Health services : a contemporary approach

Information services do not function within a vacuum. Indeed it is likely that the library and information service (LIS) which does not take into account the external environment will quickly cease to exist. The providers of services must look to the outside world and create regular ‘snapshots’ of what is happening in the external environment. A key skill is differentiating between those issues that will significantly impact on LIS, those that will have limited relevance and those with minimal relevance. For those providers of healthcare LIS the dangers in ignoring the health environment are two-fold. Services can be developed that are not required which will result in the LIS becoming atrophied. The other risk is that necessary services will not be developed and prospective users will go elsewhere. The purpose of this chapter is to identify the major drivers that are shaping the health external environment at the beginning of the 21st century. This chapter is structured around a Sociological, Technological, Economic and Political (STEP) analysis of the health external environment. Johnson and Scholes (1999) have outlined the value of this approach where the STEP analysis identifies key environmental influences that are likely to drive change. This analysis should help LIS staff consider the differential impact of key drivers on the strategic options available. Providers of LIS could use the STEP analysis to consider strategic options but that is not its primary purpose. It provides a structure to the many diverse and influential drivers that are shaping healthcare. The intention is to provide an informed insight into the challenges facing health service providers. This STEP analysis has been developed through the contributions of various experts. Between June 1999 and October 1999 a draft STEP analysis was produced. This was circulated to a range of professionals involved in healthcare delivery including a consultant surgeon, a research physiotherapist, an organizational performance development officer and a commissioning support manager. They refined the analysis which resulted in the final establishment of the drivers that provide the structure for this chapter. In Sociological factors the emphasis on self, health inequalities and demography (especially the increase in the numbers of elderly) were identified. Information and Communications Technology (ICT), biological and pharmaceutical developments and the development of medical equipment made up the Technology drivers. In terms of Economic factors, cost containment, evidence based practice and rationing were included. Finally ideology, collaboration versus cooperation and globalization were established as key Political issues. The literature used to provide detail on the STEP factors has been identified using three important criteria: currency, expertise of authors and the authors’ abilities to present comprehensive overviews. Interested readers will be able to follow up specific source material to expand on the level of detail given below.