Organisational boundaries

Fields with low levels of disciplinary professionalism, weak formal and informal entry restrictions and loose organisational boundaries are often influenced by lay audiences (who become) an important source of recognition and they may also influence the general standards and directions of research (Fuchs, 1992 183)... 

Transferring R D output across organisational boundaries remains a problem, as there appears to be a cultural mismatch between R D and other functions within a... 

A typical HIT project might involve hundreds of different individuals each with their own responsibilities and areas of interest. Frequently the controls required to mitigate the clinical risk will need to be implemented by many different stakeholders often across organisational boundaries. Ensuring that each control is examined can be a complex task and the development of the safety case allows there to be a single point of truth for what needs to be done and by whom. 

CRM projects need to be carefully planned in Une with the development or implementation project. Timelines, dependencies and deliverables need to be agreed between stakeholders and especially across organisational boundaries. 

In many projects the conttols of most significance are those which traverse organisational boundaries. In other words where one party (often the software manufacturer) establishes that to mitigate the risk to acceptable levels another party (often the healthcare organisation) is reqnired to put in place certain measures. These external controls provide an ideal starling point for downstream stakeholders to begin to build their assurance strategy on top of the safety work done by the manufacturer. 

Key controls need to be emphasized particularly where they are required to be implemented across organisational boundaries. 

A need for new controls which require implementation across organisational boundaries... 

Eason, K., Dent, M., Waterson, P, Tutt, D., Hurd, P. andThomett, A. 2012. Getting the Benefit from Electronic Patient Information that Crosses Organisational Boundaries. Final Report NIHR Service Dehvery and Oiganisation programme. Available at http //wwn. nets.nihr.ac.uk/projects/hsdr/081803226 (last accessed on 23 April 2014). 

Safety arguments are also required to address data provision and its data supply chain. A dataset presented at the system boundary should be subject to verification. This dataset should be compliant with the specified integrity requirements. Establishing the system boundary also implies that this boundary should be coincident with an organisational boundary. The question of liability for data content errors is left as the subject of a future paper. 

Perhaps the most critical enabler, but the one most difficult to achieve, is a corporate culture and mindset that is open to change and is comfortable with frequent changes to processes and working practices. Also, because some of the enablers of structural flexibility - discussed below - involve much higher levels of collaborative working across organisational boundaries, there needs to be a willingness to actively create win-win partnerships across the supply chain. 

The supply chain can be seen in this diagram as a number of processes that extend across organisational boundaries. The focal firm is embedded within the chain, and its operational processes ( inside ) must coordinate with others that are part of the same chain. Materials flow from left (upstream, or buy side ) to right (downstream, or supply side ). If everything is as orderly as it seems, then only the end-customer (to the extreme right of the chain) is free to place orders when he or she likes after that, the system takes over. 

However attractive such processes of bonding may appear, in practice the organisational boundaries and vested interests inhibit the rate at which relationships deepen. These have been described as a series of factors as a result of research in the auto industry. 

In practice management of information flows across contractual or organisational boundaries can be problematic. It may be the case that shortfalls in the (demonstrated) safety of the system are related to such boundaries and interfaces. Consequently, it is desirable that management expUcitly consider this flow of information. It may also be the case that the flow of information down fiom the system level to the software is inadequate. In order to assess the potential for the software to contribute to system hazards, a degree of information is needed about the system context. In some cases, this may mean providing information to the supplier about the wider system in order to ensure that safety requirements are satisfied. 

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