CHAPTER - 6
STRATEGIES FOR IMPLEMENTATION OF MIS IN
HOSPITALS
CHAPTER 6
STRATEGIES FOR IMPLEMENTION OF MIS IN HOSPITALS
6.1 Competitive forces model for the hospital
Information systems can play a major role in support of the strategic
objectives of an organization. This strategic role provides a hospital organization
with competitive services that give it a strategic advantage over its competitors. A
hospital can survive and succeed in the long run if it successfully develops
strategies to confront five competitive forces, as illustrated by the competitive
forces model in chapter 2, to shape the structure of competition in its area of
service.
Countering Competitive forces:
The sampled hospitals stand in the environment surrounded by five
competitive forces. The traditional competitors are the other hospitals presently
providing the same type o f services - inside and outside Manipur. The patients
are the customers o f the hospital receiving the services. They expect quality
health care, at least comparable to the ones in the adjoining state like Guwahati.
The customer s le\el ot awaieness about the quality of services has been further
upgraded by way o f access to information technology, and education. Further,
patients expect good relationship besides satisfactory services. Otherwise, patients
switch over to other hospitals, preferably outside the state. It is very important to
have good relationship with the suppliers of medical and non-medical goods and
items, because of the barriers imposed by locational disadvantage and
communication bottlenecks. Substitute products in the form of new ways of
treatment are emerging. 'I'he hospitals need to upgrade the technology employed
for the treatment process.
6.2 Strategics to deal with the competitive forces
The organization can use four basic competitive strategies to deal with
these competitive forces.
1. Scrvicc differentiation : Hospitals can develop brand loyalty by creating
unique and new services that can be distinguished from those of the
competitors, and/or potential competitors.
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2. rocusea aijicremumon: i ne hospitals can create specialized service that
discourages potential competitors.
3. Developing light linkage to customers (patients): The hospital can create
relationship with the patient’s and community by deed of good services.
The customer relationship management (CRM) is to build switching
costs into the relationship between a hospital and its customers and
community.
4. Becoming a low cost service provider: To prevent new competitors from
entering the same line of service (business), hospitals can produce
services at a lower price than competitors without sacrificing the quality
and level o f service. A hospital may achieve competitive advantage by
pursuing one o f these strategies or by pursuing several strategies
simultaneously. But the question is how can the competitive strategy
concepts be applied to the strategic role of information system in the
hospital? In other words, how can top management use investments in
information systems technology to directly support a hospital s
competitive strategies? These questions can be answered in terms of
three key strategic roles that information systems can help a hospital:
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(1) improve its operational efficiency
(2) promote innovation and
(3) build strategic information resources
These three strategic roles support a organization’s use of competitive
strategies against the competitive forces from competitors, customer’s,
community, substitutes and new entrants. Figure 6.1 outlines some potential
results from the strategic use of information system.
Figure 6.1 The Strategic roles of information systems
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Improving Operational HtTieieney
Investments in information systems technology can help in making a
hospital’s operations significantly more efficient, which could allow the hospital
to dramatically cut costs and improve the quality and delivery of its services. For
example the distribution of information can be improved by proper
communication system, telephone, EPBX, Computer network etc.
Operational efficiency allows a hospital to adopt a low cost leadership
strategy. By making investment in information technology systems, technology
that increase its operational efficiency, a hospital could also erect entry barriers.
These could be made possible by increasing the amount of investment or the
complexity of the technology required to compete in the same line of service
(business) and deter external organizations from entering the service (business).
Thus, investment in computer based information systems can make the status too
high for some present and prospective players.
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Investment in information systems technology can also allow a hospital to
lock in patients and community (and lock out competitors) by building valuable
new relationships with them. This can deter both patients and community from
abandoning the organization for its competitors or intimidating another
organization into accepting less profitable relationships. Early attempts to use
information systems technology in these relationships focused on significantly
improving the quality of service to patients and community in the hospital’s
service activities. Then the organization moved to more innovative uses of
information system technology.
Promoting service innovation
Investments in information system technology can result in the production
o f new services and processes. The use of computer network (LAN) is an
information system technology. A major emphasis in strategic information system
is to build switching costs into the relationship between a hospital and its
customers (patients) and community. That is, investments in information system
technology can make patients and community (within and outside hospital)
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dependent on the continued use of innovative, mutually beneficial inter
organizational information systems. Then, they become reluctant to pay the cost
in time, money, eltort, and inconvenience that it would take to change to a
hospital’s competitors.
Building Strategic Information Resources
Information system technology enables a hospital to build strategic
information resources that allow it to take advantage of strategic opportunities. In
many cases, this results from a hospital investing in advanced computer-based
information systems to improve the efficiency of its own internal operations.
Typically this means acquiring hardware and software, developing
telecommunications networks, hiring information system specialists, and training
end users. Then, armed with this resource base, the hospital can leverage
investment in information systems technology by developing new services.
Information system s also allow a hospital to build a strategic information base
that can provide information to support the hospital’s competitive strategies.
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Information in a hospital s database has always been a valuable asset in
promoting efficient operations and effective management o f a hospital.
However, information about a hospital’s operations, patients, supplier and
competitors, as well as other economic and demographic data, is now viewed as a
strategic resource; that is, it is used to support strategic planning, and other
strategic initiatives.
6.3 Value adding activities
An important conceptual framework that can help in identifying strategic
information systems is the value chain, which is discussed in chapter 2.
The value chain views a hospital as a series, or “chain” of basic activities
that add value to its services and then, add a margin of value to the organization.
In the value chain concept, the activities of organization are primary activities,
and others, the support activities. The value chain framework can highlight
critical areas where competitive strategies can best be applied.
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In the hospital environment, primary activities are most directly related lo
the distribution of ser\ ices that create value for the patients. Primary activities
include inbound logistics, outbound logistics, marketing and operation and
service. Inbound logistic includes receiving and storing materials for utilization in
the hospital. The hospital store system usually performs these tasks. The hospital
store service usually prepares monthly or yearly purchase requirements
accordingly sends order through purchase section. It minimizes stocks of various
items. These tasks need a proper record keeping. Preparation of important report
like list o f items below reorders level and keeping inventory level of life saving
drugs need proper record keeping. This is one of the areas where information
system can be fitted. The operation transforms materials into services. The
doctors, nurses, and technicians perform operation services. This includes
utilization of knowledge, equipments and materials in the hospital.
Doctors usually receive information regarding the patient’s illness,
diagnosis and treatment. They also prescribe medicines, prepare investigation
report discharge summary to mention a few. All these tasks need proper record
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keeping so information system will he of immense help in rendering service to the
patients. Outbound logistics entails scheduling system. Proper scheduling will
help in discharging services on time. Scheduling information should be provided
to all concerned personnel well in time, so that they can participate in the hospital
activities. Here also information system will help a lot.
Marketing is another area information system can play a major role in
hospital’s strategic planning. By using information technology like telemedicine,
medical transcription, hospital service can be distributed to the customers.
In the hospital, environment service activities include the maintenance of
equipment, furniture, building etc. Reports about the services rendered and
equipment problem reports are prepared. Such task need proper record keeping
and thus proper information system is a must.
The supportive service also adds value to the strategy formulation of the
hospital. For instance electronic data interchange (EDI) system can provide on
line telecommunication links to the supplier of material and equipment. Use of
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computer network is another development in the information system technology.
Relevant information about employee can be maintained using computerized
database. Top level management are responsible for taking strategic decision and
action. They need only summarized form of information. Preparation of statistical
data about the hospital can be achieved only through proper information system.
The service activity includes maintenance and repair o f equipment. The
maintenance system is responsible for the services. Outbound logistics entail
storing and distributing the service to the mass.
Support activities make the delivery of the primary activities and consist of
hospital’s infrastructure (administration and management), human resource
(personnel), technology (improving the service) and procurement (purchase).
Hospitals have more competitive advantage when they provide more value to
their patients or when they provide the same value to the patients at a lower price.
An information system could have strategic impact if it helped the hospitals in
providing services at the same cost, compared with competitors, but with great
value. For instance, a hospital could save money in the inbound logistic activity
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by having suppliers make delivery of medical and non-medical goods to the
hospital, thereby lowering the cost of inventory. Office automation systems can
increase the efficiency o f communication and support activities. Electronics Data
Interchange (EDI) system can provide online telecommunications link to the
supplier of materials and equipment.
6.4 Finding the gap in information
The hospitals have been growirig in terms of physical infrastructure like
bed, wards, equipment etc. The paper work has also increased correspondingly
which substantially restrains the benefits of growth. To really make use of the
enhanced facilities without compromising on the quality of patient care,
management of information is crucial in hospitals. The growth in hospitals is not
followed by the corresponding changes in the content and flow of information
within the hospital. The traditional methods have become obsolete, not reliable
and a handicap for the complexity of operations. The study of the Gillette’s eight
subsystems in the hospitals provided an understanding of information flow in
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each of the subsystems leading to an overall information flow in the hospital. The
important observations about the subsystems are:
1. The casualty and emergency services in the hospitals require a quick
action on the part of the doctor. Analysis o f the table 3.8 evidences
that complete demographic details of the patients are not recorded.
The emergency ward also suffers with similar information gap.
2. The salient observations in the out-patient service area especially in
government hospitals are:
(a) From table (5.3) it was found that the patients waste a lot of
time in reaching the right OPD room for treatment in the
absence of proper guidance.
(b) According to the finding from table 3.65, it was also found
that the number of patients visiting each OPD is very high and
therefore, record keeping and treatment are not satisfactory.
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(c) The waiting time at various stages o f treatment is reasonably
high leading to high patient dissatisfaction, table 5.3.
(d) The doctor and nurses has to perform a lot o f paper work for
each patient, such as, recording diagnosis, prescribing
medicines and investigations, preparing drug slips,
investigation slips, etc., table 4.2 and table 4.15.
(e) The monthly statistics are not generated in time and there is
normal delay in generating statistics. (Finding from table 3.61
and table 3.56).
(f) Analysis of table 4.7 and table 4.19 illustrate that records of
diseases suffered by a particular patient is not properly
maintained.
In private hospitals the scenario is quite different. The number
o f patients in OPD is quite low compared to government hospitals.
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Some ol the leatures are: Methodological record keeping, large
number ot repeat patients, convenient data analysis, computer-based
storage and retrieval of data. Drawback is the lack of proper
diagnosis equipment and late arrival of reports. (Finding from the
analysis o f table 5.3).
3. The in-patient services, which are provided free, in the government
hospitals are highly overloaded. The common problems identified in
providing these services are:
(a) The registration process, which is the beginning of in-patient
activites, suffers from incomplete, inaccurate and illegible
recording of patient data. (From table 5.3).
(b) From table 4.16 it is found that no track of patient movement
is kept after the registration for transfers, discharges, etc.
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(c) The general wards in government hospitals are overcrowded
and even patients lie on the floor. This is due to the improper
maintaining of bed occupancy rate, table 3.61.
(d) Due to increased paper work, the various charts for monitoring
the condition of patient are not maintained thereby affecting
the treatment. (Finding from table 4.1 and table 4.13).
(e) From the analysis o f table 4.15, it was found that the nursing
staff spends a lot of time in non-nursing activities such as
arranging medicines, surgical and other consumable, thereby,
affecting the patient care.
4. The following bottlenecks were identified in the delivery of
diagnostic services in the hospitals:
(a) The lack of proper maintenance of equipment is a major issue
in the functioning of this service. From table 3.51 it can be
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observed that there is a general com plaint that the expensive
equipments are not subjected to timely preventive maintenance
schedules and timely maintenance contracts. The table 3.56
found that the details about the terms and conditions of
purchase o f equipment are not available. No data is recorded
on utilization and operational aspects of the equipment, table
3.52.
(b) According to the analysis of table 5.3, test report preparation is
very slow.
5. The stores in the hospital are afflicted with a number of bottlenecks
as observed from the study of government hospitals. Some of these
are:
(a) A large number of indent books are used in the hospital system
(Finding from table 3.34 and table 3.55).
(b) I he concept ot reorder level and buffer stock is not used in the
hospitals resulting in stock out situation for many drugs and
overstocking for others, table 3.56.
(c) 1 he finding of table 3.56 is that there is no periodic inspection
ot stock in the stores.
(d) Another finding from table 3.56 shows that very little effort is
made to monitor the expiry o f drugs.
(e) The stock analysis is not performed for proper control of
critical items through annual consumption, stock movement,
etc., table 3.56.
6. The salient features observations made from the study of Medical
Records Department are:
(a) Quite often, in the patient file, the discharge report is left
incomplete and hence department has to do the follow up for
getting them completed, table 4.1.
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(b) The retrieval o f patient past record is very time consuming.
This is illustrated in found from the table 3.64.
The dietary service offers a lot of scope for economization by
enabling diet planning and menu planning apart from stock control.
This was observed from table 3.59 and table 3.37.
The laundry services, central sterile supply services and all
housekeeping services in the hospitals also suffer from number of
problems. Analysis of table 3.47 highlights that the cost accounting
of these services are not done in any hospital due to poor recording
of data. From table 3.56 it is found that the stock keeping functions
in these services are not managed effectively. It is obvious from the
analysis of table 5.3 that among the administrative service sanitary
services in the government hospitals are poor.
ofTable 5.6, table 3.68, table 4.8 and table 4.21 deduce that proper
information is extremely important for enhancing the efficiency and effect
ofof the hospitals. Thus keeping in view of the difficulties in the function g
various services, the researcher felt that a proper management information y
would help in the proper flow of information in the hospital so that the ho p
can improve in its efficiency and effectiveness. The Management Inform
System as suggested by the researcher is illustrated in the Figure 6.4.
Hospit
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Syste
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6.5 Strategic grid position of hospitals
The analysis ot table 4.4 (Chapter 4) positions, in most of hospital the
primary means of sending information by doctors is through written
communication (64.6 Per cent responses). This clearly shows that the legacy
restrains in hospitals. The analysis of table 4.6 reveals that better communication
facility will enhance the performance o f the hospital (17.8 per cent responses).
Table 4.7 shows that the main cause of information overloading is due to the use
of non-standard form for receiving relevant data (35.6 per cent responses).
Doctors also felt that proper information system is extremely important in making
the hospital efficient and effective (table 4.9). The analysis of the table 4.4(a)
depicts that, according to doctors, setting of computerized information system
would be beneficial (97.5 per cent).
The analysis o f table 4.10 observes that the main reason for information
overloading to the nurses is due to the use of non-standardized form (30.7 per
cent). Use o f non-standardized form cause a lot of repetition in recording,
resulting in data redundancy. The analysis of table 3.62 reveals that the hospital
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administration needs generation o f highly useful statistic like cost per bed, lock up
capital in drugs and deviation from strategic plan. System of referring past records
of patients by in most o f the hospitals is not satisfactory. Method used is “as per
prescription of doctors (table 3.64). Information system for locating patients
admitted in the hospital is through reception (table 3.67).
According to top management the degree o f importance of the flow of
information for improving efficiency and effectiveness of the hospital is
extremely important (table 3.68). It is found from table 3.69 that top management
did not give any comment regarding the opinion about the efficiency and
effectiveness of the present information system.
The hospitals have plans for implementing MIS (table 3.70). Top
management of the hospitals felt that computer based information system will be
beneficial (table 3.71).
From the above findings it can be observed that legacy is a growth
constrain for MIS in the hospitals. The records keeping methods and
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communication technology used are outdated. Generation o f highly useful
statistical reports are also not done properly. The hospitals are not nurturing
information system for strategic decisions.
From the findings it also can be elicited that top management are aware of
the importance of information system. It is also suggested that computer based
information system will be beneficial. All the hospitals have plans for
implementing computer based MIS, pointing to top management initiatives but
calls for intensive involvement by top management. This is clear indication of the
participation by top management. Thus the position of the hospitals in the
Mckenny Grid is around the ‘Support level’.
It is therefore suggested that with further involvement o f the top
management for “Turn around strategy” the information system can be employed
for strategic decision and movement. But first of all the hospitals need smooth
functioning o f the information systems activity.
6.6 MIS in hosp ita ls
In most o f the hospitals the use of computer is for applications. In the
hospitals only a small number of users are utilizing computers to meet the
basic organizational needs. These computers are installed in a decentralized
form. Proper flow of information among the computers does not exist. So
these computers need to be centralized and controlled properly. The
information systems in the hospitals in Manipur are in the initial stage of
the Nolan stage model.
The future of development of the hospital information system in
Manipur is towards the second stage of the Nolan stage model, which
embodies subsequent proliferation of applications cultivating
experimentation and adoption of computers by many users.
About the hypothesis, the strategic grid model positions the sampled
hospitals in the ‘Support’ level, and further analysis by way of Nolan growth
stage model places the sampled hospitals in the initial stage, thus, planning MIS
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in support for organizational operations context. Further involvement o f the top
management for ‘Turnaround strategy’ will cultivate the MIS empowering
strategic decisions and movement, and when accompanied by complementary up
gradation in the Nolan growth stage level for the MIS will tremendously boost the
performance of the organization through its MIS and consequently, substantiates
the hypothesis that proper and updated Management Information System
facilitates in the efficient performance of service sector organization like that of
hospitals in Manipur.
6.7 Strategies for MIS implementation:
Implementation of information systems is a process of organizational
change. Implementation refers to the ongoing process of preparing the
organization for a new system and introducing it in such a way as to assure its
successful use. Human and organizational factors affect the successful or
unsuccessful implementation of a new information system. Hmployees are
generally reluctant to changes, as it will involve training to adapt in the changing
system and training will involve substantial orientation of the users to their jobs.
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A change from the legacy to the modern system will take place only when
the training is completed. Change can be accomplished in several ways. The
safest method is to employ the old and new systems in parallel mechanism; the
new system is run under actual conditions vis-a-vis the old, and the results are
compared for reliability and accuracy. When the new system starts showing
consistent results for a remarkable period of time and becomes operational, and
the old system is dropped. The drawback of this method is being expensive.
Thus implementation of proper MIS may be costly and may take long time.
The following steps can be taken up for MIS implementation in the hospitals:
The legacy is changed to accommodate the modem MIS
(costly task and may lead to failure)
The old information system runs in parallel with the new
system and can cut over when the MIS is feasible and reliable.
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So the researcher s u r e s t lo implement MIS tor linking the eight hospital
subsystems viz. Patient Diagnosis and Treatment system. Patient Record System.
Patient Scheduling and Order S\stem , Patient Accounting System, Hxpenditure
and General Accounting System, Personnel System, General Supportive Service
System, and the Management Control System.
^S 'nn initial stage it is suggested to implement the MIS in each of the sub
systems and implement the same in the whole system when a fruitful result comes
out of the subsystems. MIS effectiveness is evaluated not in terms of observations, bw.1
in terms of an average o f opinions of the users, developers and of course the
hospital management. However the most profound influence of MIS is that MIS
besides offering economic value and that overcomes the costs, consigns a new
and better way of doing the things in the organization’s care.
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