Managing Change and Complexity

1. VLF has adopted the strategy of SAP ERP management strategy to manage the turnaround process of the hospital. The hospital has switched all the paper documentation techniques to electronic documentation. Moreover, the organization follows a top-down approach for management of medical units in which each division is headed by specialists. VLF strictly follows the policies regarding patient health and safety. Marcela Granados says that VLF has no official authority on the medical staff of the hospital. They are provided all the essential medical equipment and integrated work environment, so that they don’t need to dwell on outside facilities to complete their jobs. This organizational culture has not been adopted by any other hospitals in Columbia. In this way VLF has diversified the organizational culture and managed the turnover in the healthcare industry. The healthcare industry requires documentation of many records including patients’ medical records, equipment record, supply chain management, medical fees, etc. VLF was struggling to store these enormous amount of data records physically. Furthermore, the supply chain management of VLF was finding it difficult to maintain the billing records of all the drugs and medicines. Over the time, VLF was facing the problems with logistics and they were not able to control the physical space required for data storage. Although there were many IT systems working in the hospital for information integration, but they were utilized efficiently.

So, the organization shifted these software systems into the management of billing records and administration division. This comprehensive SAP ERP development improved the patient safety and made the services of the organization more well-organized and cost-effective, which increased the revenues of VLF. This is the best practice approach of VLF which can serve as a competitive advantage to other healthcare organizations. This performance management system has a long-term benefit as new records can be added efficiently and managed using a proper SAP system. There will not be any physical storage space required for records maintenance. Due to this ERP management the staff of VLF believe that everything is fair and organized, they are provided with each and every facility to perform their duties. This helps in retention of employees for a longer period. This SAP system of VLF improved the local supply chain and logistics management. However, it took six months for VLF staff to adopt the SAP in their work culture and to follow organizational principles. Organization’s performance has been improved significantly, because now there is centralized data process system which makes it easy for the insurance auditors to trace the information. Furthermore, the SAP system also improved the patient privacy by limiting the access to their data in an electronic way. Lastly, utilizing SAP tool has enhanced ERP system of VLF by providing consistent and appropriate information system.

2. Valle del Lili Foundation (VLF) is a university hospital situated in Cali, Columbia. The organization has shift from paper documentation to electronic documentation techniques which help VLF to manage their turnovers. Principles behind the success of VLF are as follows:

  • Efficient management using electronic medical records (EMR), enterprise resource planning (ERP) and computerized physician order entry (CPOE). In Columbia, Medical Records (MR) of a patient are termed as legal documents, so it is necessary to maintain confidentiality of information. During physical storage of data everybody had access to the documents, by using the electronic data storage, restrictions were easy to apply on records and hence confidentiality principle was maintained.
  • The organization learned from the study conducted on the U.S healthcare industry that most of the people die due to human error and ill record management about patient’s allergy to some drugs or previous treatments. So, VLF introduced a proper record management of all the patients about their medica history, allergies and injuries in a computerized manner. This also eliminated the problem of physicians of understanding the doctors illegible handwriting and confusion of similar medications.
  • The principle of treating administrative procedures in parallel with medical procedures has bought success to VLF. All these procedures are governed according to the rules and regulations. This standardized the care management contracts with respect to patient admission, charges, clinical charges and drug supplies. Electronic documentation improved the cash flows for VLF in the form of digitalized invoices.
  • Although this electronic documentation has cut many jobs but it has made the VLF system more efficient and improved the services of hospital. The organization does not want that the staff feel like doing clerical job of maintaining physical records.
  • The organization has improved the workflow process of hospital by eliminating all types of mediators. Physicians can directly access the patient’s healthcare records which maintains transparency at workplace. SAP enabled nurses and junior doctors to directly access the doctor’s instruction and work accordingly, which reduced the frequency of verbal orders.
  • VLF has distributed different segments of the organization to various stakeholders and formed a cross-functional team design with experts. These appointed leaders worked with the specialists who knew SAP working. This encouraged team work in the organization and every staff took their responsibility in a well-organized way.
  • VLF provides all the necessary equipment required by the medical staff and integrated work environment, so that they don’t need to dwell on outside facilities to complete their jobs. This organizational culture has not been adopted by any other hospitals in Columbia. In this way VLF has diversified the organizational culture and managed the turnover in the healthcare industry.

3. The functional structure of the Columbian healthcare system is very complex. Introduction of law 100 lead to a major change in the country’s healthcare organization. This law identified the system responsibilities and leaders. 58 per cent of VLF billing went to the Health Promotion Organizations (HPO). This was a great pitfall for VLF which impacted the organization’s revenue over the time. Moreover, the organization follows a top-down approach for management of medical units in which each division is headed by specialists. VLF strictly follows the policies regarding patient health and safety. Though surgeons are not unswervingly employed by the hospital, they work with the guidelines of the medicinal directorate and the surgeons’ decision-making assembly concerning superiority and patient protection matters.

Furthermore, the team members agree the terms by VLF and insurers, and deliver standard administrative procedures. Physicians are remunerated rendering to the quantity of patients they look after, indicting at the taxes recognized by the assurance contracts. Furthermore, VLF accounts a 20 per cent cut to fulfil the administrative expenses requirements of the organization. Every patient who is treated in VLF undergoes various steps of recovery processes in the organization. Insufficient resources and ill management system created extra work for the management staff which delays the whole process. These problems made the public to question the hospital’s management system. But maintenance of these MR was very essential for the patient health as well the VLF’s management.

The organization’s need for physical storage places increased parallel with the number of patients treated. Furthermore, physicians were often not able to understand the prescription given by the doctors, thus they used to give a similar medicine to the patients, irrespective of the knowledge whether the drug is suitable to him or not. These misunderstandings and negligence at workplace lead to a great pitfall for VLF. In order to overcome these problems, the organization decided to shift the system to an SAP system for record maintenance. Over the time, this system increased the efficiency and record management of the hospital. Due to this ERP management the staff of VLF believe that everything is fair and organized, they are provided with each and every facility to perform their duties.

Moreover, the organization provided a 24x7 helpdesk service to solve the problems of staff regarding the use of SAP system. The software had to be calibrated, and the only way of doing so was to operate it. However, it took about six months for the staff to completely understand the system and utilize it in their daily routine. Also, many employees were fired because of the COVID-19 pandemic. Other employees were hired but it took time for them to understand the SAP system. This will impact the future changes because employees are having difficulties in maintaining records digitally, if any problem occurs in the server, whole data can be lost. But creating a regular back-up of data can help in overcoming this problem in future. Moreover, training new employees of VLF about the SAP system can help them in performing their duties in a sustainable way.

4. Yes, the SAP management system of VLF is sustainable because electronic information management system has increased the safety of patient and organized the healthcare delivery services by VLF. According to Marcela Granados, CMD of VLF main reason for the success of organization is SAP system. Previously, the hospital was maintaining the records in paper-based documents which required physical storage places. The staff of VLF was finding it difficult to manage the records as they were in a bulk quantity. Furthermore, physicians were often not able to understand the prescription given by the doctors, thus they used to give a similar medicine to the patients, irrespective of the knowledge whether the drug is suitable to him or not. These misunderstandings and negligence at workplace lead to a great pitfall for VLF. Therefore, this performance management system is sustainable for VLF. According to this present scenario for COVID-19 pandemic, many patients are being admitted to the hospital daily, if there were manual record management systems, it would have been very difficult for the staff to maintain the records. Moreover, it is essential to maintain a patient’s medical history. SAP management system made it possible for VLF to easily transfer the records from one division of the hospital to other as there are different wards for the COVID patients.

This has also reduced the overhead of the clinical staff and they can focus more up on the drug development and patient’s health. All the information has been arranged at one platform, which makes it easy for the doctors also. These software developments at VLF were generally aimed at enhancement of administrative and sustenance processes rather than the medical procedures which were related to the patient’s care. The new system is sustainable because it changed the workflow at all levels of the organization. Moreover, the system has integrated all the processes of VLF to provide an amalgamated view of a patient’s care, whether it is related to his medical history, fee payment, allergies, or medications, all information has been integrated. Furthermore, this comprehensive SAP ERP development improved the patient safety and made the services of the organization more well-organized and cost-effective, which increased the revenues of VLF. Subsequently, this performance management system has reduced the mistakes in maintaining the patient’s records. Lastly, this is the best sustainable approach of VLF which can serve as a competitive advantage to other healthcare organizations.

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