Internal Buy-In, Stakeholder Involvement, and Cross Functional Systems Design Teams Contributed to the Success of SAP Implementation
In order to succeed in the implementation of the SAP ERP, Valle del Lili Foundation took steps to ensure buy-in from members of the organization and to ensure that the system was designed cooperatively by the people that know the needs of the hospital and the people that know the details of the electronic systems. It was an expensive undertaking, with 100 people working full time on the project for nearly two years. During this time, VLF was able to ensure that the systems would operate efficiently, and that the hospital staff were adequately prepared to operate the new systems. The system was able to be rolled out effectively due to several key factors:
Involved various stakeholders that would be affected by the new process in the design team
Stakeholders were responsible for defining the specifications of the new system
The teams were composed of cross functional members composed of experts from VLF (those familiar with the hospital's needs) and Compunet consultants (those familiar with SAP ERP)
Measures were taken to ensure hospital staff were positive towards the new system
The system was designed to balance the individual needs of departments and specialists with the needs of the institution as a whole
Fragmented Systems and Hectic Workloads, Managing Accountability, and Overwhelming Loads of Paperwork Presented Major Challenges for the Hospital
VLF did not have a system to interconnect all of the departments and branches of the hospital. The workload was rapidly expanding, and staff was having trouble keeping information organized and accessible.
A hospital is in a unique position to be tending to people's lives and wellbeing, not to mention the strict legal regulations required when handling medical records. The hospital had designed processes to promote traceability and accountability, but implemented on a paper system, this was a time consuming and error prone process.
It was difficult to track billing due to the hectic nature of the job. Over the years, individual departments had developed their own systems to handle the workload, resulting in over 30 individual systems operating under one roof. The hospital was processing over 40,000 paper bills per month, while billing clerks were never sure that accounts were ready to be finalized.
The Needs to Meet Increasing Demand, Streamline Process, Improve Patient Safety and Satisfaction, and Increase Revenue are Driving Forces for Change
The hospital's demand for services was exceeding its capacity to provide those services. With the thousands of patients treated every month, VLF needed a system to make providing care more efficient and to allow staff to be more productive. Overall, VLF needed an enterprise system to standardize procedures across the board, which would provide these key benefits:
provide a unified system of the service delivery process
streamline flow of patients through the care process
improved use of tests, medications, and supplies
streamline billing process
streamline insurance audits
All these benefits contribute towards primary goals of increasing revenue and improving patient safety, which would also contribute towards staff and patient's quality of life in the hospital.
Resistance to Change Impedes Overall Buy-In and Cooperation between Vendor and Organization Presents Difficulties
The primary factor that restricted VLF's transition to the enterprise system was the so-called human factor, including:
people's willingness to change
people's perception of value of the new system
fear of new technology
It was difficult for some of the doctors to see how the new system would provide benefit for themselves and the patients, which is necessary so that they will want to use the new system. Psychological factors such as these contribute to overall "buy-in" from the members of the organization. Everyone was accustomed to doing things a certain way, and people tend to resist such a workflow overhaul.
In addition, departments that already had information systems would have to trade the customization of their current systems for the standardization and connectivity of the enterprise system. Some functions were not available straight out of the box, and there was difficulty agreeing completely between the vendor and the organization. Both sides expected the other to yield to the other to make ends meet.
Lack of Downtime and Patient's Lives on the Line Means Successful Implementation is Critical
There were certainly elements of the post-implementation phase of the VLF Synapsis project, but many elements would have been similar to a typical SAP rollout. Most organizations have some kind of down time or slow period so the new system can be phased in during an appropriate time that will not affect business too much. However, the hospital is always open and the influx of people needing care depends on unpredictable factors, but there is certainly always an influx of people needing care. VLF would not have an opportunity to simply phase in the changes when nothing is really going on; there is always something important happening in the hospital.
Due to the sensitive nature of the activities performed in a hospital, the success of the new system rollout is essentially a bona fide life or death situation. If the system crashes due to poor planning, training, or implementation, people's lives could be at stake. Therefore, planning, design, and support needed to be attended to with utmost care. It would take greater encouragement for the doctors to be certain that when it was go-time, they would be able to carry out their duties. Efficiency loss is to be expected with any new system overhaul, but it was critical that there would not be any fear of catastrophic failure. VLF probably kept the post implementation support team on call for longer than a typical SAP implementation due to the critical need for success of the new system.
Overall, the rollout phase of this hospital application of SAP enterprise systems would have had many similarities to any other rollout, except for the fact that there was no downtime to schedule the update and the success of the system was a literal life or death situation.
Careful Planning, Inside buy-In, Effective Training, and Post-Implementation Support were Responsible for the Success of the ERP Roll-Out
There were several factors contributing to the success of the new system. Training was especially important to the success of the project. The ERP implementation was a success at VLF due to the careful planning and post implementation steps taken by the hospital and Compunet:
Governance was established as an important first step in the project, and VLF's most qualified people were put in charge of the project full time
Department heads supported the perception that the new system would lead to the improvements previously discussed to all employees before implementation began
Staff were assured that training for the new system would be provided, and then that training was provided as promised. VLF used a learning-based training system to ensure that everyone was up to speed before implementation began
Contingency plans were put in place before the rollout so the hospital would be prepared in case something went wrong
The project team ensured that the doctors input contributed to designing the system, which tailored the system to their needs and promoted buy-in
The hospital made a help desk available 24/7 for the first few months of the new live system, consisting of the doctors, nurses, and other staff that were responsible for designing the system
Synapsis Project at VLF Amounted to a Complete System Transformation and Existing Processes and IT Meet in the Middle to Make it Happen
The Synapsis project at VLF was a complete system overhaul; the workflow of the entire organization would change. Although the culture and goals of VLF remained the same, the system redesign brought each person in all the departments out of isolation. This required that each person be aware of how their work impacted the system. VLF already had the goal to promote traceability and accountability, but with the new system, each person's impact on the overall workflow would be more transparent than ever. Everyone had to relearn how to do their jobs to a certain extent. The same tasks were being completed, however the execution processes of these tasks would completely change.
Establishing the balance between adapting the existing system to the new IT and vice versa was a tumultuous challenge. In the end, neither existing system nor technology need to bend entirely to meet the needs of the other, but the needs of both must be considered so that system designers can find a way to bridge the gap. The needs of the existing system are important, as these needs are what give rise to the implementation of the technology in the first place. However, the organization must remain realistic as to what the IT system can offer, and often it is most advantageous for the organization to adapt the execution of meeting their needs to the standards of the software.
When the organization adapts its processes to existing processes in SAP, the package remains more stable and supportable as SAP can integrate system updates that coordinate with its other out of the box systems. This also allows the overall cost of the project to remain low. However, in this case SAP did not have a complete out of the box hospital system in place, and certain projects had to be designed from scratch. In critically custom situations, this is fine, but it is best to keep customizations to a minimum if possible.
References
Cajiao, J. & Ramirez, E. (2016). Surviving SAP Implementation in a Hospital. International Journal of Case Studies in Management, 14(2), 1-25, 1-25. https://education.hec.ca/centredecas/app/en/case/5281