This chapter presents the proposed framework as a result of the integration of findings from the literature review, observations conducted at the three hospitals (hospital 1, hospital 2, and hospital 3). As mentioned earlier in the problem statement that this research will focus in the four workflow aspects process, product, service and resource. Usually, in the development stage the engineer analysis these factors before the implementation stage. We have performed two kinds of analyses before going proposing our framework. a) Survey of the current literature review and b) Case study analysis. The following sections elaborate it in more detail.
4.1 Survey of the literature review
Earlier in the related work chapter, number of the related models have been discussed. In order to improve the healthcare system, this study focused on the concepts of defining the problem, analysis the current situation, analysis the Strengths, Weaknesses, Opportunities and Threats (SWOT) of the current situation, and solve the problem by improve the current workflow. The six sigma, business process reengineering and Zachman models cover these concepts. Six sigma helps to define and improve the problem (Ratnaningtyas & Surendro, 2013), business process reengineering determines the current workflow (Khodambashi, 2013) and analyze it using SWOT analysis tool (MSG, 2015), Zachman model helps to do a prober analysis of the current workflow factors (process, product, service and resource) (Onademuren, 2014).
4.2 Case study analysis
We have observed and analyzed hospital 1, 2 and 3 to understand the problems and weaknesses in the current systems. As mentioned earlier in chapter 3 ,a number of observations have been conducted in the IT department at three different hospitals, to observe how the existing systems can be improved is given below:
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In hospital 1 usually IT department receives a change request from the hospital departments such as outpatient, inpatient, and pharmacy to enhance the HIS. This request contains various information that help the engineers to understand the request and the required changes such as:
The current process of how the system currently functions. The exact products will be changed.
The desired function to be implemented.
The system manager will check this request, and see if is applicable. Then, changes will be implemented by the engineer. Otherwise, this request will be rejected.
In hospital 2, HIS users have to meet the IT representative in order to request any change. Usually users start defining their problems and the most of the changes are discussed during the meeting verbally and no documents are produced for the desired changes. The requested changes are applied without any study.
In hospital 3, IT department will receive the change request and the engineers will start gathering the requirements and implementing the changes. In this hospital, there is no study of the current situation, only the requirements document.
By observing these hospitals, following findings came into light:
Problems are not well defined at the beginning. So, in this case a solution that is implemented maybe not be the prober solution
In the current process, product, service, and resources are not determined, resulting in many confusion in the system functions at the development stage. Sometimes the requester asks for some changes which are already in the system but he is not fully aware or trained.
If the change request is not applicable in the system, a lot of time wasted in the requirement gathering, because the request is not based on the user and engineer’s point of view.
Lack of documentation led to develop the enhancement wrongly. On the basis of this analysis we propose here the model.
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This section presents the proposed framework for improving the healthcare information systems. As discussed earlier, the focus of this framework is to improve the current systems workflow by studying the influencing factors: Process, Product, Service, and Resource. Following is a decomposition of the suggested framework steps and the inspiration work.
1. Problem definition step is to define the current problem which need to be solved through the system and the reason and the goal that need to be accomplish thought this improvement (Ratnaningtyas & Surendro, 2013). 2. Current situation step is to determine and analyze the current workflow
and all the processes, products, services and resources within the current situation which affect the study of the problem (Onademuren, 2014). 3. SWOT analysis step is to find the problem cause from the determined
factors ant highlight the weaknesses that need to be improved (MSG, 2015).
4. Improvement step is to suggest a solutions which could solve the problem and optimize the current workflow. Moreover, describe the suggested solution and the required changes in the aspects: process, product, service and recourse to provide a well-defined and clear solution (Onademuren, 2014).
Steps Elements Objectives
Problem definition
Problem What is the
problem?
Define the current problem which need to be solved through the system and the reason behind this improvement. Goal What are we going to accomplish? Current situation Workflow What is the current workflow?
Determine and analyze the current workflow and all the processes,
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Process How it’s done? products, services and resources.
Product What to use?
Service What to provide?
Resource By whom? SWOT analysis Strengths What is the Strengths of the current situation? Using “SWOT” technique to find the problem cause from the determined factors. Weaknesses What is the Weaknesses of the current situation? Opportunities What is the Opportunities of the current situation? Threats What is the Threats of the current situation? Improvement Solution How the weaknesses can be improved? Suggest a solutions to optimize the current workflow and the aspects: process, product, service and recourse
Process
What are the changes on the process?
Product
What are the changes on the product?
Service
What are the changes on the service?
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Recourse
What are the changes on the recourse?
Table 6: Process, Product, Service, and Resource (PPSR) Framework
Table 6 show the proposed framework. The steps, elements and the objectives behind each step. In the next chapter an application of the proposed framework in table 5 on King Fahad Medical City (KFMC) / outpatient department case study to improve the workflow of the outpatient appointment. This application will show how the PPSR framework can be used in a healthcare information system problem to produce a clear and helpful solutions and improvements.
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