CASE STUDY RESEARCH REPORT ALEXANDRA HOSPITAL

2013

Swinburne University of Technology

4/28/2013

Han Chen 1728709

Kathy Tovar 2090899

Joshua Chu 9720332

Kagure Muriithi 2044005

EXECUTIVE SUMMARY

The report aims to provide information base on the case study Alexandra Hospital

(AH).In particular, the study case is focus on how the process of innovation has

successfully leveraged on experience design to transform AH and provide good and

affordable basic medical to patients.

AH is a medical centre that delivers consistent, excellent quality care and services in

order to build a healthy nation. For the purpose of this analysis different sections

have been described. The first section will give and introduction to the case study

and overview of the AH. The following sections are referred to the applicability of

technologies in relation to the improvement of health services towards hassles-free

vision. Ideally, this will describe in a very detail how the AH transformed healthcare

services with technology fully exploited. Enterprise system (ES) will be associated

while describing the process of change realised by the existing team of AH. Finally, a

summary and conclusion will be mentioned as part of the learning outcome.

TABLE OF CONTENTS

EXECUTIVE SUMMARY ...................................................................................................... 1

REPORT INTRODUCTION ................................................................................................... 3

ORGANIZATION OVERVIEW ............................................................................................... 3

ENTERPRISE SYSTEM IN RELATION TO CASE STUDY ................................................... 4

BUSINESS OBJECTIVES ..................................................................................................... 5

PACKAGE SOFTWARE ....................................................................................................... 7

ENTERPRISE SYSTEM SELECTION CRITERIA ................................................................. 8

CRITICAL SUCCESS FACTORS OF ES .............................................................................. 9

SAP BUSINESS ELEMENTS .............................................................................................. 11

CULTURE ORGANIZATION ............................................................................................... 12

EPC DIAGRAM ................................................................................................................... 13

EXTENDED ENTERPRISE SYSTEM ................................................................................. 15

SUMMARY & CONCLUSION .............................................................................................. 16

REFERENCES ................................................................................................................... 17

REPORT INTRODUCTION

This Case Study report is on the Alexandra Hospital and how they have attempted to

create a primary position in the health industry in Singapore. The Alexandra hospital

prides itself in the exceptional service it provides to its patients and how it aims to

provide safer and better quality medical environment in the industry. The modern

hospital, according to Alexandra Hospital, 2010, lies in approximately 100,000

square metre lands and was begun in 1938 with about 500 bed capacities

(Alexandra hospital, 2012).

Public entities of the 21st century have realised that it is time to position themselves

and change lest they lose to their competitors. Alexandra Hospital has realised that

the only way to do this is to do it through employing innovative IT solutions into its

operations. They have also realised the most economical and relaxed way to do this

is by integrating different hospital departments to churn hospital traffic while using

minimal effort.

This report will focus on Alexandra Hospital’s integration of Business enterprise

systems including the formation of the Clinical Digital dashboard in conjunction with

the Bed management System (BMS) as extended systems. The report will provide

analysis based on questions asked and suggestions that the Hospital may benefit

from in the implementation of the system. The major concept involves the integration

of the enterprise system, its benefits, disadvantages and success factors. We will

see how best practices can be adopted to deliver effective and efficient quality

service.

ORGANIZATION OVERVIEW

The Alexandra Hospital (AH) was originally established in1938 as a British Military

Hospital in Singapore. This was an institution that embraced modern medical

technology right to the 1970s. In 1971, the original hospital was passed to the

governmental authorities of Singapore for a sum of $1 and was renamed as

Alexandra Hospital. During the same year, it was officially opened to the general

public. The AH had undertaken a remodel in the year 2000 and came to be an

associate of the National Healthcare Group (NHG). After the major restructure, its

medical facilities and services have been constantly upgraded in order to provide a

better standard of quality services towards a hassle-free. A new health center was

opened in Yishun and named Khoo Teck Puat Hospital (KTPH) on May 2007. The

team member responsible for running the new medical centre was comprised by

existing team in AH. The following year, the KTPH and AH were joined together and

formed Alexandra Health with the restructuring.

AH has been managed by Jurong Health since August 2010 until the completion of

Jurong General Hospital by the end of 2014. To date, an extensive range of medical

services and care are still provided by AH.

ENTERPRISE SYSTEM IN RELATION TO CASE STUDY

A. Keywords applied in the case study

Off-the-shelf: It refers to the computer software and hardware that are able to

immediately suit for the requirement of company, or only needs to have slight

changes. Packaged software (off-the-shelf) is standardized and ready-made, in

some situation it might not fit for a particular use.

In this case, one example of the AH’s adoption of off-the-shelf software is the

implementation of Cisco Clinical Connection Suite (CCS) for its bed management,

and using GlobeStar System’s ConnexALL software as the integrative solution to

Cisco IP Telephony system.

Transaction Processing System: Transaction Processing System (TPS) refers to

the basic information system that serves a company’s daily activities. The TPS is

capable to collects, modifies, and retrieves relevant data.

According to the case, Clinical Digital Dashboard (CDD) at the Department of

Emergency Medicine (DEM) is an example of transaction system. CDD records all

patients’ health condition and then displays the data to doctors, enable them

prescribe medication at one go.

Management Information System: Management Information System (MIS) is the

development and use of information systems that help business achieve their goals

and objectives (D Kroenke, 2010).

In this case, the Bed Management Systems (BMS) is a comprehensive solution for

bed management that provides real-time monitoring of bed availability for patients.

Common Core Business Processes: Common Core Business Processes refers to

a series of activities that are performed among different department in an

organization in order to achieve their goals. The common core elements are usually

include marketing and sales, accounting and finance, technology support, human

resource management, and supply chain management.

In this case, the hospital delivered an in-time medical treatment through its CDD

system, and when patient require bed, AH’s BMS is able to allocate a vacancy. All

these activities are including the hospital’s sale process.

BUSINESS OBJECTIVES

When Alexandra Hospital started using the enterprise system, the first thing they

may have seen improve may have been the speed of business processes and work

flow. Since most operational and process systems were linked together, information

flow became faster than before. This would have reduced the waiting time of the

patient bed requirement. Also, because the system would link between the

accounting system and cashier counter payment system, all payments would group

the one bill under the patient name, which would only be a click away. He patient

would then evidently be satisfied by the effectiveness of our processes.

The integration of CDD and BMS would mean that operation within the DEM would

move faster which means more lives would be saved per second. As patients move

from DEM to admissions, doctors and nurses would have real-time information on

the patient to follow-up and identify development of patient status. As an example,

this would help in diet; integration with the kitchen, prescription; integration with

pharmacy, close monitoring and care in reference to doctor’s instructions.

In the long –run, patients are expected to be discharged as fast as they were

admitted. There will be no excuse not to give them the best care they need when

they need it. The ease of information access would enable the doctors in the DEM to

quickly share information and efficiently hand-over to ward doctors and staff. This

improves workflow and reduces the chance of accidents and conflicts arising.

A. Long Term

Long-term goals according to My Blue-print (2012), are goals to be achieved in the

future. They probably take a year or more. Though they may be difficult to

accomplish, they are often the most meaningful and important measures of success.

Setting a phenomenal standard for the healthcare industry in Singapore

Improve the Alexandra hospital environment to ensure quality and safer

medical services

To exploit value-added activities

To reformulate old systems of care

To redesign healthcare services around patient needs

B. Short Term

According to Connick 2013, a short-term objective is a target that can be achieved

between three to six months in the future and is normally easy to achieve. The ones

below apply to the case study;

To improve work-flow

To ensure seamless flow of patients to in-patient wards

To use innovative IT solutions

To work in synchrony with operation teams

To increase nurse-patient interaction

Improve bed turnover

To increase overall business process efficiency

To improve overall patient experience

To reduce waiting time and other administrative processing time

To capture and store patient information and use it efficiently with ease of

access while maintaining privacy

Reduce administrative processing time

To enhance patient services through exploitation of technology

To maximize communication between parties both external and internals

PACKAGE SOFTWARE

A. Advantages & Disadvantages

First of all, off-the-shelf software is a good solution for organizations with

standard business process, as it suits organizations’ own needs. Second,

compared to in-house development, packaged system is generally more

inexpensive and easier for staff training. However, there are several

disadvantages that off-the-shelf system will bring. First, because the designer is

actually outside the company, he might not understand some crucial factors of a

business, and the off-the-shelf system may not wholly suit a company’s special

need. Second, packaged software are not fully tested for a long period, and it

might have the chance to crash during certain situation, which might cause

financial loss of organization, or even worse, casualties. In the case, NYP

(college) student took charge in designing the new system at early stage. If it was

not properly controlled and unprofessionally developed, the hospital could face

the situation of system crashing, losing valuable data, and improperly treatment

of patient.

B. Case Application

According to the case, the hospital needs a new system that allowed doctors to

access to both historical and current data of patients, and reduce their waiting time

and total time spent at Department of Emergency Medicine. To satisfied all the

needs, the hospital has obtained the supports from Fujitsu Asia to implement the

CCS, implemented GlobeStar System’s ConnexALL software, and Cisco IP

Telephony system at the BMU to bridge communication gaps. All of the above

forming of a system seamlessly suit for the hospital’s need.

The reason why AH have not built system in-house is related to its resource

constrains and limitations, from where an important one is the cost factor. Since the

small hospital did not have the financial capability to spend money on a costly ‘in-

house’ system development, collaborating with NYP, the hospital finished all the

work of design, development and deployment of innovative IT solutions, which also

satisfied the hospital’s need with a balance of finance

ENTERPRISE SYSTEM SELECTION CRITERIA

A. Criteria

Company: This criterion is referred to choose the adequate Enterprise

System (ES) according to the company requirements and size.

Ease of use: The use of the software should be ease and straightforward.

This will influence in a lower cost of training employees and more efficient

tasks done.

Integration: The ease communication of different systems. More

generally real time enterprise systems are configurable information systems

packages, implemented on-line that integrate people, technology and

information processing. ES software should also give support all areas, must

be complete and integrated. The modules should be configurable for each

task.

Flexibility and adoptability: Evaluate to what extent the needs of the

company are included in the standard, and what parts should be develop out

of this standard. It is more referred to change or adopt a package easily.

Scalability: An ES solution must be prepared in case of the company growth

to scale the solution without a minimum effort, incorporating new modules,

database servers and even new companies.

Security: In a company, there is confidential information that should be

accessed only by authorized personal. For this reason, the system must

implemented different levels of access.

Price: Evaluating the cost of implementation is an important factor for

companies. The associated costs should define what it covers.

Vendor support/ reputation: It is important to assess its strength, historical

evolution and customers.

B. Case Application

Integration

AH required to improve the way of communication between BMU and Ward

13. The type of communication was mainly by static displays and phone calls,

resulting in an increased of waiting time. Another approach was to share real

time information about patient’s information and bed availability. All this was

achieved with the integration of the Cisco Clinical Connection Suite (CCS) for

its BMU and ConnexAll program as integrative approach to IP Telephony

system. Fujitsu Asia played the role of system integrator to organize

housekeepers, the ward nurses and BMU to arrange the beds for the admitted

sick person.

CRITICAL SUCCESS FACTORS OF ES

A. Critical Success Factors

Implementation of an enterprise system is successful if it offers all the

functionality that the organisation requires throughout the entire organisation with

minimal effort. According to Nah & Lau (2001), this means that an organisation’s

business processes should integrate with the system’s standard package so that

the business maintains its general strategic vision.

Another success factor is the inclusion of the users in the design and

implementation of the system’s Business process through formal education and

training. This is especially important as it counters resistance to change, one of

the greatest challenges in implementing a business enterprise system. Monitoring

and feedback at this time is important as it helps foresee crises and

nonconformities that may potentially arise in the course of its use.

A third success factor is the identification and establishment of Key Performance

metrics to enable users to gauge the benefits the addition of the system has

brought to them. According to Lee and Lee (2012), targets are important to

monitor progress of any project as they are indicators that the stakeholder’s

expectations have been met. Every organisation should outline key performance

indicators before they implement an enterprise system that they will use to

measure the success of the system on their businesses processes.

B. Case Application

Unfortunately, Alexandra Hospital has not clearly stipulated its system’s success

key performance indicators in this case study. However, we can use its project

objectives to gauge on how successful they have been so far.

According to the case study, Alexandra hospital staff participated in the

implementation of the Clinical Digital Dashboard (CDD) by providing input on how

workflow would be improved through the DEM to reduce resource constraints and

maximize value-adding activities. As the staff supported each other and openly

contributed, the system was designed with ease of use that eluded a sense of

familiarity to their former business processes. Suggestions were positive and

effective bearing in mind that the then head of DEM knew what he was doing as

he was skilled in IT.As senior staff had an infectious positive attitude and

cooperation towards learning the new system, it made it easy to learn about and

train lower-level staff and management. Commendable team-work and an open-

minded work culture also greatly contributed to successful implementation of the

system. Consistent and constructive communication was key to Alexandra

hospital’s successful project.

The system managed to reduce patient registration time and consultation.

Through ‘project Phoenix’, Doctors and nurses would operate in synchrony to

reduce out-patient contact time. The more the time reduced and quality of output

was increased, the more successful the system was. For example; according to

Teoh, Pan & Wang (2008), the average waiting time at the DEM was reduced

from 40 minutes to 20 minutes while bed waiting time reduced by 30%. The

system was tested on its ability to increase efficiency of bed turnarounds through

reducing communication between bed allocation teams and reducing effort

needed to prepare a bed for the next patient using real-time information.

Sustainability of this system and increase of client satisfaction or increased churn

of valid hospital admissions and transferrers would be rendered valid key

performance indicators of system success.

SAP BUSINESS ELEMENTS

A. Sales Area

Alexandra Hospital delivers only medical service and medicines to its customer,

since there is only one plant of the organization, it is simple to identify the structure

of the whole business. As a medical service provider, AH’s distribution channel is

through all its administration staffs, nurses and doctors. Each of the channels has

specific divisions of free & charged services and products. To sum up, there are five

general product divisions created in the hospital, and under each of them more

specific functions are existed.

Alexandra Hospital

1000

1000

Direct through Doctors, Nurses,

Admin staffs

Division 1:

01. Patient Inquiries

Division 2:

02. Appointments

Division 3:

03. Ward Services

Division 4:

04. Medical Treatments &

Nursing

Division 5:

05. Prescription Medicine

Client

Company

Code

Plant

Distribution

Channel

CULTURE ORGANIZATION

A. Organizational & National

Culture has been described by Schein (1985) as the basic assumptions,

values and artefacts which influence how people view the world and how they

behave. Organisational culture plays a critical role in ES implementation

success. Indeed ESs have also demonstrated challenging to implement even

in Western companies, often because of an underestimated requirement for

change management and the repositioning of roles and their meaning for

actors (Boersma and Kingma, 2005). The majority of organisational practices

are affected not only by societal aspects, but also by the considerations

suitable within an organisational sector, public or private. Private

organisations differ from public organisations at three distinct levels-

individual, organisational, and environmental (Heintze and Bretschneider,

2000).

B. Impact of culture on ES implementations

It is often argued that information technologies have the potential to transform

organizations and entire industries (Crowston and Myers, 2004), but the

extent of the ES over the whole company and the challenges of organizational

change required, the ES are distinguished from other information

technologies (Kumar et al., 2002).

Lines (2005) describe the ability to implement new technology, such as

valuation positive or negative which together make the members of the

organization for this initiative. When the perception of an member of the

organization departs from the perception others have on a specific technology

or the technology deviates from the cultural values that has built the

organization, it begins to be conflicts associated with the introduction of this

technology (Leidner, 2010). This causes employees to be more likely to

resist, to oppose, to despise, frustrated and trying to sabotage the change

initiative, causing it to failure, but if instead the employees have positive

attitudes toward the change organizational, they are likely to support and

facilitate the implementation of the initiative, getting a benefit to the entire

organization (Elias, 2009).

EPC DIAGRAM

A. AH organization

B. Process improvement

Since the Bed management unit will be show states on JIT mode. JIT show

information in real time process. By using JIT will allow staffs know information as

fast as possible. To make the process more affection, consider if the first

consultation doctor already has rights to request a bed unit for patient. System of

Bed management will quicker show up the requirement. Although it only a small

change, however it will improve the environment of working a lot. Manager will have

more time to get ready for new place for coming patient and provide better

arrangement.

One of the big jobs in hospital is turnover of new bed unit. Compare with Hotel, hotel

will able to have a better preparation because of the reservation system. However in

hospital normally patient not available to do a reservation since it is accident. The

other way to improve flexible of be management will be put high potential patient on

list. Staff will clearly now up to stage will need almost numbers of bed. And all of it

allows manager easier to manage the bed system and hold bed to people more

serious.

EXTENDED ENTERPRISE SYSTEM

A. Bed Management System(BMS)

This system was used to increase workflow coordination in regard to bed-

space availability. The aim of this system according to Teoh,Pan & Wang

(2008) was to ensure a ‘Just-In-Time’ resource allocation in hospital bed

management that was to result in better turnover for patient beds.

Communication involving patient information through the phone was

minimised while resourceful bed utilization was maximized thus reducing bed

waiting time. By increasing the speed of admission, efficiency of workflow

increased and the hospital was seen more as customer-focused and confident

in their operations. The system was also an integral assistant in future

planning of admissions.

B. Clinical Connection Suite(CCS)

This is an innovative IT solution which utilises the wireless LAN infrastructure

and complements the BMU system to enhance Nurse-Patient interaction.

According to Teoh,Pan & Wang (2008) , this system also bridged the

communication gap between ward 13 and BMU and enabled access to real-

time patient information. Nurses can extract patient’s status through a colour

coded setting as they have patient information available on monitors. The

system enabled nurses to prepare for incoming patients without hustle. In the

recent future, Alexandra Hospital may be looking to use the system to

respond to patient movement faster as they milk the technology’s potential.

SUMMARY & CONCLUSION

Alexandra Hospital is a model example of proper enterprise system implementation

using the cheapest existing resource. The organisation has well utilised its staff and

positive work culture to effectively ease their business process and streamline their

workflow. Positive support from technical staff and setting of a good example from

top management has led to great system-human interaction.

We have seen how the good SAP design would enable hospital staff to focus on

what matters more and spend more time with clients. Integrating business systems

and operations has helped to reduce costs and increase efficiency.

We have seen how combining BCM and ccs had brought real-time time information

to easy access helping staff to re-design their work roles to serve clients better. The

collaboration has also lead to the success of several partnerships that would be

helpful; to further develop the entity. We have also seen how the Clinical digital

dashboard maximised use of the limited floor space as to enable access from a

centralised position.

Though only time will tell, as far as we can see, the project looks promising if proper

management continues.

REFERENCES

[1]Alexandra Hospital, 2010, Alexandra Hospital, Page viewed April 23 2013

http://www.ah.com.sg/page.aspx?id=125

[2] Connick, W 2013, ‘Setting Short-Term Goals’, page viewed 23rd April 2013

http://sales.about.com/od/salesplanofaction/a/Setting-Short-Term-Goals.htm>

[3] Lee, SM and Lee, SH, 2012, ‘Success factors of open-source enterprise

information systems Development,’ Industrial Management & Data Systems, vol.

112, no. 7, pp. 1070, Emerald Group Publishing Limited, page viewed April 20 th 2013

www.emeraldinsight.com/0263-5577.htm

[4] Teoh, SY, Pan, SL and Wang, P 2008, ‘The Alexandra Hospital: Implementing

Healthcare Information Systems’, Asian IT case Centre, National University Of

Singapore.

Swinburne University Of Technology

Faculty of Information and Communication Technologies

ASSIGNMENT AND PROJECT COVER SHEET

Subject Code:_HIT 2416/6416______ Subject Title:_ENTERPRISE SYSTEMS_______

Assignment number and title;__ASSIGNEMENT 1-CASE STUDY REPORT_ Due date:_28TH APRIL 2013_

Lab/tute group:______ Tutor:__________________ Lecturer:__Phil Joyce__

Family name:________________________________ Identity no:______________

Other names:________________________________

To be completed if this is an individual assignment

I declare that this assignment is my individual work. I have not worked collaboratively nor have I copied

from any other student’s work or from any other source except where due acknowledgment is made

explicitly in the text, nor has any part been written for me by another person.

Signature:____________________

To be completed if this is a group assignment;

We declare that this is a group assignment and that no part of this submission has been copied from any other

student's work or from any other source except where due acknowledgment is made explicitly in the text, nor has any part been written for us by another person.

ID Number Name Signature

1728709 Han Chen _______HCH________

2090899 Kathy Tovar _______KTP________

2044005 Kagure Muriithi ___KMM____________

9720332 Joshua Chu ___JCH____________

Marker's comments:

Total Mark:__________

Extension certification:

This assignment has been given an extension and is now due on ______________

Signature of Convener:______________________