The case focuses on the implementation of SAP in hospitals. In a competitive healthcare sector, while reducing costs, hospitals should focus on the process to provide quality care. Several hospitals have decided to implement one or another Enterprise Resource Plan (ERP) to grow their business, but applying the ERP system can be a daunting effort. The system becomes very problematic to implement some of the most successful; many fails and lose million-dollar. Moreover, the VLF Hospital is ranked third in Latin America and best in Colombia. In addition, VLF moves to eliminate the challenges of coronation. Before the implementation of SAP, hospitals used all traditional means for conducting organizational activities. All patients visiting the hospital essential that the hospital management synchronize every process that arisen from the preliminary meet with the patient to the final phase after the implementation. Also, this case presented how hospitals can achieve these ambitious goals. It shows how companies can tackle the process of large-scale change (Chikati, 2018).
Instant access: SAP integrates all hospital systems so that physicians can gain quick access to their patient. Access to various services is at the fingertips as all systems are centralized.
Standardizes Capacities: An integrated system thus improves the work efficiency of the staff and helps to store the information of different hospital departments in one database (Oshikoya et al. 2019).
Cost-effective and easy management: This includes many health-related procedures that help in running a sound management of hospital. This optimize inventory maintenance, lab report records, medical records, income, and patient records.
Superior control: The main goal of ERP design is to create a coherent platform for controlled operations. It provides a summary of the effectiveness and direct effectiveness of the various departments. This allows for more control over routine planning, nursing care and surgery.
Ensured Patient Satisfaction: The success of a hospital depends on patient satisfaction. When employees in an organization work in an integrated manner, it aids its customers without a drawback.
3) The process of implementing SAP in Colombian hospitals helps in executing the work timely and accurately. For example, the pharmacy management is made easier than how it is prior to SAP implementation that helps to minimize manual errors. SAP helps reduce processing time for billing and recovery of patients’ medical history. Implementation of SAP helps patients manage record files based on recognized criteria. It has improved and assisted better coordination between the administrative and medical departments.
4) A grade can be awarded for SAP implementation. It is because VLF was done within budget and time constraints until the end of implementation of ERP projects. It provides all the facilities with the implementation of ERP system in hospitals. It has helped in managing the insurance process, cash flow, payroll, paperless election. It helps in better coordination between hospital departments like OPD, emergency etc. and referral documentation by the physician.
Management is hesitant to change management. However, the organization moved to take risk of changing its systems from manual to electronics as well as SAP implementation. Thus, leadership can be considered as a positive step (Kao et al. 2016).
SAP is an enterprise software system with specific modules designed for healthcare facilities to support their administrative and operational tasks such as IS-M MED. SAP would provide VLF with a single database to begin tracking patient activity and history which could be accessed my multiple users from multiple locations, all at the same time. A major advantage over the paper charts which were limited to being in one place, at one time, in use by one-person. SAP also had existing modules that could handle the creation of charges, bill out and collections. However, it lacked several of the more advanced features that VLF was needing –advanced drug inventory tracking and drug administration along with clinical decision support system (CDSS) matching with a computerized provider order entry (CPOE) to help alert physicians and staff of proper procedures and drug interactions based on existing patient medication. These systems would need to be integrated with the SAP database. Additionally, the company itself was founded in Germany and therefore many of the modules were modeled after German practices which differed from the Columbian reimbursement terms and healthcare industry construct, which dictates which procedures individuals are entitled to.
The VLF Hospital started implementing SAP with the ambitious goal of maintaining its exceptional patient safety centered environment and healthcare services. On the basis of clinical, financial, and administrative indicators, the VLF has won several awards as the best hospital in Colombia and provides extensive medical care with the help of medical resources and staff for treatment. Despite the motivation and means to support the company’s current goals, plans to expand its services in the future put tremendous pressure on existing systems. The provision of patient care, including many medical specialists in different departments on patient travel, treats patients, treats them surgically, treats them for recovery, and ultimately throws in the process requiring close coordination between administrative staff and patient care. The combination is relied upon treatment records that include clinical procedures, medications, and necessary supplies (Baseleres and Oller, 2015).
VLF Hospital is ranked third in Latin America and best in Colombia. The hospital has decided to implement electronic data management affected by various factors. First select VLF to address the hospital coordination challenge. Before the implementation of SAP, hospitals used conventional methods to perform organizational activities. Each patient visited in the hospital must be put to the final stage after completing all the procedures that occur after the initial conflict with the patient while operating the hospital. Moreover, several activities undertaken at various stages, such as preparation of medical equipment, consultation, activities performed by supply store staff, clerical staff, medical practitioners, etc. were all synchronized manually and so it shown a major challenge to the management. In this way, any nonperformance or failure on one activity affected the whole patientcare process. Hence, it offered a challenge. Also, the use of manual system adds unnecessary workload to every party involved and resulted to poor service quality. Then again, the hospital faces the challenge of increasing the use of paperwork that is not easily accessible to patients in various departments. The manual traditional system means that patient files can only be accessed by a specialist or department. In this case, for example, if a surgeon is needed to access information about a patient's file at a pharmacist, they should request and wait for the file to be sent after physically from the pharmacist (Ametowobla and Prechelt, 2020).
One of the main challenges for VLF before the implementation of the Synapsis project was coordination. Multiple staff will be assigned to analyze the situation or documentation for each patient admitted to the VLF. In this stage, VLF would have to coordinate “surgeons, anesthesiologists, medical equipment preparers, assistants, operating room (OR)supply store staff, and clerical staff”, based on the prognosis of patient. The document is handwritten and merged into the patient's file. Lack of communication or any mix-up document among staff members endorse deficiencies in VLF practice and creates unnecessary workload for all parties involved.
Second, the use of paperwork forbidden vital information of patient to be in many locations when needed all at once. If a surgeon or a pharmacist each desired particular medical record, they would either need to come together to review the document or one would should wait after the other to review the files themselves. It does not consider the fact that a carrier, especially a nurse would have to deliver the paperwork to its next location. In short, employees are only allowed to view patient files once, or share information when many contractors are in the same location at the same time. This fact further delayed the various roles of the VLF, excluding the confidentiality of medical records (Cajiao Saénz and Ramírez Robledo, 2016).
As mentioned, SAP already has modules for handling electronic medical record (EMR) and other administrative tasks, but must be configured for VLF parameters. Besides, the advanced features that the system lacked would require to be created through customization; which could be done either with a modification to the SAP code (ABAP) itself or through an enhancement outside the SAP system but that is integrated with the database. Enhancements are often the preferred method as the underlying code remains intact, which allows for an easier upgrade process.
Systems Applications and Products (SAP) gives an unpredictable and strong undertaking asset arranging framework. SAP ERP principally centers on the inner exercises of the association by coordinating practical and cross-useful administration and operational help measures. Nonetheless, SAP's healthcare applications and arrangements uphold conditions where treatment is less unpredictable. All in all, the plan of action of a medical clinic depends on coordination among regulatory and quiet consideration staff. In this way, its business measures should be coordinated into the board and clinical cycles. This can be accomplished by coordinating SAP's unpredictable ERP framework with SAP's less intricate healthcare arrangements through a fundamental design that incorporates clinic measures with SAP's viability. A case of such an expansion to the German medical clinic plan of action. On the other hand, the healthcare system in the United States, especially in Colombia, is more complex. Act 100 (1993) sets out strict guidelines regarding responsibilities administered by health promotion agencies (such as insurance) and care providers (such as hospitals such as VLFs). These guidelines affect the charge of billing of CDO against HPO, supply chain management of CDO, and the charges that is received by CDOs for treatment. Furthermore, the study highlighted an increase in deaths in the United States due to human error related to medical records and hospital discipline. Thus, the Columbia Hospital business model requires strong coordination between the administration, medical records, medical orders and pharmacy management processes. In order to implement SAP in such an environment, most of these modules do not exist in SAP's existing healthcare solutions, so SAP's ERP system needs to be integrated with all other processes through extensive development. Such SAP integration is important for real-time patient access at Columbia Hospital to improve the ERP system (Chikati, 2018).
SAP Success Factor is a cloud-based platform that provides SAP for managing Human Resources (HR) related activities within an organization.
The main challenges facing the Valle del Lille Foundation (VLF) - lack of technology, risk of change, layoffs, new billing system, doctors not approved by VLF
In this case, different personalities need to be considered. The top admin was totally behind this application and supported the change management process. Physicians were quite hesitant and resisted because they could make the billing system work. The CEO Dr. Borrero has been quite helpful in the implementation of SAP. VLF manages execution properly and manages communications. Each department head confirmed that the members of the project and they had a complete idea about the purpose of the hospital. They expressed concern that the implementation would change the workflow at all levels and not move too fast. SAP will remove some work, but hospitals have been asked to work on new changes, he said. Always related benefits related to MR access and improved billing process. VLF has set up a computer lab with SAP modules, 24 hours a day, 7 days a week, to help employees get used to the new system (Wahyu, et al. 2018).
The driving force is the lack of access to computerized physical orders for centralized electronic medical record data and the lack of corporate resource planning.
VLF Hospitals has started implementing SAP with the ambitious goal of maintaining great healthcare services and a patient-centered environment. Based on the clinical, administrative and financial indicators, VLF has won several awards as the best hospital in Colombia and is fully equipped 24 hours a day with medical resources and staff support for the treatment of patients. We provide medical care.
Their motivations and methods currently support the organization's goals but plans to expand their services put a lot of pressure on existing processes.
Many treatment professionals from different departments are involved in a patient’s journey to provide patient care when the patient is admitted to the hospital, referred for surgery, referred for recovery, and finally discharged. Therefore, this approach requires intensive coordination between management and patient care personnel. The combination between them is based on the clinical system, treatment records, including medications and necessary supplies.
Achieve power-maintenance, change and take stable action
The most significant obstacles to this change are:
In the next phase of implementation, full-time consultants and 24/7 support will be phased out to help them reach the unique VLF IT inter-project goals. Achieve the project goals by moving from paper to electronic documents and medical records (MR) in all relevant clinical and administrative procedures. The project was practical and VLF earned $ 200 million in 2014, making it the best hospital in Latin America and the best in Colombia. The unique part is that we hired the same computer consultant six months later. Also, the help desk will be closed for 6 months after applying 24/7 support (Altokhais, et al. 2017).
When they first started, some of them were hesitant to change because the workflow was different from the way they used it and the change caused resistance. As a result, there was disagreement about adaptation and coordination. Over time, however, things began to get easier as people became more familiar with the system and learned about it and were able to resume the average workplace. Also, the functionality of the system has been greatly improved (Kraljić and Kraljić, 2018). End users can imagine the many things they have, and the Valle Dale Lille Foundation (VLF) can help advice users if they want to further customize. The advice was to adapt to the best practices provided by SAP for different industries. And the software didn’t try to adapt to the process that they already had. VLF has made the right decision to change the SAP standard.
In this case, different personalities should be considered. Superior management is actually behind this implementation and supports the process of managing change. Physicians are reluctant and hesitant to change because they may have their own billing system. The CEO, Dr. Borrero, strongly supports the implementation of SAP. Moreover, VLF managed communication of change management and the implementation of SAP efficiently. Every department head made sure that its members know the project and the purpose of the hospital for it. Emphasize that its implementation will change the workflow at all levels and will not be the fastest transition. He said that when SAP would remove some of the efforts, but the hospital would have a strong demand to address the new changes. The VLF installed a computer lab with SAP modules available 24/7 to familiarize its employees to the new system, highlighting improved billing processes, and communication facilities, like access to MR access at anytime and anywhere.
Altokhais, T.I., Al‐Obaid, O.A., Kattan, A.E., Amer, Y.S. and CPG Collaborative Groups, 2017. Assessment of implementability of an adapted clinical practice guideline for surgical antimicrobial prophylaxis at a tertiary care university hospital. Journal of evaluation in clinical practice, 23(1), pp.156-164.
Ametowobla, D. and Prechelt, L., 2020, June. How layered reuse can support harmful micropolitics: SAP ERP in surgery planning. In Proceedings of the ACM/IEEE 42nd International Conference on Software Engineering: Software Engineering in Society (pp. 39-48).
Baseleres, P.J.M. and Oller, P.G., 2015. Improving the compliance to the surgical antibiotic prophylaxis (SAP) policy of administering antibiotic within 1 hour prior to skin incision. Journal of Microbiology, Immunology and Infection, 48(2), p.S127.
Cajiao Saénz, J. and Ramírez Robledo, C.E., 2016. Surviving SAP Implementation in a Hospital. International Journal of Case Studies in Management, Vol. 14, No. 2-2016, 14(2), pp.1-25.
Chikati, A.T., 2018. A critical evaluation of SAP healthcare industry solution implementation as a source of competitive advantage: A case study of Chitungwiza General Hospital.
Kao, H.Y., Yu, M.C., Masud, M., Wu, W.H., Chen, L.J. and Wu, Y.C.J., 2016. Design and evaluation of hospital-based business intelligence system (HBIS): A foundation for design science research methodology. Computers in Human Behavior, 62, pp.495-505.
Kraljić, A. and Kraljić, T., 2018, September. Agile software engineering practices and ERP implementation with focus on SAP activate methodology. In International Conference on Business Informatics Research (pp. 190-201). Springer, Cham.
Oshikoya, K.A., Ogunyinka, I.A., Adamaigbo, C. and Olowo-Okere, A., 2019. Surgical antimicrobial prophylaxis and its dose appropriateness among paediatric patients in a Nigerian teaching hospital. Journal of Chemotherapy, 31(6), pp.329-342.
Wahyu, D., Nursalam, N. and Soenarnatalina, M., 2018. Evaluation of Discharge Planning Implementation in Pamekasan Hospital.
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