When the U.K. government mandated that national hospitals reduce patient treatment waiting times by nearly a third, officials at the highly specialized University College London Hospitals (UCLH) calculated that they could comply -- by hiring 12,000 people. Since that wasn't a possibility, they looked into business process management solutions to automate aspects of patient management instead.
"The new target was quite challenging," said James Thomas, IT director at UCLH, who proposed using a business process management solution to tackle the new mandate, which set a target of reducing the waiting times for hospital treatment for half a million patients from 26 weeks to 18.
The hospitals' cancer center had met a government mandate for patient treatment by dedicating seven people to follow patients regularly -- checking charts, ordering tests, etc. But scaling that model would have required 12,000 more people for the rest of the seven hospitals.
Instead, Thomas embarked on a business process management (BPM) journey that began with the need to educate senior management, then involved mapping and automating processes and monitoring business activity. This would let the hospitals attain efficiencies and eliminate the need for more staff.
Selling BPM to the executive suite
Although Thomas was familiar with BPM technologies, the executive board was not. If the board chose to implement BPM, it would be the first hospital in the U.K to do so.
"The executive board was apprehensive because it was new to them. We had a mission-critical problem, and no one wanted to attempt to resolve that with an unproven technology," Thomas said.
For many first-time implementers, getting staff members on board is often more difficult than choosing the BPM solution, according to Michele Cantara, research vice president of business process management at Stamford, Conn.-based Gartner Inc.
"The setbacks are less on choosing the right tool and more on people adoption -- getting business analysts to start following the process models and getting IT comfortable with the processes in general," she said.
Once the hospital board decided that BPM was an option, Thomas ran a three-month trial in two different departments in one of the seven hospitals. Then he got the go-ahead to implement a BPM suite, Lombardi Teamworks, in one of the hospitals.
Thomas said he chose Teamworks because it integrated well with existing systems and was "hidden" behind the scenes -- users could interact with their normal applications while Teamworks orchestrated the process in the background.
"A system like [Teamworks] makes a very good reuse case. Our existing applications are fully used, our staff didn't require any further training, and we already had several bits in our technology sector that made implementation a smooth process," Thomas said.
Those "bits" included middleware, master indexes that other systems were subscribed to and clinical data repositories.
Even with the foundation for a system already established, Thomas chose to purchase a business process management solution rather than have the code developed by his IT managed services team because "we knew we needed something more intelligent than a reporting tool," he said.
Lombardi has competed against internal development before, said Wayne Snell, senior director of marketing at the company , but it is all dependent on the approach the individual company wants to take.
"When internal development is a competitor, generally the company is not thinking about BPM as a process improvement tool, but rather as an alternative application development tool," Snell said. "And if development is their No. 1 goal, then the developers will prefer to write Java. BPM is a business tool."
Cantara said many companies may be using BPM tools without even realizing it (Cordiant CRM in accounts payable, for example). More extensive implementation may occur as people look to reduce costs by improving processes.
"Many people are finding that it often costs much less than other forms of application development, and it provides insight into how to change processes to become more efficient and competitive in the economic downturn," Cantara said.
Realizing quick results with a business process management solution
Thomas started seeing results within a few months of implementation at UCLH, as business process modeling and business activity monitoring tools preemptively managed outcomes.
"When you're striving to meet deadlines, you need more than just a reporting tool," Thomas said. "We could track progress, real-time alerts if something had fallen out of parameters. These were very intelligent prompts."
The BPM is reducing the repetitive tedium and provides the staff with more contextual information to keep moving forward.
James Thomas, IT director, University College London Hospitals
The real-time information also helped the hospital identify bottlenecks and then determine where to make investments to improve care.
"When one department said they needed another MRI scanner to keep up with the volume of patients, we looked into it to produce some real evidence. Come to find out, the blockages started with reception, administration and the call center," Thomas said. "So we could divert our investments to where we really needed them."
Patient satisfaction also improved. Within four to five weeks of implementation, patient complaints were greatly reduced as patients spent less time chasing down things like referral letters. With the business activity monitoring process keeping tabs on the processes and goals, there is no room for "anything to fall between the cracks," Thomas said.
"The BAM engine never goes on holiday," he said. "If the patient repository has not received a referral letter, for example, that will trigger an email to be sent requesting that particular patient's letter to be scanned into the repository."
Even doctors and specialists who were adamant that their processes were too unique to ever be automated are pleased with the results. Most patient pathways were actually very similar, beginning and ending with administration; only the middle steps required customization. "This information will allow us to standardize processes to become more efficient," he said.
And with more efficient processes, UCLH can take on more patients -- and in the public sector in the U.K, this means more money. UCLH made 540 million pounds last year, up from 480 million pounds the year before.
BPM solution: Not all blue skies
Although Thomas said he considers the implementation a success, he did encounter a few hurdles along the way. Convincing patients that they were still being cared for as individuals and weren't just patients going through processes was an initial problem.
"We had to make the distinction between a patient as a process and using the process to be more efficient in supporting the specific needs of the patient," Thomas said.
Administrative staff also voiced fears of being replaced by the automated BPM system. Thomas quickly extinguished these fears by saying, "The BPM is reducing the repetitive tedium and provides the staff with more contextual information to keep moving forward."
Where does Thomas see the UCLH going in the future?
"We're already looking at our process models to see how we can change the construction to become even more efficient in the future," Thomas said.
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