooperation. The purpose of IT governance is
to establish structures, processes and cooperation mechanisms to govern IT processes (Van
Grembergen et al., 2004) and to agree IT decision-making rights (Weill and Ross, 2004). By doing so
IT governance attempts to secure value delivery from the deployment of IT, such as investments into
social security and healthcare information systems. Another purpose is to guide relevant stakeholders
to deploy IT responsibly (IT Governance Institute, 2003, ISO/IEC, 2008), for example, to develop and
operate IT from the perspective of providing better healthcare and social welfare services. IT
governance research has indeed revealed that well-organized governance improves both IT
performance and organizational performance. Improvements in IT services’ quality and IT budget
control are examples of better IT performance. Higher revenues with lower costs and improved returns
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on IT investments describe improved organizational performance (Weill and Ross, 2004, Brown and
Grant, 2005).
The empirical data of this article was collected in a project where an inter-organizational IT
governance arrangement was established for one of the above mentioned special catchment areas
during a 9-month period mainly in 2013. Geographically the case covers almost half of the country
with 68 municipalities and the same number of municipal social welfare and healthcare functions, 33
basic healthcare centres, and 5 healthcare districts with 9 hospitals including one university hospital.
The project group that accomplished this, included the chief medical officer of one healthcare district,
CIOs of three healthcare districts, the CIO of a major city, two enterprise architects, three specialist
from social welfare development centres, healthcare districts and National Institute for Health and
Welfare, one expert from another special catchment area, two senior advisors from the Ministry of
Social Affairs and Health and two senior advisors from the Association of Finnish Local and Regional
Authorities, and the researcher, 16 persons in total. A national enterprise architecture program steered
the project. The established IT governance arrangement organized for the first time systematic IT
cooperation between specialized medical care, basic healthcare and social welfare organizations in
this or other comparable areas of the country. Although there were strong pressures to increase interorganizational IT cooperation, the arrangement was voluntary since the Constitution of the country
guarantees autonomy with taxation right to each municipality.
Project group members described desires to deploy IT to purposes discussed above as “long-term
IT governance objectives”. They expressed also several “short-term IT governance objectives”. In line
with the current service systems and their (undocumented) “IT governance models”, each organisation
had developed and run its own IT. A large municipal organization (=city), which is major owner in
the nearest healthcare district, provided competing basic healthcare services with separate IT to those
of the healthcare district. Municipal healthcare and social welfare IT were not integrated and
cooperation between them had been almost non-existent. Most IT experts employed by participating
organizations knew each other and would have liked to cooperate. Due to the lack of organized IT
cooperation between and within special catchment areas, healthcare districts and even municipal
organizations, IT cooperation was limited to experience sharing and to cooperation in a few expert
services between near-by municipalities. Radiology and laboratory IT services were shared with adhoc IT governance arrangements between some municipalities.
This IT governance model was described to have several adverse consequences. Data is
fragmented to the extent that even organizations, which had purchased the same IS from the same IS
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vendor experience difficulties in digital data sharing. Organization and even sectors-specific instances,
data models as well as differences in data coding, entry and maintenance practices hamper further data
sharing. Similar modifications are made to each IS as bespoke maintenance and paid separately
instead of shared maintenance distributed to all organizations. The power of one organization is
limited in negotiations with IT service providers as compared to joint pooled purchases and
negotiation power. Without IT resource and asset sharing, possibilities to recruit highly skilled
specialists or to purchase expensive IT assets are limited due to financial, availability and other
constrains. (Author note: Issues and statements described above are documented into the documents
of the case such as the final report. That report is publicly available through the Association of Finnish
Local and Regional Authorities as a part of so called Akusti documentation. It has been discarded
from References for the same reasons as the other documents written in local languages.)
Against the above-depicted background this article investigates how the voluntary interorganizational IT governance arrangement was established and especially what this required from the
knowledge and theoretical background of IT governance. Research on how to design and implement
IT governance has been conducted mainly in single organizations (De Haes et al., 2013). They even
claim that the establishment of intra- and inter-organizational IT governance are similar. This article
challenges that claim in a complex IT governance environment. The environment is complex since
participating organizations are legally independent and run independent IT functions. Moreover, they
are different size public sector organizations where politicians participate into (IT) decision-making.
Finally, competition between organizations and past failures to establish inter-organizational IT
governance had caused trust issues.
This article contributes to previous research also by considering the role of perceived need to
cooperate with envisioned cooperation benefits during the establishment of inter-organizational IT
governance. The significance of perceived cooperation benefits are evaluated on individual and
organizational levels with a survey. The research idea is, that if participants perceive as individuals
that cooperation is beneficial to them and their organizations, that will influence positively the
creation of inter-organizational IT governance (Ajzen and Fishbein, 1980, Ajzen, 1991). These are
new constructs introduced to IT governance research. Extensions to the theoretical basis of IT
governance are sought from the constructs of resource-based view (RBV) (Barney, 1991, Wiengarten
et al., 2013), transaction cost economics (TCE) theory (Williamson, 1985) and social network theory
(Granovetter, 1985, Jones et al. 1997).
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In summary, this article aims to answer two related research questions: Does the establishment of
IT governance differ between inter-organizational and single organizational arrangements, and if so
are the governance constructs of RBV, TCE and social network theories useful enhancements to the
knowledge base of IT governance? Secondly, are perceived need to cooperate with cooperation
benefits useful constructs during the establishment of inter-organizational IT governance?
To answer these research questions, section 2 discusses IT governance, RBV, TCE and social
network theories. Section 3 covers methodological issues. The results of the case and answers to the
research questions are disclosed in section 4. Discussion on the findings ends this article.
2. THEORETICAL BACKGROUND
Governance of IT (Zmud, 1984), IT Governance (IT Governance Institute, 2003) and Corporate
Governance of IT (ISO/IEC, 2008) concepts emerged almost thirty years ago. IT governance is both a
strategic IT management practice and an academic research topic. Although IT governance has
become a widely adopted concept it has many definitions. This article follows the definitions of IT
Governance Institute (2003) and the ISO/IEC 38500 Corporate Governance of IT standards family
(ISO/IEC 2008; 2014a; 2014b). Governance of IT and IT governance are synonyms.
2.1. IT governance principles, practice and methods
IT governance practice is principles and methods based (ISO/IEC, 2008). The six IT governance
principles expressed in the ISO/IEC 38500 standard together with its reference model aim to guide
both IT governance practice and methods. IT deployment is looked at “from the outside”, that is, from
corporate governance perspective, as the need to secure that those who provide funds to IT receive
agreed benefits (2008). IT is considered as an integral part of an organization’s strategy as opposed to
something supportive to, separate from or below strategy. Similarly, IT deployment and management
are seen as elements in the execution of an organisations activities, for example the arrangement or
providing of social welfare and healthcare services.
IT governance and IT management are considered separate activities (Weill and Ross, 2004,
ISO/IEC, 2008). The ISO/IEC 38500:2008 standard specifies that the responsibility for IT governance
needs to be given to a governing body, for example, to chief social welfare and healthcare officers’
committees. The task of the governing body is to evaluate for what purposes should IT be deployed.
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They then need to direct IT management to plan and execute actions to achieve objectives specified
during the evaluation. Finally the governing body should monitor IT management to secure that the
objectives are achieved. This is called the evaluate-direct-monitor (EDM) process (ISO/IEC, 2008).
Correspondingly, the responsibility of IT management is to plan actions, to execute planned actions, to
compare the results of actions to plans and to act correctively if needed. This is called the plan-delivercheck-act (PDCA) process (Axelos, 2015).
Accountabilities for IT decisions and processes need to be clear, well communicated and shared
between “business” and IT. Due to business criticality of IT, accountabilities cannot be allocated to IT
professionals only (IT Governance Institute, 2003). Research findings show that key IT decisions and
processes could have different IT governance arrangements. For example, the accountabilities of
healthcare and social welfare IT architecture could differ from IS purchase decisions. Similarly
organizations with focus on growth, such as the development of new IT-enabled healthcare and social
welfare services, have different allocation of accountabilities than organizations with focus on cost
savings (Weill and Ross, 2004; 2005). When compared to the long tradition of centralized versus
decentralized IT decision-making (Zmud, 1984), these findings advocate for more varied IT
governance arrangements. The idea is to establish IT governance so that the arrangement fits to the
business needs of governed IT services, processes and decisions (Weill and Ross, 2004; 2005).
Several approaches to establish IT governance have been proposed (Brown and Grant, 2005).
Some emphasize IT governance structures and others processes (Dahlberg and Kivijärvi, 2006). The
matrixed approach to IT governance developed by academics (Weill and Ross, 2004) is probably the
best-known structural approach. Academics have also proposed process approaches [e.g. Dahlberg
and Kivijarvi, 2006]. Yet, most popular approaches are embedded into so-called best practice methods
[Axelos, 2015, ISACA, 2015, The Open Group, 2015) and the ISO/IEC 38500 standards (2008;
2014a; 2014b). Best practice methods include domains and processes, which define the scope of IT
governance and management. For example, the current version of COBIT (ISACA, 2015) has five
domains with 37 IT processes. Five are governance and the rest management processes.
Van Grembergen et al (2004) propose that cooperation mechanisms are necessary to establish
functioning IT governance in addition to structures and processes. Even with best possible structures,
such as IT decision making-rights allocation, and best possible processes, such as well executed EDM
cycle, individuals with different competencies, work histories and responsibility areas need to work
together. Cooperation mechanisms ensure that individuals participating into the governance of IT are
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able to agree objectives, to solve disputes and to organize work. Cooperation mechanisms may also
address questions such as what benefits can reasonably be expected from IT cooperation.
IT governance methods offer detailed advice on the establishment of IT governance arrangements.
The matrixed approach to designing IT governance (Weill and Ross, 2004; 2005) proposes that
decision-making rights should be agreed for five key IT decision areas. Weill and Ross list 22 specific
IT issues to accomplish this. They identified six IT governance archetypes (2004) and reduced them
later to five (2005). When the key IT decision-making areas and governance archetypes are mapped,
the result is the IT governance matrix. In practice, governance archetypes are replaced with actual
organizational (decision-making) bodies. Within the examined case, public sector healthcare and
social welfare bodies include municipal, healthcare district and other councils and boards as well as
departmental and IT committees within and between the participating organizations. As discussed the
matrixed approach to IT governance advocates for varied IT governance arrangements in the five IT
decision-making areas. This approach also suggests that the performance of IT governance
arrangements should be evaluated with four criteria: cost-efficient use of IT, financial returns on IT
investments, financial returns on assets, and effective use of IT for business flexibility (Weill and
Ross, 2004).
Since the matrixed approach focuses on decision-making structures it does not describe how IT
governance and management processes are linked, a necessity to establish IT cooperation within and
between organizations (Van Grembergen and De Haes, 2008). COBIT and other best practice
methods do that. COBIT (ISACA, 2015) describes in detail how IT governance and management
processes are linked on organizational and process levels. COBIT calls them the process for the
governance of enterprise IT and the process for the management of enterprise IT. COBIT describes
how 20+ typical business objectives are linked to 20+ IT objectives, which are then linked to 37 IT
processes and their performance metrics, called information criteria. Best practice methods have
comprehensive lists of IT processes. By compiling relevant IT processes from COBIT (ISACA,
2015), IT service management processes from ITIL (Axelos, 2015) and architectural work products
from TOGAF (The Open Group, 2015) it is possible to define the scope of an IT governance and
management arrangement with its composition of IT processes, services and architecture elements.
Such definitions are probably more practical definitions for the scope of IT governance and
management arrangements than the 22 characteristics of IT decision-making areas. Mentioned
methods have even compared their contents (ISACA, 2015). Best practice methods include rich sets
of detailed metrics to evaluate the performance of IT governance and management processes. COBIT
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divides them into the following information criteria: effectiveness, efficiency, integrity, reliability,
availability, confidentiality and compliance. Finally, best practice methods apply the RACI
(responsible, accountable, consulted, informed) role model to allocate IT governance and management
accountabilities to organizational bodies and persons within them for every IT process, service or
architecture element.
As a method, the ISO/IEC 38500:2008 Corporate Governance of Information Technology standard
(ISO/IEC, 2008) includes the EDM (evaluate–direct–monitor) process and the six principles for good
IT governance. The ISO/IEC DTS 38501:2014 is the implementation guide to establish IT governance
(ISO/IEC 2014a). The ISO/IEC TR 38502:2014 reference model (ISO/IEC, 2014b) depicts the
conceptual background of the EDM model and the IT governance principles. They constitute the basis
for the specifications of IT governance principles in real-world contexts.
2.2. RBV, TSE, social network theory and IT governance
As mentioned, the number of inter-organizational IT governance articles is smallish (De Haes et al.,
2013). Inter-organizational IT governance could still mean IT governance between multiple units
within an (international) corporation, such as in the article of De Haes et al (2013). IT governance is
perhaps similar between the single and multi-country units within a corporation. That approach,
however, is unable to provide answers to such questions as: Why should I, and my organization
participate to the establishment of an inter-organizational IT governance arrangement? What are the
measurable benefits of such arrangement? Is it possible to avoid the repeating of events that led into
past failures and created trust issues between organizations?
The reasons for selecting RBV, TCE and social network theory to augment the theoretical
background of IT governance were that they answer the question should an organization execute
activities internally or rely on cooperation, and that they complement each other. RBV (Weingarten et
al., 2013), TCE (Williamson, 1975; 1985) and social network theory (Jones et al., 1997) consider
single organization (vertical governance in TCE), markets (market governance in TCE), and alliances
and networks (hierarchical and relational governance in TCE) as the three forms of governance. In the
investigated case, inter-organizational IT governance is the chosen arrangement to govern and manage
IT with an alliance (relational governance) structure in order to provide better healthcare and social
welfare services to citizens. RBV addresses revenue and value increases (Weingarten et al., 2013) and
TCE cost reductions (Geyskens et al., 2006) as the outcomes of inter-organizational (IT) governance.
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Social network theory explains how cooperation should be executed within inter-organizational (IT)
governance, such as trust building, dispute mediation and structural gap filling (Jones et al., 1997)
RBV considers each organization unique (Barney, 1991, Weingarten et al., 2013. An organization
is equivalent to the broad set of tangible and intangible assets / resources it owns (semi-) permanently
(Das and Teng, 2000, Weingarten et al., 2013). These resources as a whole, and especially imperfectly
mobile, imitable and substitutable resources, with their use arrangements determine the value creation
potential of the organization. Strategic alliances are voluntary cooperative inter-organizational
agreements, which aim to produce competitive advantages for their partners (Das and Teng, 2000).
RBV proposes reliance on inter-organizational cooperation if that provides win-win value to the
participants by pooling, aggregating, sharing and exchanging their valuable unique resources, and if
such value cannot be achieve better with other arrangements. RBV research has discovered that
strategic alliances are more likely when organizations perceive themselves vulnerable (Das and Teng,
2000). Due to pressures to reform social welfare and healthcare systems, it is logical to reason that
such uncertainties increase willingness to cooperate due to the phenomenon “cooperate or become
cooperated”. RBV research has also discovered that lack of trust reduces willingness to cooperate
[Das and Teng, 2000, Park et al., 2004)]. Park et al. (2004) classify the positive outcomes discovered
in RBV research into seven categories: conserve resources, share risks, obtain information, access
complementary resources, reduce product development costs, improve technological capabilities, and
enhance reliability.
Williamson (1975; 1985) developed TCE introduced by Coase (1937). Coase used the governance
structure construct to describe markets and hierarchies and proposed that the choice between markets
(buy/cooperate) and hierarchies (make) is determined by differences in transaction costs rather than in
production costs (Geyskens et al., 2006). Williamson introduced asset specificity, uncertainty and
transaction frequency as the determinants by which firms (organizations) choose to make, buy or ally
while they execute transactions. When the TCE theory developed, two different forms of alliance
governance were introduced, hierarchical and relational governance. Hierarchical governance is
typical to supply chains, where one organization (usually a manufacturer) dominates others
(subcontractors) (Gereffi et al., 2005). The voluntary inter-organizational IT governance arrangement
investigated in this study is a relational hierarchy according to TCE. Geyskens et al. (2006, p. 525)
defined relational governance as “governance modes characterized by the parties to a transaction
jointly developing policies directed toward the achievement of certain goals”, such as better social
welfare and healthcare services. According to TCE, trust is the property of relational governance. It
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impacts both the creation of an alliance and its performance (Geyskens et al., 2006). Practical
implications are similar to RBV; lack of trust weakens the likelihood and benefits of cooperation.
Cumulatively TCE research has used dozens of operationalized measures to evaluate the benefits of
asset specificity, uncertainty and frequency. Geyskens et al. (2006) divided the performance benefits
of TCE into cost inclusive (e.g. level and growth of revenues and costs, abnormal returns on assets)
and cost exclusive impacts (e.g. level and growth of activities). Dyer and Singh (1998) used speed of
development and level and changes in quality - for example, improved availability and impact of
social welfare and healthcare services - as benefit measures.
Social network theory saw daylight in the 1970s. Researchers on labor market studies started to
investigate the social processes of job-hunting (Granovetter, 1973). Granovetter (1985) expanded this
research to “macro-level” structures by studying the social embeddedness of institutions. During the
last four decades social network theory has spread to many disciplines and studies are conducted from
single actor to country level (Gulati, 1999). Partnering and alliance analyses on the connections
between organizations are useful additions to IT governance knowledge, for example the work carried
out by Gulati (1999). Embeddedness of organizations is the key construct in social network theory.
Embeddedness impacts actions that organizations take as responses to market challenges and
developments. Organizations form and join networks for this reason. The longer and tighter the
relations between organizations, the more embedded they become (Zaheer et al., 2010). According to
them organizations in tight networks have been discovered to take different actions than un-networked
organizations. Social capital and structural holes are other social network theory constructs (Jones et
al., 1997, Zaheer et al., 2010). Social capital describes the value of connections between
organizations. Structural hole means the lack of straight connections between organizations. A third
party handles connections between organizations to fill a structural hole and benefits from doing that.
Social network governance applies social mechanisms - (=cooperation mechanisms) - to guide actions
and solve network problems. Jones et al. (1997) identified four social mechanisms: restrictions to
access the network, collective sanctions, use of social memory and cultural processes. Restricted
access and cultural processes are used to coordinate network operations. Collective sanctions and
social memory are used to safeguard network operations. Restricted access has a dual role as it also
safeguards network operations.
Cooperation benefits are conceptualized as collaboration antecedents. They are seen to differ at
personal, inter-unit (organizational units) and inter-organizational levels. Actor similarities,
personalities, proximity and organizational structure, and environmental factors are personal level
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antecedents. Interpersonal ties, functional ties and organizational processes, and control mechanisms
are inter-unit antecedents. Personal and inter-unit motives to collaborate are also inter-organizational
antecedents. Motives (new resources, uncertainty reduction, legitimacy, shared goals), learning about
an industry or networks, relational trust, common norms and monitoring, equality between partners
and contexts affecting participating organizations are other inter-organizational antecedents for
collaboration (Brass et al., 2004). Eisenhardt and Schoonhoven (1996) discovered that the
vulnerability of strategic positions and well-connected top management teams are additional
antecedents for collaboration. Networks transmit information to equalize common knowledge, share
innovations, resources and power between participants, and mediate disputes between organizations
and individuals.
3.
METHODOLOGY
The project described in Section one defined 7 IT governance principles and 13 IT governance
benefits while establishing the inter-organizational IT governance arrangement. Table 1 shows the
seven IT governance principles with their connections to the theoretical background discussed in
Section two. Appendix 1 shows the 13 IT governance benefit statement with their connections to RBV
and TCE theories.
A mix-method approach was used in to collect and analyse empirical data. Due to the role of the
researcher, reflective observation approach describes best, how the IT principles and IT cooperation
benefits statements were created. They reflect both the literature discussed in Section two and the
researchers interventions. The researcher wrote drafts for the principle and benefit statements and
helped project members to select them from larger sets of statements. Guidelines outlined for case
studies (Eisenhardt, 1989, Yin, 2009), and for the building of research constructs (Sireci, 1998) were
followed.
A web-based self-administrated survey was conducted to evaluate defined IT governance principle
and benefits statements. Survey design followed guidelines provided by (Yin, 2009) and was
influenced by (Ajzen and Fishbein, 1980) and (Ajzen, 1991). The survey had five background
questions about respondents and their organizations. In statistical analysis they were used as
independent (explaining) variables. The second category of variables consisted of 20 evaluative
questions about IT and its role in social welfare and healthcare (7 questions), about the status of IT
deployment within the respondent’s organization (10 questions), and about the accountabilities in the
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development of welfare and healthcare IT services (3 questions). In statistical data analysis these
responses were used as independent (explaining) control variables similar to background variables.
The third category of questions evaluated the benefits of IT governance (13 questions) and the
principles of the established IT governance arrangement (7 questions). In statistical data analysis
responses were treated as dependent (explained) variables.
Table 1. IT governance principles to be evaluated
PRINCIPLE
THEORETICAL BASIS USED AND/OR APPLIED
Matrixed
approach to IT
governance
Best practice
methods
(RACI, lists of
IT processes)
ISO/IEC
38500
standards
family (EDM
model,
principles)
Benefits of
alliances and
embeddedness Social Network
Theory
Benefits of interorganizational
governance Resource Based
View,
Transaction
Cost Economics
No
Yes
Yes
Yes
Yes
Lack of cooperation during early phase of
IT service development and operation is an
obstacle to IT cooperation (and needs to be
fixed)
Yes/no
No
Yes/no
Yes
Yes
Lack of cooperation during operation of IT
service development and operation is an
obstacle to IT cooperation (and needs to be
fixed)
Yes/no
No
Yes/no
Yes
Yes
Special Catchment area level IT
governance with local IT management is a
useful practical solution
Yes
Yes
Yes
Yes/no
Yes/no
Special Catchment Area level IT
governance development team is a useful
practical solution
Yes/no
No
Yes/no
Yes/no
Yes/no
The establishment of Special Catchment
Area level IT governance council is a useful
practical solution
Yes/no
No
Yes/no
Yes/no
Yes/no
Start small from selected IT services and
process on the basis of experience is a
useful practical solution
Yes/no
No
Yes/no
Yes/no
Yes/no
Description of the IT governance principle
Organization responsible for the
arrangement of social welfare and
healthcare is also responsible for the
arrangement of IT services
Each of the 40 (=20+13+7) questions was expressed as a positively formulated statement on a 7point Likert scale; from totally disagree (=-3) to totally agree (=+3). The scale was converted to 1–7
for statistical analysis to avoid zero values. In addition to evaluative questions also written comments
were collected but are omitted here.
13
During the reforms described in Section one, the Association of Finnish Local and Regional
Authorities had collected a list of 260 leading healthcare and social welfare experts in the country. An
invitation to participate into the survey was emailed to them as they were deemed to influence
decisions on the establishment of comparable IT governance arrangements. Please, note that the
selection of the respondents is not a convenience sample compromising the results of the survey
although it does not follow random sampling. After one reminder 68 responses (26% response rate)
were received.
Respondents had the following characteristics:
• Slightly over half (37) were from the geographic area of the project.
• Eight respondents had participated into the establishment of the inter-organizational IT governance
arrangement.
• Slightly over half (53%) worked in healthcare districts, 37% in municipalities and 10 % in other
organizations.
• 66% were executives / managers and 34% experts.
• 43% were healthcare or social welfare executives / managers and 12% specialists. CIOs and IT
managers accounted for 23% and IT specialists for 22%.
• Healthcare and social welfare executives / managers had worked in those positions on average for
15.9 years (median 15 years), experts 12.7 years (median 10 years). Healthcare and social welfare
CIOs and IT managers had worked in those positions on average for 7.2 years (median 3.5 years)
and IT experts 8.8 years (7 years).
The expectation drawn from the theoretical background and from the project was that the
evaluations show high values on Likert scale for both IT governance benefits and principles. On the
other hand, no expectations were made regarding whether there would be differences in evaluations in
relation to background or control variables. Due to the limited number of responses, multivariate
statistical methods, including structured equation models were not used.
4. RESULTS
The first research question asked does the establishment of IT governance differ between intra- and
inter-organizational arrangements. The evidence of the case indicates that they do. During the first
months of the project, a matrix of 24 key IT processes and services with RACI roles and new
cooperation mechanisms was crafted. The intention was to do the same for enterprise architecture
14
elements. IT governance knowledge discussed in Section 2.1 was applied to do this. That proved
insufficient. One of the CIOs coined the problem “Although I understand the governance matrix with
RACI roles that we crafted in the previous workshops, it is totally useless in my organization. Doctors
do not understand from the matrix the benefits of IT cooperation. They ask me, why should we waste
time on considering inter-organizational IT governance when we have so many burning IT issues of
our own.”
Workshops were rescheduled to define IT governance benefits and to redefine IT governance
principles so that even they describe IT governance benefits. The draft of the IT governance
arrangement was presented in the area with a road show. The question of one medical chief officer
characterizes best feedback received: “When am I able to get easily all patient data from all relevant
data registers so that data is consistent and reliable?” The number of benefit statements was
increased. Modifications made to the IT governance principles and benefit statements by using
constructs taken from RBV, TCE and social network theories were decisive for the acceptance of the
established inter-organizational IT governance arrangement. This also answers the two research
questions of the article.
The statistical analysis of survey data provides detailed support to these answers. Figure 1
illustrates the distribution of responses to 9 benefit statements and Table 2 shows the statistical means
and medians of all 13 statements. Means and medians were high, as expected. The means of the
responses were then analysed with t-test. There were no systematic statistically significant differences
between groups formed on the basis of the 5 background variables and between the agree/disagree
groups created by dividing the responses to the 20 evaluative control variables into two groups for
each variable separately. All in all there were 26 statistically significant differences among the 325 ttests, see Appendix 2 for details. As a whole, respondents thus evaluated the 13 IT benefit statements
similarly despite of differences in profession, type of organization, organizational position, ITexpertise and geographical area.
Although there were no systematic differences, the following differences need to be mentioned:
•
When respondents evaluated that: IT is able to provide equal social welfare and healthcare
services; is important for these services currently; is important for the development of these services,
they also evaluated several of the benefit statements more positively, such as ability to avoid
overlapping development, to create enterprise architecture, to participate to national level development
and to ensure the availability of services everywhere.
15
•
When respondents evaluated that the role IT is considered too important and that as little
funds as possible should be used into IT, they also evaluated some of the benefit statements more
negatively. These included the availability of equal services everywhere, implementation of national
level services, and efficient and effective use of IT resources.
Special$Catchment$AreaIlevel$wellIorganized$IT$
cooperaHon$is$needed$in$order$to$...$
Avoid$the$development$of$overlapping$and$difficult$to$
integrate$IT$services$for$social$welfare$and$healthcare$
10%$
87%$
Be$able$to$increase$the$interoperability$of$paHent/
customer$informaHon$systems$and$data$storages$
9%$
87%$
Be$able$to$create$enterprise$architecture$for$social$
welfare$and$healthcare$service$IT$and$its$development$
13%$
79%$
To$source$costIefficiently$and$effecHvely$IT$services$to$
social$welfare$and$healthcare$IT$services$
18%$
75%$
To$implement$efficiently$and$effecHvely$naHonal$level$
social$welfare$and$healthcare$IT$services$$
16%$
75%$
Ensure$the$ability$to$parHcipate$to$the$naHonal$level$
development$of$social$welfare$and$healthcare$services$$
12%$
72%$
Use$social$welfare$and$healthcare$IT$resources$
efficiently$and$effecHvely$in$their$development$and$
16%$
71%$
Ensure$access$to$special$competencies$social$welfare$
and$healthcare$everywhere$in$the$area$
18%$
69%$
Ensure$the$availability$of$equal$social$welfare$and$
services$everywhere$in$the$area$
16%$
0%$
diasagree$
Do$not$know$
20%$
68%$
40%$
Agree$to$some$extent$
60%$
80%$
100%$
Agree$strongly$
Figure 1. Evaluations on the benefits of IT cooperation in social welfare and healthcare on special
catchment area level (n=68)
Figure 2 illustrates the means and medians of the evaluations on each IT governance principle
statement. The means of the responses analysed with t-test did not have any systematic statistically
significant differences between groups formed on the basis of the 5 background variables and between
the agree/disagree groups created by dividing the responses to the 20 evaluative control variables into
these groups. All in all there were 6 statistically significant differences among 175 t-tests. The
16
respondents evaluated IT governance principle statements similarly despite of differences in
profession, type of organization, organizational position, IT-expertise and geographical areas. Their
evaluations were also similar despite of differences in their attitudes to the use of IT, perceptions over
the deployment of IT in their organization and beliefs about who should be accountable for social
welfare and healthcare IT. The results of the t-test are shown in appendix 3.
•
Table 2. Means and median on the evaluations on the benefits of IT governance in social welfare
and healthcare on special catchment area level (n=68)
Survey Item
Avoid the development of overlapping and difficult to integrate
IT services for social welfare and healthcare
Increase the interoperability of patient/customer information
systems and data storages
Create enterprise architecture for social welfare and healthcare
service IT and its developmen
Source cost-efficiently and effectively IT services to social
welfare and healthcare IT services
Implement efficiently and effectively national level social
welfare and healthcare IT services
Ensure the ability to participate to the national level development
of social welfare and healthcare services
Use social welfare and healthcare IT resources efficiently and
effectively in their development and operations
Ensure access to special competencies social welfare and
healthcare everywhere in the area
Ensure the availability of equal social welfare and services
everywhere in the area
Enforce tighter cooperation on national level for social welfare
and healthcare data
Enforce tighter cooperation on local (special catchment area)
level for social welfare and healthcare data
Create jointly agreed data models with stick to these models
Enforce tighter cooperation between social welfare and
healthcare to secure data interoperability
Mean
Median
Proportion of strongly agree
6.4
7.0
86.8%
6.3
6.5
86.8%
6.1
6.0
79.4%
6.0
6.0
75.0%
6.0
6.0
75.0%
5.8
6.0
72.1%
5.7
6.0
70.6%
5.8
6.0
69.1%
5.7
6.0
67.6%
6.4
7.0
89.7%
6.3
6.3
6.5
7.0
85.3%
85.3%
6.3
7.0
79.4%
This research is subject to some limitations. The case covers one special catchment area in one
country and one industry. Different results might be obtained in other environments. The researcher
acted as a consultant in the case. Although there are no reasons to interpret the empirical material
from some predetermined perspective that might still have happened. Finally, changing legislation
together with the strong objective of the Finnish Government and other national level authorities to
integrate social welfare and healthcare services under one service system may have created strong
incentives for cooperation. They could then explain the findings of this research.
17
5. DISCUSSION AND CONCLUSIONS
This article has shown that reliance on traditional IT governance knowledge alone may not be
sufficient to establish inter-organizational IT governance arrangements for networked social welfare
and healthcare IT. Experiences of the investigated case suggest that concrete principles and envisioned
benefits of IT-governance could be critical for the establishment of this type of inter-organizational IT
governance. Additional studies are necessary to determine the generalizability of these findings.
Means and Median of Evaluations on the
Principles of the Governance Arrangement (Scale: 1
= totally disagree, 7 = totally agree)
Organization responsible for the arrangement of
social welfare and healthcare is also responsible for
the arrangement of IT services
6.0
5.9
Lack of cooperation during the early phase of IT
service development and operation is an obstacle to
IT cooperation
5.0
5.1
Lack of cooperation during the operation phases of
IT service development and operation is an obstacle
to IT cooperation
6.0
5.4
Catchment Area level IT governance with local IT
management is a useful practical solution
5.2
Catchment Area level IT governance development
team is a useful practical solution
5.2
6.0
6.0
Catchment Area level IT governance counsil is a
useful practical solution
6.0
5.5
Start small from selected IT services and proceed on
the basis of experience as a useful practical solution
6.0
5.7
1.0
Median
2.0
3.0
4.0
5.0
6.0
7.0
Mean
Figure 2. Evaluations of statements on the principles of the created inter-organizational IT
governance arrangement on special catchment area level (n=68)
This research linked the constructs of resource-based view, transaction cost economics theory and
social networks theory to IT governance knowledge in two ways. Their constructs were used to depict
various (IT) governance forms from single organization to voluntary networks, such as the
18
investigated case. Secondly, these constructs were used to define concrete level benefits and
governance principles together with established IT governance knowledge
This research offers new venues for future research. It could be possible to compare the theoretical
basis of IT governance between the various forms of IT governance. Other questions that future
research could then address include: How common are inter-organizational IT-governance
arrangements similar to this case? Are they typical only for IT cooperation between public sector
organisations or could they also be descriptive for networked IT-enabled services and electronic
markets.
This article started by considering driving forces for the reform of social welfare and healthcare
service systems. By looking at the benefits and principles of the established IT governance
arrangements one detects that “long-term IT governance objectives” are rare among the benefit
statements as compared to “short-term objectives”. Long-term objectives were presented similar to
short-term objectives to the members of the project group but did not rank high. How to balance longterm and short-term objectives, is something that national level experts may need to consider. This
could also be one of the reasons, why the reforms of entire service systems have been slow and
troubled. It could be difficult to proceed with long-term objectives if the actual reality is very far from
such objectives. This is another possible venue for future research.
My advice to practitioners is to consider IT cooperation benefits and trust between individuals and
organizations, when networked inter-organizational IT governance arrangements are crafted. Similar
to some other studies this research suggests that key IT decisions, services and processes can have
different IT governance and management arrangements.
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Appendix 1
Appendix 2
Appendix 3
Appendixes 1 – 3 are provided as an attached file
22
APPENDIX 1 – IT Governance benefit statements
Benefits of cooperation from inter-organizational IT governance arrangement
Construct SURVEY ITEM
Construct / measure in RBV Construct / measure in TCE
Inter-organizational well-organized cooperation in
healthcare and social welfare IT is needed in order to
…
Avoid the development of overlapping and difficult to
integrate IT services for social welfare and healthcare
Increase the interoperability of patient/customer
information systems and data storages
Create enterprise architecture for social welfare and
healthcare service IT and its developmen
Source cost-efficiently and effectively IT services to
social welfare and healthcare IT services
Implement efficiently and effectively national level social
welfare and healthcare IT services
Valuable, surplus, wasteful /
conserve resources, reduce costs
Substitute, mobile, property based /
obtain information, reliability
Substitute, knowledge based /
improve capabilities, reliability
Imitable, complementary / reduce
costs, access resources
Imitable, knowledge based / reduce
costs, complementary, capabilities
Asset specificity / scale technology
restructure technology, physical
Specifity, technology uncertainty /
need to know, information visibility
Technology & behavior uncertainty
/ integration, flexibility
Specificity, behavior uncertainty /
service, customer, seller
Specificity, technology uncertainty /
service, complexity, integration
Ensure the ability to participate to the national level
development of social welfare and healthcare services
Rare, property based / conserve
resources, obtain information
Specificity, technology uncertainty /
service, improvement, specification
Use social welfare and healthcare IT resources efficiently imitable, supplementary / conserve
and effectively in their development and operations
resources, reduce costs, risks
Volume & behavior uncertainty /
volumes, expectations
Specificity, volume, behavior uncert
Ensure access to special competencies social welfare and Rare, property&knowledge based /
/ confidency, predictable,
healthcare everywhere in the area
access and improve resources
asymmetry
Ensure the availability of equal social welfare and
Valuable, complementary / conserve Specificity, behavior uncertainty /
services everywhere in the area
& access resources
site, customer expectations
The development of patient / customer information
systems and data storages require ...
Enforce tighter cooperation on national level for social
Substitute, property / conserve
Technology & behavior uncertainty
welfare and healthcare data
resources, obtain information
/ improvements, capabilities
Volume & technology uncertainty /
Substitute, property / conserve
Enforce tighter cooperation on local (special catchment
volume predictability,
resources, reduce costs
area) level for social welfare and healthcare data
improvements
Create jointly agreed data models with stick to these
Imitable, knowledge / obtain
Technology & behavior uncertainty
models
information, reduce costs
/ information visibility, trust
Enforce tighter cooperation between social welfare and
Substitute, property / complementary Specificity, behavior uncertainty /
healthcare to secure data interoperability
resources
customer complexity, expectations
23
APPENDIX 2a – Means and medians of survey items
Behavioral control variables
Demographic and situational
control variables
Principles of the established IT governance
arrangement
Principles of the established IT governance
arrangement
Construct SURVEY ITEM
Inter-organizational well-organized cooperation in healthcare and social welfare IT is needed in
order to …
Avoid the development of overlapping and difficult to integrate IT services for social welfare and
healthcare
Increase the interoperability of patient/customer information systems and data storages
Create enterprise architecture for social welfare and healthcare service IT and its developmen
Source cost-efficiently and effectively IT services to social welfare and healthcare IT services
Implement efficiently and effectively national level social welfare and healthcare IT services
Ensure the ability to participate to the national level development of social welfare and healthcare services
Use social welfare and healthcare IT resources efficiently and effectively in their development and
operations
Ensure access to special competencies social welfare and healthcare everywhere in the area
Ensure the availability of equal social welfare and services everywhere in the area
The development of patient / customer information systems and data storages require ...
Enforce tighter cooperation on national level for social welfare and healthcare data
Enforce tighter cooperation on local (special catchment area) level for social welfare and healthcare data
Create jointly agreed data models with stick to these models
Enforce tighter cooperation between social welfare and healthcare to secure data interoperability
Evaluation of IT governance principles in the established inter-organizational IT governance
arrangement
Organization responsible for the arrangement of social welfare and healthcare is also responsible for the
arrangement of IT services
Lack of cooperation during early phase of IT service development and operation is an obstacle to IT
cooperation (and needs to be fixed)
Lack of cooperation during operation of IT service development and operation is an obstacle to IT
cooperation (and needs to be fixed)
The scope of inter-organizational governance of social welfare and healthcare needs to cover all IT
processes, tasks and decisions
Although IT is deployed in all social wellfare and healthcare services its role is different in each service.
Special Catchmen Area level IT goveernance is a useful practical solution
The proposed inter-organizational IT governance arrangement has to be implementable in steps
The proposed inter-organizational IT governance arrangement has to organization independent, that is,
adaptable to the ongoing changes in laws and other regulations
Type of organization (municipal, healthcare district)
Geographic area (the area of the research, other parts of the country)
Organizational status (H/S manager, H/S expert, IT manager, IT expert), where H/S = healthcare / social
welfare
Experience in years in social welfare / healthcare managerial positions
Experience in years in social welfare / healthcare expert positions
Experience in years in IT managerial positions
Experience in years in IT expert positions
Involvement in the establishment of the inter-organizational IT governance arrangement (=project group
member)
Perceived role of IT in social welfare and healthcare activities and services
IT plays a key role in securing the availability of equal social welfare and healthcare services everywhere in
the country
As a whole the role of IT is generally regarded as much too important for healthcare and social welfare
services
The development of social welfare and healthcare services relies on the deployment of IT
The production and delivery of social welfare and healthcare services relies on the deployment of IT
The objective of IT deployment has to be to produce and deliver as good social welfare and healthcare
services as possible
As few as possible funds should be used for healthcare and social welfare IT services
In future IT will be much more important to the development and operation of social welfare and healthcare
services
Perceived deployment of IT within the respondents organization
My organization is a highly competent deployer of IT for social welfare and healthcare services
The operational strategy of my organization secures good alignment between social welfare & healthcare
activities and IT
In my organization social welfare and healthcare processes establish a well-functioning whole with IT
infrastructure, applications and data/information
In my organization IT governance accountabilities as a whole are allocated clearly between social welfare
& healthcare and IT professionals
My organization has clear measurable objectives for the deployment of IT within social welfare and
healthcare services
We know well the impacts of IT on social welfare and healthcare activities on the basis of reliable metrics
We develop systematically IT competencies needed in the development and operations of social welfare
and healthcare activities
We develop systematically IT governance and management as well as IT-function leadership competencies
needed in the development and operations of social welfare and healthcare activities
We find it easy to recruit competent IT and IT function experts to our organization to respond to the needs
of social welfare and healthcare activities
My organization deploys IT so well to social welfare and healthcare activities that I would grade it as A or
A+ if educational grading from A to F would be used
Resondent's attitude on organizing the accountability for improved data interoperability
The responsibility for the increase in the interoperability of patient/customer registers and other social
welfare and healthcare registers lies with social welfare and healthcare professionals
The responsibility for the increase in the interoperability of patient/customer registers and other social
welfare and healthcare registers lies with IT professionals
The responsibility for the increase in the interoperability of patient/customer registers and other social
welfare and healthcare registers lies with IT service vendors
Mean
Median
6.4
6.3
6.1
6.0
6.0
5.8
7
6.5
6
6
6
6
5.7
5.8
5.7
6
6
6
6.4
6.3
6.3
6.3
7
6.5
7
7
5.9
6
5.1
6
5.1
5
5.4
6
5.2
6
5.5
6
5.7
6
15.9
12.7
7.2
8.8
15
10
3.5
7
6.0
6
3.1
2
5.3
5.0
6
5
6.3
7
2.3
2
6.2
7
4.5
5
4.5
5
4.2
5
4.3
5
3.4
3
3.1
3
4.0
4
4.0
4
3.4
3
3.1
3
5.2
3
5.5
6
4.1
5
24
APPENDIX 2b – statistical testing of IT governance benefits (1)
The Results of Statistical Testing with Student's t-test for equality of means: Responses (n=68) were divided into
two groups on the basis of demographic and attitudinal control variables. Table shows statisistical significance (P)
SURVEY ITEM USED IN TWO-TAILED t-TEST
COLUMNS: Original benefits of cooperation from the
established inter-organizational IT governance arrangement.
ROWS: Demographic background variables and attitudinal
control variables divided into attitude to the deployment of IT,
deployment of IT within respondent's organization, and
perception of where accountability should be
Type of organization: Respondents working in municipal
organizations versus respondents working in healthcare districts
Geographic area: Respondents working in OYS-ERVA area
versus respondents working in other areas of the country
Organizational status:Respondents working in manager,
director and executive positions versus respondents working in
expert positions
Organizational status: Social welfare & healthcare professionals
versus IT professionals
Involvement in the establishment of the inter-organizational IT
governance arrangement: Participants versus other respondents*
Perceived role of IT in social welfare and healthcare
activities and services**
IT plays a key role in securing the availability of equal social
welfare and healthcare services everywhere in the country
As a whole the role of IT is generally regarded as much too
important for healthcare and social welfare services
The development of social welfare and healthcare services
relies on the deployment of IT
The production and delivery of social welfare and healthcare
services relies on the deployment of IT
Behavioral control variables
The objective of IT deployment has to be to produce and deliver
as good social welfare and healthcare services as possible
As few as possible funds should be used for healthcare and
social welfare IT services
In future IT will be much more important to the development
and operation of social welfare and healthcare services
Perceived deployment of IT within the respondents
organization***
My organization is a highly competent deployer of IT for social
welfare and healthcare services
The operational strategy of my organization secures good
alignment between social welfare & healthcare activities and IT
In my organization social welfare and healthcare processes
establish a well-functioning whole with IT infrastructure,
applications and data/information
In my organization IT governance accountabilities as a whole
are allocated clearly between social welfare & healthcare and IT
professionals
My organization has clear measurable objectives for the
deployment of IT within social welfare and healthcare services
We know well the impacts of IT on social welfare and
healthcare activities on the basis of reliable metrics
We develop systematically IT competencies needed in the
development and operations of social welfare and healthcare
activities
We develop systematically IT governance and management as
well as IT-function leadership competencies needed in the
development and operations of social welfare and healthcare
activities
We find it easy to recruit competent IT and IT function experts
to our organization to respond to the needs of social welfare and
healthcare activities
My organization deploys IT so well to social welfare and
healthcare activities that I would grade it as A or A+ if
educational grading from A to F would be used
Resondent's attitude on organizing the accountability for
improved data interoperability***
The responsibility for the increase in the interoperability of
patient/customer registers and other social welfare and
healthcare registers lies with social welfare and healthcare
professionals
The responsibility for the increase in the interoperability of
patient/customer registers and other social welfare and
healthcare registers lies with IT professionals
The responsibility for the increase in the interoperability of
patient/customer registers and other social welfare and
healthcare registers lies with IT service vendors*
Comments and explanations:
Statistical significance is shown in bold letters with four digits
for statistically significant differences (P<.05) otherwise with
two digits.
Statistical significance is considered very high with P<.001,
high with P<.01 and modest with P<.05
Ensure the availability of
equal social welfare and
services everywhere in the
Ensure access to special
competencies social welfare
and healthcare everywhere
Use social welfare and
healthcare IT resources
efficiently and effectively in
their development and
Ensure the ability to
participate to the national
level development of social
welfare and healthcare
Implement efficiently and
effectively national level
social welfare and healthcare
Source cost-efficiently and
effectively IT services to
social welfare and healthcare
Create enterprise
architecture for social
welfare and healthcare
Increase the interoperability
of patient/customer
information systems and
Avoid the development of
overlapping and difficult to
integrate IT services for
social welfare and healthcare
Demographic and situational
control variables
Construct
0.77
0.82
0.12
0.50
0.15
0.36
0.51
0.28
0.09
0.29
0.62
0.38
0.98
0.99
0.98
0.53
0.63
0.93
0.0129
0.30
0.56
0.60
0.99
0.71
0.99
0.83
0.49
0.93
0.77
0.33
0.12
0.38
0.71
0.66
0.50
0.55
0.92
0.68
0.92
0.78
0.37
0.20
0.30
0.59
0.13
0.06
0.07
0.0031
0.06
0.0001
0.0081
0.0125
0.12
0.0017
0.80
0.26
0.55
0.67
0.0187
0.08
0.0158
0.08
0.0213
0.0414
0.48
0.14
0.0156
0.19
0.0448
0.06
0.09
0.0153
0.0103
0.10
0.39
0.0266
0.99
0.19
0.62
0.46
0.58
0.028
0.08
0.12
0.0431 0.0428
0.21
0.15
0.71
0.28
0.0089
0.0003
0.07
0.09
0.08
0.0351
0.0367
0.41
0.28
0.22
0.28
0.51
0.77
0.32
0.54
0.69
0.68
0.96
0.30
0.93
0.27
0.63
0.58
0.54
0.84
0.34
0.56
0.16
0.16
0.0232
0.34
0.15
0.37
0.14
0.64
0.95
0.66
0.49
0.07
0.7
0.34
0.94
0.38
0.22
0.70
0.44
0.13
0.24
0.61
0.56
0.74
0.90
0.64
0.31
0.80
0.79
0.33
0.99
0.92
0.58
0.85
0.24
0.25
0.88
0.23
0.68
0.17
0.32
0.23
0.67
0.41
0.31
0.19
0.59
0.76
0.36
0.39
0.29
0.16
0.50
0.69
0.22
0.23
0.99
0.38
0.37
0.18
0.36
0.57
0.99
0.97
0.56
1.00
0.99
0.37
0.43
0.94
0.35
0.22
0.93
0.68
0.46
0.51
0.81
0.71
0.35
0.77
0.43
0.29
0.21
0.58
0.64
0.11
0.29
0.43
0.35
0.53
0.78
0.96
0.64
0.97
0.21
0.30
0.34
0.72
0.19
0.31
0.90
0.56
0.43
0.87
0.92
0.56
0.0486 0.0245
Number of responses in one group lower than 10 (8 and 4). Test result not
* reliable
For this construct low values on 1-7 Likert scale from 1-5 are used to
form one one group and high values 6 and 7 to form the other group. The
** reverse is used for the statements, which claim that IT is considerted too
significant and that as little money as possible should be used. Low
values 1 and 2 form one group and values 3-7 the other group.
For these constructs low values on 1-7 Likert scale from 1-3 are used to
***
form one one group and high values 5-7 to form the other group.
25
APPENDIX 2c – statistical testing of IT governance benefits (2)
The Results of Statistical Testing with Student's t-test for equality of means: Responses (n=68) were
divided into two groups on the basis of demographic and attitudinal control variables. Table shown
statisistical significance (P)
Enforce tighter
cooperation between
social welfare and
healthcare to secure
data interoperability
Statistical significance is shown in bold letters with four digits for
statistically significant differences (P<.05) otherwise with two digits.
Statistical significance is considered very high with P<.001, high with P<.01
and modest with P<.05
Create jointly agreed
data models with stick
to these models
COLUMNS: Benefits resulting from increased interoperability of social
welfare and healthcare data expressed in action statements from the
established inter-organizational IT governance arrangement.
ROWS: Demographic background variables and attitudinal control variables
divided into attitude to the deployment of IT, deployment of IT within
respondent's organization, and perception of where accountability should be
Type of organization: Respondents working in municipal organizations
versus respondents working in healthcare districts
Geographic area: Respondents working in OYS-ERVA area versus
respondents working in other areas of the country
Organizational status:Respondents working in manager, director and
executive positions versus respondents working in expert positions
Organizational status: Social welfare & healthcare professionals versus IT
professionals
Involvement in the establishment of the inter-organizational IT governance
arrangement: Participants versus other respondents*
Perceived role of IT in social welfare and healthcare activities and
services**
IT plays a key role in securing the availability of equal social welfare and
healthcare services everywhere in the country
As a whole the role of IT is generally regarded as much too important for
healthcare and social welfare services
The development of social welfare and healthcare services relies on the
deployment of IT
The production and delivery of social welfare and healthcare services relies
on the deployment of IT
The objective of IT deployment has to be to produce and deliver as good
social welfare and healthcare services as possible
As few as possible funds should be used for healthcare and social welfare IT
services
In future IT will be much more important to the development and operation
of social welfare and healthcare services
Perceived deployment of IT within the respondents organization***
My organization is a highly competent deployer of IT for social welfare and
healthcare services
The operational strategy of my organization secures good alignment between
social welfare & healthcare activities and IT
In my organization social welfare and healthcare processes establish a wellfunctioning whole with IT infrastructure, applications and data/information
In my organization IT governance accountabilities as a whole are allocated
clearly between social welfare & healthcare and IT professionals
My organization has clear measurable objectives for the deployment of IT
within social welfare and healthcare services
We know well the impacts of IT on social welfare and healthcare activities on
the basis of reliable metrics
We develop systematically IT competencies needed in the development and
operations of social welfare and healthcare activities
We develop systematically IT governance and management as well as ITfunction leadership competencies needed in the development and operations
of social welfare and healthcare activities
We find it easy to recruit competent IT and IT function experts to our
organization to respond to the needs of social welfare and healthcare
activities
My organization deploys IT so well to social welfare and healthcare activities
that I would grade it as A or A+ if educational grading from A to F would be
used
Resondent's attitude on organizing the accountability for improved data
interoperability***
The responsibility for the increase in the interoperability of patient/customer
registers and other social welfare and healthcare registers lies with social
welfare and healthcare professionals
The responsibility for the increase in the interoperability of patient/customer
registers and other social welfare and healthcare registers lies with IT
professionals
The responsibility for the increase in the interoperability of patient/customer
registers and other social welfare and healthcare registers lies with IT service
vendors*
Comments and explanations:
Enforce tighter
cooperation on local
(special catchment area)
level for social welfare
and healthcare data
Behavioral control variables
SURVEY ITEM USED IN TWO-TAILED t-TEST
Enforce tighter
cooperation on national
level for social welfare
and healthcare data
Demographic and situational
control variables
Construct
0.96
0.96
0.47
0.08
0.99
0.60
0.44
0.68
0.98
0.84
0.33
0.82
0.63
0.20
0.79
0.88
0.83
0.70
0.75
0.78
0.25
0.0029
0.07
0.0032
0.57
0.28
0.61
0.0273
0.73
0.24
0.25
0.34
0.36
0.61
0.59
0.63
0.28
0.46
0.87
0.75
0.91
0.09
0.0318
0.0253
0.07
0.0319
0.14
0.23
0.13
0.83
0.53
0.95
0.34
0.0198
0.93
0.46
0.54
0.11
0.76
0.09
0.68
0.83
0.56
0.69
0.49
0.17
0.85
0.76
0.09
0.57
0.31
0.08
0.29
0.67
0.97
0.75
0.0359
0.76
0.42
0.30
0.12
0.18
0.79
0.33
0.97
0.53
0.57
0.41
0.17
0.23
,94
0.84
0.39
0.25
0.76
0.80
0.53
0.40
0.63
0.27
* As in previous table
** As in previous table
*** As in previous table
26
APPENDIX 3 – statistical testing of IT governance principles
The Results of Statistical Testing with Student's t-test for equality of means: Responses (n=68) were divided into two groups on the basis of
demographic and attitudinal control variables. Table shows statisistical significance (P)
The proposed interorganizational IT governance
arrangement has to
organization independent, that
is, adaptable to the ongoing
changes in laws and other
regulations
Behavioral control variables
The proposed interorganizational IT governance
arrangement has to be
implementable in steps
Although IT is deployed in all
social wellfare and healthcare
services its role is different in
each service. Special Catchmen
Area level IT goveernance is a
useful practical solution
The scope of interorganizational governance of
social welfare and healthcare
needs to cover all IT processes,
tasks and decisions
Statistical significance is shown in bold letters with four
digits for statistically significant differences (P<.05)
otherwise with two digits.
Statistical significance is considered very high with P<.001,
high with P<.01 and modest with P<.05
Lack of cooperation during
operation of IT service
development and operation is
an obstacle to IT cooperation
(and needs to be fixed)
Comments and explanations:
Lack of cooperation during
early phase of IT service
development and operation is
an obstacle to IT cooperation
(and needs to be fixed)
COLUMNS: IT governance principles defined on the basis
of IT governance knowledge and operationalized to the
context of the case in order to establish the interorganizational IT governance arrangement.
ROWS: Demographic background variables and attitudinal
control variables divided into attitude to the deployment of
IT, deployment of IT within respondent's organization, and
perception of where accountability should be
Type of organization: Respondents working in municipal
organizations versus respondents working in healthcare
districts
Geographic area: Respondents working in OYS-ERVA area
versus respondents working in other areas of the country
Organizational status:Respondents working in manager,
director and executive positions versus respondents working
in expert positions
Organizational status: Social welfare & healthcare
professionals versus IT professionals
Involvement in the establishment of the inter-organizational
IT governance arrangement: Participants versus other
respondents*
Perceived role of IT in social welfare and healthcare
activities and services**
IT plays a key role in securing the availability of equal
social welfare and healthcare services everywhere in the
country
As a whole the role of IT is generally regarded as much too
important for healthcare and social welfare services
The development of social welfare and healthcare services
relies on the deployment of IT
The production and delivery of social welfare and
healthcare services relies on the deployment of IT
The objective of IT deployment has to be to produce and
deliver as good social welfare and healthcare services as
possible
As few as possible funds should be used for healthcare and
social welfare IT services
In future IT will be much more important to the
development and operation of social welfare and healthcare
services
Perceived deployment of IT within the respondents
organization***
My organization is a highly competent deployer of IT for
social welfare and healthcare services
The operational strategy of my organization secures good
alignment between social welfare & healthcare activities
and IT
In my organization social welfare and healthcare processes
establish a well-functioning whole with IT infrastructure,
applications and data/information
In my organization IT governance accountabilities as a
whole are allocated clearly between social welfare &
healthcare and IT professionals
My organization has clear measurable objectives for the
deployment of IT within social welfare and healthcare
services
We know well the impacts of IT on social welfare and
healthcare activities on the basis of reliable metrics
We develop systematically IT competencies needed in the
development and operations of social welfare and healthcare
activities
We develop systematically IT governance and management
as well as IT-function leadership competencies needed in
the development and operations of social welfare and
healthcare activities
We find it easy to recruit competent IT and IT function
experts to our organization to respond to the needs of social
welfare and healthcare activities
My organization deploys IT so well to social welfare and
healthcare activities that I would grade it as A or A+ if
educational grading from A to F would be used
Resondent's attitude on organizing the accountability
for improved data interoperability***
The responsibility for the increase in the interoperability of
patient/customer registers and other social welfare and
healthcare registers lies with social welfare and healthcare
professionals
The responsibility for the increase in the interoperability of
patient/customer registers and other social welfare and
healthcare registers lies with IT professionals
The responsibility for the increase in the interoperability of
patient/customer registers and other social welfare and
healthcare registers lies with IT service vendors*
Organization responsible for
the arrangement of social
welfare and healthcare is also
responsible for the
arrangement of IT services
Demographic and situational control
variables
Construct SURVEY ITEM USED IN TWO-TAILED t-TEST
0.31
0.13
0.17
0.99
0.68
0.57
0.47
0.40
0.0481
0.09
0.08
0.37
0.20
0.92
0.61
0.67
0.38
0.47
0.78
0.97
0.79
0.51
0.18
0.37
0.73
0.70
0.38
0.61
0.35
0.99
0.90
0.06
0.0191
0.08
0.14
0.75
0.24
0.44
0.69
0.56
0.65
0.14
0.69
0.63
0.09
0.45
0.48
0.13
0.21
0.56
0.16
0.59
0.13
0.14
0.28
0.16
0.21
0.47
0.34
0.23
0.14
0.50
0.08
0.18
0.83
0.68
0.94
0.49
0.61
0.90
0.70
0.06
0.07
0.11
0.0029
0.0277
0.0000
0.43
0.88
0.79
0.79
0.99
0.85
0.49
0.86
0.30
0.79
0.65
0.85
0.41
0.49
0.99
0.58
0.55
0.60
0.30
0.49
0.46
0.72
0.62
0.84
0.62
0.19
0.21
0.14
0.39
0.17
0.11
0.47
0.59
0.46
0.87
0.98
0.78
0.29
0.0375
0.18
0.0339
0.34
0.73
0.62
0.13
0.25
0.43
0.45
0.63
0.08
0.68
0.59
0.33
0.77
0.54
0.97
0.08
0.61
0.75
0.22
0.63
0.77
0.48
0.91
0.85
0.60
0.63
0.85
0.68
0.87
0.57
0.87
0.82
0.85
0.49
0.59
0.60
0.32
0.06
0.20
0.97
0.34
0.87
0.55
0.0104
0.83
0.59
0.98
0.77
0.35
0.45
0.80
0.74
0.73
0.25
0.66
0.07
0.91
* Number of responses in one group lower than 10 (8 and 4). Test result not reliable
For this construct low values on 1-7 Likert scale from 1-5 are used to form one one group and high values 6
** and 7 to form the other group. The reverse is used for the statements, which claim that IT is considerted too
significant and that as little money as possible should be used. Low values 1 and 2 form one group and
values 3-7 the other group.
For these constructs low values on 1-7 Likert scale from 1-3 are used to form one one group and high values
***
5-7 to form the other group.