In this chapter, the study research methods is outlined. Research design, research strategy and the research structure is presented. This chapter show how the research objectives mentioned earlier in chapter 1 (investigate the quality process model in HIS as practiced in several selected hospitals in Saudi Arabia, propose as appropriate framework for HIS quality for application and testing and test the applicability and the effectiveness of the framework in a single case environment) will be achieved using the research activities such as literature review, observations, case study, interviews, questionnaires and simulation.
3.1 Research design
As aforementioned in chapter 2, there exists a large number of proposed frameworks and models to improve the quality of software, but improving the health care information system’s quality is still a challenge. In this work, a quality improvement framework will be proposed in chapter 4 to help engineers in healthcare to improve the quality of information systems in the healthcare industries. This thesis will conduct surveys and simulation method to test the applicability of the proposed framework. Moreover, a systematic review of the current literature which is related to the research question and number of observations in several selected hospitals in Saudi Arabia will be conducted in order to investigate the practiced quality process model in HIS. Furthermore, mixed methods (qualitative and quantitative) will be followed.
3.2 Research strategy
This thesis is aiming to suggest a framework for quality improvement in healthcare information systems by studying the existing quality improvement models and frameworks, and by observing the current quality improvement practices in three hospitals.
An applied research methodology used in this thesis matching with existing pre- knowledge and theories available within the scientific community to answer the research questions. A new framework will be proposed to improve the quality of
43
healthcare information systems. The proposed framework will be applied in a case study that is (King Fahad Medical City Healthcare Information System – new generation project). This will be validated through a simulation method presented in chapter 6. This framework is expected to be applied in the information technology (IT) department in healthcare industry.
3.3 Research structure:
The research methodology will follow different methods as shown in figure 5 to find the best way to improve the information systems in healthcare.
The work methodology in this research identified in two phases:
Phase 1: to identify and apply the suggested methodology using the interviews and observations
3.3.1 Literature review
First, the existing quality improvement models and frameworks will be evaluated. Literature review (Cronin, Ryan, & Coughlan, 2008) will include how improvements of software quality is handled. A collection of recent research papers, discussing the idea of improving healthcare information system quality have been collected, and reviewed in chapter 2. Section 2.7 show the selected frameworks to be tested.
Interviews Observations
Proposed Framework Research activities
Case Study
Survey
Figure 5: Research Activities
Literature Review
Literature Review
Literature Review
Literature Review
Simulation Statistical data collection
Phase 1
Phase 2
44
3.3.2 Observation
This section discusses a number of observation made to see how in practice HIS is improved in the hospitals’ IT departments, the observation method is one of the most important method used depend on the research question (Driscoll, 2010). Three hospitals (Hospital 1, Hospital 2, and Hospital 3) were visited to observe the processes which have been followed to improve the HIS. The documents and techniques used to gather requirements and enhancements requests ware also observed. All hospitals have been visited multiple times except (Hospital 3), this hospital has been visited only once.
3.3.3 Interviews
The main data collection in this research is the Interviews (Driscoll, 2010). A number of interviews were held in KFMC with employees who have a key function in the outpatient appointment workflow such as an outpatient department manager and receptionist. In total, seven interviews were held with four employees working in different hospital. Each interview took between 30 and 60 minutes.
The interviews conducted using semi-structured methods. The main topic has been discussed with all interviewees and the interview becomes more depth based on the interviewee role, or based on the discussion during the interview. The data about current appointments workflow and its processes, services products and resources have been collected and discussed in details. Although, a number of interviewees suggest different ideas as a solution to the defined problem based on their experience.
Also a number of interviews with the IT managers will be conducted in order to investigate the quality process model in HIS as practiced in several selected hospitals (hospital 1, hospital 2 and hospital 3) in Saudi Arabia. We will ask them are they follow any quality improvement process? If yes what kind of quality improvement process they applied? What is the main factors they focus on in the improvement process? Appendix A section 4 show the response of each manager in these hospitals.
45
3.3.4 Propose a framework
Based on the literature review, the observations and interviews conducted the research will propose a framework to be applied in the case study (Baxter & Jack , 2008). This framework will be discussed in details in chapter 4.
3.3.5 Case study
This section describes the detailed case study of the research. This part of the research has been conducted in the outpatient department in King Fahad Medical City in Riyadh, kingdom of Saudi Arabia to ensure that the goals of the proposed framework are being met.
This section will first provide a short introduction of King Fahad Medical City where the case study took place, and how the proposed framework has been applied in the outpatient appointment management. After that, the research methods that have been used are described, followed by the results. These results then are discussed and summarized. Finally, the detailed application of PPSR framework will be presented.
3.3.5.1 King Fahad Medical City
King Fahad Medical City (KFMC) in Riyadh, the capital city of Saudi Arabia, is considered the largest advanced medical complex in the Middle East with capacity of 1095 beds covered four hospitals (Main, Rehabilitation, Children’s, and Maternity). KFMC is expected to treat annually more than 50,000 in- patients and over 600,000 outpatients. (About King Fahad Medical City, 2014)
Currently, KFMC is in the process of improving the existing HIS and to produce a new generation. This project will cover a number of new features that help to solve the current problems and reach their main objective to provide every Saudi citizen with the best health care service.
One of the project goals is to improve the appointment module in order to solve the most important issue which is the appointments’ late in date.
Phase 2: to validate and test the proposed framework thru collecting a statistical data, simulation and surveys.
46
3.3.6 Questionnaire
Two questionnaires have been conducted (Phellas, Bloch, & Seale, 2011) “patient questionnaire” and “Staff questionnaire” These were intended for completion by King Fahad Medical City (KFMC) patients and staff respectively. These instruments designed to gather information about the patient’s and staff’s opinions and to identify the feasibility of the waiting list and voice messages reminder to confirm, cancel or reschedule appointments as ideas suggested after applying the framework to improve the quality of the appointment module. These questionnaires and its results are attached in the appendix A section 1 and 2.
3.3.7 Collecting a statistical data
A statistical data will be collected (Phellas, Bloch, & Seale, 2011) to test the applicability of the proposed framework throughout a simulation approach. The simulation detail will be discussed in chapter 6. Appendix A section 3 show the collected report from outpatient department in KFMC. This approach starts by collecting the appointments data of two weeks in KFMC’s hospitals. Number of booked appointments, number of did not attend (DNA) patients, number of show patients and number of walk-in patients has been collected for the period of 30 November to 11 December 2014.
3.3.8 Simulation
This research will apply the simulation (Carlsson, 2013) to test the applicability and the effectiveness of the proposed framework in a single case environment. This was by examines the effectiveness of the suggested solution “using Interactive voice response (IVR) to manage the appointment status” in KFMC case study analyzed in chapter 5 to compare it with the current situation. An adjustment will be applied to the number of DNA patients for all KFMC hospitals for two weeks to validate the suggested cancellation process through IVR. Simulating 1%, 3%, 5%, 7%, 10%, 15%, or 30% of DNA patients cancelling their appointments through IVR. This simulation calculated manually using excel sheet.
47