BUS303: Strategic Information Technology

Health care literature extensively addresses issues facing health care delivery worldwide. Among the major challenges are rising costs, variations in quality, diversity in consumers, and concerns about value return on investment. A growing concern that is grounded in operations management is the constant tradeoff between the need to cut down on costs while at the same time raising awareness of greater patient responsiveness and improving health care quality, which should not go below a certain level. Faced with financial crises and fear of unsustainable health systems worldwide, a constant call from policy makers is to cut down costs even though resources are becoming more expensive and patient expectations are higher. These are hard decisions, often involving ethical dilemmas, namely, balancing cost cutting while providing full support to patients. When tackling challenges, we need to dissect each challenge and look at the microlevel issues in public health, primary, secondary, and tertiary care. Then we need to achieve the tradeoff between cost and responsiveness. The tension between individual versus population-based orientation in health care is particularly relevant in financial crises, for example, the decision to use expensive technology at the expense of mass vaccination.

Other major pressures on health systems are aging populations with conditions like dementia and diabetes becoming more difficult to support, advances in medicine and medical technology providing better diagnostics and treatment but creating more socioeconomic class differences in affordability of care, and widening of services. Health systems are finding difficulties in supporting these challenges. This begs the question of how can policy makers and providers make rational decisions. Other than strategic and policy issues, there are numerous operational issues and challenges such as resource allocation, scheduling activities, waiting time reduction, length of stay in hospital, procurement of drugs and disposables, and handling biomedical wastes. Every decision is connected to efficiency and patient responsiveness tradeoff. The BPM approach can provide us with a solution to the challenges that health care faces today through process reengineering. Process mapping is the first step. It follows by identification of the process parameters and measuring current performance, deriving issues and challenges through root cause analysis, and determining enablers for achieving superior performance and process reengineering. Process performance measurement and patient-focused quality management offer other means for effective health care delivery.

Whatever method is applied, a deep understanding of how to face or combat the issues and challenges facing health today needs to be achieved. Business process mapping not only helps to develop standardized processes within health care systems but also helps to minimize the variation in quality of health care delivery and errors. BPM also helps to select the right enablers in information management and technology so as to manage these processes. As highlighted earlier, BPM can also help managing patient flow and information flow, which facilitate managing waiting time in health care delivery. Additionally, BPM integrates health care processes with IT to achieve efficiency and at the same time patient satisfaction. Furthermore, BPM approach advocates using process-based performance measurement over outcome-based performance measurement that enables practicing proactive approach in health care delivery. This leads to better understanding of issues and challenges proactively, which in turn enables providers to be better prepared for achieving the planned targets.

BPM approach has been extensively used in industry through TQM, continuous improvement, six sigma, business process reengineering, and benchmarking. We have also identified evidences of their application in health care. Despite the fact that we have seen increases in the application of BPM techniques in the health care sector, we still have reports of unsustainable health systems, system failures, and variations in quality of care because of the challenges highlighted earlier. This may be due to the fact that the application of these techniques is still not widespread enough or also due to improper adoption of BPM without proper synergetic integration with the IT. Indeed, the four interrelated dimensions that are necessary for the success of BPM adoption are process engineering, cultural (underlying beliefs, values, norms, and behaviors of organization), technological (training and information support systems), and structural changes (mechanisms to facilitate learning). These four dimensions are all necessary for their multiplicative function to ensure organization-wide improvement.

If one dimension is missing, improvement is likely to be unsustainable. For example, if the structural change dimension is not considered, despite registering success in the other three, it is likely to result in unsustainable performance. Additionally, can we really adopt US culture to another culture by simply using software technology without involving the people and training them in this? This will lead to disaster. Unfortunately, health care systems, even those in highly developed countries, seem to have these problems and are not benefiting from the expected outcomes of the advances in information and communication technology and adoption of BPM approach. Prior studies reveal that many enterprise resource-planning projects in industry failed not due to technological failure but because of cultural adoption failure.