Abstract

Competitive Technologies such as decision support systems (DSS)

Intelligence are helpful in solving many kinds of problems, especially

those that are based on quantitative data and/or are
tactical in scope. For strategic decisions, however,
Systems: decision makers can benefit greatly from a tool that
tracks and organizes qualitative and other nebulous

Qualitative DSS information. Such a tool would help cultivate and

leverage an organization's intellectual assets to help
users address decision making in a more informed
for Strategic fashion. While DSS technologies have not commonly
been used in such situations, they can be adapted to do
Decision Making so. This paper addresses the development of a
qualitative DSS in a health care setting that allowed
hospital administrators to exploit the qualitative
information obtained by its network of field
Vicki L. Sauter representatives for strategic benefit. This type of system,
University of Missouri - St. Louis and its corresponding benefits, can be extended to other
business situations.

ACM Categories: H4.3, D2.2, , J.3, K.4.3, K.6.1

Donna Free
Oakland University Keywords: Decision Support Systems; Health Care;
Strategic Knowledge Acquisition

Introduction
Increased competition, uncertain markets, and a global
economy all contribute to the complexity of managing in
st
the 21 century. An ever-changing landscape of
customers, competitors and regulations complicate
decision making, and require decision makers to refocus
their attention and increase attentiveness to
environmental shifts and trends when making choices.
For example, although health care administrators were
long accustomed to dynamic and unstable business
environments, today's world of managed care, merging
facilities, and increasing health care costs require
administrators to balance the demands of a variety of
stakeholders. They must balance the conflicting needs
of a myriad of customers, including doctors, other
medical care providers, patients, investors, lawyers,
accountants, government regulators, public opinion, and
the voice of the governing board. Managing the interests
of stakeholders requires current and accurate
information about changing needs, concerns,
requirements, legislation, best practices, and trends in
affiliations and cost tradeoffs (Forgionne & Kohli, 1996;
Orr, 2000). Consequently, in health care, as well as in
other sectors, broad information availability can be a
source of competitive advantage (Agarwal et al., 1992;
Bolloju, 1996; Drucker, 1992; Simon, 1992).
The dynamic process of acquiring, evaluating,
integrating, deploying and exploiting information is
critical to the development of organizational capabilities
and the realization of competitive advantages (Kogut,

The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2) 43
1988; Madhok, 1997; Mody, 1993). As a result,
managers' expectations of, and challenges to, their
decision support systems are increasing (Lederer &
Mendelow, 1993). In fact, it has been suggested that
skill in managing a wide variety of information about an
organization's environment is the ultimate source of
competitive advantage (Loebecke et al., 1999). Certainly
development of enterprise-wide systems and data
warehousing systems, which capture and integrate
transactions from a variety of perspectives, can help
meet managers' decision support needs (Kelly, 1997;
Power, 1998).
However, traditional (and more formal) approaches,
such as quantitative models, data mining or exception
reporting, are not likely to provide relevant or reliable
support for decisions in turbulent environments,
especially if the choices considered are long range
and/or strategic (Hickson et al., 1986; Minzberg et al.,
1976; Salmela et al., 2000; Samamurthy et al., 1994;
Sauter, 1985; Ahituv, 1998). Early indicators of changes
in the environment generally are provided as qualitative
information, and are often no more than rumors
(Dauten, 1999). In his work considering strategic
decision making, Brugha (1998c) explicitly suggests that
decision makers seek such information, and that they
consult with a spectrum of individual perspectives when
considering strategic options. In fact, he particularly
notes the need to consult perceptions of workers on the
front lines, and to cast a wide net to include as many
individuals’ knowledge about the environment as
possible. Similarly, Goold and Campbell (1987) argue
that communication must be opened widely to
understand appropriate strategic choices. Even poorly
structured information can provide useful insights when
similar rumors come from multiple sources, and are
subsequently verified to be true, or even when certified
to be false. In this case, the accumulated record can
highlight possible opportunities, and so provide valuable
knowledge for the manager.
A variety of studies have demonstrated that decision
makers facing strategic decisions employ judgement
more often than analytical studies in the choice process
(see, for example, Hickson et al., 1986; Minzberg, 1976;
Nutt, 2000). In fact, Nutt (2000) found that 93% of
decision makers applied intuition and judgement as their
primary form of analysis in strategic decisions. However,
when left unchecked, such judgements may provide
biased estimates of relevant parameters, especially
without a broad range of inputs (Nutt, 2000).
A critical question is then: if, in fact, this informal,
sporadically collected information could be beneficial or
even essential to supporting some kinds of decisions,
how can it be managed and exploited to provide the kind
of support necessary for good decision making? This
includes the questions of how one should identify, collect
44 The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2)
and store the information; how one should codify the
information to provide the best support; and how one
gets the information to the appropriate individuals at a
good time. Such systems need to mimic the positive
human skills of inference, even when denied desired
details of a situation, while compensating for human
inadequacies of not remembering, not recognizing
relationships, or not being able to see the forest for the
trees. In addition, such systems must provide systematic
approaches of organizing and retrieving information so
as to respond to cognitive limitations stemming from
overload and preconceived biases of decision makers
(Nutt, 2000). Finally, such systems need a mechanism
that adapts to the social structure of the organization
and motivates individuals to share knowledge
throughout the system (Hickens, 1998; Manville, 1996;
O'Dell & Jackson, 1998).
In this paper, we explore the necessary characteristics
of a system that adapts DSS technology to provide
competitive intelligence and strategic planning support.
This DSS tracks fuzzy, qualitative information—even
rumors—and transforms those data into actionable
knowledge helpful for strategic planning. The goal of this
paper is to illustrate how the DSS technologies must be
adapted, and to show how the output of such a system
can support executive or other high-level decision
making.
We began exploration for the needs and benefits of
such systems in a health care setting because the
turbulent environment and unstructured decision making
provided a rich context. The DSS described here was
designed for a tertiary hospital in a major metropolitan
area to help it respond to a turbulent environment. Not
only did this system ease rapid and meaningful changes,
it allowed the hospital to harness the power of
information that had previously been underutilized in the
management of the operations of that hospital.
The characteristics of the system we explored were
driven by two aspects of the literature: the emerging
Knowledge Management literature and Simon's “tiered
decision making model.” Each of those literatures, and
their contribution to this project, will be discussed in the
next section. Following those discussions will be further
description of the decision making environment, the
system, and then the principles that resulted from this
analysis.
Knowledge Management
The Knowledge Management (KM) literature calls for
mechanisms to leverage information and individuals'
experiences for the benefit of the organization. KM
requires the explicit creation of an information repository,
the careful codification of information, and the selective
routing of that codified information to the individuals who
can act upon it (Parlby, 1998). At its foundation is the
need to manage and cultivate the intellectual assets that
are becoming increasingly crucial to understanding the
operations of a well-managed enterprise (“Industry
Week,” 1999; Kramer, 1998). Knowledge management
certainly appears to answer the need: if an organization
can get the right information to the right people in the
right form at the right time, it can improve the speed and
quality of decision makers' responses to events. The
potential rewards from a knowledge management
system, including more responsive customer attention,
better acquisition of resources and greater control over
strategic planning initiatives, are significant (Malhotra,
1997; Oxbrow, 1998).
However, few empirically-based examples exist to guide
the implementation of knowledge management systems.
Much of the literature available does not facilitate
implementation because of the ambiguity associated
with the technique. As it has been discussed in the
research and popular literatures, KM is more of a
process to follow than a system of specific procedures
(Hickens, 1998; Kramer, 1998; Oxbrow, 1998).
Identifying specific steps that all companies need to take
is difficult because to each organization “knowledge”
means something different (Gautschi, 1999; Malhotra,
1997). Most organizations have difficulty maintaining
standard information, and find the need to maintain
fuzzy and poorly structured information daunting
(Kramer, 1998). Even if the information is managed well,
KM still requires putting the knowledge in the hands of
the appropriate individuals in a useful form and in a
timely fashion (Bender, 1998). The identification of those
individuals, and the management of the process for
getting information to them, can be difficult (Vaas, 1999).
While the benefits of such a system may be high, so are
the expected costs of developing such a system. To
avoid those costs, but to realize the potential of
knowledge management, organizations must leverage
existing technologies and mechanisms for collecting
data by the organization (Carr, 1999; Desmarais et al.,
1997; Murray, 1998; Nidumolu & Knots, 1998). In other
words, qualitative information is important to track and
maintain, especially to support high level decision
making. However, in most organizations, this will mean
adapting known technologies in unknown ways. It was
this call for novel applications of known technologies that
led the authors to consider the project of adapting
decision support systems. Unfortunately, the KM
literature does not provide real guidance on the
characteristics of such a system, or on how those
characteristics might be implemented. Simon's decision
making model, presented in the next section, provides
some guidance on the relevant characteristics. Later
sections will provide greater guidance on the how such
systems might be built.
The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2)
Simon's Decision Making Model
Simon (1997) proposed a three-phase process of
decision making: the intelligence phase, the design
phase and the choice phase. High-level decision makers
are especially dependent on doing the first of these, the
intelligence phase (sometimes called the 'competitive
intelligence' phase) well.
Competitive intelligence is the process of monitoring the
competition or environmental factors, capturing essential
measures of activity, organizing the measures, and
presenting that information so that it helps decision
makers detect and respond to changes in the
environment before competitors. This monitoring can
provide answers to questions such as which companies
are going out of business; which new products or
services are being introduced; which offices are
merging; and which competitors are opening new
offices. At the most basic level, this effort includes
reading trade journals and other publications. To monitor
dynamic markets, however, one needs information
regarding the specific environment, time and location.
Collection of such information is not sufficient. The
information must be organized and digested, and must
be presented so that someone will look at it (Salmela et
al., 2000; Samamurthy et al., 1994; Verkasalo, 1998).
Furthermore, studies have shown that if such
competitive intelligence is defined regularly, it will be
considered more reliably and systematically, thus
resulting in better choices (Dean & Sharfman, 1996).
In today's environment, with more complex
organizations, multinational influences, and rapid
transmittal of information, being able to identify and
evaluate this intelligence quickly is crucial. This
environment includes a rapidly changing landscape
where new competitors are entering the marketplace,
where current competitors are offering new products,
and where the need to be proactive is critical. It is
essential that information on the environment be
accessible to management when needed. In particular,
decision makers need the following:
• An early warning of threats and opportunities:
what are competitors, customers, and suppliers
doing and how will it help or hurt business?
• Support for the strategy development process:
what are the current trends in the marketplace,
and what strategies will help the decision
makers to capitalize on those trends?
• Assistance with instilling a sense of urgency
and motivation toward action: what does the
sales force know that headquarters decision
makers do not know? How would this
exchange of pertinent information affect
business decision making?
45
 • Support for strategic and operational decision
making: What should the company do to
compete effectively during the next five years?
What changes would help us run the business
better today?
No longer can management use intuition alone to drive
their decision making. Rather, management needs
systematic support regarding information external to the
organization as the basis of decision making even when
such data are qualitative in nature.
Qualitative-based analyses are more complicated
because they do not fit in the black box associated with
conventional (quantitative) models. In particular,
qualitative-based analyses are characterized by the
feature that relevant criteria cannot be quantified in a
common measure. The evaluation of each alternative is
unique, and there exists no external standard for
comparison. Further, the respective criteria lack
common units; intercomparison of the alternatives
cannot be completed in a lexicographic manner as is
done with conventional support tools (Brugha, 1998a).
As such, it is impossible to provide even ordinal rank
results without subjecting the information to the
particular information processing routines of decision
makers (often described as judgement) (Brugha, 2000).
Said differently, qualitative decisions are distinguishable
by the fact that they are reliant upon the wisdom,
experience and information processing capabilities of
the decision maker. Any analysis of the data outside of
that processing system is not meaningful.
Because these distinctions cannot be made
quantitatively, however, should not mean that decision
makers should be left with nothing but fuzzy
impressions. Brugha (1998a, 1998b) challenges us to
incorporate a scientific approach to using and evaluating
these qualitative data. He presents his general approach
based on the philosophical premises of Hegel and the
science of qualitative decision making identified as
nomology by Hamilton (1877). In particular, he describes
a need for labeling phenomena, discovering patterns
and creating directions for activity.
Research recommends that to achieve support for
Simon's “intelligence phase” of decision making DSS
need to (1) bring together the widest possible
experiences prior to encouraging decision makers to
apply their judgement to a choice process, (2) make the
process easy, and (3) get information to the people who
can use it at the time of the earliest warning signals
(Bergeron et al., 1991; Cole et al., 1997; Nutt, 2000;
O'Dell & Jackson, 1998; Segers & Grover, 1998).
It is this kind of system that we highlight in the paper,
and for which we provide design guidelines. Before
explaining this system, we will provide an overview of
the scenario in which it was implemented for
background purposes.
46 The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2)
Site Overview
The methodology used in this project is that of an
administrative experiment. That is, the authors
developed and implemented a system guided by the
literature to explore the opportunities for and issues
associated with developing a competitive intelligence
system (Baskerville & Wood-Harper, 1998; Susman &
Evered, 1978). To understand those issues and
opportunities, it is important that the reader understand
the context in which the system was developed and
evaluated.
The Competitive Intelligence System (CIS) described
here was developed for a tertiary hospital in a major
metropolitan area. A tertiary hospital has specialized
programs and facilities not usually found in community
hospitals, and it provides a broad range of super-
specialty and specialty services, such as intensive care,
vascular, cardiothoracic, oncology, renal, neurosurgery
and high-risk obstetrics. Care encompasses those
services provided either in an acute hospital setting, or
as part of specific hospice initiatives or similar post-
acute hospital outreach programs. Tertiary hospitals
provide significant levels of inpatient care, cater to rare
diseases, and provide unusually complex, experimental,
and/or costly forms of treatment.
This hospital has six field representatives, each
responsible for covering a specific portion of the 150-
mile radius area served by the hospital. Their goal is to
be a link between the hospital and the referral sources,
to share information, market new products and services,
and address complaints. As such, they spend the bulk of
their time visiting new physicians, nursing homes, pre-
hospital care providers, managed care case managers,
primary and secondary hospital emergency rooms,
independent practice associations, and mid-level
practitioners. These field representatives report to a
manager who coordinates their information, and, in turn,
reports to a vice president of the hospital.
The goal of the CIS was to provide hospital
administrators with support regarding their strategic
positioning in the health care market for the area.
Among the issues needing consideration by these
administrators were: (a) alliances with physicians to
provide patients to the hospital; (b) alliances with
insurance providers to support their services; (c)
alliances with groups of physicians and negotiation of
rates; (d) legislation and regulation; (e) mergers of other
hospitals from which patients might be referred (since
this is a tertiary hospital); and (f) factors that undermine
the stability of the hospital in providing those tertiary
services in the metropolitan area.
Pre-System Intelligence Base
Before the introduction of the CIS, hospital
administrators relied upon field personnel to share
information with them when it became relevant. Field
representatives, who visit with physicians, administrators
of managed care sites and associated staff, have many
opportunities to talk informally with the providers, the
provider staffs, and others who may be aware of factors
influencing the site. As such, these field representatives
have access to significant early warning signals of
environmental changes requiring action by the hospital.
For example, they generally have early access to
information about mergers and sales of private practices
and decisions to affiliate with particular health care
systems. However, they have access only to those
providers in their own geographical region, and certainly
do not have access to the strategies under consideration
at high levels of administration. Furthermore, any
turnover in field representatives would lead to a loss of
the historical record that might be used to detect a trend
needing attention.
The most common scenario for sharing of information
was that the hospital field representatives might hear
information and share it with their supervisor. The
supervisor had the advantage of receiving such
information from all of the field representatives and,
therefore, could see patterns in the information provided
from various locations. In addition, the supervisor had
been in that position for some time, and so she carried
significant history in her memory that could be drawn
upon to establish trends. Furthermore, the supervisor
had access to hospital administrators who might act
upon the information when it became desirable or
necessary.
A typical scenario might be the following. A
representative who visits several clients hears a rumor
that Dr. Bricker is considering affiliating her practice with
a managed care practice or selling her practice. When
the representative has the opportunity, he talks with Dr.
Bricker and learns that she is considering those options.
Further, she shares that she is in the process of
negotiating with the Finney Managed Care Consortium
for buyout, as are many other doctors in her building.
Suppose further, that the representative talks with
individuals at Finney Managed Care Consortium who
confide that they are negotiating with Willis Managed
Care Consortium for a merger of the two organizations.
These two facts individually may not represent any
significant factors needing attention by the hospital in
question. However, put together, especially if linked with
the fact that Willis Managed Care has not been affiliated
with the hospital in the past, these become information
that suggests a need for hospital action. The merger of
these organizations, and the buyout of physicians
currently sending their patients to the hospital could
result in fewer physician affiliations with (and thus
referrals to) the hospital. That, in turn, could lead to less
use of the beds in the hospital and less resulting
revenue for the hospital. Therefore, the hospital
understands that negotiating with Willis Managed Care
The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2)
now (before the merger) would be advantageous to
ensure that its referral base would be protected under
this new arrangement.
If all these facts came to the same person, became
known simultaneously, and if the information receiver
had the knowledge and skill to link them together and to
communicate them to the appropriate individuals, then
an appropriate strategic response might be taken early
enough to maximize the benefit of the outcome from the
perspective of the hospital. However, such facts often
come from disparate individuals over an interval of time.
Further, expecting the supervisor, or any other
individual, to process them efficiently while still
completing other assigned duties is unreasonable. What
would be invaluable instead is to provide an archive that
can link together these qualitative facts and to report
developing patterns so they could best support strategic
decision making. The CIS was developed to accomplish
this.
The CIS
The goal of the CIS is to provide decision support when
the most appropriate information to use is qualitative,
and decisions are strategic. As defined earlier, the need
for qualitative support is found when the criteria needed
for evaluation of alternatives lack common measures,
hence making normative intercomparisons of
alternatives difficult. So, the CIS must provide a
mechanism for analyzing, reporting and prioritizing
information in a manner that will facilitate evaluations
and provide a regulated environment for applying
judgement to the data (Massetti, 1996).
Furthermore, the CIS is designed to provide decision
makers access to data gathering results and
perceptions of a broad group of individuals. Researchers
have found that this access not only gives decision
makers access to early warning symptoms of a change
in the environment, but also provides a check on the
application of judgement to a choice process (Brugha,
1998c; Goold & Campbell, 1987; Nutt, 2000).
Decisions regarding the provision of health care, such
as hospital administrators trying to protect the hospital's
market share, introduce an additional requirement on
the system. Generally health care providers believe that
a socialized process of strategic planning, which relies
on many informal and unstructured discussions, is the
key to excellence (Forgionne & Kohli, 1996; Nutt, 1998a;
Swain et al., 1997). Given that predisposition, many
health care providers will shun computerized systems.
Hence, the implementation must encourage all parties to
use the system. It must provide a mechanism to
encourage the front line workers to enter data into the
system that will later be analyzed. Further, it must
provide incentives for the decision makers to consider
the data and analyses seriously and regularly.
47
Ultimately, getting information from the CIS must be
simple because the complexities of the analyses must
be completed by the decision maker (Gery, 1991).
A. Information
The basis for any decision support system is information
about a set of transactions conducted by the
organization. In this case, the system foundation is not
the conventional set of transactions regarding items
bought or sold. Rather, a transaction in this system is an
“intelligence report” provided by a member of the
hospital staff. These reports may be items heard in the
media, or, they may represent information provided by
one of the field personnel after meeting with clients on a
visit. Alternatively, the information might be provided by
a vice-president after a high level meeting. Theoretically,
the information can come from any source in the
hospital. Realistically, the information is most often input
by one of the field personnel regarding a facility or doctor
in his or her region. On the other hand, the individuals
who will ultimately use the information are more likely to
be at the level of vice-president or above.
Regardless of the source of the “intelligence report,” it
would be entered into the system using the information
entry form shown in Figure 1. This figure is a screen
shot of the actual data entry screen for the CIS as it
might be completed by one of the case workers. As will
be discussed later, this entry screen allows for three
separate comment areas that fulfill different missions.
As Figure 1 shows, the goal is to provide uniformity in
the categorization of the information, while allowing
flexibility in the content of the information. By using pull-
down menus, the user (who provides the “intelligence
report”) can select the source of the information (from
whom did he or she learn about this intelligence), and
the type of information and the object (about what
medical facility or provider is the intelligence being
entered). For example, when the menu is accessed for
source, the user is given the opportunity to select the
original source of the intelligence report from five
categories: (a) the person about whom the report is filed;
(b) another health care professional; (c) a non-health
care professional; (d) media, which generally refers to
(but is not limited to) newspapers; and (e) any other
source. Similarly, the information type can be
categorized by selecting from the following menu: (a)
complaint; (b) a statement of concern; (c) a statement
of dissatisfaction; (d) information about location; (e)
information about merger plans; (f) information about
moving plans; (g) changes in ownership; (h) personal
information; (i) information about retirement plans; (j) a
statement about satisfaction; or (k) other information. As
we will show later, this early categorization of information
provided by the person adding the information to the
database, will help decision makers glean patterns more
easily.
48 The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2)
Another function on this first screen also eases the
metamorphosis from anecdotes to more reliable
support. Each record receives a record number for later
cross-reference, and a date of input. In addition, each
record is coded by the person who entered the
information and the person who first learned of, or
discovered, the information. This will allow decision
makers later to audit the entries in the system, thereby
checking the reliability of the information obtained from
different sources. This will help them use the output of
the system more efficiently and effectively.
A third kind of functionality is enabled by the coding of
information as noted, verified, or disproved. As
information is entered for the first time, the user can
mark them as “Noted” to show that information was
obtained, but that the user has no knowledge as to the
accuracy of the information, only that it was shared with
him or her. Later, if similar information is verified by this
or another individual, the statement can be noted as
“Verified” so that it will have more credibility with users.
Such labeling also allows the user to track the period of
the evolution of the information from rumors to facts.
Finally, if the statement later is shown to be false, it can
be noted as “Disproved”, again allowing for users to
understand the credibility level and to track the time
horizon during which it was thought to be true. While
there may be reasons to drop the reference from the
database once the information is identified as false,
more often, keeping the information in the system is
appropriate; even disproved information may suggest a
phenomenon that needs attention by decision makers.
The middle area on the screen has five buttons with
which the user can classify the subject of the information
as concerning any of the following: doctor, hospital,
managed care affiliate, region, or health care system.
Once a category is selected, the system responds with a
box asking for identification. All of the remaining options
do have pull-menus from which a user could select
options to maximize reliability of data entry, which, in
turn, contributes to the reliability of the reports.
The bottom portion of Figure 1 allows a location for
actually entering the information in the system. Fields in
this section are free form memo fields, encouraging the
user to write about the information in any convenient
manner, and with as much detail as the user feels is
necessary. It includes three categories: (a) public
comment; (b) department comment; and (c) personal
comment. Users are not required to enter anything into
any of the categories, but they may use all three
categories. Any information put into the public comment
section would be shared with any other user who
receives a report and/or makes a query into the system.
It is intended as the most conservative entry, one that
would require no explanation and/or background to
interpret.
 Figure 1. Introductory Screen
Material entered into the department comment, on the
other hand, would be shared only with the user and his
or her supervisor. This would allow the user to enter
perhaps more sensitive information, or information that
would require substantial explanation to put it into
context. Since the supervisor would have access to the
individual who entered the information, he or she could
get additional information to expand upon or clarify the
information before decision makers access it or act upon
it. Furthermore, since the supervisor would have access
to entries from all of the field representatives, he or she
could monitor similarities and differences, and share the
accumulated information with higher level decision
makers if necessary.
Finally, material entered into the personal comment field
would be available only to the individual who entered the
information. While this field might include particularly
The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2)
sensitive details about information entered into the
system, it is believed that the information in this field will
more often simply be private notes to the representative
in a personal information management form. This might
include things such as bring additional brochures, or
remind lab assistants to provide a certain kind of
information with that doctor's orders. This information
would not contribute to the main purposes of the system.
However, this option has the benefit of providing the
user with a personal benefit from the system. Such
personal benefits are believed to provide appropriate
incentives to the users, i.e., field representatives, to find
the information and input it in the appropriate form in a
timely manner (Sauter, 1985). Without their cooperation,
the system could quickly become irrelevant.
The basic entry forms have a clean and robust format.
More important, the information entry forms are user-
49
friendly, thereby encouraging the staff to enter
information when they become available, and to use the
system to analyze the available information.
Significant strategic information can be determined
simply by observing the environment and reading
published sources of information. A key information
resource is a news clipping effort by representatives in
the field, and staff at the office, of newspapers and trade
journals (for stories about their situation). At this time,
someone needs to enter the information into the system,
but once the information has been summarized in the
system, it can be analyzed with information from a
variety of other sources. These news reports, or market
reports, company profiles, and trend analyses can all be
entered into the system as the foundation of the ultimate
analysis done to create competitive intelligence.
B. The Chassis Principles
While the collection and maintenance of this information
do provide a foundation for achieving the goal of
decision support for strategic decisions, it is the analysis
and presentation of the information in a meaningful and
succinct form that makes the system useful. Without
these tools, decision makers would need to scan the
database frequently to learn if information is available
about his or her interest. Most decision makers find such
a process tedious and unproductive. It takes significant
time to wade through all of the information to come up
with the one or two tidbits that would be of use.
Furthermore, the search process is not well defined, and
often does not result in any useful information. Finally,
this process seems more like rumors on the grapevine
than productive analysis of cues for action.
Therefore, before the potentialities of the system can be
realized, the hospital's culture must change from
thinking about this information as just anecdotes to a
valuable resource for strategic decision making. The
system was designed as a chassis, or foundation, to
address that particular goal. Three principles were used
to help change that culture.
P 1. Successful deployment of a strategic DSS
requires the development of a reporting
system that automatically interlaces
information from a variety of sources to
highlight possible areas to which decision
makers need to put their attention.
Decision makers historically have relied upon their own
interpersonal communication and informal
communications channels for strategic decision making
(Chiasson & Lovato, 2001). Some have better
developed methods for creating those channels than
others. However, we know from the literature discussed
earlier, that the more diverse the channels of information
acquisition, the better the “intelligence” for strategic
50 The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2)
decision making (Chiasson & Lovato, 2001; Dean &
Sharfman, 1996). A good system, then, will easily weave
together information from diverse sources to help
decision makers recognize the deficiencies in a manner
that will allow decision makers to see its relevance to
their goals. This has been shown to be effective in
facilitating strategic decision making (Nutt, 1998b).
However, even those decision makers who believe in
the usefulness of systems are likely to be skeptical of a
technology that has historically embraced primarily
formal, quantitative tools. So, in order to attract our
audience, we need not only to make the systems useful
and easy to use (as per the significant TAM literature),
we need to make them almost immediately rewarding.
We know that the earlier decision makers adopt a
system, the more likely they will stick with it in the long
run (Chiasson & Lovato, 2001).
Operationally, this means that with the introduction of the
system, giving decision makers a logical, organized
vehicle through which to consider the information while
giving the field representatives the flexibility to represent
what they learned while visiting clients was crucial.
Further, it was important to adapt the input mechanism
to something that would provide a value-added resource
to the field representatives and would allow decision
makers to extract information consistent with their own
decision making styles. This goal guided the design of
the user interface and the design and timing of reports.
The system can also be used to generate early warning
signals of a problem or opportunity. In particular, the
system can generate regular reports summarizing
entries made in the system during the previous week,
month, six month period, or year. Of course, a decision
maker does not want to view all entries during any of
those intervals, only those that suggest action and relate
to their (or the organization's) goals. So, the system is
set up to generate reports about those physicians,
hospitals, and/or managed care affiliates for which there
are several entries in a given interval. The default is to
generate such reports for those that have at least five
entries during the previous month, but this can be
adjusted by the decision maker if he or she finds a need
for detailed information or information over shorter or
longer periods. These summaries, when viewed as a
whole, might suggest action.
Consider the information that might be generated from a
report about physicians, as shown in Figure 2. Figure 2
shows a typical regular report that is sorted by physician,
and shows all entries regarding that physician that have
been entered during the previous month.
The five entries relating to Dr. Schremp in the database
over a six-week period are not the only information
relevant in the system. Note two additional entries are
printed in this report, one for the hospital with which Dr.
Schremp has his primary affiliation, and one for the
 Figure 2. Physician Report

The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2) 51
region in which Dr. Schremp operates. These entries are
linked automatically not only to this report, but also to all
physician reports for whom the affiliation is the Nelson
Hospital and is in the particular region. Similarly, if Dr.
Schremp were affiliated with a managed care plan, or
located in a state for which an entry was relevant, these
too would be printed on Dr. Schremp's report. In this
way, the decision maker gets the benefit of the broader
information source without needing to remember to
check other reports.
Individually, none of the statements in Figure 2 provide
any reason for action. However, when viewed as a
group, they clearly note a need for action since they
suggest that the hospital is in jeopardy of losing 5% of its
referrals in that particular specialty within a short time. It
does not tell the complete picture, because the summary
is only providing information for one doctor, so the
decision maker could run reports for the Nelson
Hospital, and could link to affiliated physicians and print
records for which there is an entry during the relevant
period, or the decision maker could run reports for all
physicians in a particular specialty to gain insight into
what the impact might be.
The system does not provide a solution, but it allows the
decision maker to view all of the facts in toto, and from
different perspectives to come to his or her own
conclusion.
Without the system, however, the hospital administrator
would likely not have had access to all of this information
simultaneously. Even if the information were available as
rumors, the hospital administrator would need to
accumulate them, link them together and verify them.
Considering the large number of physicians involved in
the hospital, the odds are against the administrator
knowing about, much less linking together, the relevant
facts about, any particular physician in a timely fashion.
In addition, deriving patterns from an internal system at
the hospital provides decision makers with what has
been referred to in the literature as social desirability of
appearing proactive, and not simply reactive to external
events (Nutt, 1998a; Swain et al., 1997).
P2. It is important to develop a query capability
that not only allows, but encourages
decision makers to examine the data from
a variety of perspectives.
The system is flexible in how it provides support to the
decision makers at the hospital. If a decision maker has
a suspicion of some activity in a particular sector, he or
she could query the system regarding that suspicion. For
example, if the decision maker knew from regular news
sources that a particular managed care affiliate was
losing physician affiliates rapidly, he or she could query
the system for entries in the system that reference that
managed care affiliate. By accessing the comments
52 The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2)
available in the system, he or she can form a more
thorough picture of what is really happening regarding
the physicians who use this hospital, and decide how
much impact this phenomenon is likely to have on the
hospital. With all likelihood, this decision maker will only
have access to the public comments available in the
database. However, if the system shows that the other
comment fields are populated, the decision maker will
know that there is more to the issue that he or she
needs to know and a readily available source of
information to complete the gaps exists (the field
representatives). Furthermore, the decision maker can
again query the system to find if there are any recent
entries regarding other managed care affiliates. This
allows the decision maker to see if there are related
opportunities or related problems that might affect how
the hospital responds to the changes in the
environment. In this way, the decision maker can
complete significant research on the issue in a very
timely manner and, therefore, be able to act upon the
information soon enough to protect the hospital or to
improve its position.
P3. Design a strategic DSS without typical
“bells and whistles” to encourage users to
think of it as a work in progress. In this
way, decision makers will be more likely to
build the system as their needs grow in a
way that is conducive to their decision
making style.
The last principle we adopted was to provide a system
that was clearly not a finished product, but rather a
system in evolution. While the system did have the
appropriate functionality to provide strategic information,
it was designed not to have the bells and whistles that
generally are associated with a delivered product in this
day of desktop computing. The goal was based on
Brugha's (1998a, 1998c) principle for supporting
qualitative decision making: make the support simple.
We wanted the decision maker's primary cognitive
concern to be the information in the system, not the
system itself. So, the CIS was streamlined to make it
quite easy to learn, and not to distract the user with
options for which he or she might not have immediate
need. This encouraged decision makers to identify other
key information that should be maintained by the system
to maximize the CIS utility to them (Cooper &
Bhattacherjee, 2001). Furthermore, such control over
design is well documented in the IS literature as a
mechanism for growing user-ownership of a system
which, in turn, increases adoption and long term use.
Finally, the simplicity of the system led to easy use,
which encouraged early adoption of the system. The
literature suggests these measures to encourage early
adoption of a system will maximize the likelihood of
continued usage over time (Parthasarathy
Bhattacherjee, 1998).
Second, and more important, we wanted the users to
think of the system as something they owned which they
could mold to their needs as they developed over time.
The literature suggests that the ability to try a system
and have its flaws adapted will increase the likelihood of
CIS usage to facilitate strategic planning (Chiasson &
Lovato, 2001; Parthasarathy & Bhattacherjee, 1998). In
this spirit, we focused on providing an infrastructure that
would allow flexibility for future uses, but did not impose
many prior biases on what those future uses might be.
The resulting simplicity of the system and
documentation allowed the hospital staff to be able to
adapt the system over time as the needs grew. In fact,
although it is new, hospital staff have already adapted
the system to respond to a need that was not anticipated
at the outset.
System Performance and Lessons
Learned
The health care delivery system exists in an ever-
changing landscape where competitors emerge and
disappear suddenly, and the environment can change
abruptly. Given the rapid pace of these changes, it is
essential that information on the competitive
environment be readily accessible to management when
making decisions that will affect the long term viability of
the corporation.
The CIS described in this paper was implemented and
used by a large Midwestern tertiary hospital to assess
changes in its environment. The examples described in
the previous section represent actual (although
disguised) applications to which the system was put.
Through its use, decision makers could identify
situations providing opportunities to secure additional
affiliations (and therefore additional patients), and to
avoid losing affiliations (and therefore patients).
1
In
fact, shortly after implementation, the system helped in
the timely identification of some changes contemplated
by a provider group that helped the hospital position
itself to avoid the loss of patients covered by a major
insurance carrier. This, in turn, put the hospital in a more
favorable position for cooperating with others in the
region, and for a successful merger with another health
system. Specifically, these decision makers found the
system provided two kinds of support.
First, the system provided early warnings of threats
and/or opportunities. By providing information while it
was still at a low level of formality (such as the first
1
While it would be desirable to provide more information about the
benefits the hospital has received from using the system, such
information would compromise confidentiality of the site.
The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2)
& stages of a rumor), decision makers were made aware
of situations earlier. Decision makers then had more
time to consider the potential impacts, available options
and consequences, which, in turn, helped them to
develop a more reasoned response to the changes.
Furthermore, since they could query the database after
being sensitized to a potential problem or opportunity,
decision makers were more likely to spot any related
phenomena that should be considered in the
development of a response. This too helped decision
makers to create more reasoned and complete
responses.
Second, the system impressed a sense of urgency and
motivation toward some actions (upon which they might
not have moved as quickly). Since the system
highlighted appearances of specific indicators
suggesting the development of a situation, and the
observation of growth in frequency and/or amplitude of
indicators, decision makers did not need to spend time
pondering the meaning of the data. Instead, the system
provided distinct directions for their attention and distinct
likely consequences of inaction. This helped decision
makers to act quickly. Of course, after seeing the
system “work,” decision makers were more likely to trust
its power, and, thus, see increasing urgency in response
to problematic conditions.
From our experience with the implementation, we
identified three keys to success used to launch this
system that should not be ignored in future work.
P4. Incentives should be established to ensure
regular acquisition and accumulation of
data about the environment.
The first key to the system success was in the regular
acquisition and accumulation of information that could
be translated into actionable knowledge; the absence of
this information would have made the system unusable.
To ensure that representatives entered data in a timely
fashion, we established a personal value for the system,
so the effort would not be seen as just another add-on
activity. Clearly, the simplicity of the system, and the
ease of its use contributed to the representatives being
willing to work with the system.
The feature of the “private” notes in the record (which
were only accessible by the individual representatives)
was an incentive for representatives to use the system.
Since this feature allowed them to keep notes for
themselves, it provided a medium for them to create
reminders and recommendations, and to track their
clients in a manner they had previously been unable to
do. Once the representatives learned the ease with
which they could track their clients, they were
encouraged to use the system for their own purposes.
In addition, to ease the use of the system,
53
representatives were given a job “perk”, the exclusive
use of a laptop computer. This provided not only a
recognition of their contribution to the organization, it
eased their use of the system to record information in
both the private and public areas of the system. The
ability to populate the private records, and thus to
complete their own jobs more easily, especially when
coupled with what was seen as a significant corporate
perk, provided representatives with the incentive to use
the system. Once they were using the system regularly,
it was not a significant burden to add the collection of
related information as well.
P5. Regular and meaningful summaries of data
are crucial to ensure system use.
As data were added to the system regularly, the second
key became important: the regular and meaningful
summary of the entries in the system. It is critical that
decision makers not be required to sift through large
amounts of data and to link together relationships on
their own. Even though the system was easy to use,
decision makers tended not to think of getting
information from the system as their first option. Hence,
rather than relying upon them to query the system
regularly, we created a reporting mechanism that would
bring ideas to the attention of the decision makers
quickly. This further encouraged early adoption, because
the information was “chauffeured” to the decision maker
at the outset to help them experience the value of the
information and hence the system before they learned
the specifics of running the system (for themselves).
This provided the extra value to encourage the decision
makers to accommodate the system in their regular
choice processes (Chiasson & Lovato, 2001; Verkasalo,
1998).
But, a conventional reporting system would not meet the
needs of the decision makers. The CIS was intended to
make information accessible to decision makers so they
could weigh those data in light of their experience and
wisdom. Without some summarization and screening,
the amount of information is too large for the decision
maker to process carefully, and thus runs the risk that
the system will overwhelm the decision maker in much
the same way that e-mail does in some organizations
(Lederer & Sethi, 1988). On the other hand, regular
reporting of the volume of instances within categories
helps to provide decision makers with a “sense” of what
is happening in the system and to where their attention
should be directed.
The summarization was accomplished by providing
statistics for the number of entries during the reporting
2
cycle . Clearly those with only a few entries during the
2
The periodicity of reporting depends on the rate of change of
factors in the environment. For this application, we selected a weekly
reporting cycle to obtain currency in the events as well as a monthly
54 The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2)
cycle were less crucial for attention than those for which
there were many entries during the cycle. This increased
the efficiency by which decision makers worked with the
system because they only needed to consider a relative
minority of the entries in any given cycle. This helped
decrease the likelihood that our system would overload
decision makers. Of course, they still had access to the
complete set of entries if preliminary analyses suggested
the need to read the records completely.
These reports required the a priori definition of an
indexing system for the entries. In order to make
information available to decision makers as soon as
possible, records were coded as they were entered. In
that way, records immediately were identified as to their
relevance on key issues of importance to decision
makers. Hence, once the information was in the system,
decision makers could use it immediately through a
query capability; there was no untoward delay as
someone decided how to represent the information to
management. Such an indexing system allows the
system to report regularly on those items for which there
have been entries in a fixed time period. This allowed
decision makers to consider the entire record at one
time as a way of showing the big picture that might
suggest a problem or opportunity. The early availability
of the index also allowed developers to build in linkages
between categories of indices. For example, if all entries
about a particular managed care affiliate were a
complaint, even if they were only minor complaints, the
total record suggests a need for additional attention to
that affiliate. Or, if a large number of negative entries
about a specific group of physicians were eventually
disproved, that might suggest a need for more attention
either to the group of physicians or that there was a
problem with the employee who first entered the
information. In this way, decision makers could examine
not only specific information in the system, but also
patterns in how the information was being entered.
Since these patterns were also recorded and accessible,
this allowed decision makers to investigate both linear
and nonlinear relationships and easily query the system
for additional explanatory information.
P6. Statistical summarization of qualitative data
provided a sense of legitimacy to the data
and encouraged usage by decision
makers.
As stated previously, the data entered into the system
were qualitative indicators of changes in the
environment. Many decision makers viewed the data as
no more than rumors, and therefore not worthy of their
reporting cycle to obtain a “long term” perspective on what was
happening. Less volatile environments might have only the monthly
perspective or a combination of monthly reports for currency with a
quarterly or semi-annual reporting cycle for perspective.
attention, and not “legitimate” decision support. They
had a different view of the report, and summary statistics
associated with the report, which were viewed as useful.
Once the data were entered into the system, and
provided from the computer, it metamorphosized rumors
into “qualitative data,” which were legitimate support for
decision making. Even if humans could keep track of the
wide range of data that came into the CIS, and
processed it in the same manner, it would not have had
the same impact as did the system. In the former case,
the data would still be “rumors,” and thus not appropriate
for decision making.
Once decision makers found a pattern of responses that
was of interest, the flexibility in the system allowed
decision makers to query it for additional information.
This might include the more detailed descriptions of the
comments provided in the individual records. Or, it might
include the search for similar situations involving other
entities of the system. Ease in looking at features from
different perspectives clearly was the third key to the
success of the system.
While this paper illustrated the use of a system in the
health care environment, clearly the need for such a
system is not limited to the health care market, but
would be of use to any organization pursuing strategic or
competitive decision making. Corporations trying to
decide among two paths for product development could
find valuable insights from this kind of information. Sales
representatives who interact with the public on a regular
basis could share information about what customers like
and do not like about current products. This information
might include a list of developments that would convince
potential customers to switch to the company's product
as well as what aspects would, if changed, cause
current customers to switch to competitors' products.
Taken as a whole, the record would, of course, give the
decision makers direction about how to proceed. More
important, though, it would help them understand the
implications of making particular choices.
Political candidates with a well developed grass roots
system might similarly use a CIS such as the one
described herein to help them understand how their
positions and actions affect the voting populace. Or,
such a system might be employed to help managers
understand the desirability of a newly instituted sales
incentive. In each of these cases, the CIS provides
detailed information that other forms of data-gathering
are not likely to collect. Further, the CIS provides
decision makers access to the information earlier than
other forms of data-gathering since the system
encourages users to enter information early, and
certainly before rules of statistical significance would
apply. This, in turn, allows the decision makers to act
upon the information before competitors have access to
it or before it could be damaging in the eyes of
customers, employees, or constituents.
The DATA BASE for Advances in Information Systems - Spring 2005 (Vol. 36, No. 2)
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About the Authors
Vicki Sauter is a Professor of Information Systems at
UM-St. Louis. She publishes in the area of systems
development and design, with a particular focus on how
decision processes affect design criteria. Her current
focus involves both the design issues for internet- and
intranet-based decision support, and trends of women in
computing. She has one book and many publications in
scholarly journals. Email: Vicki.Sauter@umsl.edu
Donna Free is the Coordinator of Graduate Business
Programs and an Accounting Instructor at Oakland
University. She joined Oakland University last year. Prior
to moving to Michigan, Donna was a member of the
accounting faculty at UM-St. Louis for the past eleven
years. Donna is a CPA and has a Masters in
Accounting. She started her career in public accounting
with the firm Ernst & Young. Email: free@oakland.edu
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