CHAPTER - 6

STRATEGIES FOR IMPLEMENTATION OF MIS IN

HOSPITALS

CHAPTER 6

STRATEGIES FOR IMPLEMENTION OF MIS IN HOSPITALS

6.1 Competitive forces model for the hospital

Information systems can play a major role in support of the strategic

objectives of an organization. This strategic role provides a hospital organization

with competitive services that give it a strategic advantage over its competitors. A

hospital can survive and succeed in the long run if it successfully develops

strategies to confront five competitive forces, as illustrated by the competitive

forces model in chapter 2, to shape the structure of competition in its area of

service.

Countering Competitive forces:

The sampled hospitals stand in the environment surrounded by five

competitive forces. The traditional competitors are the other hospitals presently

providing the same type o f services - inside and outside Manipur. The patients

are the customers o f the hospital receiving the services. They expect quality

health care, at least comparable to the ones in the adjoining state like Guwahati.

The customer s le\el ot awaieness about the quality of services has been further

upgraded by way o f access to information technology, and education. Further,

patients expect good relationship besides satisfactory services. Otherwise, patients

switch over to other hospitals, preferably outside the state. It is very important to

have good relationship with the suppliers of medical and non-medical goods and

items, because of the barriers imposed by locational disadvantage and

communication bottlenecks. Substitute products in the form of new ways of

treatment are emerging. 'I'he hospitals need to upgrade the technology employed

for the treatment process.

6.2 Strategics to deal with the competitive forces

The organization can use four basic competitive strategies to deal with

these competitive forces.

1. Scrvicc differentiation : Hospitals can develop brand loyalty by creating

unique and new services that can be distinguished from those of the

competitors, and/or potential competitors.

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2. rocusea aijicremumon: i ne hospitals can create specialized service that

discourages potential competitors.

3. Developing light linkage to customers (patients): The hospital can create

relationship with the patient’s and community by deed of good services.

The customer relationship management (CRM) is to build switching

costs into the relationship between a hospital and its customers and

community.

4. Becoming a low cost service provider: To prevent new competitors from

entering the same line of service (business), hospitals can produce

services at a lower price than competitors without sacrificing the quality

and level o f service. A hospital may achieve competitive advantage by

pursuing one o f these strategies or by pursuing several strategies

simultaneously. But the question is how can the competitive strategy

concepts be applied to the strategic role of information system in the

hospital? In other words, how can top management use investments in

information systems technology to directly support a hospital s

competitive strategies? These questions can be answered in terms of

three key strategic roles that information systems can help a hospital:

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(1) improve its operational efficiency

(2) promote innovation and

(3) build strategic information resources

These three strategic roles support a organization’s use of competitive

strategies against the competitive forces from competitors, customer’s,

community, substitutes and new entrants. Figure 6.1 outlines some potential

results from the strategic use of information system.

Figure 6.1 The Strategic roles of information systems

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Improving Operational HtTieieney

Investments in information systems technology can help in making a

hospital’s operations significantly more efficient, which could allow the hospital

to dramatically cut costs and improve the quality and delivery of its services. For

example the distribution of information can be improved by proper

communication system, telephone, EPBX, Computer network etc.

Operational efficiency allows a hospital to adopt a low cost leadership

strategy. By making investment in information technology systems, technology

that increase its operational efficiency, a hospital could also erect entry barriers.

These could be made possible by increasing the amount of investment or the

complexity of the technology required to compete in the same line of service

(business) and deter external organizations from entering the service (business).

Thus, investment in computer based information systems can make the status too

high for some present and prospective players.

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Investment in information systems technology can also allow a hospital to

lock in patients and community (and lock out competitors) by building valuable

new relationships with them. This can deter both patients and community from

abandoning the organization for its competitors or intimidating another

organization into accepting less profitable relationships. Early attempts to use

information systems technology in these relationships focused on significantly

improving the quality of service to patients and community in the hospital’s

service activities. Then the organization moved to more innovative uses of

information system technology.

Promoting service innovation

Investments in information system technology can result in the production

o f new services and processes. The use of computer network (LAN) is an

information system technology. A major emphasis in strategic information system

is to build switching costs into the relationship between a hospital and its

customers (patients) and community. That is, investments in information system

technology can make patients and community (within and outside hospital)

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dependent on the continued use of innovative, mutually beneficial inter

organizational information systems. Then, they become reluctant to pay the cost

in time, money, eltort, and inconvenience that it would take to change to a

hospital’s competitors.

Building Strategic Information Resources

Information system technology enables a hospital to build strategic

information resources that allow it to take advantage of strategic opportunities. In

many cases, this results from a hospital investing in advanced computer-based

information systems to improve the efficiency of its own internal operations.

Typically this means acquiring hardware and software, developing

telecommunications networks, hiring information system specialists, and training

end users. Then, armed with this resource base, the hospital can leverage

investment in information systems technology by developing new services.

Information system s also allow a hospital to build a strategic information base

that can provide information to support the hospital’s competitive strategies.

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Information in a hospital s database has always been a valuable asset in

promoting efficient operations and effective management o f a hospital.

However, information about a hospital’s operations, patients, supplier and

competitors, as well as other economic and demographic data, is now viewed as a

strategic resource; that is, it is used to support strategic planning, and other

strategic initiatives.

6.3 Value adding activities

An important conceptual framework that can help in identifying strategic

information systems is the value chain, which is discussed in chapter 2.

The value chain views a hospital as a series, or “chain” of basic activities

that add value to its services and then, add a margin of value to the organization.

In the value chain concept, the activities of organization are primary activities,

and others, the support activities. The value chain framework can highlight

critical areas where competitive strategies can best be applied.

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In the hospital environment, primary activities are most directly related lo

the distribution of ser\ ices that create value for the patients. Primary activities

include inbound logistics, outbound logistics, marketing and operation and

service. Inbound logistic includes receiving and storing materials for utilization in

the hospital. The hospital store system usually performs these tasks. The hospital

store service usually prepares monthly or yearly purchase requirements

accordingly sends order through purchase section. It minimizes stocks of various

items. These tasks need a proper record keeping. Preparation of important report

like list o f items below reorders level and keeping inventory level of life saving

drugs need proper record keeping. This is one of the areas where information

system can be fitted. The operation transforms materials into services. The

doctors, nurses, and technicians perform operation services. This includes

utilization of knowledge, equipments and materials in the hospital.

Doctors usually receive information regarding the patient’s illness,

diagnosis and treatment. They also prescribe medicines, prepare investigation

report discharge summary to mention a few. All these tasks need proper record

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keeping so information system will he of immense help in rendering service to the

patients. Outbound logistics entails scheduling system. Proper scheduling will

help in discharging services on time. Scheduling information should be provided

to all concerned personnel well in time, so that they can participate in the hospital

activities. Here also information system will help a lot.

Marketing is another area information system can play a major role in

hospital’s strategic planning. By using information technology like telemedicine,

medical transcription, hospital service can be distributed to the customers.

In the hospital, environment service activities include the maintenance of

equipment, furniture, building etc. Reports about the services rendered and

equipment problem reports are prepared. Such task need proper record keeping

and thus proper information system is a must.

The supportive service also adds value to the strategy formulation of the

hospital. For instance electronic data interchange (EDI) system can provide on

line telecommunication links to the supplier of material and equipment. Use of

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computer network is another development in the information system technology.

Relevant information about employee can be maintained using computerized

database. Top level management are responsible for taking strategic decision and

action. They need only summarized form of information. Preparation of statistical

data about the hospital can be achieved only through proper information system.

The service activity includes maintenance and repair o f equipment. The

maintenance system is responsible for the services. Outbound logistics entail

storing and distributing the service to the mass.

Support activities make the delivery of the primary activities and consist of

hospital’s infrastructure (administration and management), human resource

(personnel), technology (improving the service) and procurement (purchase).

Hospitals have more competitive advantage when they provide more value to

their patients or when they provide the same value to the patients at a lower price.

An information system could have strategic impact if it helped the hospitals in

providing services at the same cost, compared with competitors, but with great

value. For instance, a hospital could save money in the inbound logistic activity

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by having suppliers make delivery of medical and non-medical goods to the

hospital, thereby lowering the cost of inventory. Office automation systems can

increase the efficiency o f communication and support activities. Electronics Data

Interchange (EDI) system can provide online telecommunications link to the

supplier of materials and equipment.

6.4 Finding the gap in information

The hospitals have been growirig in terms of physical infrastructure like

bed, wards, equipment etc. The paper work has also increased correspondingly

which substantially restrains the benefits of growth. To really make use of the

enhanced facilities without compromising on the quality of patient care,

management of information is crucial in hospitals. The growth in hospitals is not

followed by the corresponding changes in the content and flow of information

within the hospital. The traditional methods have become obsolete, not reliable

and a handicap for the complexity of operations. The study of the Gillette’s eight

subsystems in the hospitals provided an understanding of information flow in

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each of the subsystems leading to an overall information flow in the hospital. The

important observations about the subsystems are:

1. The casualty and emergency services in the hospitals require a quick

action on the part of the doctor. Analysis o f the table 3.8 evidences

that complete demographic details of the patients are not recorded.

The emergency ward also suffers with similar information gap.

2. The salient observations in the out-patient service area especially in

government hospitals are:

(a) From table (5.3) it was found that the patients waste a lot of

time in reaching the right OPD room for treatment in the

absence of proper guidance.

(b) According to the finding from table 3.65, it was also found

that the number of patients visiting each OPD is very high and

therefore, record keeping and treatment are not satisfactory.

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(c) The waiting time at various stages o f treatment is reasonably

high leading to high patient dissatisfaction, table 5.3.

(d) The doctor and nurses has to perform a lot o f paper work for

each patient, such as, recording diagnosis, prescribing

medicines and investigations, preparing drug slips,

investigation slips, etc., table 4.2 and table 4.15.

(e) The monthly statistics are not generated in time and there is

normal delay in generating statistics. (Finding from table 3.61

and table 3.56).

(f) Analysis of table 4.7 and table 4.19 illustrate that records of

diseases suffered by a particular patient is not properly

maintained.

In private hospitals the scenario is quite different. The number

o f patients in OPD is quite low compared to government hospitals.

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Some ol the leatures are: Methodological record keeping, large

number ot repeat patients, convenient data analysis, computer-based

storage and retrieval of data. Drawback is the lack of proper

diagnosis equipment and late arrival of reports. (Finding from the

analysis o f table 5.3).

3. The in-patient services, which are provided free, in the government

hospitals are highly overloaded. The common problems identified in

providing these services are:

(a) The registration process, which is the beginning of in-patient

activites, suffers from incomplete, inaccurate and illegible

recording of patient data. (From table 5.3).

(b) From table 4.16 it is found that no track of patient movement

is kept after the registration for transfers, discharges, etc.

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(c) The general wards in government hospitals are overcrowded

and even patients lie on the floor. This is due to the improper

maintaining of bed occupancy rate, table 3.61.

(d) Due to increased paper work, the various charts for monitoring

the condition of patient are not maintained thereby affecting

the treatment. (Finding from table 4.1 and table 4.13).

(e) From the analysis o f table 4.15, it was found that the nursing

staff spends a lot of time in non-nursing activities such as

arranging medicines, surgical and other consumable, thereby,

affecting the patient care.

4. The following bottlenecks were identified in the delivery of

diagnostic services in the hospitals:

(a) The lack of proper maintenance of equipment is a major issue

in the functioning of this service. From table 3.51 it can be

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observed that there is a general com plaint that the expensive

equipments are not subjected to timely preventive maintenance

schedules and timely maintenance contracts. The table 3.56

found that the details about the terms and conditions of

purchase o f equipment are not available. No data is recorded

on utilization and operational aspects of the equipment, table

3.52.

(b) According to the analysis of table 5.3, test report preparation is

very slow.

5. The stores in the hospital are afflicted with a number of bottlenecks

as observed from the study of government hospitals. Some of these

are:

(a) A large number of indent books are used in the hospital system

(Finding from table 3.34 and table 3.55).

(b) I he concept ot reorder level and buffer stock is not used in the

hospitals resulting in stock out situation for many drugs and

overstocking for others, table 3.56.

(c) 1 he finding of table 3.56 is that there is no periodic inspection

ot stock in the stores.

(d) Another finding from table 3.56 shows that very little effort is

made to monitor the expiry o f drugs.

(e) The stock analysis is not performed for proper control of

critical items through annual consumption, stock movement,

etc., table 3.56.

6. The salient features observations made from the study of Medical

Records Department are:

(a) Quite often, in the patient file, the discharge report is left

incomplete and hence department has to do the follow up for

getting them completed, table 4.1.

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(b) The retrieval o f patient past record is very time consuming.

This is illustrated in found from the table 3.64.

The dietary service offers a lot of scope for economization by

enabling diet planning and menu planning apart from stock control.

This was observed from table 3.59 and table 3.37.

The laundry services, central sterile supply services and all

housekeeping services in the hospitals also suffer from number of

problems. Analysis of table 3.47 highlights that the cost accounting

of these services are not done in any hospital due to poor recording

of data. From table 3.56 it is found that the stock keeping functions

in these services are not managed effectively. It is obvious from the

analysis of table 5.3 that among the administrative service sanitary

services in the government hospitals are poor.

ofTable 5.6, table 3.68, table 4.8 and table 4.21 deduce that proper

information is extremely important for enhancing the efficiency and effect

ofof the hospitals. Thus keeping in view of the difficulties in the function g

various services, the researcher felt that a proper management information y

would help in the proper flow of information in the hospital so that the ho p

can improve in its efficiency and effectiveness. The Management Inform

System as suggested by the researcher is illustrated in the Figure 6.4.

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6.5 Strategic grid position of hospitals

The analysis ot table 4.4 (Chapter 4) positions, in most of hospital the

primary means of sending information by doctors is through written

communication (64.6 Per cent responses). This clearly shows that the legacy

restrains in hospitals. The analysis of table 4.6 reveals that better communication

facility will enhance the performance o f the hospital (17.8 per cent responses).

Table 4.7 shows that the main cause of information overloading is due to the use

of non-standard form for receiving relevant data (35.6 per cent responses).

Doctors also felt that proper information system is extremely important in making

the hospital efficient and effective (table 4.9). The analysis of the table 4.4(a)

depicts that, according to doctors, setting of computerized information system

would be beneficial (97.5 per cent).

The analysis o f table 4.10 observes that the main reason for information

overloading to the nurses is due to the use of non-standardized form (30.7 per

cent). Use o f non-standardized form cause a lot of repetition in recording,

resulting in data redundancy. The analysis of table 3.62 reveals that the hospital

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administration needs generation o f highly useful statistic like cost per bed, lock up

capital in drugs and deviation from strategic plan. System of referring past records

of patients by in most o f the hospitals is not satisfactory. Method used is “as per

prescription of doctors (table 3.64). Information system for locating patients

admitted in the hospital is through reception (table 3.67).

According to top management the degree o f importance of the flow of

information for improving efficiency and effectiveness of the hospital is

extremely important (table 3.68). It is found from table 3.69 that top management

did not give any comment regarding the opinion about the efficiency and

effectiveness of the present information system.

The hospitals have plans for implementing MIS (table 3.70). Top

management of the hospitals felt that computer based information system will be

beneficial (table 3.71).

From the above findings it can be observed that legacy is a growth

constrain for MIS in the hospitals. The records keeping methods and

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communication technology used are outdated. Generation o f highly useful

statistical reports are also not done properly. The hospitals are not nurturing

information system for strategic decisions.

From the findings it also can be elicited that top management are aware of

the importance of information system. It is also suggested that computer based

information system will be beneficial. All the hospitals have plans for

implementing computer based MIS, pointing to top management initiatives but

calls for intensive involvement by top management. This is clear indication of the

participation by top management. Thus the position of the hospitals in the

Mckenny Grid is around the ‘Support level’.

It is therefore suggested that with further involvement o f the top

management for “Turn around strategy” the information system can be employed

for strategic decision and movement. But first of all the hospitals need smooth

functioning o f the information systems activity.

6.6 MIS in hosp ita ls

In most o f the hospitals the use of computer is for applications. In the

hospitals only a small number of users are utilizing computers to meet the

basic organizational needs. These computers are installed in a decentralized

form. Proper flow of information among the computers does not exist. So

these computers need to be centralized and controlled properly. The

information systems in the hospitals in Manipur are in the initial stage of

the Nolan stage model.

The future of development of the hospital information system in

Manipur is towards the second stage of the Nolan stage model, which

embodies subsequent proliferation of applications cultivating

experimentation and adoption of computers by many users.

About the hypothesis, the strategic grid model positions the sampled

hospitals in the ‘Support’ level, and further analysis by way of Nolan growth

stage model places the sampled hospitals in the initial stage, thus, planning MIS

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in support for organizational operations context. Further involvement o f the top

management for ‘Turnaround strategy’ will cultivate the MIS empowering

strategic decisions and movement, and when accompanied by complementary up

gradation in the Nolan growth stage level for the MIS will tremendously boost the

performance of the organization through its MIS and consequently, substantiates

the hypothesis that proper and updated Management Information System

facilitates in the efficient performance of service sector organization like that of

hospitals in Manipur.

6.7 Strategies for MIS implementation:

Implementation of information systems is a process of organizational

change. Implementation refers to the ongoing process of preparing the

organization for a new system and introducing it in such a way as to assure its

successful use. Human and organizational factors affect the successful or

unsuccessful implementation of a new information system. Hmployees are

generally reluctant to changes, as it will involve training to adapt in the changing

system and training will involve substantial orientation of the users to their jobs.

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A change from the legacy to the modern system will take place only when

the training is completed. Change can be accomplished in several ways. The

safest method is to employ the old and new systems in parallel mechanism; the

new system is run under actual conditions vis-a-vis the old, and the results are

compared for reliability and accuracy. When the new system starts showing

consistent results for a remarkable period of time and becomes operational, and

the old system is dropped. The drawback of this method is being expensive.

Thus implementation of proper MIS may be costly and may take long time.

The following steps can be taken up for MIS implementation in the hospitals:

The legacy is changed to accommodate the modem MIS

(costly task and may lead to failure)

The old information system runs in parallel with the new

system and can cut over when the MIS is feasible and reliable.

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So the researcher s u r e s t lo implement MIS tor linking the eight hospital

subsystems viz. Patient Diagnosis and Treatment system. Patient Record System.

Patient Scheduling and Order S\stem , Patient Accounting System, Hxpenditure

and General Accounting System, Personnel System, General Supportive Service

System, and the Management Control System.

^S 'nn initial stage it is suggested to implement the MIS in each of the sub­

systems and implement the same in the whole system when a fruitful result comes

out of the subsystems. MIS effectiveness is evaluated not in terms of observations, bw.1

in terms of an average o f opinions of the users, developers and of course the

hospital management. However the most profound influence of MIS is that MIS

besides offering economic value and that overcomes the costs, consigns a new

and better way of doing the things in the organization’s care.

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