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Can process approach work in healthcare?

Throughout many years, we are all hearing about how important is to not limit IT and especially implementation projects of key applications to functionality or technical exercise but have a look at processes first. As nice keynote will be stating, only if you will sort-out and optimise your processes, reflect your strategic and tactical goals, you should begging to realise real value from the IT investment. Sadly, what you typically will see in real life: all the big talk about process redesign and improvement is either cut-out from the scope or after enthusiastic kick-off it sooner or later slips into endless attempt to map current processes with little practical value in the end; then the team or angry management finally puts the effort away for its ultimate jump straight into features and functions. Going around users and asking them “tell me how you do it now and I will try to reflect it in your new system” leads often to freezing the current way of doing business and missing the chance for improvement which IT implementation represents. No wonder that IT is being often labelled as not supportive to business or organisational goals and end on the level as one of many cost-center (with inevitable cuts coming during the difficult times). Recent McKinsey’s study from Dec 2008 is well illustrative about this fact.


Reflecting all such generic difficulties into healthcare industry, get ready to expect even bigger challenges. Such empowered users, conservativeness, strong stakeholders and show stoppers on all levels within the organisation makes any intent of change almost impossible, especially when IT crowd should be taking the lead. While being conservative is of absolute importance in treatments and procedures, it becomes strong enemy to any organisational improvement. How often you’ll hear that the process is done this way because that’s how it is for last 20 years in this hospital! 


Learning all this in my past 9 years in healthcare, I was surprised that there was a company called Healthlink who understood dynamics of healthcare and challenges of health IT and came with simple, but practical way how to work with users, manage change, use process maps and drive decisions BEFORE customisation of the systems. And their reference base of about 2,500 projects in hospitals of all sizes probably convinced IBM to acquire Healthlink and reshape the value proposition which was created during last 15 years towards healthcare markets around the globe.

The methodology came in two components – Prolink4 represents a roadmap to efficiently drive implementation project towards improving processes on measurable basis; and ProMap, set of tools and databases including best practices for process modelling and capturing of benefits, metrics and key decision examples. ProMap contains more the 2.000 template maps, 6.000+ client delivered process maps and 18.000+ design organisational decisions (!).  One of a key attribute of ProMap with great practical value is database of vendor-specific processes. You’ll get not only “generic” best practices, so for example how the admission process on OR department can look alike, but also information and guidance how you can make it happen in specific software. How many great process improvement suggestions ended on a paper in a drawer because limitations or different “logic” of specific software was not considered!


Therefore it did not took a long time after the Healthlink acquisition and IBM started to talk to SAP about what the methodology is about and how it might be practical for SAP in healthcare. I need to say we have found supportive, open-minded and proactive people around SAP for healthcare and soon agreed on combining the best of both worlds in order to achieve:


  • Enabling work with SAP functionality in simple, not technical and healthcare relevant manner
  • To support face-to-face sessions with hospital users in all levels by understandable graphical content
  • To make project-related decisions more transparent and increase the quality of documentation
  • Having structured engagement of relevant executives, managers, subject matter experts and users during different phases of the project in order to secure common ground for change management program
  • Measure and evaluate project contribution

SAP Prolink enablement

Two principal pieces of work were done to combine Prolink nd SAP:

  1. Mapping of key SAP processes in healthcare

The mapping project done by combined IBM and SAP team captured key processes of back office and patient management. More then 80 SAP process maps are ready to be used and/or further customised on individual projects. The scope is following SAP functionality:

  • SAP Patient Management
  • SAP Financials
  • Asset management
  • Controlling
  • SAP Human resources
  • SAP Logistics/Materials Management



Example of a map -MM purchase order. Golden stars are indicating SAP specific best practices.


The maps are structured into “swimlanes” which are making the readability easier for all types of users across the healthcare organization. The maps are capturing the future state functionality which is transformed into the functional prototype during the blueprint phase based on ASAP established practice. 


  1. ASAP methodology alignment

Second part of the project was focused on methodology matching. Combined team aligned IBM Prolink4 methodology and ASAP methodology together, so the delivery teams have now advantage of industry unique value and change management driven roadmap of Prolink4 and customisation and quality control leverage delivered through ASAP.

Following illustration is showing key steps in Prolink and ASAP methodologies and its linkage.




The major stages of the project flow are covering complete lifecycle of the related work steps:

  1. Frame the Future – after definition of a project charter and governance the major focus in on creating the future state processes and scenarios as foundation for decision making process. After that structured decision days program help to reach consensus and decision necessary for continuing towards application customization in next phase. The phase is covered mainly by Prolink4 methodology components.
  2. Build the Future – once the future state is decided, project work continues in two tracks:
  • System customization
  • Change management program

The change management goal is to have users on board with the anticipated future state and focus around issues related to changing the way they work now. The program is realized across healthcare organization to make sure user readiness and acceptance for change and is based mainly on Prolink4.

The customization track is focused on building a blueprint, prototyping, training and testing the application. It is relevant to ASAP Blueprint, Realization and Final preparation phase with underlying quality control track.

  1. Go Live/Refine – includes support for going live and post-go live user support. The methodologies converge here.
  2. Adopt and Realize / Project completion phase is focused around measuring deliverables of the project, productive support and integrating lessons learned back into the project. Both Prolink4 and ASAP are used to support governance of this phase.


Looking into the future

As the original scope included only SAP-owned components, ERP and IS-H was covered. Nevertheless, the plan from the beginning was to have complete SAP-based proposition enabled for Prolink and therefore we wanted to include i.s.h. med in a later stage. Thanks to great response from GSD in Berlin, the missing part represented in clinical, CPOE and EMR functionality was started in mid 2008. As planned, by Q1/ 2009 results of the work will be available and will include both key processes and methodology alignment for i.s.h. med.

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