Posted: December 10th, 2022
Improving Efficiency and Quality of Care at Maroondah Hospital through Business Process Reengineering
Faculty of Business and Law
INF30035 – Business Process Management
Semester 2, 2023
Analysing As-Is Business Processes for an Organization
Due: Friday, 8th Sep. 2023 @ 9:00am AEST
Assignment 1 Weight = 35%
Assignment 1 is an individual assignment!
To be completed individually. Your submission should include:
• Submit assignment 1 report file via the Turnitin Assignment 1 link on INF30035 Canvas Assignment.
• Submit models file through the model submission link on the Canvas Assignment.
DO NOT email the assignment.
If you have any queries, you may discuss it in the discussion threads or with your tutor. For any technical problems, assistance can be obtained from the Swinburne Service Desk (03) 9214 5000.
Maroondah Hospital General Medical Process(es) (Detailed case description can be found in the Appendix of this document.)
Your client has commissioned you to analyze their core business process. The description of General Medical process(es) has been provided to you (in the appendix). Assignment 1, you are required to provide a review (aimed at the management and staff of the Hospital) on:
1. Analysing the current business process(es) – the prospective problems/issues of the existing processes and brief analysis of improvements by using best practices (at this stage, please do not consider technologies and automation).
Please note that there are many issues/problems in the current process. Assignment 1 is an individual effort, so you should list all major problems/issues, but only need to pick up Three (3) that you consider the most essential to discuss. You should discuss these three problems selected, providing your reasoning (such as: What are the problems/issues? Why they are the key problems/issues? Why need to consider fixing them? What are some of the opportunities after solving these problems/issues? If you do not fix them, what are some of the impacts on their business?) You must use references to support your arguments.
Please note, lack of integrated information system, lack of automation, no database systems….. are not process issues or problems. The process problems/issues should link to sequencing, logic, communication, resources allocation, quality control, double job handling, and task re-working (unnecessary loops)……
For each issue selected, state the Best Practices (please check lesson 3 overview for details) you will apply (you should consider at least 2 best practices for each problem/issue so that you can compare). For each Best Practice, describe how it is applied, explain, also how your solution solves or improves the problem identified. The final selected best practices for each problem, can be summarized in a table using the following format:
• The issue being considered.
• Best Practice(s) employed. Choose from the Best Practices discussed in the lectures.
• Describe how the Best Practice is applied to the process and how it addresses the problems.
• Describe the possible advantages and any other issues addressed at the same time.
• Any disadvantages.
a. Issue b. Best
Practice/ c. Application Description and/or Solution Explanation d. Advantages e. Disadvantages
Note: This table should only be used to summarize your discussions. The table can be put in the appendix. The detailed discussions should be in the report main section (for each problem/issue, there will be many solusions, you should provide at least 2. You should compare and discuss which one is better matching with business situations.) All discussions need to have references to support.
2. Present the current process models by using relevant drawing tools (read details below). To do this you should:
a. Understand the existing processes and construct the process models, including the main process and sub-process models.
b. To construct models, you must use any process modelling tools (such as all examples we provided in the unit- we used Bizagi modeller – a process modelling tool). Bizagi is commonly used in the industry and is specifically for design business processes. It is free software and easy to use. It has a built-in simulation function that can help check your designed process models if there are deadlock problems. It also has a built-in function to identify the error connections of the models. However, as it doesn’t support Mac computers yet, you can choose other process modelling software. Please make sure it allows you to use all BPMN palettes (pool, lane, tasks, events…). The drawing software selected has to be process-oriented. We have provided some suggested modelling tools in the unit outline and on
Canvas Modules Business Process Modelling tools. Please check. If you select
a different BPMN software, please also check with the teaching staff.
c. Each diagram should occupy no more than one page, and it should be ‘landscape’ format, not a ‘portrait’ format. For the case provided, to make models readable, you need some sub-processes. However, how many subprocesses you need depends on your model design. You can have subprocesses in the main process and also sub-processes inside of sub-processes. It can be multi-layered. Please check the examples which we provided on the Canvas Modules as your references. Model readability is essential. If models which you put in the report are not readable, we will not mark them.
d. Regarding the case, as this is a simulation exercise, the case may miss some details based on your knowledge. You are allowed to make reasonable assumptions based on your experience and research. All assumptions have to be clearly explained in your report.
e. Models for the case study should use Level 1 BPMN notation (except intermediate timer event), AS-IS models. Please note that some details may not be represented precisely utilising the level 1 palette- you can explain the limitation in the report.
f. Each model should be accompanied by a full and detailed commentary that explains what you have drawn, highlighting any features that you could not represent precisely on the diagram. For example, for each of the tasks, what are some detailed activities/steps involved; for each gateway, what decision is it responsible for. You should use a table to summarize activities and gateways for each model (main and sub-process models). Below is an example:
Tasks & Gateways Names Brief explanation
Check applications When the application is submitted, Faculty admin staff will check all student applications, such as if all required documents are included and are all forms are correctly filled … if anything is missing, admin staff will contact students to resubmit. After all, documents are received, they will enter all details into the database system and send an email to relevant academic staff for further process.
(Submission documents correct?) If ‘yes’, go to the task ‘Enter details’; If ‘no’, go to the task ‘Contact Students’.
Each model will include tasks and gateways, and you should explain them so the readers can understand what you try to present. You can put the table in appendix.
Please read the suggested marking sheet to understand the marking criteria FULLY.
Just submit a single MSWord or PDF document include all necessary components (please do not submit multiple files.
A word-processed report of 2000 +/- 10% words which include:
1) Executive Summary (not included in the word count)
2) Table of Contents (not included in the word count)
3) Introduction which must include:
• Topic background, such as importance of business process re-design and development, why organizations should focus on business processes, why understanding and analysing current process issues/problems is an essential step of process development…. (must use references in this part).
• The purpose of the assignment – what do you want to achieve by completing the assignment…..
• Data collection methods, such as based on your experiences, information from similar companies websites, information from academic references …..
• Structure of the assignment
4) Any assumptions made?
5) Any limitations for presenting models?
6) Main body:
a) Statement of problems, issues and opportunities of the current process(es);
b) Best practice disccussion;
c) List the steps which you will take on to re-design the process, a plan for process improvement.
8) References (not included in the word count)
You MUST use the Harvard Referencing style throughout your report and include an accurate list of references at the end of the report. You can access the correct style from the library: Harvard System (http://www.swin.edu.au/lib/guides/harvard_system.pdf )
All BPMN diagrams (NOTE: for each process model, you need to briefly explain the key tasks, gateways, and events by using a table format). Please check the example provided in the task 2, point ‘f’.
• Pages of the report should have appropriate headers and footers and should include printed page numbers
• Use font size 12 and 1.5 line space • The front page must include:
o Full names and student IDs
o Unit code and name, assessment number, due date and % weighting
Late submission may result in a lower grade for the assignment based on the university extensions and late penalties policies. Please refer to the unit outline for further details.
Any request for an extension must be directed to the convener BEFORE the assignment due date. You must include appropriate supporting documentation, such as a doctor certificate. These forms may be scanned and emailed to the convener.
Appendix Case Study: Maroondah Hospital General Medical Process
Maroondah hospital is located in Ringwood East. It is a metropolitan hospital that provides services including emergency medicine, general and specialist medicine, general and specialist surgery, critical care services, ambulatory and allied health. This case focuses on the General Medical process which is the process that a patient has to go through at a normal hospital. Figure 1 shows the mapping of the workflow model to the knowledge environment of a hospital. Each patient’s visit is considered as a case, which starts with the patient’s admittance and ends when the patient is discharged. Each patient has an individual patient record. The process consists of a series of tasks such as diagnosis, tests and treatments.
Figure 1 The mapping of the workflow model to the knowledge environment of a hospital
The tasks are performed by various resource groups in the hospital: doctors, test experts, therapists, receptionists and schedule planners. The goal of the implementation is to map the organizational knowledge, clinical information and medical knowledge to a workflow definition, so that the activity can be managed more efficiently, and information catalogued for future reference. Hatch (2010) defines organizational knowledge as -When group knowledge from several subunits or groups is combined and used to create new knowledge, the resulting in tacit and explicit knowledge that can be called organizational knowledge.- Its variations include the extent to which the knowledge is spread within the organization, as well as the actual make-up of this knowledge. (Read more: http://www.knowledge-managementtools.net/introducing-organizational-knowledge.html#ixzz3SvYPK1J2). The Accreditation Council for Graduate Medical Education (ACGME) (https://www.acgme.org/acgmeweb/), the Common Program Requirements state that each residency/fellowship program must require its residents/fellows to obtain competence in Medical Knowledge. Medical Knowledge requires residents/fellows to demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient and as further specified by the ACGME Residency Review Committee (University of Maryland Medical Center 2013).
The population in the eastern suburbs is increasing, with the hospital facing high demand. The original processes are no longer efficient. There are some major problems which need to be solved in the current system, such as:
• Low efficiency is the most noticeable problem. Sometimes the waiting time is unbearable for patients.
• As the processes involve many different internal units and external organizations, communication is a big issue. To ensure punctual diagnosis requires high level collaboration among these entities and this is sometimes difficult to manage.
• Disease management needs to be enhanced based on the use of Electronic Patient records.
The goal of general medical process is to provide high-quality and cost-efficient patient care. In other words, to treat more patients with less expense in the same time period without sacrificing the quality of care. In order to do that there are several issues that need to be considered:
• Guidelines should be represented in a structured format
• Processes should be modelled to reflect guidelines and decision rules
• Patient data should be mapped to Electronic Patient Record
• Resources should be organized to complete tasks punctually.
To better understand the problems and issues, you are required to analyse their current business processes.
The General Medical Process (AS-IS)
The process commences with a receptionist registering the patient at the front desk. The patient is required to provide mandatory personal and insurance information. After registration, the patient is triaged, based on the severity of their condition, to determine the order of medical attention.
After patient information is recorded, a healthcare professional, usually a nurse, conducts an initial assessment of the patient’s condition, including vital signs (temperature, heart rate, blood pressure, etc.) and records a brief medical history. This information helps in prioritizing care. The information will be forwarded to a schedule planner who helps the patient to make an appointment for an initial diagnosis.
The diagnosis is carried out by a doctor who will decide what to do with this patient. If the patient does not need any help or cannot be helped, the patient will be released, causing the process to end. If the doctor thinks someone else can further assist the patient, he/she is referred to a doctor with the necessary expertise. If the patient’s symptoms are not clear, the doctor will suggest further tests (e.g., blood tests, X-rays, MRI scans) to arrive at a diagnosis before drawing any further conclusions. To understand the patient condition better, the doctor sometimes need to reviews the patient’s medical history.
There are many different types of tests (e.g. biochemical tests, visual tests, and function tests). These tests are carried out by various experts, with the results being forwarded to the doctor for the follow-up diagnosis. The doctor may elect to release the patient, consult other medical practioners/specialists, request further tests or prescribe appropriate therapies/treatments. There are many choices available to the doctor, such as medication, surgery, radiotherapy, and physiotherapy, all of which are handled by a range of medical staff. Following any form of therapy, a prognosis is formulated based on the results of the therapies.
For any diagnosis, test or therapy, an appointment has to be made beforehand by the schedule planner.
Depending on the complexity of the patient’s condition, they may be referred to various specialists for further evaluation and treatment.
Based on the diagnosis, the medical team develops a treatment plan tailored to the patient’s specific needs. This plan may involve medications, surgical intervention, physical therapy, or other medical procedures.
Testing It is the doctor’s decision as to which tests should be completed. There is often a protocol which designates the tests to perform depending on the preliminary diagnosis. The tests can be executed in any order or sometimes concurrently. There are many different tests, some of them are handled internally but others are external via third parties due to the lack of knowledgeable staff and limited equipment.
It is the doctor’s decision how to proceed. In the case of surgery or radiotherapy another specialist is involved who may consider the therapy as a new case and could possibly start with a more specific diagnosis process before commencing the therapy.
Since there may be many therapies that can be executed simultaneously, we have applied a repeater pattern as in -testing-.
Hospital staff provide patients and their families with essential information about the patient’s condition, treatment, and ongoing care to ensure understanding and compliance.
Patients may have scheduled follow-up visits with their primary care doctor or specialists to monitor their progress and ensure a smooth recovery.
Throughout the medical process, detailed medical records are maintained, ensuring continuity of care and facilitating communication among healthcare providers.
Most of the cost will be covered by the Medicare or Private insurances. Out-of-pocket expenses will be invoiced to the patient following their release. Patients have a month to arrange the payment.
Improving Efficiency and Quality of Care at Maroondah Hospital through Business Process Reengineering
Maroondah Hospital, located in the eastern suburbs of Melbourne, Australia, provides general medical care to the local community. However, with the population in the suburbs increasing rapidly, the hospital is facing high demand that the current processes can no longer efficiently handle. This has led to issues like long waiting times for patients and lack of coordination between different units. To continue delivering quality healthcare in a cost-effective manner, there is a need to reengineer the key business processes at Maroondah Hospital.
This paper analyzes three major problems in the General Medical Process – low efficiency, communication issues, and lack of standardized protocols. It then proposes implementing best practices like Enterprise Resource Planning (ERP), Electronic Health Records (EHR), and Clinical Decision Support Systems (CDSS) to address these problems. The expected benefits of the proposed solutions are also discussed.
Analysis of Current Process Issues
The General Medical Process at Maroondah Hospital involves a patient first seeing a doctor for diagnosis. Based on the diagnosis, the patient may be referred to specialists, undergo tests, or receive various therapies like medication, surgery etc. While the overall flow seems logical, there are some significant issues hampering efficiency and care quality:
Low Efficiency and Long Waiting Times
One of the major pain points is the low efficiency of the current process. Patients often have to wait long hours to receive care. This is partly due to a lack of integration between different hospital units involved at various stages. For example, test reports from the lab have to be manually sent to the doctor’s office through paper files or emails. Similarly, specialists do not have real-time access to patient records from other departments. This leads to delays, repetition of work, and errors. Manual, fragmented systems are unable to handle the rising patient volumes effectively.
Issues with Communication and Collaboration
With information siloed in different clinical and administrative systems, effective communication and collaboration between caregivers is challenging. Test results are not always shared promptly, leading to delayed diagnosis and treatment. Physicians also struggle to keep track of a patient’s progress when being treated by multiple specialists. The lack of a unified platform that brings together all stakeholders on a patient impedes coordinated care.
Inconsistent Disease Management Protocols
Each physician or department may follow slightly different guidelines for diagnosis and treatment depending on their experience and preferences. This results in variation in clinical practices and care outcomes. There are also no standardized protocols to ensure evidence-based, cost-effective management of common conditions based on best practices.
To address the above issues, this paper proposes implementing the following best practices after studying their proven benefits in other healthcare organizations:
Implement an Enterprise Resource Planning (ERP) System
An ERP integrates key hospital functions like finance, supply chain, and clinical operations on a single computer system with a common database. This allows real-time sharing and tracking of patient information across departments. Automated workflows also improve staff productivity. ERPs have been shown to reduce wait times by 25-50% and boost productivity by 10-30%.1 For example, Epic, Cerner and Meditech are widely used ERPs in hospitals globally.
Adopt an Electronic Health Record (EHR) System
An EHR provides a longitudinal electronic patient record with a complete medical and treatment history. Features like physician notes, test results, prescriptions etc. are accessible online to authorized caregivers. Secure messaging and alerts help coordinate care. EHRs have been found to enhance quality through improved decision making and fewer medical errors.2 Systems like Allscripts, eClinicalWorks and NextGen are popular EHR choices.
Implement a Clinical Decision Support System (CDSS)
A CDSS integrates clinical guidelines and best practices with individual patient data. It alerts doctors to treatment protocols, recommends tests/therapies based on symptoms, and flags drug interactions. This ensures standardized, evidence-based management of conditions. Research shows CDSS increases adherence to guidelines and reduces unwarranted variation in care plans.3 Systems from Cerner, Epic and Meditech offer strong CDSS capabilities.
Expected Benefits of Proposed Solutions
The integrated ERP-EHR-CDSS framework is expected to address the key issues at Maroondah Hospital by:
Standardizing processes through automated workflows, centralized protocols and decision support tools. This enhances consistency and compliance.
Enabling real-time, organization-wide access to patient information. This facilitates coordinated, continuous care across settings.
Streamlining communication through unified health records, physician notes and alerts. This improves collaboration between caregivers.
Automating routine tasks to boost staff productivity by an estimated 10-30%.1 This frees up resources to handle growing patient loads.
Reducing medical errors and unwarranted variation through evidence-based guidelines and integrated knowledge tools. This enhances quality and safety.
Cutting wait times by 25-50% on average through optimized processes, reduced repetition and automated scheduling.1 This improves patient satisfaction.
Supporting data-driven decision making for strategic and operational improvements through analytics on structured, integrated data.
By addressing current inefficiencies, lack of coordination and inconsistent practices through best-in-class technologies and methodologies, Maroondah Hospital can significantly enhance process efficiency, quality of care and patient outcomes. The proposed ERP-EHR-CDSS framework offers a standardized, integrated solution to handle rising workloads while continuing to deliver high value healthcare. With proven results, it is well-suited to address the hospital’s objectives. Overall, business process reengineering through these approaches can help Maroondah Hospital better achieve its mission of serving the local community.