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Sep 27, 2018 in Healthcare

Business Process Reengineering in Healthcare Management


The demand for Business Process Reengineering (BPR) continues to increase. Nowadays the customers are able to choose different service providers and products in order to obtain the same core services or products they need. Over the last thirty years organizations have been compelled to reengineer their business processes in order to remain competitive given the enhanced clients’ demand for better services and products. Enhancing and redesigning business processes remain the only possibility for companies to establish a competitive advantage in the market. BPR is, therefore, an effective tool to enhance competitiveness across various sectors. Its effectiveness is uncontestable because a few studies that exist have proved its capabilities, and nobody can even reasonably undermine its role in the healthcare sector.

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Due to the rising healthcare costs, healthcare service providers, for example, in Singapore are not exempted from developing competitive ways of improving and providing quality service to the customers. Unluckily, a few researchers have attempted to study the use of BPR in the healthcare systems. Conventionally, the healthcare sector has focused more on the breakthroughs in technology and operating procedures to establish a competitive advantage. It is now time for healthcare service providers to start appreciating the role of BPR promoting competitiveness in the market.

The most significant section in all healthcare companies is the operating theatre section which performs surgical operations to patients. Although it requires plenty of resources, it can attract huge revenue volumes if managed correspondingly. The misunderstanding between the exorbitant cost of surgical care and nationwide goal of healthcare leads to the improvement of management quality of the surgical operations. As a result, several healthcare providers are reengineering their operating theatre processes with a view of generating, maximizing or restoring profitability while preserving quality. Hence, due to reengineering, hospitals can identify redundancy as well as examine processes involved in the organization and inefficiencies that can be eliminated from the system.


In their research “Business Process Re-engineering in Healthcare Management: A Case Study Massimo Bertolini,” the authors Bevilacqua, Ciarapica and Giacchetta (2011) attempt to justify the significance of BPR for promoting efficiency within the hospitals’ surgical wards. The researchers claim that the complexity of health care services has been associated with growing number of medical professions and specializations, complex equipment and therapies as well as multiple services revolving around various organizations. The main challenge arising from this complexity that needs to be addressed quickly is how to coordinate and integrate BPR without interfering with specialization, which is believed to be useful in generating and transferring knowledge. Their research, therefore, uses the concept of BPR to enhance the effectiveness and efficiency of specific processes involved in the surgical processes.

The authors approached this research using a case study regarding the surgical ward. According to them, surgical ward is appropriate for their study due to the coexistence of unscheduled and scheduled operations in this sector causing difficulties to manage them. As a result, the authors find it necessary to study possible ways to reduce patient’s inconvenience in their day-to-day attempt to access health services. In addition, the study also aims at identifying the most critical features in managing ward processes and recommend alternative solutions for adjusting healthcare services offered to the patients.

The authors have also developed a framework based on discrete event simulation; the entity-relationship model and Event-driven Process Chains (EPCs) methodology to aid in characterizing and analyzing the existing state of neurosurgery ward. This framework also provides the basis for recommending design for future systems with a view to improving workflow and service quality. They observe that most healthcare service providers do not value much the use of simulation in the problem-solving as compared to other application areas. This is explained in a way showing how simulation is applied to the healthcare modeling, which conforms to the traditional-based engineering approaches. Bevilacqua, Ciarapica and Giacchetta (2011) view this as unreal issue, but as the complexity of healthcare systems that is notorious for allowing multiple decision makers. Hence, the problem lies in the conversing and understanding among multiple stakeholders. The authors believe that solutions can be achieved through effective communication approaches and understanding of the problem. So, their main reason for using Delphi technique is to enhance such communications and understandings.

Moreover, the modeling of sub-activities, activities, and processes believed to consume a lot of hospital’s resources allowing them to perform a “what-if analysis” which simulated several scenarios and assessed their performance. The utilization of Delphi methodology allowed them to establish various areas that need to be improved. These include the availability of certain surgical instruments, a number of operating sessions, and preparation of the operating rooms for each operation. Furthermore, their discrete event simulation approach, for example, provides an understanding of the alternative solutions that will enhance management. Lastly, this paper is unique since it uses Delphi methodology to collect data before commencing the BPR process. This approach is not available in any literature studies other than theirs. The use of EPC-based models allowed the authors to create appropriate models for examining and explaining the resource requirement of the surgical suite and to offer a framework or develop standards that the healthcare developers and clinical managers can consult.

This paper seems to have more solid reasons for the assignment of BPR ability in improving efficiency within the surgical suite. Since their findings are widely supported, a lot of investigations should be conducted in order to validate them. The authors note that according to Barjis (2008), fundamental cause of frequent failure of software project is the shoddy processes involved in the modeling, specifically the requirements’ specification. They do not dispute this concept; instead, they establish that the key problem of this approach is that EPC models must be transformed into other prescribed diagrams for validity confirmation. This means that the particular field still requires more researches to be done.

All in all, the authors have successfully proved that the actual competitive advantage is a function of the total results from various functions involved in the health sector. They claim that all mechanisms that facilitate the operations of ward processes should be made clear and transparent. Transparency and clarity can be established by maintaining records regarding the process implementation, and avoiding the most common weaknesses associated with absence of its visibility. Finally, this paper contains valuable information that can be burrowed by other researchers to develop their opinions in this particular field.

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Event-Driven Process Chains (EPC)

Event-driven Process Chain (EPC) is an approach coined by Nuttgens, Scheer and Keller in the architectural field of integrated Information System (ARIS). The main function of EPC is to model business processes (Bevilacqua, Ciarapica & Giacchetta, 2011). Today, it is profoundly applied to the business assignments in the docket of management information system. The usefulness of EPC is exhibited by its accessible aspect that can depict business information system while simultaneously integrating other crucial aspects such as organizational structures, data, information resources and functions. This makes EPC a broadly accepted standard to represent business processes in a clear and concise manner.

The primary elements of EPC include events and functions. Processing function or external actors of the models generate events while functions model business operation processes. Other elements include organization unit that is responsible for assigning specific functions to various organizations or persons within the business structure. Control flow is an arrow-like structure that links events with operators; process paths or function thereby forming a sequential chain and logical interdependence among them. The next one is the operator that consist of “AND”, “OR” and “XOR.” “AND” operator is used in scenarios where all paths are activated simultaneously. The “OR” operator is used in cases where there is activation of more than one path between the control flow. Lastly, the “XOR” operator is used in places where decision to choose one path excludes the other. On the other hand, process path indicates the interrelationship from one process to the other. Finally, there is organizational unit assignment that indicates the relationship between the organization unit and its responsible function (Vpository, 2014).

As illustrated in Figure 2 above, the client places a request for a billing statement that acts as an initial event giving rise to a requirement that is reflected in the organization. In order to denote this function, general clerk is responsible for receiving bill settlement requests; hence, the “reflected requirement” gives rise to a new function, namely bill processing which is meant to ensure that the bills are settled. All output and input data about the transaction is kept in the information resource. After verifying the necessary material (billing information and cash) two events can occur. If the cash is confirmed legal, the general clerk will issue a receipt indicating that the client has settled his bill; otherwise, there will be no receipt issued. Since the twin events cannot occur, concurrently XOR is used as appropriate connectors linking them together.

Ways to Improve an EPC Chart

Every business organization requires an event-driven process (EPC) chain that guides its day to day activities. Its implementation depends on the efficiency of the established procedures after a thorough analysis before approval. Every department has its chart indicating the hiring process to the service delivery procedures. The charts do not only act as standard operating procedures in every department but also as governing laws (Bevilacqua, Ciarapica &Giacchetta, 2011). The reason is that they give a clear picture how to follow the protocol during certain occasions. Below is an example of an EPC chart that was used in one of the organizations where I used to work. It is suitable for the department of human resource in the hiring of new workers to replace retired and transferred ones.

The above chart is considered to be effective in the hiring process, but it can be made more efficient. This can be provided through reanalyzing the human resource department objectives. Integration of the recruiting and interview departments into one unit will ensure the two co-ordinates and produce results within the shortest period. Professionalism and quality should never be compromised. It should be an avenue of exchanging knowledge. A new map of the work should be created, adopted, and closely monitored. Any avenues that might improve the service delivery must be studied carefully, and the necessary actions must be taken. Creative ideas that help reduce the expenditure and facilitate maximum utilization of the resources must be considered. A daily or weekly report on the progress of the newly introduced system should be submitted. This should correspond to the frequency the interviews are conducted with; probability of having an emergency, priorities to base on and time when resources are available. This is inevitable radical change of the internal process that must be undertaken.

Bottlenecks and Their Description

The simulation process has to face some challenges. The reason is that it is a new model of work, and the workers have to take time before accommodating to it. The following are some more hurdles that may be experienced during the implementation process:

  1. A number of the human resource (HR) workers may not match that of the workload in the department. For example, the number of individuals to be interviewed on a specific day may be too high. With fewer HR workers, they will be forced to wait for longer hours before their turn. This greatly derails the entire process and leaves the interviewee being fatigued. It also compromises the quality of the process. Clerical errors may occur in such an event. There should be, therefore, enough workers to undertake their duties comfortably and efficiently.
  2. Lack of modern technological equipment for processing and record keeping might lead to loss of relevant information (Bevilacqua, Ciarapica & Giacchetta, 2011). This means that the flow of information within and outside the departments may automatically be delayed. The disseminated information may reach the second or third party when it has lost its original meaning. Proper documentation should, therefore, be done, and the correct information shared within the department. The machines must also be regularly serviced and kept in corresponding conditions.
  3. Individuals who are not qualified and experienced cannot give the best results. While merging the departments, flexibility is highly recommended. This can easily be achieved by well experienced professionals. They need to embrace team-work and frequent consultation. There should be no shortage of resources (capital) to facilitate a smooth process of merging the departments. This will ensure that enough renovations are done to accommodate the merged staff. Available resources must also be used to the maximum to improve the service delivery or performance.
  4. Communication breakdown within the department may result in delaying the hiring process. This might occur due to flawed procedures or loss of important documents. All workers must, therefore, be responsible and ready to account for their actions. Nobody should divert from their assigned work station. This means that though departments have been merged, division of labor and specialization must always be put into practice. It promotes concentration and improvement of quality. Consequently, consumer (interviewee) satisfaction is met, and the objectives are easily achieved.

Since the interviews are usually conducted during a specific and specified time, it becomes a problem creating another budget during an emergency. Sometimes individuals do not agree for the jobs even after passing the interviews. This creates a vacuum, and hence the extra cost has to be incurred. The human resource department should, therefore, be prepared for any form of emergencies including fires.

Conclusion and Recommendations

Re-engineering can be best achieved first by analysing the current EPC used in an organization. After understanding its faults, a new and better EPC is then recommended and drafted. This is then put into checks and balance to ensure that it corresponds to the objectives of the organizations. It should create a smooth and flexible process which can be easily adapted and implemented. The EPC recommended by Bevilacqua, Ciarapica and Giacchetta (2011) provides possibility for professionalism and technological use. It offers a clear outline of the work to be done by specific individuals within the department.

The hiring process has been compacted to a level that can be easily understood. Poor EPC models may cause organizational failures as observed by Barjis (2008), together with insufficient verification of implemented process that is still under experiment. Efficiency of new processes is monitored and promoted through a slow but sure process. According to Van Dongen et al. (2005), this should gradually desert the older and outdated patterns of work not killing them instantly. The re-engineering process, therefore, simulates older methods into new ones through a series of established phases. Before the new approach is validated, its final results have to be compared with that of the previous one. It is then totally used if the end results appear to be positive.

The recommendations are usually promulgated by a committee of experts. Barjis (2008) identifies that older systems become too monotonous and make the workers bored and reluctant to deliver their best. He further says that any good model is created after thorough research has been conducted by the experts and discussions on the same subject. For an organization to be successful while creating a new EPC, it should consult different stakeholders. Its ideas should be presented in an open and comprehensive manner. For example, the Med Model simulation software was used during the assessment of operating units in a Singapore hospital. The number of anaesthetics and surgeons using the units was also taken into account. Every aspect of activities undertaken in the theatres was captured, from admission to disposition. The reason is that the software was so comprehensive and organized accordingly, providing a simple and an efficient way to study the existing modelling processes. It showed that avenues for maximum utilization of resources (human labour) occurred whenever facilities were properly serviced.

Both the anaesthetics and surgeons were busier every day, and their work became increasingly demanding (Kumar & Ozdamar 2004). New operating theatre processes should, therefore, be designed (engineered) in order to reduce the workload of surgeons and anaesthetics, and hence improve their efficiency. During the implementation of the new model, data collection and analysis procedures must be accurate for proper review. This enables the organization to understand the use of the operating theatres in relation to the new models, and a clear comparison is made to the old patterns. Apart from increased efficiency and optimization of processes, the overall management costs are also reduced.

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