Improvement of hospital processes through business process management in Qaem Teaching Hospital: A work in progress.

In a world of continuously changing business environments, organizations have no option; however, to deal with such a big level of transformation in order to adjust the consequential demands. Therefore, many companies need to continually improve and review their processes to maintain their competitive advantages in an uncertain environment. Meeting these challenges requires implementing the most efficient possible business processes, geared to the needs of the industry and market segments that the organization serves globally. In the last 10 years, total quality management, business process reengineering, and business process management (BPM) have been some of the management tools applied by organizations to increase business competiveness. This paper is an original article that presents implementation of "BPM" approach in the healthcare domain that allows an organization to improve and review its critical business processes. This project was performed in "Qaem Teaching Hospital" in Mashhad city, Iran and consists of four distinct steps; (1) identify business processes, (2) document the process, (3) analyze and measure the process, and (4) improve the process. Implementing BPM in Qaem Teaching Hospital changed the nature of management by allowing the organization to avoid the complexity of disparate, soloed systems. BPM instead enabled the organization to focus on business processes at a higher level.

INTRODUCTION

In the current turbulent and uncertain economic times, organizations need to be more agile and competitive.[1] Today's businesses not only must meet global competitive threats; however, they also need to do so while complying with ever-increasing government, industry, and internal regulatory requirements. Meeting these challenges requires implementing the most efficient possible business processes, geared to the needs of the industry, and market segments that the organization serves globally.[2] Over the last decade, the concept of “business process” has entered the business mainstream. Leading organizations in virtually every industry have discovered that by harnessing, managing, and redesigning the organizations business processes, organizations can achieve spectacular improvements in business performance, and customer service.[3] The continuum of the reform movement starts with a total quality management, then business process reengineering, and after that we saw the emergence of business process management (BPM). All of them have been some of the management tools applied by organizations to increase business competiveness.[4] BPM technology has become an important instrument for supporting complex coordination scenarios and for improving business process performance.[5] BPM can be determined as a field of knowledge at the intersection between management and information technology, involving all necessary sources such as humans, organizations, applications, documents, and further information sources.[6] In a similar vein, employees with high job satisfaction are likely to exert more effort in their assigned tasks and pursue organizational interests. An organization that fosters high employee job satisfaction is also more capable of retaining and attracting employees with the skills that it needs.[7] BPM is a rather new concept in management that promises many advantages to the organizations;[8] however, in various forms has been around for the last 10-15 years. During this time, BPM has progressed to a holistic management.[9] It is a structured method of understanding, documenting, modeling, analyzing, simulating, executing, and continuously changing end-to-end business processes and all relevant resources in relation to an organization's ability to add value to the business. It is the current term utilized to encapsulate a process-driven approach to attain enterprise operational efficiency.[10] Organizations increasingly recognize the requirement for an increased process orientation and require appropriate comprehensive frame-works, which help to scope and evaluate their BPM initiative.[11] It requires the freedom to modify organizational structures and free core business processes from non-value adding activities. In business sectors like health-care, there are a variety of legal restrictions and treatment guidelines practitioners have to comply with.[12] Hence, freedom to reorganize the organization and to omit non-value adding activities is heavily compromised. In business sectors like health-care, on one hand, there are a variety of legal restrictions and treatment guidelines practitioners have to comply with. Hence, freedom to reorganize the organization and to omit non-value adding activities is heavily compromised.[13]

On the other hand, health-care organizations are faced with increasing complexity of care, diminishing resources, and increased regulatory oversight. Providers are attempting to improve quality and efficiency while trying to decrease costs in an effort to maximize “value”.[14] A main discipline in dealing with this matter is business process modeling. Key elements of the business process modeling discipline are as follows:

Optimizing the performance of end-to-end business processes that span functions, as well as processes that might extend beyond the enterprise to include partners, suppliers, and customers;

Keeping the business process model in sync with process execution;

Empowering business users and analysts to manipulate a business process model to modify instances of the process; and

Enabling rapid iteration of processes and underlying systems for continuous process improvement and optimization.[6]

In this context, with this study, we analyze BPM as one of today's prominent management trend for organizational change, in “Qaem Teaching Hospital” in order to examine its efficiency in the mentioned organization. Finally, the survey results of implementation of BPM in the mentioned hospital are presented. “Qaem Teaching Hospital” is one of the main referral health centers, which is located in Mashhad city of Khorasan province in Iran. Its space is 2000 m2; the hospital has 19 par clinic units (physiotherapy, laboratory, radiology, endoscopy, etc.), 21 clinics (General Surgery, Gynecology, Obstetrics, and Plastic surgery, etc.), 20 departments (Surgery, Gynecology and Obstetrics, ENT, etc.), and many research units (Rheumatology, Orthopedics, Endocrinology, Dermatology, and Nutrition, etc.).[15]

MATERIALS AND METHODS

This study is an original article that is performed in Qaem hospital affiliated to Mashhad University of Medical Science. The project scope included three to five preferable processes that are selected by process improvement committee. Achieving to project goals the action plan identified and determined. Process improvement project was implemented in four phases. The first phase consists of identifying the present situation and the priority processes. To implement business process redesign several best practices can be distinguished.[16] Then, the processes were organized through the four steps presented below:

Conducting expert interviews with senior managers

Teaching the concepts of process

Holding workshops for pilot-selected processes

Organizing process's teams.

As mentioned in step 3, workshops were hold in order to select list of top priority processes under the supervision of managers and executives. The selected processes were examined in the project for improvements. A form of prioritization processes has been used to determine the precedence of processes. The results of this step are summarized in Tables 1 and 2.

Table 1

The form of prioritization processes in order to determine the precedence of processes

Table 2

The form of Organizing Process's teams and person in charge

Business process modeling has gained widespread acceptance as a valuable design and the management technique for a variety of purposes.[17] The second phase is the modeling of the selected processes, which comprises four steps, which as follows:

Providing an overview of the processes’ concepts,

Training modeling techniques,

Holding workshops on modeling and documenting the pilot processes, and

Teaching developing indicators

The third phase is aimed at identifying issues, summarizing and improving the selected processes. This phase consists of three steps mentioned below:

Addressing issues, finalizing the processes’ information forms and drawing workflow diagrams.

Instructing improvement techniques.

Organizing workshops on how to improve the pilot processes and modify work-flow. This step comprises filling in the “analyze and engineer a process” forms, identifying improvement opportunities, and relevant actions. The recognized opportunities and improvement actions must be confirmed by the pertinent managerial positions.

Last but not least is the fourth phase which is aimed at summarizing and finalizing the documentations of the selected processes? This phase consists of the following four steps:

Finalization the improvement proposals

Developing ID for selected processes

Developing and training the process management bylaws which includes documents’ guide, procedures for updating the processes, recording and analyzing the applied procedural information, constructing analyzing tables, measurements and defining the improvement actions

Presenting the achievements of the improved processes in the organization.

After implementing all the above steps, for each elected process the “process improvement action plan” form is filled out. Finally, the proposed improvement action plan for each process is applied.

In Tables 3–7, examples of “process improvement action plan form” for different units of Qaem Teaching Hospital have been shown. For each unit, the problem and improvement stately and action plan have been defined.

Table 3

The form of process improvement action plan for get medication's discount from social worker unit process

Table 7

The form of process improvement action plan for drug and supply recording in Health Information System process

CONCLUSION

The recent push for health-care reform has caused healthcare organizations to focus on ways to streamline their processes in order to deliver high-quality care while at the same time reducing costs. Health-care processes are very complex, involving both clinical and administrative tasks, large volumes of data, and a large number of patients and personnel. Health-care processes are also very dynamic.[18] Health-care processes require the cooperation of different organizational units and medical disciplines. In such an environment, optimal process support becomes crucial.[19] The main progress has been achieved through emerging concepts of business processes, business process orientation, and business process developments. The steadily growing number of published articles in empirical BPM research shows an increase in interest in the research field.[20] BPM gains importance in the industry as well as in the health-care organization. In this study, BPM was implemented in Ghaem Teaching Hospital in order to examine the resulting outcomes of establishing BMP in the organization. Although, the results show significant improvements in the selected processes, there is still room for more investigations, and we hope that the current study has paved the way for conducting more research in this area, especially in Iran.

Table 4

The form of process improvement action plan for dismissing process

Table 5

The form of process improvement action plan for admission patient in radiotherapy department process

Table 6

The form of process improvement action plan for admission process