Not long ago, I was talking with a fellow architect from Switzerland about the use of architecture tooling in the healthcare industry. Since we both have a background in this sector, our conversation quickly moved in the direction of Enterprise Architecture in healthcare in a general sense. It didn’t take us long to conclude that the challenges and solutions related to architecture in healthcare are similar in both our countries.

We see the same challenges for which the same ad-hoc point solutions are devised and where there is also the same incorrect image of architecture.

Architecture still part of IT

The healthcare sector in the Netherlands uses a job evaluation and classification system to set up its own job house. This is an instrument with which the weight of a function can be determined. 

The job evaluation and classification system, the FWG, recognises the function of Concern IT Architect; this is the only function in the field of architecture. 

Looking at the name of the function, one can immediately see that it is positioned within the IT department. It is therefore not surprising that hospitals* do not use architecture as it is intended; namely at the enterprise level, possibly supplemented by underlying domains. 

To illustrate: 

None of the relatively smaller regional hospitals employ an Enterprise Architect. All three of the aforementioned hospitals do however have the desire to exchange data and make information interoperable. 

The business is excluded

If an architect function is present at all, it usually is that of an IT or Information Architect. Unfortunately, it is not enough to only look at that single layer of the architecture. Sure, IT and information are very important topics in healthcare (for instance interoperability and data exchange), but no groundbreaking results will be achieved by only looking at issues from a single and bottom-up perspective.

This is why all (really, all!) architecture frameworks emphasize the importance of the dialogue with the organisation (in this case the organisation and the healthcare processes). It is the translation of the need which originates from the organisation (top-down) that determines what should happen in the area of the underlying architectural layers. Appointing an architect for the IT or information domain does not automatically ensure that the organisation is properly involved in clarifying and answering the necessary questions with regard to their needs.

It is therefore not surprising that major challenges in the healthcare sector have an incredibly long lead time and are often not brought to a successful conclusion.

What needs to be done

What is needed in the healthcare sector is the realisation that architecture cannot be implemented from a single layer or point of view. Of course, it is good to have an IT or Information Architect, but only when there is also an Enterprise Architect around.

Architecture is not new anymore, and has been around for decades. It is time for the healthcare industry to realise that keeping the complexity of the environment manageable does not solely require an IT Architect. It is essential to act organisation-wide and from the Enterprise Architecture perspective. Only when this permeates the industry will it be able to break free from constantly being behind the times.

And yes, over the years the sector has made progress. That is the image it likes to uphold. But in all honesty, after years of effort, the industry still has not managed to reach any kind of organisation-wide maturity as far as architecture is concerned.

As long as architecture is not seen as an essential part of strategy and business operations it will always remain at an immature level.

* Of course, this is an average and does not apply to all hospitals in the Netherlands. The large academic hospitals have a better view on (Enterprise) Architecture, although it remains a fact that even there they do not work under architecture entirely.