1684 Organisational Challenges of Implementing E-Business in the Public Services Table 3. continued No. Organisational challenges Steps taken to meet organisational challenges Data from NMA 6 Establish the right model of organisational design for the organisation - Design and implement the right structure for an e-business starting from NMA’s core business processes - Focus on core organisational competences: data collection, data management, exploitation of new technologies and partner/customer management “ The normal practice would be: you take the external consultancy methodology cookbook and you apply things from it and other projects that you worked for, and you get a sense of the right way to do things … but this organisation is different and ZHZDQWHGWKHVWUXFWXUHWRUHÀHFWZKDWZHGRQRW what consultants want us to do”.(Board member responsible for the structural change, 2003) “We did not want an off-the-shelf structure. Consultants came with a whole series of structural models, they came with the toolkit but didn’t know KRZWR¿WLW´6WUDWHJLVW “ Don’t expect everything to work without some adjustment and don’t be afraid to review changes at an early stage to keep the reorganisation on track”. (Business Group Director, 2003) 7 Top management commitment and the business case - CEO with experience and personally LGHQWL¿HGZLWKWKHHVWUDWHJ\SURMHFW - Have a multi functional leadership team i.e. from sales, marketing and IT -Involve senior management from sales and marketing in the strategy implementation “The fundamentals are you need to have a really clear leader of the structure, somebody who has a very clear vision about what the endgame looks like” (Senior Manager, 2002) “ Sales and Marketing senior management buy- in was absolutely fundamental for the process to work … There must be a vision, there must be a strategy and there must be support behind it. (Senior change manager, 2003) 8 Political resistance to change of various stakeholders and managing simultaneously their diverse expectations - Consistent communication allied to the use of facilitated workshops “ Consistency of message and purpose is one of the most important success factors in making change happen. Crystal-clear purpose, understood by all, including ‘what it means for me’, should be made explicit” (NMA Employee, 2002) 1685 Organisational Challenges of Implementing E-Business in the Public Services Table 3. continued No. Organisational challenges Steps taken to meet organisational challenges Data from NMA 9 External ‘customer acceptance’ barriers and problems - Communicate consistently with end users, at the beginning to build FRQ¿GHQFH DQG WKURXJKRXW WR communicate progress and to get feedback - Use customer relationship management WRUHEXLOGWKHFRQ¿GHQFHRIFXVWRPHUV who are confused about who they are actually buying products and services from “ The changes in our business processes - for example, procurement, reporting and customer relationship management, were so massive that the smallest error could have potentially serious consequences during business processes switching, damaging customer relationships and delivery channels for a lengthy period of time. Communicating proposed changes to our customers, users and clients was essential. They demanded honest, consistent and up-to-date information whether the news were good or bad.” (.” (Business Improvement Manager, 2002) “ It was important to ensure all the time our customers, users and clients that we had a back- up or disaster recovery plan should something go wrong during the transition” (Sales and Marketing Manager, 2002) 10 Aligning the objectives of the 21 projects with the overall objectives of the e-business strategy and establishing timelines in place - People involved in the projects have clear understanding of their roles and responsibilities - Good project management to avoid GXSOLFDWLRQV DQG FRQÀLFWLQJ EXVLQHVV objectives “ … this great big machine called project planning comes in and it takes up vast amounts of time and systems space, because of all these critical paths which chunter away. Actually this is too big right now, and frightening people.” (Senior Manager, 2002) 11 Blending major change with major continuity - Integrate the e-commerce strategy with the business strategy and with the core operations from the start “ We needed to be able to adapt to shifting circumstances in market conditions and identify potential changes in course sooner rather than later …” (Senior Marketing manager, 2003) 1686 Organisational Challenges of Implementing E-Business in the Public Services agement Team to clearly articulate the vision, purpose, goals, and values for the organisation and to communicate them clearly businesswide. It also required pulling together the leadership, communication, and engagement activity, whilst ensuring that all existing projects, initiatives, and everyday activities were aligned and integrated with this. This high level strategic activity was also about leveraging what was already in place and, most importantly, maintain consistency across cultural, behavioural, and leadership ap- proaches. Second, the case of Britain’s National Map- ping Agency shows that, in practice, the transi- tion from government monopoly to commercial organisation whilst embracing e-business as a corporate philosophy can be extremely challeng- ing to achieve. Although e-business has enabled NMA to tap new customers and new revenues and opened up a space for importation of private sector practices into NMA, the strong public interest for its activities was still present. Yet the organisa- tion was expected to operate commercially, cover its costs, and build up reserves through its own commercial style operations. That situated the organisation in the intersection of two different spheres—the public and the private. Becoming an e-bu si ness , in t his c ontext, require d colla bor a- tive working not only with commercial partners but also with different parts of the government. 7KH ³LQEHWZHHQ´ VLWXDWLRQ WKXV WHVWHG WR WKH full extent the capability of the organisation to lead and manage change, especially in terms of ¿QGLQJWKHSHUIHFWEDODQFHEHWZHHQIXO¿OOLQJLWV still strategic role as national agency and provid- ing high-quality services to its customers in a dynamic marketplace. One of the senior managers interviewed de- scribed this situation with the following words: ³:H>DVDQRUJDQLVDWLRQ@ZDQWWREHKDYHDVLIZH were situated in the commercial business sec- tor, but we cannot escape our origins” (Senior Manager, 2004). 7KLUGWKHFDVH¿QGLQJVGHPRQVWUDWHWKDWVXF- cessful organisational transformation involving e- business implementation relies on changing some fundamental business processes and attitudes. Close cooperation between many different sets of people—from middle managers to program- mers, and from technical architects to system users within the organisation—is needed. This convergence of business process, creative, and technical skills created in NMA a new dimension for teamwork, which in turn shifted the culture RIWKHRUJDQLVDWLRQIURP³NQRZOHGJHLVSRZHU´ WR ³VKDULQJ NQRZOHGJH LV SRZHU´ 7HFKQRORJ\ can be an important enabler but not a driver of knowledge sharing. Finally, one key challenge in NMA was how to blend major change with major continuity. In this respect, a major lesson learnt from this organisation’s experience was that it is essential to integrate the e-commerce strategy with the business strategy and with the core operations IURPWKHVWDUW7KLVHFKRHVWKH¿QGLQJVRI'XWWD and Segev (1999) that successes result from close partnerships between commercial and IT man- agers, and that companies making e-commerce central to their organisation do better than those that make it an afterthought. CONCLUSIONS This article aimed to reveal the processes of strategic and organisational transformation en- gendered by e-business during the implementa- tion of a complex structural and cultural change programme aimed at reshaping a commercialised public sector organisation and rethinking how it provided value to its customers. The discussion H[DPLQHGWKHGLOHPPDVDQGFRQVWUDLQWVLGHQWL¿HG by managers in the interpretation of the e-busi- ness strategy concept and why its implementa- tion in practice could be challenging. Whilst the Internet offers a technological solution, the ¿QGLQJVRIWKLVFDVHVWXG\VXJJHVWWKDWWKHVXF- cessful implementation of a wider e-business 1687 Organisational Challenges of Implementing E-Business in the Public Services strategy depends on managing simultaneously a number of projects which cross organisational boundaries and linking together organisational and technological factors. :KLOVWWKLVUHÀHFWLYHDFFRXQWPD\EHXQLTXH it does, however, provide pointers to other large organisations undertaking a similar e-transforma- WLRQDQGUHÀHFWVRQWKHGHJUHHRIRUJDQLVDWLRQDO transformation required by traditional organisa- tions in meeting this imperative and successfully making the change to e-business. In particular, WKH¿QGLQJVLOOXVWUDWHWKDWDQHEXVLQHVVVWUDWHJ\ is not just about technology. It also embraces the business challenges that result from managing change in a fast moving environment, as well as the important issues of people, organisation, culture, communication, and how an organisation must create a process for delivering innovation. )XUWKHU HPSLULFDO¿HOGVWXGLHV LQ RWKHU VHW- tings would enrich the concepts developed in WKLVVWXG\DQGZRXOGSURGXFHDGH¿QLWLYHOLVWRI best practices. The case highlights, however, the complex nature of the notion of e-business in a public sector context and shows that when imple- mented successfully, it can transform entirely these organisations and their capabilities. REFERENCES Barnes, D., Hinton, M., & Mieczkowska, S. (2005). Enhancing customer service operations in e-business: The emotional dimension. Journal of Electronic Commerce in Organizations, 3(2), 17-33. Barnes, S., & Hunt, B. (2001). E-commerce and e-business: Business models for global success. Oxford: Butterworth-Heinemann. Barua, A., Konona, P., Whinston, A., & Yin, F. 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Lee, Volume 2, Issue 4, pp. 39-60, copyright 2006 by IGI Publishing (an imprint of IGI Global). 1690 Copyright © 2009, IGI Global, distributing in print or electronic forms without written permission of IGI Global is prohibited. Chapter 5.19 From ASP to Web Services: Identifying Key Performance Areas and Indicators for Healthcare Matthew W. Guah Warwick University, UK Wendy L. Currie Warwick University, UK ABSTRACT Value creation from e-business for customers in healthcare is an important topic in academic and practitioner circles. This chapter reports the ¿QGLQJVIURPDWZR\HDUUHVHDUFKVWXG\ZKLFK found that disappointing results from the much- hyped application service provider (ASP) business model is currently being replaced by perceived new opportunities from Web services. Yet past failings from ASP do not guarantee future suc- cess with Web services models, particularly as evidence shows that accruing value-added ben- H¿WVIURPHEXVLQHVVLQLWLDWLYHVLVRIWHQIUDXJKW ZLWKGLI¿FXOW\+HDOWKFDUHLVQRH[FHSWLRQDQGLV likely to pose more problems given the complex- ity of the organizational structures, processes, procedures, and activities within this vertical sector. This research study calls for a more rigorous approach in identifying and evaluating key performance areas and indicators from new e-business initiatives involving emerging tech- nologies and platforms such as Web services. Yet the measures and metrics used for healthcare may differ from those adopted in other sectors. Healthcare professionals will therefore need to GHYHORSFRQWH[WVSHFL¿FNH\SHUIRUPDQFHDUHDV (KPAs) and KPIs, and caution against accepting DW³IDFHYDOXH´WKHYDOXHSURSRVLWLRQGHYLVHGE\ Web service providers. INTRODUCTION The process of healthcare management modern- ization is maturing in Europe, North America, and in other developed countries. This has resulted to an exponential increase in demand for rapid business process execution, more accurate and timely information, and additional automated 1691 From ASP to Web Services information systems (IS). Interest in Web services is emerging in many different guises. As subset of e-business, Web services offer customers soft- ware as a service. The principle of operation is similar to the application service provision (ASP) model, priced on a pay-as-you-go, utility model of business computing (Currie, Desai, & Khan, 2004). Against a background of disappointing results from ASP (Hagel, 2002), Web services are designed to resolve problems of poor integration (interoperability) between software applications and low customer satisfaction. This research study treats the Web services business model as the main unit of analysis and seeks to identify how value is created for customers (Perseid, 2003; Sleeper & Robins, 2001). Despite the promises of vendors, Web services have fared poorly in terms of attracting a large client base (CBDI, 2003). The reasons for this are both technical and commercial (Hagel, 2002). The fallout from the ASP market provides some important lessons for vendors offering software as a service, and for e-business models more generally. 7KLV FKDSWHU SUHVHQWV WKH ¿QGLQJV IURP D two-year research that examines both the supply side and customer side of deploying, hosting, and integrating e-business models, focussing primar- ily on Web services in the UK health sector. The chapter is structured into three main areas. It begins with a discussion of ASP taxonomies and argues that the various templates for ASP were HVVHQWLDOO\ÀDZHGIRUDFRPELQDWLRQRIWHFKQLFDO or business reasons. Within the healthcare sector, technology vendors failed to develop e-business models that created value for customers. They adopted a technology push strategy where product and services are offered to customers without a clear understanding of their business requirements (Cassidy, 2002). This section is followed by an overview of the research study and methods used for data collection and analysis. Next, we pres- ent the results from a questionnaire survey and interviews with healthcare professionals. Using a ULVNDVVHVVPHQWIUDPHZRUNZKLFKFDSWXUHV¿YH key performance areas (KPAs) for evaluating the software-as-a-service business model (which includes both ASP and Web services) (Currie, 2003), this research applies this framework within the healthcare sector. Comparing the results from KHDOWKFDUHZLWKWKRVHRI¿YHVHFWRUV&XUULHHW al., 2004), we observe that priorities and prefer- ences vary. This suggests that service provider vendors need to identify a more rigorous approach in developing their value propositions from e- EXVLQHVV IRUVSHFL¿F LQGXVWULDO VHFWRUVVLQFHD RQHVL]H¿WVDOO approach is inappropriate. The chapter concludes by offering future directions for research on emerging technologies within healthcare. LESSONS FROM THE FIRST PHASE OF THE ASP MODEL The emergence of the ASP model suggested an D Q V Z H U W R S U H Y D L O L Q J T X H V W L R Q ³ : K \ V K R X O G V P D O O businesses and non-IT organizations spend sub- stantial resources on continuously upgrading their IT?” Many believed that application outsourcing, using the ASP model could provide the solution WRHQKDQFLQJ,7HI¿FLHQF\DQGUHGXFLQJWKHto- tal cost of ownership of IT (IDC, 2000). Within the context of healthcare, ASPs could offer both horizontal (business facing) and vertical (sector VSHFL¿FVRIWZDUHVROXWLRQV$QH[DPSOHRIWKH latter could be in the form of electronic patient records (EPR) systems (Guah & Currie, 2004). An ASP assumes responsibility for buying, host- ing, and maintaining a software application on its own facilities, publishing its user interfaces over the networks, and provides its clients with a shared access to the published interfaces. The customer simply has to subscribe to the service to receive the application over an Internet or dedicated intranet connection, as an alternative to hosting the same application in-house (Guah & Currie, 2004). The impetus behind ASP was fuelled by the 1692 From ASP to Web Services belief that utility computing offered a new business model to customers, similar to electricity, gas, and water. The commercialization of the Internet PHDQWWKDWDVQHWZRUNWUDI¿FLQFUHDVHGLQD¿UP¶V data centre, IT architecture would trigger other resources into action, including idle servers, ap- SOLFDWLRQVRUSRROVRIQHWZRUNVWRUDJH7KH¿UP would pay only for the amount of time it used the VHUYLFHV7KXVWKHFRQFHSWRI³VRIWZDUHDVDVHU- vice” was created. Accessing IT resources in this way would result in reduced up-front investment DQGH[SHQGLWXUHHQDEOLQJ¿UPVWREX\VHUYLFHV on a variable-price basis (Dewire, 2000). This fuelled opportunities in the late 1990s for service providers to offer software applications and IT infrastructure on a rental, pay-as-you-go pricing model (Bennet & Timbrell, 2000). An ASP could be a commercial entity, providing a paid service to customers (Susarla, Barua, & Whinston, 2003) RUFRQYHUVHO\DQRWIRUSUR¿WRUJDQL]DWLRQVXS- porting end users (Currie et al., 2004). In healthcare, an ASP may provide some mix of application services for laboratory, prescribing, charting, outpatient visit, coding, and clinician scheduling, and reporting. Some may even offer clinical alerts normally associated with expensive institution-based EPR systems, including health warnings of potential drug reactions. Through the provision of this one-to-many model over the Internet, an ASP takes patient charts and medical records and keeps them on a centrally managed repository, to which a healthcare provider can gain access from anywhere in the world. This can allow for a physician to review the patient’s medication lists from all previous encounters and WKHLUSUHVFULSWLRQ¿OOLQJKDELWVSURYLGHGDOOWKH OHJDOUHTXLUHPHQWVRISDWLHQWFRQ¿GHQWLDOLW\KDYH been arranged). ASP Taxonomies 7D[RQRPLHVUHSUHVHQW³LGHDOW\SH´VFHQDULRV which may not exist in their pure form (Currie et al., 2004). They are useful for providing a frame- work for organizing phenomena by attempting to deconstruct the various components and/or characteristics. Variations exist within ideal- typical categories, as well as overlap between FDWHJRULHV 'XULQJ WKH ¿UVW ZDYH RI WKH $63 market, many different types of ASP emerged. Some were concerned to offer a broad, horizon- tal product and service portfolio, while others WDUJHWVSHFL¿FYHUWLFDOLQGXVWU\VHFWRUVVXFKDV healthcare. Table 10.1 focuses on a horizontal ASP products/services portfolio, and Table 10.2 looks at the service providers targeting the healthcare vertical sector. Each of these categories implies a different outsourcing relationship between sup- plier and customer. 7KH¿UVW$63WD[RQRP\7DEOHGHOLQHDWHV ASPs into vertical LQGXVWU\VSHFL¿Fhorizontal (across/within business functions); enterprise (complex software such as ERP and CRM); pure-play (Web-enabled applications) and infra- structure (data centre, networking, and other sup- porting technology) (Currie et al., 2004). Whilst many research analysts and pundits suggested that vertical ASPs offered excellent opportunities for business development, they also needed to ad- dress key challenges, such as a limited customer base; potential problems in serving only one sector/subsector; potential overreliance on one Internet service vendor (ISV); and others. By restricting their potential customer base, vertical ASPs believed they could offer a high level of service since they marketed themselves as having an in-depth knowledge of the sector/subsector they served. The second taxonomy (Table 2) of the ASP PDUNHWDGRSWV¿YHFDWHJRULHVASP resellers, ASP developers, ASP aggregators, hosting services, and managed services providers (Hagel, 2002, p. 45). Comparing the two ASP taxonomies reveals VLJQL¿FDQWVLPLODULWLHVZLWKFRQVLGHUDEOHRYHUODS between categories and activities of the various players. The ideal-typical categories provided by different taxonomies offer an illustration of the market/strategic positioning and product/service 1693 From ASP to Web Services portfolios of ASPs, and should not be treated as rigid categories in their own right. Given the FRQIXVLRQ ZKLFK VXUURXQGHG WKH ¿UVW ZDYH RI ASPs, attempts to deconstruct the ASP business model and market into taxonomies is a useful exercise, which may provide some clarity to the phenomenon under scrutiny. ASP taxonomies can be further mapped across the netsourcing stack, which captures a variety of customer/supplier scenarios “where relationships in this space are very complicated” (Kern, Lacity, & Willcocks, 2002, p. 115). For example, an ASP delivering a hosted software application to the end customer, may subcontract data centre services, billing, help desk, and other support services to DGGLWLRQDO¿UPV)XUWKHUPRUHWKH$63PD\QRW even own or have developed the software, as this may be the intellectual property of an Internet service vendor. In the case of enterprise ASPs and ASP resellers, developers, and aggregators, WKHVH¿UPVPD\IRUPFRPSOH[VWUDWHJLFDOOLDQFHV or partnerships with leading ERP vendors, usually IRUVSHFL¿FWDUJHWFXVWRPHU7DEOH As a forerunner to the current Web services market, ASP was highly volatile, dynamic, and immature market. A recent review of the ASP industry (Susarla et al., 2003) concluded that the technological factors like scalability, speed and focus, and the behavioral aspects of price and ÀH[LELOLW\ZHUHWKHNH\GULYHUVRIWKHPRGHO7KH inhibitors of the model were poor connectivity, lack of trust in the model, reluctance to be locked into long-term contracts with suppliers, lack of customization, poor choice and suitability of software applications from ASPs, and few op- portunities to integrate disparate applications across technology platforms and business environ- ments. These factors and others led Hagel (2002) to conclude that Table 1. Taxonomy of ASPs based on a horizontal product/service portfolio (Currie et al., 2004) Type of ASP Description Generic Examples Key Challenges Mixed/ Vertical ,QGXVWU\VSHFL¿F KHDOWK¿QDQFH transportation) SchlumbergerSema (health) Bloomberg (Finance) S/W for Excellence (Dental) Limited customer base Reliant upon major vendors Restricted by sector-based economic Horizontal Business software (accounting, human resource, travel) Salesforce.com (HR) Concur (travel) SAGE (accounting) Low barriers to entry; Undifferentiated products/services Enterprise Complex business software (ERP, CRM, supply andlogistics) SAP Oracle McKesson Very expensive for small/medium organisations &KDQQHOFRQÀLFWV Data security/integrity Pure-Play Internet/Web- enabled software application (email/ security/disaster recovery) Graphnet Health iSoft Mail.com 8QSUR¿WDEOHFRPPRGLW\DSSOLFDWLRQV Reliant upon VC funding; Unstable/volatile/dynamic market Infrastructure Technology partners to ASP (telco, data centre, networking) Cable andWireless BT CISCO Technical inhibitors Over-capacity Severe competition . choice and suitability of software applications from ASPs, and few op- portunities to integrate disparate applications across technology platforms and business environ- ments. These factors and. strategy and with the core operations IURPWKHVWDUW7KLVHFKRHVWKH¿QGLQJVRI'XWWD and Segev (1999) that successes result from close partnerships between commercial and IT man- agers, and. service operations in e -business: The emotional dimension. Journal of Electronic Commerce in Organizations, 3(2), 17-33. Barnes, S., & Hunt, B. (2001). E-commerce and e -business: Business models