Developing an Information System in Hospital Emergency Departments
Anne De Vos, Claire Lobet-Maris,
Cellule Interfacultaire de Technology Assessment (CITA), University of Namur, 21, rue Grandgagnage, 5000 Namur,
Anne Rousseau
Centre d’Innovation par les Technologies de l’Innovatio (CITI), Centre de Recherche Public Henri Tudor, 29 Avenue JF
Kennedy , 1855 Luxembourg
Keywords: Information systems, organizational change, methodology, constructivist perspective
Abstract: In this article, we develop a method of Requirements Engineering (RE), based on the contributions of the
theories of the organizations. This method was developed within the framework of an IS project led in three
Hospital Emergency Departments (HEDs) in Belgium. The method intends to take into account as well the
functional aspects of the specifications as their political and cultural dimensions. The method that we
propose is built on three theoretical levels: the first is mechanical or functional and allows us to describe the
existing organizational structure; the second is relational or political and allows us to understand this
structure in action; finally, the third is cultural or symbolic system and opens to us with the values which
guide the actions in organization.
Empirical studies relating to the development of
Information Systems (IS) shows that the
Requirements Engineering (RE) is one of the most
critical phase of the development of an IS project
and its success (Boehm, 1991, Chaos, 1994-2001,
ESPITTI, 1996). Generally, one considers that RE
rests on two principal sources of information : the
description of the field of application of the project
and the requirements and expectations of the
different categories of actors, direct or indirect users
of the future system. On the basis of this
information, the conceivers draw up then the
specifications of the future system that is to say the
expected functionality's and behavior of the future
The quality of the specifications is thus directly
related to the quality of the information collected on
the application field and the requirements of the
future users. And the quality of this collect of
information depends on the theoretical model used
to understand the existing organization and the
requirements of the various actors. Very often, the
models stick to a functional and rational vision of
the organization, leaving on side the less rational
aspects of the human behavior in organization. The
importance of these less rational or functional
dimensions in RE appeared to us shouting within the
framework of an IS project developed in 3 HEDs
Initially, this project aimed at improving the
efficiency of the coordination of the care and the
management of flows of patients within these
services. Presented like such, the project seems very
mechanical directing the glance of the analysts
towards the workflow and the structures which
underlie the activity of these services.
But the things are never as simple. Very quickly
the first confrontations with the grounds of the
HEDs showed us how much the relatively intangible
and abstract elements such as the equity of treatment
of the patients, the quality of the care, the global
approach of the patient, the assumption of each
An inter-university project (UCL, FPTMS, ULg, FUNDP)
financed by the Walloon Region in Belgium (2000-2003).
De Vos A., Lobet-Maris C. and Rousseau A. (2005).
WHAT CAN ORGANIZATIONAL ANALYS GIVE TO REQUIREMENT ANALYS? - Developing an Information System in Hospital Emergency Departments.
In Proceedings of the Seventh International Conference on Enterprise Information Systems - DISI, pages 390-393
responsibility, the management of the stress, etc.
were dimensions important to take into account in
RE although the traditional methods of engineering
are not prepared to. To capture these more intangible
elements, it appeared necessary to enrich the
organizational visions which generally chair RE. It
is from this point of view that we worked out a
model based on three dimensions.
The central assumption on which our model rests is
that a relevant representation of organizational
reality concerns three dimensions.
The first dimension is purely mechanical or
rational. Resting on classic work, such those of
March and Simon (1958), Thompson (1967),
Galbraith (1973) and Mintzberg (1979), it considers
the organization under the angle of the structures
implemented to back the activity. From a pure
mechanical point of view, the structure aims to co-
ordination and puts back on two contradictory
orders, namely, on a side the differentiation which
consists in simplifying the activity and, on the other
the integration which aims to connect it. The
efficiency of a structure depends on balance to find
between these two orders. In RE, the approach by
the existing structures is our first entrance point.
This first approach does not say anything on the
way in which the actors make function these
structures. All occurs in the mechanical approach as
if the structures functioned all alone. However, the
operation of a structure of organization depends on
the behavior of the actors. It is them which, through
their actions, produce these structures and contribute
to transform them. But this “acting together” is far
from natural... It however puts in the presence of the
actors with various interests which must together
manage their interdependencies to make "turn" the
organization. This idea brings us to the second
dimension of our model, in which the analyst will
try to understand the way in which the actors grasp
the existing structure, operate with it and transform
it to regulate their necessary co-operation. (Crozier,
1963; Crozier, Friedberg, 1977; Friedberg 1988;
Friedberg 1993).
The third dimension intends to understand the
principles and the values on which the actors support
their actions and decisions in organization.
According to Boltanski and Thevenot (1999), the
problem of acting together in an organization is not
only a problem of co-operation between various and
personal interests but it is also a problem of
convention to define between various
representations of values and principles that should
guide the actions and decisions in organization. With
this third dimension, it is the loyalty of actors which
is questioned or the way they can find and define a
community of values, legitimate for each of them
and giving an acceptable meaning of their work.
In this section, we will present the research methods
that we use to describe the domain and to define the
requirement in HEDs. The initial system
requirements must allow patients to be tracked
continuously from first contact to the time they are
discharged, and also allow data to be shared among
several responders who may be miles from the
The methodology used has two main
characteristic features: first of all, it is multi-
disciplinary and combines concepts and techniques
from two disciplines, namely Organizational
Sciences and Software Requirements Engineering;
and secondly, it is participative and aims at strongly
involving the actors concerned about the
computerization of the organization.
To collect the relevant information for the RE,
we chose to follow the principles of qualitative
research based on case studies as defined by Yin
(1990) : because it places emphasis on the dynamics
at work in a fully contextualized perspective. This
focus is justified by the complexity of the HEDs
We proceeded to two periods of observation at
each site in order to better capture the structure and
the dynamics of action in the three HEDS. This first
range of information was completed by interviews
with relevant actors (nurses, doctors and
administrative staff) in each of the considered
Let us explain now the method followed to apply
our model to RE in the 3 HEDs.
3.1 The organizational context: the
co-ordination approach
The first dimension of the analysis aims to
understand the current state of the organization, in a
pure mechanical analysis.
System in Hospital Emergency Departments
To understand the structure of the HEDs, we
have initially to analyze their external context in
order to locate the various pressures and constraints
coming from their environment. Then, we have
focused on the objectives which structure these 3
HEDs. To do that, we have applied the typology of
Mintzberg concerning goals.
To analyze the organizational structure, we
identified principles of the division of tasks,
specialization's and the system of roles, and we
attempted to determine the organigram of the
organizational unity analyzed. In the same manner,
we paid quite close attention to mechanisms of
integration. Such mechanisms can be of many kinds,
involving existing hierarchies, norms and
procedures, values.
At the end of this stage, we were able to proceed
to an initial organizational diagnosis of the structure
and dynamic of the organizational units under
An organizational diagnosis of this existing
situation aims at evaluating how satisfactorily the
identified objectives are met. This led us to the
identification of certain functional problems linked
to the handling of information and the management
of interdependent relationships between various
emergency response actors, having to do with
This initial diagnosis also allowed us to build
different scenarios that illuminate the extent of the
field of possibilities regarding the future information
3.2 The map of actors and their
interdependence: the co-operation
The second dimension focus on actors and the way
they manage their necessary co-operation.
Depending on the particular information system
one is attempting to design, the identification of
actors is done in a contingent manner, through
determination of the various parties who are to
participate in the design of the system and its future
We have therefore set up what we call a map of
actors, their identification and their relationships
which connect them. We were particularly interested
in exchanges of information between actors, since
this is an essential and important power resource
(Crozier, Friedberg, 1977). The nature of such
information and the mode of exchanging it were
noted in specific observations.
After having identified the actors and their
exchanges of information, we have focused on the
way in which each one perceived its role, its
resources and its interests in this network of
interdependences. We also considered the way in
which the actors perceived the role of the future IS,
expectations and resistance's to which this one gave
place. This collect of information can only be
accomplished through in depth interviews of actors
involved in the system being constructed.
Actor’s interests in a situation in which a new
information system is about to be introduced can
never be predicted because the situation is always
quite fluid. The basic idea is that these interests do
not necessarily coincide with those of the
organization such as these might be identified
through a mechanical analysis such as was presented
Collective action always depends on
participation by members, and this participation is
always negotiated through leader, even implicitly.
The terms of this kind of negotiation are exactly
what we were trying to identify.
The understanding of those terms allowed us to
narrow down the field of possibilities identified in
the initial diagnosis, yielding specifications which
were certainly less optimal than those which would
have been produced by the mechanical analysis,
though more satisfying or practical regarding the
actors and their positions.
3.3 The “common higher principle”
identification: the cultural
With the cultural approach we wanted to take into
account the forms of justification (Boltanski,
Thevenot, 1999) which are mobilized by actors in
order to legitimate their actions and their perceptions
of the information system which was being
constructed. For this, we based ourselves on the
typology of “ Economics of Worth”. We sought to
identify in the 3 HEDs. We founded on
- the “common higher principle” held to by
those at the scene, principle which could
serve as a basis for constructing agreements
regarding the the system to be designed ;
- and on, the “states of worth” which
characterize what is “the greater” or “the
smaller” with regard to the higher principles
which were identified. These permanent
states allowed us to determine what is
legitimate within the organization but also
regarding the future IS.
We obtained those data from specific documents,
as rules and charters defining the missions and the
codes of conduct to be applied in the HEDs. But this
stage of the analysis can also be assisted by
discussion sessions with the actors so that changes
which are acceptable can emerge from dialogue. Our
recourse to a symbolic level allows us to understand
the norms and values which help to regulate the
behavior of the HEDs’professionals. It also allows
us to test different possible ways of constructing the
IS, these possibilities having different meanings and
legitimacy for various actors.
This article underlines the interest of bringing
together Organization Sciences and Requirements
Engineering to build an information system which is
a success i.e. which is adapted to users' expectations
and who is finally used.
If the approach seems profitable, it remains to
convince the world of the IS in developing some
formal tools able to represent those intangible
dimensions of the organizations.
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System in Hospital Emergency Departments