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Saturday, February 13, 2016

Johns Hopkins Aramco Healthcare Business Case Study

Business Case:


Johns Hopkins Aramco Healthcare 


Operations Management Report


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 organizations 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 firms 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.

Background on Johns Hopkins Aramco Healthcare (JHAH)

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

OM Best Practices in Healthcare

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 todays 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 organizations 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 organizations 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 organizations 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.

Comparison Between Healthcare & Food industry

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.

Challenges Within JHAH and Way Forward

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 organizationals costumers and clients. And activity is the meaning how the OM process is managed within the organizations 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 ventures vision to become a leading healthcare industry in the region.

The healthcare business will always be driven by the four Vs 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.

Leverage JHAH Strengths to Succeed

The organizations 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.

Project Objectives

Referencing the organizations 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.

Planing and Control of Resources

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.

Analysis & Action Plan

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:
-    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.
-    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:
-    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).
-    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:
-    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.
-    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).

Additional Quick-Wins

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).

Applying Porters 5 Forces to Risk Management

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 Porters five forces model to the potential risks facing the organization.

Porters 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 identifys 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 Porters five forces is (Rice, 2010):
     Internal organization
Resembling a similar concept of the above 5 forces and their impact on the organizations 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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