Executive Summary / Abstract
Al-Wazarat Health Center (WHC) is located in Riyadh City, the capital of Saudi Arabia. The center is associated with the Riyadh Military Hospital Program. RMH is part of the Medical Services Department (MSD) of the Ministry of Defense and Aviation (MODA). The center is specialized as a Family and Community Medicine Department, with a large practitioner service and is currently incorporating a dermatology clinic, well women’s clinic, and a pediatric clinic to accommodate the growing population and to further enhance the quality of patient care. In addition to the ordinary healthcare facility and auxiliary, the center also contains other medical facilities such as a Pharmacy Department, Radiology Department, treatment rooms, specimen rooms, resuscitation and ECG rooms, and a nebulizing room.
The Family and Community Department aims to provide the best standard of healthcare services for its patients by meeting their expectations, and has full commitment to the principles of Total Quality Management. It also provides optimum support to all employees through effective training to further its management objectives.
Like any healthcare organization, WHC involves complex clinical and administrative tasks and processes to manage their daily operation which covers different specialty services. The clinical workflow varies from appointment registration, clinical procedures and investigation (e.g. laboratory/radiology), and may include a referral to the outpatient clinic or the emergency room. The various tasks and processes also involve healthcare providers, physicians, pharmacist, nurses, clerks and administrative personnel.
WHC developed a collaborative and process-oriented Business Process Management (BPM) system (eMedServe) built on Bizagi BPM Suite, which captures all of WHC clinical and administrative processes and activities, and automates them as they actually are. The aim was to enhance efficiency of health care delivery within a patient-centered interdisciplinary approach. Bizagi was able to provide the appropriate BPM system offering a robust, high-level and multifunctional application that would allow WHC to achieve faster results.
Al-Wazarat Health Center (WHC) is located in Riyadh City, the capital of Saudi Arabia. The center is associated with the Riyadh Military Hospita Program. RMH is part of the Medical Services Department (MSD) of the Ministry of Defense and Aviation (MODA). The center is specialized as a Family and Community Medicine Department. This department has a large practitioner service for patients attending the center for medical treatment, which may involve treatment for acute or chronic disorders, ante-natal care, child welfare, vaccination programs, and care of chronic/acute wounds and injuries. A dermatology clinic, well women’s clinic, and a pediatric clinic are being added to accommodate the growing population and to further enhance the quality of patient care. In addition to the ordinary healthcare facility and auxiliary, the center also contains other medical facilities such as a Pharmacy Department, Radiology Department, treatment rooms, specimen rooms, resuscitation and ECG rooms, and a nebulizing room.
The Family and Community Department of RMH offers medical treatment and follow-up to all eligible patients through the different clinics held daily from 07:30 a.m. to 23:30 p.m. The Family and Community Department aims to provide the best standard of healthcare services for its patients by meeting their expectations, and has full commitment to the principles of Total Quality Management. The Family and Community Department also provides optimum support to all employees through effective training to further its management objectives.
Like any healthcare organization, WHC involves complex processes that cover different specialty services. The clinical workflow varies from appointment registration, clinical procedures and investigation (e.g. laboratory/radiology), and may include a referral to the outpatient clinic or the emergency room if the particular case involved is of serious nature. The process involves clinical and administrative tasks which are handled by the healthcare provider according to the specialty-specific role which will alternate between different users.
The BPM system has helped to enhance the efficiency of health care delivery by improving health care interactions within a patient-centered interdisciplinary approach (e.g. physician to patient; physician to physician; physician to pharmacist). It encourages many forms of inter-partnerships to support patient care. A key factor in the success of a BPM system implementation is collaboration. While a data-centered application system tends to remain stable (i.e., unchanged) for rather long periods of time, a process-oriented application must be modified whenever the business processes they support change, and this may happen rather frequently in real working environments. The process–oriented system allows clinicians to update, manage and change a particular treatment protocol as new drugs are discovered or emitted, and shows new methods of application of how to treat certain diseases, including information concerning a course of a particular disease and its patterns. Other information such as a pre-planned treatment process, and organization policies and procedures are at the user’s finger tips.
The challenges that the BPM system had to resolve regarding WHC´s operation are summarized in the following list:
- Increased patient waiting time
- Postponed or cancelled procedures
- Repetitive procedures
- Long treatment times
- Increased cost spends
- Inability to determine task times
- Allocation of resources on time
- Inability to estimate the needs for expansion
- Inability to maintain standards according to policy and procedures
Benefits and positive results regarding all these challenges were obtained with the BPM system developed with Bizagi BPM Suite.
The process involves clinical and administrative tasks which are handled by the healthcare provider according to the specialty-specific role which will alternate between different users. Depending on the task; the initial process will be the registration of the patient by the clerk, and then the patient information will be reviewed by the nurse, and from there it will go to the physician for review. Once the information has been reviewed by the physician, he will input notations and send the information back to the nurse to complete certain procedures. Afterwards, the physician will make an evaluation/diagnosis dependent upon the test results.
The tasks in the work flow are performed either manually or by reviewing the results of an automated process in which new data is available for analysis and the next steps can be completed. The cooperation between different sections as well as between healthcare providers is crucial to accomplish the required process, since the work of each user (regarding a patient) is dependent upon accurate entries by the other user. Much of the value derived from the delivery system results from the effective communication of information from one party to another and, the ability of multiple parties to engage in interactive communication of information.
The (dynamic) planning of the patient flow is a very complex and error-prone task, since activities may be closely related to each other due to clinical, organizational, or logistic reasons; because of this, they can neither be executed sequentially nor completely independently of each other. For a particular patient, medical interventions may have to be performed in a certain order or with a minimum or maximum time distance between them.
Due to the complexity and size of the process, the sensitivity of the information that it handles and the accuracy with which it needs to be managed, the WHC decided and identified the necessity to implement a BPM system that would allow increasing efficiency and meeting service standards and policies.
The Key Innovations
The BPM project´s purpose was to map and automate the “Core Processes” of Al-Wazarat Healthcare Center (WHC), which is part of Family & Community Medicine (F&CM) Department at RMH. WHC has a total staff of 200 personnel in the following categories: Administration, Reception Areas (Clinical Reception Clerks / Appointment Desk / Referral Desk), Nursing, Doctors, Pharmacy, Laboratory, and Radiology.
In order to provide a standards certified health service of the utmost quality to its patients (the military officers and their relatives) the Riyadh Military Hospital (RMH) embarked in a BPM initiative with Bizagi. This innovative project brought several benefits to WHC, including business agility and efficiency.
In terms of business and operation structure, the innovations include:
- Total of 4 Main Processes were automated
- Total of 6 Structural Sub-Processes were created
- Total of 67 Sub-Processes & Electronic Requests were automated
- Total of 41 WHC Printed-Letter Templates were created
The BPM initiative is being led by the Technological Research and Development unit at the RMH, called MedIcen.
In its first approach, the MedIcen personnel have automated over 70 processes for the Wasarat Health Centre (WHC) primary care centre (PCC).
These processes can be classified in 4 main services:
- Walk-In process: Attention of patient that walk in to the hospital without any prior appointment.
- Short-booked: general service provided for patients that have booked an appointment.
- Speciality booked: speciality service provided for patients that have booked an appointment.
- Emergency: patients that come to the hospital because an emergency.
The project covers the complete life-cycle of the patient, from registration, triage, to diagnose and treatment and will be used by approximately 400 users serving approximately 2.000 patients per day.
Once the system was rolled-out, the BPM team at MedIcen initiated the definition and automation of the processes at the much larger RMH, where there will be several thousands of users serving no less than 6.000 patients per day.
Application Development Process:
The BPM system was built on Bizagi Business Process Management (BPM) solution. The eMedServe system is designed, developed, and implemented by the Medical Informatics Research and Development Center (MedICen), Riyadh Military Hospital (RMH). The purpose of eMedServe is to computerize the business of Al-Wazarat Healthcare Center (WHC) and automate its clinical practices built-on the Bizagi platform. The current release of eMedServe captures all of WHC clinical processes and activities, and automates them as they actually are.
The following process model shows part of the Emergency Management process with some of its structural sub-processes such as: Treatment Room Process, Investigation Process, Referral Process…etc
The following image shows the stages of the project used to define the process architecture:
To help Al-Wazarat Health Center (WHC) with the appropriate technology, WHC management was in need of Business Process Management (BPM). This required changing their Health Information System (HIS) to a process-oriented system, which would help WHC management to streamline their processes so that they can deliver high quality care while at the same time reducing costs.
The Business Process Management - BPM system is responsible for keeping track of the practical tasks required and enables the user to perform a specific task, in a specific time, in the appropriate order. The system ensures the completion of the required task, and provides the flexibility to change the order of tasks (Business Process Reengineering or Improvement) when required without having to reprogram the system. It works by showing the user the function that is required to perform the selected task, and all necessary information is displayed in the proper sequence.
The system includes features that also allow the integration of functions and services of more than one system which is known as Business Applications Integration. It also supports the technology with Service Oriented Architecture.
The main challenge was to deal with the complexity of the process due to the large number of areas, stakeholders and actors involved. Also, the sensibility of the information handled by the process and the necessary coordination and interaction between tasks, activities and people were factors that had to be managed with care and detail.
Regarding the process itself, there were several challenges which needed to be resolved. These include:
- Increased patient waiting time for different reasons such as a healthcare provider not being present, or lack of resources like: medical equipment not available, or lack of an efficient systematic process.
- Procedures may not be performed, or may need to be postponed due to important information not readily available such as lab results, a missing file, or lack of preparatory measures, etc.
- Repetitive procedures which effect patients by exposing them to too many procedures (e.g. x-rays).
- Treatment time may take longer than necessary.
- Increased cost spends.
- Inability to determine the actual time needed to perform a task in order to evaluate the performance of the healthcare provider, and to be sure that high quality service is being provided to a patient in an appropriate time frame.
- The ability to allocate the necessary resources for each unit and distribute them according to the need in sufficient time.
- Ability to estimate the needs for expansion of the healthcare facility and to know precisely where the demands are needed most.
- The ability to maintain standards according to policy and procedure and update them as needed, and to apply a monitoring mechanism for adherence to the PPG's (total quality management standards and regulations).
To overcome the business and process challenges, it was necessary to develop the first stages of the project with special attention and detail, that is, the process definition and architecture design. This made it possible to perform an effective process modeling for a successful implementation and execution. Also, transforming the system to a process-oriented application was an important factor to guarantee meeting the project objectives.
Together with the aim of improving customer service and patient care, there was the need for reducing costs. Cost reductions are observed from the reduction of manual activities and paperwork as well as the optimization of resources and reallocation of activities and people.
The process and sub-process cycles have experience a significant reduction in time. The effective interaction and coordinated work between differen areas as well as between healthcare providers and other personnel has helped WHC to deliver a faster and high-quality patient-care service. Effective communication, rapid data entry, and coordination from one party to another have been the key factors to obtain time reductions.
Other cycle time reductions are observed in: decreased patient waiting times, faster completion of procedures, shorter treatment times and quicker activity planning.
The main objective of this project was to enhance efficiency of patient care delivery within a patient-centered interdisciplinary approach and meet patient expectations. This objective has certainly been met and because new levels of efficiency have been reached, there have been indirect increased revenues. Specific revenue numbers are confidential.
Healthcare providers are now able to perform their job more efficiently; data is available on time for analysis and revision, annotations from co-workers are included in the system and procedures are completed much faster. Eliminating manual tasks also helps to improve process tracking, visibility and control. This results in optimized access to patient records and increased productivity levels.
Productivity improvements are also observed from increased cooperation, interaction and communication between the areas and parties involved in the process.
Best Practices, Learning Points and Pitfalls
Best Practices and Learning Points
- Project development by phases
- Involvement and feedback from stakeholders
- Process-oriented system
- Avoid solving problems during advanced stages of the project or late feedback from stakeholders. Try to look at all possible scenarios during the definition and design phase.
Staying ahead of industry standards has now become a necessity, especially in industries like healthcare where service levels will always be looked at with detail by patients and regulatory entities.
WHC has gone one step forward. With the determination of providing the best standard of healthcare services for its patients, WHC has definitely achieved a competitive advantage over other health institutions that haven´t recognized yet the value that agile and transparent processes, efficiency and reduction of manual tasks can bring for their patients.
WHC selected Bizagi BPM Suite for the automation of their complete clinical and administrative operation, covering processes, tasks and activities from several specialty services. WHC used Bizagi Process Modeler to map and design the process flow and then Bizagi BPM Suite for process execution/automation.
Bizagi is an integrated BPM Suite which enabled WHC to manage their complete process cycles and is flexible enough to support changes in business and market conditions. Bizagi is a robust, high-level and multifunctional process management system which can support mission critical operations and organizational growth.
Other technical aspects include:
a. Integration-Related (Web Services & Virtualization)
- Patient Demographic Data
- Drug History
- BPMN Process Modeler
- 100% Model Driven Architecture
- Drag & Drop Forms Designer
- Business Rule Engine
- Service Oriented Architecture Integration
- Execution Engine
- Web Work Portal
- Process Indicators
- Business Activity Monitoring (BAM)
The Technology and Service Providers
WHC selected Bizagi BPM (http://www.bizagi.com) for the implementation of their first BPM initiative. Bizagi is a leading BPM solution capable of empowering businesses of all types and industries around the world, providing them with unprecedented adaptability to changing business and market conditions through optimal business process automation (execution) and continuous improvement.
Bizagi is a business productivity tool for faster process automation. Bizagi´s built-in functionalities, ease of use and flexibility makes it the ideal BPM solution to obtain faster results. In Bizagi, most of the common and reoccurring requirements in process automation have been pre-built. These refer to:
- Control and visibility
- Alarms and notifications
- Performance analysis and reporting
- Auditing and traceability
- Workload routing and balancing
- Corporate features (multi-tenancy, BPMN process engine, multiple language support, time-zones, long lasting process transactions, enterprise data model, among others)
Bizagi is available in multiple editions to support the varying needs of organizations. The corporate editions are appropriate for mission critical and core business processes, satisfying the most demanding needs in larger organizations. Corporate editions (Enterprise .NET and Enterprise JEE) are similar in functionality, the only difference is the platform where they execute.
Copyright: This case study was originally published in the Excellence in Practice series in the book entitled “Delivering Competitive Advantage” published by Future Strategies Inc. ©