Business Case:
Table of Content
Johns Hopkins Aramco Healthcare Operations Management Report 1
Introduction 3
Background on Johns Hopkins Aramco Healthcare (JHAH) 4
OM Best Practices in Healthcare 5
Comparison Between Healthcare & Food industry 5
Challenges Within JHAH and Way Forward 6
Leverage JHAH Strengths to Succeed 7
Project Objectives 7
Planing and Control of Resources 8
Analysis & Action Plan 9
Additional Quick-Wins 15
Applying
Porter’s 5 Forces to Risk Management 15
Conclusion 17
References 18
Operation management is
a function that cannot coexist without cooperating with other functions within
an organization to effectively execute organizational performance (Slack, Brandon-Jones
& Johnston, 2014).
Operations management
(OM) is consist of strategic planning and processing taking place in a complex environment. Our
central focus is on the organization’s operational systems, each built up from
their own subsystems. Each layer and component subsystem adds complexity that
makes generalizations more difficult to see and substantiate. Even when we
break the range of organizations down into more manageable, comparable groups,
the variety among operations systems remains staggering. The conceptual
frameworks that form the OM body of knowledge must recognize all the
contingencies and factors that distinguish one firm’s operations (and its situation) from others (Stuart, McCutcheon,
Handfield, McLachlin & Samson, 2002).
In healthcare,
operations management is applied on different scales supporting multiple
processes and strategies that meets the organizational objectives. My
organization is a very mature healthcare system which have been in business for
a little over 80 years; the organization in both physical structure as well as
operations has been through a number of transformations. As of last year the
most recent transformation embarked as the parent-organization had created a
Joint Venture (JV) with a world-class healthcare system from the US; and in May
2014 the now joint venture was born to become Johns Hopkins Aramco Healthcare
(JHAH) Company.
As a world-class Oil
& Gas Company, and serving over 300,000 patients (employees and their
dependents) the parent-company had this initiative to establish a joint venture
for the past couple of years knowing that they are considered a leading
organization in the oil & gas industry and they have been providing
high-quality of healthcare to their patients. The change came as part of the
initiative to continue providing the best quality of care to our patients and
become a center of excellence in healthcare in Saudi Arabia and region.
The healthcare system in
general has all the similar aspects of any business including operations
management and strategic planning. As the supply and demand changes locally and
competition is increasing and the need to step up and challenge our current
status quo to become pioneers in the healthcare delivery system in the region.
For this project the
selection was made to illustrate and challenge the process of health information
management within the organization. As physicians utilizes their knowledge and
patient information available to support and effectively diagnose their
patients in order to treat realtime and perceived patient concerns (Slack, Brandon-Jones
& Johnston, 2014) and the
clinical and non-clinical support services job is to ensure the availability of
patients’ information during the patients’ episodes of care.
This healthcare system
is a unique establishment with a long history of success from both parent
companies owning the joint venture. This venture was established with the
vision of “Johns Hopkins Aramco Healthcare will evolve
into a center of excellence that provides enhanced specialty and subspecialty
services, new lines of treatment, research and education that address some of
the most significant health care challenges in the region.”
(Johns Hopkins Medicine, n.d.).
One of the key
operational objectives is to establish primary, secondary and tertiary
facilities owned by JHAH leveraging their knowledge and experience in
healthcare to improve the healthcare quality and system in Saudi Arabia.
The history of this
organization (before the joint venture) is rich. The organization was a large
healthcare institute serving over 300,000 patients between employees and
dependents of a global leader company in the oil & gas industry. Moreover,
the healthcare organization is well known for its bureaucracy in operations
though it has continuous efforts and attempts to shed it off in the past
decades but still change is difficult and the organization still has some of
the distinct characteristics of a bureaucratic organization such as (Spangler,
Tikhomirov, Sotak & Palrecha, 2014):
1.
Must have
positive relationship with superiors/authority
2.
Competing
with peers and others
3.
Superiors
impose wishes on their subordinates
4.
Assertive
behavior
5.
Must always
out-stand the group; and
6.
Continuously
perform the administrative functions
As the organization
matures, best practices are crucial to revamp the current operations and focus
on critical aspects of the business to change in order to become the leading
healthcare organization we are aiming to be.
“The Challenge in today’s
world is to stay viable”-Ranadive, MD; as part of a competitive business and
industry, the need to sustain a long-term plan for securing financial income
and organization’s reputation are crucial aspects of any
business. Three main aspects of a healthcare system to ensure competitive
advantage in the market is to have (Pofeldt, 2014):
I.
Front-line
staff - and your organization’s image where these employees can help
patients to provide them with the desired patients’ experience.
II.
Maintain
online reputation - and the organization image on social media since words
travel fast through the internet and accessibility to information that would
either benefit or harm the organization’s image and reputation.
III.
Fine-tune
the organizational operations - can be anything from revising account
receivables, to evaluate recurrent cost and motivate employees to improve
performance.
An article was published
and had interesting comparison between the healthcare system in the U.S and the
food industry. Both industries are considered complex operations with supply
chain activities with some similarity towards the benefits of streamlining the
business operations to ensure that they organization improves quality of services
and reduce cost. Healthcare is a need in any economy, moreover (Kumar & Blair, 2013):
1.
Healthcare
is a basic need in life; similar to how people needs food to survive, good
quality healthcare services is also considered a basic need in life
2.
Healthcare
services should be customized since every patient has their own history and
medical status
3.
Healthcare
professionals must be highly trained and are able to utilize sophisticated
equipment and diagnostic medicine to treat their patients
4.
Long-term
personal relationships such as having primary care giver assigned to an
individual or a family is considered on of the key success factor in delivering
primary and preventive healthcare services to patients.
The cornerstone of any
organization is its ‘People’, employees are your drivers of change and any
embarked transformation. And since one of the operations principle is that all
organizational processes have transforming input elements and transformed
resources to create the output products and services desired (Slack,
Brandon-Jones & Johnston, 2014).
Since JHAH is an
existing organization, utilizing operations management best practices in
healthcare is crucial to its infancy period as it evolves from a resource and
finance consumer to a healthcare system that is profitable and generates
revenue to sustain in the market. Operations management is both a ‘function’ and an ‘activity’; meaning that the function is the part of the
organization that creates and delivers services/products for the organizational’s
costumers and clients. And activity is the meaning how the OM process is
managed within the organization’s functions (Slack,
Brandon-Jones & Johnston, 2014).
In this context, the challenge in addition to what it was mentioned in week
one, the executive managers and directors of the operations are in need to
function properly in order to support the joint venture’s
vision to become a leading healthcare industry in the region.
The healthcare business
will always be driven by the four V’s especially the volume-variety model as the
supply and demand is required to be properly rendered to the population in need
(Slack,
Brandon-Jones & Johnston, 2014);
this would be in order to understand the market and customers demands to ensure
the availability of care in the geographical locations to properly service the
health needs of the patients.
One important framework
that the organization is building on how to utilize Population Health data to
project the healthcare supply and demand in the local communities around the
population currently served by the organization (JHAH) to allow for quick-wins
and improve accessibility to the services needed for the patients. For
instance, Saudi Arabia is known to have a very young population a long with a
large percent of an aging population, meaning that the healthcare population
planning is in need to give additional focus on both primary care services for
the young such as immunizations, patients portals, technology based services,
etc and for the aging population to provide them with services such as family
medicine specialist to monitor Diabetics, hypertensive, etc and other cases as
well as Geriatric services to decrease the numbers of hospital admissions for
elderly patients needing mainly hospice care or home health.
The organization’s
survival and sustainability will rely on their ability to be a robust
organization and how can they innovate in order to gain competitive advantage
over their peers in the market. An interesting model ‘The
Care Continuum Alliance (CCA)’ is
a similar analytical framework in concept to what JHAH is striving to achieve.
The framework relies on identify and understand the population served,
categorize and risk stratify the patients’ populations, providing patient-centered care
such as decentralizing primary healthcare services within the communities for
easy access, evaluate the goals of the CCA model and continuously revaluate to
improve the quality of the services (Struijs, Drewes, Heijink & Baan, 2015); these aspects are currently analyzed to
establish a similar framework and how the organization will leverage their
technology capabilities and infrastructure to support such initiatives; yet the
challenge is to execute and implement these changes which will allow the
organization to achieve short-term success and competitive advantage among
their peers in the market.
Referencing the
organization’s vision where the transformation aims to
become a center of excellence that provides high quality services including new
lines of treatments and become a center of research and education that will
help address some of the most challenging cases in the region.
The difficulty of
handing this project will relay on the scale, complexity and uncertainty of the
end results (Slack, Brandon-Jones & Johnston, 2014). Operating a healthcare organization may be
as complex as any other industry if not more due to the high levels of
uncertainty and emergency response planning comparing to some of the other
industries. Yet the challenge is to plan for the unpredictable and emergency
scenarios.
In this report the
discussion will take place on three main challenges that the organization as a
new joint venture is setting as main objectives to achieve from an operational
prospective to improve the quality of care provided by leveraging technologies
and the clinical support services.
In supply chain a large
number of frameworks are established and developed in order to meet different
industrial needs. DART framework was established by Prahalad and Ramaswamy
(2004) and was used in supply chain to support the supply and demand needed
through providing a logistics framework to segregate the upstream and
downstream processes. The DART stands for dialogue, access, risk & benefits
analysis and transparency; these are all elements that will enable for a value creation
collaboration to achieve the desired objectives (Chakraborty &
Dobrzykowski, 2013).
Parts of the DART
framework can be utilized to illustrate the action plan intended for this
paper.
In literature there are
variety of approaches to qualitative data analysis and resources to verify the
data which makes it difficult to provide a consistent set of criteria to
interpret the quality and accuracy of the data gathered and analyzed. And in
this section the focus will be on utilizing qualitative analysis tools and the
goal is to have rich descriptions of the data gathered rather than measurement
of specific variables which maybe challenging in such context (Schutt, n.d.).
In this study we will utilize the SWOT Analysis tool that we believe will add
value to the results and conclusion of this study which will support the management in the decision making process through
identifying the resources need and shift capacity by increasing or decreasing
attributes to optimize the performance. Nevertheless, there are additional
other tools that maybe considered for future studies such as: Gap analysis and
Value Chain analysis for determining value added from technical processes
(Rice, 2010).
Objective One: Streamlining the processes related to the
management of patients’ medical records and make them available at the
time of the patients’ appointments; in addition to leverage the use
of hybrid medical record to improve continuity of care.
SWOT Analysis:
|
Strengths
|
Weaknesses
|
|
-
Having a semi-structured policy to guide the
flow of medical records within the organization is the first step to take it
further.
-
Healthcare providers can 90% of the time
utilize the electronic medical record to review patients diagnostics and
medications without needing the chart.
|
-
Physical files are easy to misplace and move
from one place to another without proper tracking to be able to locate the
medical record when needed.
-
Rarely the electronic system maybe down and
the entire system will revert to a manual process until the system is back
on.
|
|
Opportunities
|
Threats
|
|
-
Centralize the Filing Room for Medical Records
to ensure availability when needed.
-
Apply Medical Records policy on all related facilities
to ensure consistency with management of the files.
|
-
The organization estimates around 5-10 medical
records missing/misplaced at the time of patient care causing the information
to be unavailable for the provides.
|
Action: dialogue ‘communication’ and access ‘to information’; these two main
elements are key drivers of this objective.
• The action is to establish a clear policy with
a flowchart on the process of managing medical records such as introducing
track-in and track-out function using the electronic system to monitor the
movement of medical records.
• A cost-effective study can be done to evaluate
the possibility of implementing RFID to track medical records within the
facilities.
Risks &
Transparency: There are three risk areas found for this objective and requires
to eliminate obstacles to improve the outcome:
• Healthcare providers lock on incomplete charts
• The medical record is located in a different
facility
• The patient has multiple appointments in
different clinics
• Patient is transferring from a different
facility and no historical information is available on the patient
• Missing/lost medical records (physical file)
and only electronic information is available
Objective Two: To successfully adapt and implement a
world-class electronic health record (EHR).
SWOT Analysis:
|
Strengths
|
Weaknesses
|
|
-
Epic is a world-class Electronic Health Record
with several awards in the field.
-
JHAH partner in USA, Johns Hopkins
Medicine (JHM) had already adapted the
same system allowing us to have leverage, share knowledge and lessons learned
from their implementation.
|
-
The infrastructure is not the same between
JHAH and JHM.
-
Cannot adapt or replicate all Epic workflows
since JHAH do not operate the same way as JHM (different countries policies
and procedures).
|
|
Opportunities
|
Threats
|
|
-
JHAH has a large number of knowledgable staff
and leveraging JHM experience while considering JHAH policies and regulations
will result in a successful and fruitful outcome with the go-live.
-
Leadership commitment to the go-live date is a
huge support for the implementation process.
-
Organizational change processes using a change
management framework, organizations may be better able to motivate, lead, and
succeed with EHR adoption as a major change for the organization (McAlearney,
Hefner, Sieck & Huerta, 2015).
|
-
Shortage in staff to complete the design,
validation, and implementation process can lead to delay in the go-live
timeframe.
-
Failing to strategically develop a communication
and change management program to support a smooth transition for all
employees within the organization.
|
Action: The critical
success factor (CSFs) for this implementation is common a number of case
studies that have undergo a successful implementation; these common factors are
(Standing & Cripps, 2015) and (Deokar & Sarnikar, 2014):
• To involve Stakeholders & users
• To have a clear vision/plan for the role for
the information & communication technology (ICT) and technical support
• To align the implementation with the
organizational mission, goals and objectives
• To have a well-established roadmap on the implementation which will include the redesign of the current
processes, integration of systems and conversion from the old to new system
• And most importantly have a well-established
communication and training plan to ensure the users buying and allow them to be
part of the workflow design to achieve the desired outcome of implementing an
integrated EHR
Risks &
Transparency: There are two main risk areas abstracted from this objective and
requires to be addressed for the success of this project:
• Streamlining the operations management from
the current process to the future one
• The change management process of existing
employees from the current processes to the new desired ones; change will have
a powerful benefits on the quality of care, cost, and populations (McAlearney,
Hefner, Sieck & Huerta, 2015).
• Insufficient involvement of stakeholders and
communication; such as lacking strong clinical leadership
Objective Three: Become a center of excellence in healthcare
in the region, through transforming from a semi-private organization managed
with a set budget to a private organization that requires process streamlining
and efficiency in performance to create sustainability in the healthcare
market.
SWOT Analysis:
|
Strengths
|
Weaknesses
|
|
-
Before the joint venture was established, the
organization had very strong and high reputation of being best in the market
and among a number of competitors.
-
All the hired c-suite managers are experienced
healthcare leaders that had made a difference throughout their careers.
|
-
The new leadership requires time to understand
the operation and shift from the USA operations mind set to Saudi Arabia’s
rules and regulations in order to excel in business.
-
Lack of commitment and loyalty from a number
of middle-management.
-
Having a weak change management program and
not fully implemented and supported.
|
|
Opportunities
|
Threats
|
|
-
Ability to execute projects outside of the
parent company cutting the previous processing time to a very short and
effective timeframe.
-
Agility in adapting new processes and
achieving quick wins to gain employees confidence and demonstrate the change
that the organization aim to achieve.
|
-
The challenges facing the new management is
impacting several aspects of the organization. i.e.. maintaing sufficient
number of staffing and managing the increasing workload without delaying
care, etc.
|
Action: Leadership plays
a great role in the success of this objective and requiring the:
• Management should properly define the role and
methods of process design and support these with the required resources (Qiang & Wood, 2006).
• Identifying key operational changes in layout
and workflow for this transition to identity and allocate the resources and
time to achieve; in this example the mixed layout would be the best suitable
for a healthcare institute (Slack, Brandon-Jones & Johnston, 2014). The main objective is to build a clear
framework that will identify clear roles and objectives by the leadership and
ensure the cascade of information to the organization as employees are the key
driver for the success of this transformation.
Risks &
Transparency:
• Undergoing several change management programs
(such as implementing and electronic health record and shifting operations to
become a private organization) is a major shift for the employees and since
change is difficult on employees early engagement may relive some of the
resistance to the new changes.
• The timeframe needed to complete this
transition is required as identifying any schedule constrains from
resource-constrain and time-constrain; and plan accordingly to overcome
barriers that may affect the success of this transition (Slack,
Brandon-Jones & Johnston, 2014).
HR Opportunities:
•
Motivate and
challenge employees through conducting an overall organization analysis to all
current job descriptions and compare them to other job descriptions in the
market and in similar industries and settings. The process will require to
identify and map any gaps and illustrate how the current job descriptions are
not supporting the needs of the dynamically changing operational environment. Therefore
do not adequately support proper training, deployment, defining the scope of
practice, and remuneration for equitable services and benefits within the
organization (Buwembo, Munabi, Galukande, Kituuka & Luboga, 2014).
In the real world, no
matter how much effort the organization put into improving its operations,
there will always be a risk of an unexpected incident or an unusual event that
will occur and may reverse all the improvement processes in place (Slack,
Brandon-Jones & Johnston, 2014).
Nevertheless, to mitigate the unpredictable risks in order to minimize the
impact financially and operationally, the organization require to conduct a
comprehensive analysis through applying models such as Porter’s
five forces model to the potential risks facing the organization.
Porter’s
five forces applied to risk stratification are (Kotler & Keller, 2012):
1.
Threat of
intense segment rivalry, the risk arises when the market starts to mature and
have multiple strong competitors in the healthcare market leading to
sustainability challenges. The remaining four forces are all impacting this
threat as it identify’s the organization as a whole.
2.
Threat of
potential entrants, the organization will be mostly attractive when the entry
barriers are high and exit barriers are low, and the worst is to have the
opposite of low entry barriers and high at exit making it hard to leave during
bad times, which always creates a risk if aspects such as solvable HR
challenges are not resolved efficiently.
3.
Threat of
substitutes, hesitation in employees leaving the organization is due to the
unattractiveness of the actual/potential substitute of human resources by
technology and other systems.
4.
Threat of
buyers growing bargaining power, as part of the supply chain and operations
process of implementing all of the above action plans. The risk of buyers (i.e.
insurance companies and private payors) are presented with other competitors in
the market in a similar quality and services tier leading to risk of losing the
power over others in the market.
5.
Threat of
suppliers growing bargaining power, suppliers loyalty and relationship comes a
long way in this aspect, as suppliers may change their cost and prices based on
market values but can gain some leverage when establishing a supplier
relationship to ensure having the best quality and cost available in the
market.
Developing a risk model
based on the above five forces will allow managers and decision-makers to
identify the environmental threats and evaluate them so decision-makers can become more successful in
creating clear strategies and
contingency planning to neutralize them. The risk management model from Porter’s
five forces is (Rice, 2010):
• Internal organization
• Industry
• Information
• Infrastructure
• Influences
Resembling a similar
concept of the above 5 forces and their impact on the organization’s
overall performance and services.
‘Managing projects is, it is said, like
juggling three balls - cost, quality, and time. Programme management … is like organizing a troupe of jugglers all
juggling three balls and swapping balls from time to time’ (Slack, Brandon-Jones & Johnston, 2014, p. 497). The triangle of projects’ objectives allows to understand the project
different requirements and what type of emphasis among the three project
management objectives (cost, quality & time).
Organizations defer in
operations yet applying project management support methodologies such as
quality management is common practice for all industries. For instance, Lean
methodology is useful once updating or
modifying a process redesign which allows to eliminate waste and non-valued
processes. Moreover, these processes can help in strategizing and implementing
process change. Some projects have used other quality management methodologies
in post-implementation stages such as continuous improvement cycle which post-implementation committees are sustained to continue
supporting any raising issues in processes
and workflows and also prioritize implementation and updates needed (Deokar
& Sarnikar, 2014).
In order for this
project to succeed the key is leadership commitment to change and
willingness to dedicate their efforts and resources to support and empower the
employees to make it happen.
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