How implementing of BPR can help NHS to increase service efficiency

RESEARCH TITLE: HOW IMPLEMENTING OF BPR CAN HELP NHS TO INCREASE SERVICE EFFICIENCY

2012STUDENT NAME: ZAHIR RAYHAN SALIMSTUDENT ID: 43548PROGRAM: MBA INNOVATIVE MANAGEMENTSUBMISSION DEADLINE: OCT’2012

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Contents

Executive Summary..................................................4Chapter 1..........................................................5

Introduction.......................................................5Research Background................................................6

Research Aim.......................................................6Research Objectives................................................6

Research Questions.................................................7Chapter 2..........................................................8

Literature Review..................................................8Business Process Reengineering:..................................8

Re-engineering...................................................8Process Engineering Lifecycle:..................................10

Visualizing New Process:........................................11Secureseniormanagementsupport...................................12

Discovering Chance for Re-engineering:...........................12BPR and other Traditional Improvement Programmes:...............12

Other Business Improvement Initiatives..........................12Total Quality Management (TQM)................................12

Difference between BPR and TQM:.................................13TQM and BPR in Context of Changing Management Philosophies......14

Summary of BPR & Other Business Improvement Initiatives.........14BPR & ORGANIZATIONAL ENABLERS:..................................15

The use of information technology (IT):.........................16BPR & IT ENABLERS...............................................16

Role of redesign in NHS:........................................17Pilot approach introduced in NHS :..............................18

BPR in forced caution:..........................................18Chapter 3.........................................................22

Research Methodology..............................................22

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Research Purpose................................................22Research Approach...............................................22

Quantitative research materials:..............................22Qualitative research materials:...............................22

Research Strategy...............................................23Research Methods................................................23

Source of Data..................................................24Primary Sources: -............................................24

Secondary Sources:-...........................................24Method of Data Analysis.........................................24

Justification of Research Method................................25Research Limitation.............................................25

Time Table for Dissertation:....................................25Ethical Consideration:..........................................27

Chapter 4.........................................................27NHS Privatization and BPR.........................................27

BPR Principles Within Redesigned NHS............................28Winners Due to NHS Privatisation................................31

Losers Due to NHS Privatisation.................................32Chapter 5.........................................................33

Data Presentation and Analysis....................................33NHS Organisations Survey........................................33

NHS Patients Survey.............................................52Chapter 6.........................................................62

Discussion and Recommendations:...................................62Conclusion:.......................................................64

References:.......................................................65APPENDIX A: BPR in NHS Questionnaire [For NHS organisations]......68

APPENDIX B: BPR in NHS Questionnaire [For NHS Patients]...........73

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Table of Figures:

Figure 1: Process Engineering Lifecycle Sample for NHS.............9Figure 2: A FLOWCHART REPRESENTATION OF THE X-RAY PATHWAY FROM A&E (SOURCE: SMITH 2006)..............................................17Figure 3: A Segment of a Traditional Flowchart Representing the Pathway (Source: Klein, 2006).....................................18Figure 4: An X-Ray sub pathway distinguishing patient and information flows (Source: Spurgeon)..............................19Figure 5: Time Scale of the Research..............................25Figure 6: EXPECTED ARRANGEMENTS IN A FEW YEARS - market-led, mixed provision, managed care model dominates................27

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Executive Summary

BPR is one of the key innovative management for businesses. While

BPR promises to reshape the organisation by cutting unnecessary

production cost, wait timing etc. It is also a time consuming

process to implement. This research was about NHS and the

possibility of increasing its service efficiency by successful

implementation of BPR. Some of the key elements of BPR was

scrutinized and reviewed. The related literature was covered. As an

integral part of the study there were two full length questionnaire

based surveys conducted where the researcher questioned selected

respondents to get a glimpse of the current state of BPR

implementation. There are growing concerns on privatization of NHS.

This research also tried to discuss about that probability as well.

To conclude the research was concluded successfully and the research

objectives were successfully met by answering the research

questions. Even this research work can be taken further by

incremented survey and industry analysis.

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Chapter 1

Introduction

Business Process Re-engineering can be considered as management

approach. It was Hammar who considered to be the first to acquaint

us with this theory in early nineties. If we think of technological

as well as business advancement together in this world of

globalization we have to adopt BPR concept. In order to run an

organization, enhancement of both efficiency and effectiveness is a

prerequisite and that’s what BRP proposition stands for. By adopting

this approach of BPR Organizations incline to observe their business

process and can also evaluate how these process can be well

constructed.

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Different companies’ run with the vision to explore its experience,

working skills and multidisciplinary through using information and

communication technology which possess powerful optimistic approach.

Organizations also focus on the feedback or the return on investment

and it is therefore a major matter of concern where skill and

experience factor are fluctuated due to the negligence of the

supervisor. In this regard BPR can be a solution that play an

important role to raise organizational competitiveness by combining

the engineering structure with specialist’sself-taught

creativity.BPR is used not only in metropolitan call centres,

wireless area networking but also in transportation, intelligent

buildings.

In this research, the researcher is going to look into the NHS in

the UK. In the summer Olympics 2012 the opening ceremony there was a

controversial glorification of NHS. Controversy apart NHS is an

exemplary service organisation. Recently there is being a lot going

on with NHS. With privatization efforts are taking over there is

still room for research to see how BPR is reshaping this health care

organisation.

Research Background

In the world of change management we see Business Process

Reengineering (BPR) has achieved massive recognition during the past

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few years. The operational model of enterprise entirely changed by

BPR which was brought about by the evolution of IT (Information

Technology) considered as catalysis of management revolution of

enterprise. In order to comprehend the objective of revolution and

to understand the vision of enterprise, BPR must be supported by IT.

Simultaneously IT must be applied under the guide of BPR in order to

avoid “black hole”, information break and realize sharing

information.

NHS with an aim to save £20bn by 2015 by implementing BPR in IT had

a hard task ahead. Whereas successful integration of BPR in NHS is

still incomplete it has achieved some true milestones. This study

will see how NHS have gone ahead with their ambitious project and

where it stands today.

Research Aim

NHS has gone through tremendous changes in recent years. The purpose

of research is to investigate how BPR can help NHS revolutionize

services provided by NHS.

Research Objectives

SMART research objectives are listed below:

1. Explore concepts and theories of BPR specially related to IT

sector and Business Management.

2. Investigate successful integration of BPR in NHS.

3. Review the privatization of NHS.

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4. Evaluate its progress so far and make suitable

recommendations.

The stated objectives are SMART because the research objectives are

specific which is manageable within the given timeframe considering

whole task is being sub divided into smaller sections. The

objectives are attainable as NHS is based in the UK and the research

is taking place in the UK. These objectives are relevant as we are

measuring the success of integration of BPR in IT in NHS in the year

2012 with focus on 2015.

Research Questions

To be precise this research will embark upon the current status of

the privatization and state of BPR in NHS.

The research questions are stated below:

1. Is BPR theories supports use of BPR in Healthcare Services

2. How far BPR is being implemented in NHS

3. Is privatization going to create issues with current progress

of NHS

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Chapter 2

Literature Review

Business Process Reengineering:

If we look at the following sample definitions of BPR that was

stated by many researchers and practitioners, we will see that BPR

has been defined and conceptualized in many different ways.

Davenport and Short (1990) defined‘Business Process Redesign’ as a

design of working process that continue to exist within and between

the organization.Whereas Hammer and Champy (1993) define re-

engineering as a way of massive improvement in fundamental business

process which can flourish company quality, cost, service. (CSC

Index 1994) also agreed with this approach.

(Goll, 1992) point of view is also similar to that of Davenport and

Short who stated reengineering as reshaping of business process in a

free manner along with ensure better performance throughout the

business.

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From the above practitioner definitions, we can sort out the

function of BPR. its aim is to ensure better performance ,business

process analysis, being an essential element for information

technology to flourish organizational competitiveness.

Re-engineering

The term Reengineering can be defined as fundamental redesign of the

process of an organization mentoring production, marketing,

accounting. For better output organizations need to be re-engineered

which is implemented within an organization through design of

consecutive manual procedure and after that it automatically enhance

proportionally with technological development.And this phenomenon

possess no effect on optimizing procedure or functional control so

as externalities of an organization. As time passes by only the

infrastructure of an organization become well-furnished butis still

motivated by its original fundamental rules and regulations.

To overcome this problem it is good to ensure development and

application of information technologywhich was usuallyadopt in order

to acquire improvementfor a very limited period of time of the

ongoing process. Because of globalization the requirements of

customer change and competition is heightened so as new approach had

to come in the pipeline to increase organizational flexibility. It

was clearer with the concept that was given by Guha et. al. (1993)

has point out the contribution of the localized,incremental approach

which has minor contribution to the effectiveness of a company in

comparison to today’s business world.

BPR comprehend four factors which are very important run an

organization smoothly. These are Technology, Strategies, Processes

and People. If an organization wants to make proper use of

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technology as well as workers activity then it has to consider

strategically approach and process as the preliminary requirement.

Now here is a description of these four component which well be

helpful to understand this process.

Strategies:

An organization need to have good strategy that will help to make a

good realization of employee motivation so that support of the

workers is achieved. Strategy also focus on the following area such

as technology, organization and human resource. Strategically

approach must have to indoctrinate what the goal of a company .It

must have an option to redefine and reconstruct both external and

internal confinement.

Technology:

Technology is consider to be the most important component through

which the function of an organization broadly spread out. In other

words it can be said that adopting ancient ideas to run an

organization would neither effective nor productive. Because the

world is changing everyday due to globalization so we need to use

new technology like groupware. So organization of today’s world

should accept technological change and therefore adopt IT to enhance

organizational structure.

Processes

Theprocess of an organization depends on two factors first one is

customer satisfaction wrt their need and second one is it add value

for them. Process give importance on customer requirement. In this

regard organization’s own requirement is not a matter of concern but

organizational compulsion is taken under consideration. Redesign of

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whole company structure is needed when a company turn its functional

department to interfunctional process.

People

It is the most sensitive and sophisticated component of

reengineering. It is seen that in most organization top management

appreciate BPR efforts but as it hardly deduct workforce it creates

some difficulties in middle management because they have to come up

with this change opportunities and also execute them. Other

important fact is to make workers familiar with the company strategy

to pursue cultural context within organization. If the worker is

supported by the top management and if they are provided with better

training for the welfare of the company then it well give them a

positive aspiration to work within company with wholehearted effort.

It should keep in mind that top management have to control workers

and also have to extract the best work from them that’s why they

have to make them feel trustworthy.

Process Engineering Lifecycle:

A well organized, better implementable formulation of BPR method

hasn’t yet published but several attempt to achieve it was performed

earlier.

Such a methodology approach named life cycle of process

reengineering will be helpful to understand the working principle of

BPR which was introduced by (GUH1993).this methodology implies six

consecutive stage. Presenting this particular methodology doesn’t

indoctrinate supporting this particular view but to realize the

purpose of BPR for an organization. Figure below represent process

engineering life cycle:

13Feedback

Visualise

Impregnable allegiance frommanagement

Distinguish chancefor reengineering

Recognise altering technology

Coordinate with embodied

Pundit

Coordinatereengineering team

Adjust performance goal

Diagnose

Text fileof existing process

Expose pathology

Redesigninvent substitute design

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Figure 1: Process Engineering Lifecycle Sample for NHS

Visualizing New Process:

Because of stem approach of BPR, this type of jeopardize demand for

an authentic appreciation from the top management of an

organization.to do so top management leaders to run their business

in such a way that doesn’t limit freedom. This approach indicate how

the overall performance of an organization can be flourished rather

than to change the present situation. The process surely include a

panorama of adjusting reengineering crusade with the aim of an

organization and embodied schemes. In the first step three major

point is taken under consideration first one is support from top

management is established, second one is proper information

technology is canvassed, and third one is critical appendage are

distinguished.

Secureseniormanagementsupport

As it is discussed earlier that to established BPR within the whole

organization it very much necessary to establish support for it from

top management which includes not only CEO but also departmental

MonitorPerformance measurement Quality

improvement

Remodel

Installation of IT

acknowledge

Redesign

Designhuman resource

Unveil pathology

prototype

New processdesign

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heads of an organization and it’s a precondition. The success in

this section can only be possible if ongoing procedure or trend of

an organization is changed but all depends on the understanding of

BPR as well as the mentality to establish it within an organization.

Discovering Chance forRe-engineering:

To make exertion of reengineering approach it is necessary to point

out important factors. In order to establish this some prerequisite

must need to fulfil. First of all organization need to know

resolution of business procedure.it must think of customer need and

expectation.

BPR and other Traditional Improvement Programmes:

There are different types of traditional improvement programmes they

can be classified as restructuring of business, downsizing of the

business, TQM ( Total Quality Management), Six Sigma, JIT(Just in

Time). Business Process Reengineeringfocus on discontinuous and

fundamental breakthrough of performance that prosecute its aim to

maintain better cost, quality, and accuracy. It also compel

structure of an organizational management along with designing

business process and also attitude of employee in such a way that is

supported by information technology.

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Other Business Improvement Initiatives

Total Quality Management (TQM)

As an outcome TQM (Total Quality Management) and business revolution

in Japan’s posted 1945 can be linked together and has introduced by

the Total Quality Management which has become the most desired and

most acceptable method for many management programmes.According to

Kutchker (1994), some organization like IBM, British Telecom, Xerox,

DEC apply TQM concept to pursue orientation process in

organizations.TQM is considered as an useful source of security in

the west and so do many companies adopting BPR in TQM technique as

an additional component to boost up organizational effectiveness.

Engineering effort along with pursuing successful TQM have made

success for an organization. We can sort out the core components of

TQM and we find proper team work, customer care, innovation and

implementation of better working method, involvement of employees to

achieve goal, benchmarking are the main focus of TQM and these are

also familiar to BPR.

Difference between BPRand TQM:

The drawback of TQM is that itneeds a long time frame to

executewhile BPR requires less time than that of TQMthat cause loss

of project credibility.BPR always manipulates information technology

to ensure better performance and also invent new process and reshape

existing process for the welfare of an organization.Whereasmain

concentration of TQM most of the time imply on general work of

employee and quality. The main difference TQM and BPR is that TQM

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focus on incremental business process and provide improvement in

organizational performance to 10-20% and in comparison to this BPR’s

goal to accomplish change through more intense pressure which

performance to 30-40%.As a whole BPR amalgamate the total system

analysis, ensure better quality, development of organization socio-

technical development.

TQM and BPR in Context of Changing Management

Philosophies

Reengineering – Michael Hammer 1988

Federal Executive Order 1986

TQM Movement, Quality circles 1980

Zero Defects – Philip Crosby 1970

-Japanese Quality Movement written by Ishikawa, Taguchi

1950 Statistical process control written

by W E Demming Av Feigengaum, JM Juran, Reconstruction of Japan

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1940 SS techniques application for bureau of

census

written by W Edwards Deming

1930 Statistical Sampling (SS) written by –

Walter A. Shewhart

1920 Motion and time Studies written by – Frederick

Taylor

(Source: James 2006)

Summary of BPR & Other Business Improvement Initiatives

BPRwhich concentrates on change and improvement of basic laws of

organization. It also focus on main methodology of a business

approach and where productivity enhancement of an organization is

required, information technology plays the role of a catalyst. In

this regard it needs to mention that. In early nineties this concept

was popular and almost 55-77% companies of USA and UK were planned

to use BPR method in their companies.

Whereas JIT’s aim is to accumulate operational activity and make a

harmony with demand. In case of future process of production which

is demanded by the customer, it provide small item in a very

definite amount. This method is well known in Japan but when it

comes to the point of product quality, introduction to new product

item, satisfaction of customer then can’t fulfil this particular

prerequisite and therefore it cause less impact on the enhancement

of BPR and TQM process.

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Another business improvement process is restructuring which is adopt

for a company in order to improve both production and profit. But

the fact is that it needs help of BPR to ensure better performance

in an organizational activity.

Through socio technical design working environment along with

responsibilities of workers is hardly split as its main focus is on

these two factors that is whether employees job satisfaction is

ensured or not another is quality of work. In this case we found

similarity with BPR.

If we take socio technical design as a Business Improvement

Initiatives then we can see that very beneficial approach that

enhance productivity, ensure employee job satisfaction. It also

provide good working environment and also ensure technological

advancement.

BPR & ORGANIZATIONAL ENABLERS:

A number of perspectives of BPR project came forward to measure

their degree of success gain from this approach. As in any new

field, different factors are highlighted by researchers to identify

the success of BPR. Four objects of BPR were identified by Davenport

and Short (1990) those include quality of output, time minimization,

quality of work life and minimize cost. According to Morris and

Brandon (1993) there are six basic functionwhich is performed by BPR

such as distillation of the operation process, quality

improvement,cost reduction, improvement of orientation of customer,

increment of percentage revenueand make harmony with operational

procedure. On the other hand Stow (1993) reports that successive

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BPR approach always run for efficiency, competitiveness and profit

that help reach an organizational development up to the mark. His

argument supports the view that successful BPR project define its

objectives first.

In order to make a business re-conceptualized, it is necessary to

simplify group activities by redesigning particular process and it

also comprise relationship with its customers and suppliers. It can

be said that BPR brings a new dimension in management sector which

purpose is ensuring consummate desirable improvement in customer

care,it combines organizational outrace business procedure with

Transformation of the power of ITto get optimizing performance and

major benefits by applying its techniques, prior rules and

assumptions.

The use of information technology(IT):

In order to achieve competitive advantage and supporting business

activities in a dynamic environment we must need to give importance

on the use of IT and so it has done during past few years.BPR get

highly appreciation from some authors, Gerstein (1995), Harrington

(1991), Ciborra (1992), Clegg (1990), Davidow and Malone (1992) and

Keen (1991).Modern information technology was emphasized by all of

them but implication of formal theory on IT was missing therefore

general discussion is required of the use of IT in BPR.

BPR & IT ENABLERS

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IT plays a supporting role in BPR.So it can be considered as an

enabler. The definition of enabler had given by Hammer

&Champy(1993)who stated enabler as an agent that permit

organizations to come out from ancient rule and establish new

reengineered processes. IT is needed to be fundamentally reshaped

and should be evaluated more than an increasing force as like

business process. IT can also amalgamate enabling technology that is

highly desired for an organization to support its business. Some

important factors such as design, engineering, management

information, control are associated with IT.Though IT has enormous

applications but it is difficult to use them effectively. The

significance of BPR over IT is to address these obstacles by

directly designing the effective use of IT into reengineered

business processes. New and improved uses of IT are often discovered

at the time of BPR’s examination of existing business processes. It

is only BPR that relate the use of IT directly to business

processes. To enable the productivity enhancement, IT can enable

basicmodifications of the cost structure of the jobs. According to

Parker(1996).IT is also an enabler of social and organizational

transformation, making it an integral part of an organization’s

strategy.BPR use the following IT such as:

a) Databases and related technologies in NHS.

b) Networking and communication in NHS.

c) Electronic data interchange (EDI) in NHS.

d) Workflow automation and GroupWare in NHS.

e) Internet web-based technology in NHS.

Role of redesign in NHS:

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In order to mention the contribution of BPR in NHS we need to go

through some thinkers’ point of view.According to (Grey and Mitey,

1995), there are two catalyst for which BPR process is picked apart

and that is dissatisfaction of work and focus on new technology. But

(Be´langer et al., 2002, p. 17) states that BPR focus on how jobs

are reconfigured in an organization. There is another criterion

which has mentioned here is it introduce in an organization where

absence of worker is a matter of concern. To enhance service

quality and efficiency within national healthcare organization

(NHS), Leicester Royal Infirmary first introduce BPR in it.The

attempt was pretty much successful to achieve its goal but lag

behind fiscal saving.According to (McNulty and Ferlie, 2002)

progressive changes gained because of analytical analysis in patient

care due to the application of BPR in it, also purvey of effective

leadership as well as Critical mass of practitioners also involved

in health care system . Where workforce is limited and labour cost

is higher in that case NHS has proved its success to provide

liquidity of skill. Recently there is a consecutive change in

workforce has seen in UK and other countries. But it is frequently

observe that almost all workers in an organization are skilled so

there is a shortage of skilled worker as well as labour cost is

increasing which sometimes exceed the overall healthcare

expenditure. BPR has been used in industry level for 30 year and

its use in NHS have proved cost effective to almost 10-15% .It

provides job satisfaction, morality ,improvement of service of the

workers. The method which is used in NHS is a combination of both

BPR and TQM and the principle of restrain which implies conjoining a

system that is absolutely pertinent in a healthcare service demand

for representing and transmitting patient tracts. If we want to help

the local staff by apprising them to improve the whole

organizational structure tracing function is obvious consideration

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of PDSA (Plan do study act). The goal of redesign process is to

ensure improvement of healthcare process and also minimize

organizational waste. In hospital we see patients wait for a long

time and enjoy less facility and service. The goal of redesign is

minimize delay by introducing a process based system which will also

increase facility for staff.

If we want to establish BPR in NHS we need to establish a specific

tract for it.The process will then demonstrate wide range of

clinical leaders along with managerial staff .If high intensity

footpath is used form the very beginning then BPR may be beneficial.

This enamour a general realization of the footpath of forcible

patient travel, gives information and duties of staff. The process

of representation have to accomplish in such a way that staff get

maximum perceptiveness or their duty. In this way staff will go

through some questionnaire to patients eliminating re-examine

procedure.

Pilot approach introduced in NHS :

From mid-nineties the fundamental management and organization was

completely promulgate by the gov.at that time one of the major

concern was to make national healthcare service privatize and make

an administrative structure which is hierarchical in manner.to gain

better result a search for research management was made.gov also

tried to control the money that is spent over NHS and pursue for

internal market related to healthcare. This ultimately result for a

degradation in service rescue and increase competition among service

providers and in this way cash cumbered emptor have that choice to

select cheapest Medicare no matter it is from NHS or from private

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sector. This new approach to NHS definitely need ensure some change

especially gross financial gain which is related to the efficiency

of resource management.in order to improve performance of a

hospital, touchstone of it along with staff morale need improve a

lot.to do so BPR pilot project was introduced and was helped by

extraneous advisor. In order to identify the main clinical process

each practitioner guided a multitrained team. Each case were point

out up to twenty appendage with a particular start and stop. Pilot

approach was successful and later applied to whole hospital.

BPR in forced caution:

NHS has developed its footpath way by concentrated on redesign

procedure in case of Medicare which is not scheduled. National

health care system in Scotland introduce extra care synergistic care

curriculum to increase betterservice. The was to spend maximum four

hours for intervention in Accidental or exigency case.to do so team

consisted with practicians,congressmen coaches are assigned to

monitor service to redesign the footpath of patient. Inearlier stage

the flow chart of the process pursue conventional text format

representation .total format of the map was still not sympathized by

them. They considered the process will give 100% support to the

corroboration but not define its contribution in the process of

redesign. The flow chart was too complex to recognize pleonastic

taxes. The conventional chart is given below:

The extra work was hard to distinguish because of the complexity of

the flow chart. In this way menstrual and classes of patient was

hard to secern. To overcome this problem simulation procedure was

introduced which was really helpful to upgrade communication by

using graphics. The improvisation was granted in 2009 and simulation

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procedure was applied with the help of hypertextmark-up

language(HTML).this map simplify the whole process and produce

private details. The whole process was explained below:

Figure 2: A FLOWCHART REPRESENTATION OF THE X-RAY PATHWAY FROM A&E (SOURCE: SMITH

2006)

The above flow chart make easier to represent the extra work . here

we can see for an accidental & emergency case occurred in a

arbitrary time and it was then informed to the X-ray staff and after

that staff inform the porter who carries the luggage of the patient

and carried the patient to X-Ray room. After completion of X-Ray

nursing staff call porter and here patient has to wait for a while

and finally transfer to A&E room. Here the mentioned icon indicates

the whole procedure starting from patient admission into a ward to

final medicure.The pathway also indicates the no. time a patient has

to wait. Here we can see the accessibility of porter and they are

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positioned to do a particular job for accident and emergency case.

All procedure are clearly defined to avoid all extra work.

Figure 3: A Segment of a Traditional Flowchart Representing the Pathway (Source:

Klein, 2006)

Performance measurement was also mentioned which indicates waiting

related to doctor’s judgment and conducted to examine again of

staffing. There are options for the user to select patient

category.A patient can choose category like medical or operative,

major or minor .this indicates which patient should keep under

serious observation and which one is not in a priority basis.so

minor patient will be treated by the nurse and major one will be by

the doctor. This will ensure better treatment for major injury

patient. To ensure whether this pathway system was good or bad a

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voting was made for all members from junior to senior management and

the result was very much positive. Staff agreed with the view that

mapping tool was very helpful to give all information on time which

is required for documentation and play a vital role to make harmony

between total healthcare system with individual process. The

procedure improvised with the increment of application and the model

was represented by graphic design. It can be showed by the figure

below:

Figure 4: An X-Ray sub pathway distinguishing patient and information flows

(Source:Spurgeon)

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This was applied in NHS and proved very helpful to make the staff

understand the difference between practices and local condition in

national healthcare system. This tract helps a lot to identify

redesign process. The development of this tract method took 18 week

to complete. Each and every step gain discernment for care

activities.

Chapter 3

Research Methodology

Research Purpose

The determination of exploration can be a complex matter and will

contrast across diverse methodical arena as and disciplines.

Scientific research is divisible in 2 categories which is ‘pure

research’ and ‘applied research’.

Orderly and impartial procedure of assembly, recording and

evaluating facts for assistance in making business verdicts is the

type of applied investigation that is termed as business research.

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Research Approach

In order to carry on the research it is important to choose a

suitable approach. Two types of research approaches are:

Quantitative Research and Qualitative Research.

Quantitative research materials:

As a simple definition by Neuman(2003), information in the form of

numbers is quantitative data. Comparatively Babbie (2004) specified

quantitative marketing explores a marketing investigation of

empirical assessments that comprise mathematical quantities and

scrutiny methods that addresses the study objectives through.

Qualitative research materials:

As per Krueger(2003), an investigation approach frequently stress

influences other than the quantification in the gathering and study

of statistics is qualitative research. Qualitative investigation is

used to achieve vision into commons outlooks, deeds, price schemes,

distresses, incentives, goals, philosophy or existences. It’s used

to appraise commercial conclusions, strategy construction,

communication and exploration.

Elementary philosophies of science are share in both the

quantitative and qualitative methods however two methods also

contrasting noteworthy ways as Table 1 demonstrates. Despite each

having its strength and limits, themes or subjects, both the styles

accompaniment each other.

Table 1 :Quantitative Style and Qualitative Style of Research

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Source: Creswell, 2009

Qualitative research methods developedprogressively as imperative

methods of analysis for the social sciences and practicalarenas such

as learning, localdevelopment and management.

Research Strategy

There is always an ongoing debate on the preferred method of

research. The reason why it is complicated is both of this methods

have their own merit and demerits. Actually this will vary over the

topic chosen by the researcher. Now it was a difficult to decide the

research method to be used.

After careful consideration of both the methods the researcher came

to a conclusion that the research will be carried out using both

approaches. Qualitative method is going to be used to assess the

scenario from previous studies and quantitative method to survey NHS

to see how the literature matches with reality.

Research Methods

31

Surveysare among the peak common methods of producingprimary data.

Survey is a research practicein which evidenceis collectedafter a

sample of individuals by use of opinion poll.

Thoughthey are not similarlysuitable to computing all kinds of data,

questionnaires are quite stretchyin what they can measure.

Designing and administering a questionnaire should include these

steps:

1. Clearly stating objectives

2. Deciding Sampling Group

3. Questionnaire formulation

4. Questionnaire administering

5. ResultsInterpretation

Source of Data

Collected data sources can be divided into two types (i) primary

source & (ii) secondary source.

Primary Sources: -

This source are unique in the sense that academics haven’t

researched into that source before or previously done research did

not look into the resources in the same perspective. Actual evidence

composed through several approaches such as quizzing, questionnaire,

interview, e-mailing etc are primary data.

Secondary Sources:-

32

Secondary data sources are those that are already being published

and available publicly for further investigation or research. Some

common secondary data are: annual reports, previous papers,

whitepapers, newspaper articles, financial statements of companies,

Govt. Statistical reports etc.

Method of Data Analysis

In order to get primary data there was questionnaire based survey.

There was two set of questionnaire prepared to survey NHS

organisations and Patients. For both the survey there were 100

respondents. These people were chosen randomly from 9 boroughs of

London. After gathering the data SPSS will be used to process the

data. In this case, two way ANOVA will be used to analysis the

variance.

Justification of Research Method

The research method was chosen on the basis of time allocated for

research that will give positive conclusion regarding the research

objectives. Both quantitative and qualitative method were used to

analysis the previous studies and analysis the primary data.

Research Limitation

Time constraint is the main limitation. The secondary data collected

from various NHS premises, online sources might not be sufficient

33

for this kind of intensive research. However the materials used for

this research were carefully selected to remove unnecessary

inclusion of wrong information. The sample size was 100 for both the

cases. Though it is a significant sample size but does not guarantee

a 100% clear representation of the total population.

Time Table for Dissertation:

The research will be processed as the Gantt chart shows. According

to this time table, the process can be scheduled much more

effectively and reasonably in order to finish the report successful

34

Figure 5: Time Scale of the Research

35

Ethical Consideration:

Every research has some ethical considerations. As this research is

going to deal with NHS there will be some relevant ethical

consideration. Ethical issues that this research is concerned are

publication of sensitive data that might involve certain names or

NHS centres. Tough the researcher will try to keep their credentials

as discrete as possible but again this has be maintained throughout

the research. Prior publishing any names approval will be taken from

the person or centre after that the researcher will consult the

research supervisor to see if there will be any issue if the data is

published..

Chapter4

NHS Privatization and BPR

As per the new coalition government’s strategy, after privatization

they way services are provided by NHS at the moment will be changed.

Using BPR the whole business will be redesigned to a money

generating business. Indeed it will be a tough challenge however, as

the way it will be redesigned NHS will still be getting funds from

the taxpayers. Tough the prime motivation will switch from being

providing care or public service to providing profit to partners or

private shareholders. It is presumed that the profit will experience

an exponential growth which comes from the percentage of money paid

36

from the taxpayer’s money. On an interesting note, private patients

could get up to 49% of the beds of NHS hospital rest of the 51% will

be kept for public.

The policy reform has three key stage. Which are:

a) NHS will be transformed as independent performing trust.

b) There will be increase in the use of joint ventures among the

private sector and NHS.

c) ‘Health Credit’ system will be introduced that will be

combined with a contributory NHS scheme based on individual

health budget.

37

Figure 6:EXPECTED ARRANGEMENTS IN A FEW YEARS - market-led, mixed

provision, managed care model dominates

BPR Principles Within Redesigned NHS

The strategies used to redesign a business can be applied in NHS. As

a part of the research BPR principles within a healthcare

organisation’s context was evaluated.

The researcher examined the ten principles of BPR integration as

suggested by Armistead and Rowland below:

38

1. Lose Wait: This principle focuses primarily on waiting time

for patients as well waiting time in between processes in

healthcare organizations. There are many ways BPR can be

embedded in NHS. One of such case will be the way waiting

patients are handled. Let’s say one patient is waiting for lab

results then he needs to get the result and book an

appointment to the doctor which is dependent upon doctor’s

availability in that given time frame. What BPR will do is

make that waiting time less by making the lab process faster.

Which can be done by optimizing the labs for frequently done

tests. After that the appointment system can be optimized by

finding the nearest health service provider with relevant

doctor.

2. Orchestrate:This principle looks into balancing workload by

coordinating between different service providers or same kind

of service provider. For instance, let’s say in one hospital

there is `more beds for kidney patient than another hospital.

Now if these two hospitals shares the amount of kidney

patients they handle will ensure they have similar capacity

level. That is eventually more efficient than waiting for one

to fill up then sending rest to the other hospital. When a

department has less than 100% of capacity then obviously the

medical staff can provide better care for all admitted

patients. This can lead to shortening the total length of time

spent by patients in hospital.In between different labs this

can be also implemented where use of BPR can save the work

around time for patients.

39

3. Mass customize: This principle regards flexibility of interaction

between service provider and patients. Tough it is difficult

for healthcare services but however this can used for cases

where the patients have different levels of health literacy

and there will be several means of different communication.

Patients can be offered multiple access point for services

which can be personal appointments,consultation via telephone

ordirect email. For example: Diabetic patients can be provided

with extra online tools for record and graph their blood sugar

afterwards they can be given customized feedback on the basis

of their progress.

4. Synchronize:This principle is about synchronizing the process

which includes both physical and virtual side. One of the use

of this is where all medical data is available to the

institutes and patient side which is accessible from anywhere

in the UK. Similar thing can be done in case of medical

supplies by monitoring the lab reports and medical reviews

electronically thus ensuring all the bits and pieces joins

together affirmatively.

5. Digitise and propagate. This principle is one of the key element that

ensures moving into the next generation of healthcare. In this

age there is enormous value of digitalizing gigantic amount of

information’s related to heath records, workflows and generic

health information. Digital data is easy to share which is

also reliable and faster. One of the commonly used tactics

that can be used here is to reduce carbon footprint or paper

use by storing data in computer systems. Before registering a

patient doctors can ask several structured question that will

lead to formation of medical history of that patient. This

40

will help the communication channels as everyone will be aware

of the circumstances. On the other side this is remove

unnecessary time consumed by clerical checks done by doctors.

6. Vitrify: This principle implies to make the processes in

healthcare to be transparent operationally. This can be done

by processing patient’sinformation throughout the NHS system.

With this done the data will be transparently accessible

nationwide. A definite thing to do to make the system more

useful and understandable. By nature of it this must also

follow and respect patient’s privacy policies.

7. Sensitize: This principle deals from the root to a dedication of

continuous improvement and prevention of medical errors. There

should be sensors that will be used to detect such anomalies

in the processes in the system. For example if a patient is

waiting for longer than expected it must have procedures in

place to detect such issues and respond as quickly as

possible. This will also work in settings where there will be

automatic alert to get patients update about health condition.

Further instance will be detection of prescription errors in

terms of incorrect use instructions, dosages or drug-drug

chemical interaction.

8. Analyze and synthesize: As stated earlier by using set principles

NHS processes can be monitor in a regular basis and take

timely decisions. For instance to find out if there is an

epidemic of TB, NHS officials can simply look into the current

number of patient reporting for TB symptoms. It can work other

way round too where by looking at a particular disease

reporting govt. can take decision. When this information is

41

shared across the network then it becomes simpler for the

administrators to take necessary precautions or schedule

enough medical staff to tackle the situation. With extensive

data analysis it will be easier to find out which areas might

be next affected, how long it takes for the virus to spread

all over a region etc. This principles makes provision for

data analysis for middle and top researchers in NHS. Potential

of data mining is gigantic as after a given period this will

lead to create evidence based medication. Nevertheless this

will also lead to take vital decision regarding improvement of

services of health care system in general by reducing on

operation cost and quality of service.

9. Connect, collect, and create: This principle is about knowledge

management from top to bottom. By sharing the experience with

certain patients with specific diseases the system gets

improved with time. The best practice will be to create

community of medical stuff who will share their experience

thus forming a huge knowledge repository or in other word

expertise map. In order to make it work in NHS there should be

system to capture knowledge from the patients as well. Exit

interview can be used with patients to find out their

experience.

10. Personalize:This principle is about making relationship

deeper and stronger with healthcare professional and patients.

Similar things are already present in traditional medical

system where there is a family doctor who knows more about the

preferences of the patient. How this can be extended to NHS

setting is getting to know the customer a little more like

preference of medication such as choice of antibiotic,

42

homeopathic treatment. If these data is saved across the

system then it will make things easier for the other NHS

professionals to judge the patient. Also from patients side it

will give them a better feeling about the service.

Winners Due to NHS Privatisation

After implementation of new business strategies there will be a

winner group who will be benefited as a result of proposed changes.

The researchers tried to look into some of those winners.

1. Investors will get profit as with right strategies NHS can

turn into a profitable venture.

2. Developers who will receive land from insolvent hospital who

will have to give up their land.

3. Willingness to pay will be a deciding factor on receiving the

treatment rather than importance of getting a treatment. Hence

queue jumpers will be gainers.

4. Insurance companies will be a sure winner. Insurance companies

will be taking care of the primary care. There will a

transition of the GP system to more like US health insurance

based model.

Losers Due to NHS Privatisation

After implementation of new business strategies there will be a

loser group who will be lose as a result of proposed changes.

43

The researchers tried to look into some of those losing

stakeholders.

1. Patients: Patients will be the first stakeholders who will be

directly affected. The patients will need to ration care which

will be accompanied by more self-funding for treatment.

Increase of overtreatment induced harm (there will be cases

where unnecessary medication will be provided, extra X-rays

will be done that can lead to cancer etc.). Also there will be

longer waiting list as medical insurance holders will be able

to jump the queue with private insurance healthcare top ups.

2. Communities:According to the proposed ACT NHS hospitals has

the means to go broke and shut. In such instances it will

directly affect the nearest communities.

3. Staff: After privatization NHS services have to turn in to

‘Fordisation’ and wage saving means which will be the key to

profit. Private sector tends to shift tasks to less skilled

people to save money; sooner or later NHS has to follow the

same pattern to avoid any operational issues.

4. GPs: GPs will be set up eventually for scapegoating that will

be replaced by privatized health insurance companies who will

then operate the ‘integrated care model’ of PHE( Private

Health Insurance. These organizations will aim more to save or

maximize insurer’s money rather than maintaining or assuring a

good quality health care.

5. Taxpayers: Taxpayers will still be funding NHS services. As

it has come up in earlier research these are the people who

44

has to fund for the over treatments but at the end the private

sector service providers will extract the money from these

taxpayers.

Chapter 5

Data Presentation and Analysis

The research required to undertake supervised data collection as

part of primary data. There were two sets of questionnaire designed

to survey both the NHS organisation and NHS patients. These

questionnaires were accompanied by individual interviews from both

service provider and service recipient.

NHS Organisations Survey

After careful consideration 100 NHS organisations were chosen to

conduct the first survey. This survey included questions answers of

which will add together to support the literature review of the

research. The organisations were chosen on the basis of Simple

Random Selection method and organisations from 9 different boroughs

of Greater London was selected.

45

The collected data and analysis of the data is presented below:

Question 1: Which one of these best represents your organisation?

This question was asked

to get an overall idea

about the type of NHS

organisation the

researcher surveyed.

Most of the surveyed organisation was GP practices with 28 centres.

Next was Pharmacies with 19% entry. NHS walk in centre and NHS

trusts were next with 13% and 11% respectively. Others to follow

were Hospital (10%), Optician (8%) and NHS Direct (2%).

This shows the organisations that were chosen for the survey

represented the correct population.

Question 2: Which Level you work in the organisation?

A. Top LevelB. Middle LevelC. Entry Level

A

.

NHS Direct E

.

Hospital

B

.

NHS Walk in

Centre

F

.

Opticians

C

.

GP Practices G

.

Pharmacists

D

.

Dentists H

.

NHS Trusts

46

The next question was asked to see which level of staff are

representing these organisations. A mix of all three levels would be

appropriate as this will give a reasonable response.

As per the survey we had Top and Entry level worker representation

25% and 28%. However the Middle level staff had the highest

percentage with 47 out of 100.

This means the research will have fair resonance as all three layers

representative was surveyed.

Question 3: Are you aware of the term Business Process

Reengineering?

A. YesB. No

A67%

B33%

Graphical Representation

47

This question straightaway lead to the main theme of the research.

Where the researcher forwards to the main theme of the research.

Surprisingly most of them were not aware of the concept of BPR.

Where 66% said they don’t know about BPR only 34% percent said they

do have knowledge about BPR.

Question 4: How you will rate your knowledge about the organisation?

A. ExcellentB. Good KnowledgeC. Working/Little knowledge

A67%

B33%


48

The researcher wanted to see the way employees are engaged in the

organisation and how much they value the history of the NHS

organisation that they represent.

For option B there was 41% response compared to 33% for A and 26%

for C. Therefore 74% respondent had positive response regarding

their knowledge about the organisation which is commendable. For

those who said they have little idea probably they will catch up

with time or they need additional training.

Question 5: How you will rate your knowledge about the department

you work?


A67%

B33%


A B

49

This question was to check how much NHS employees know about their

department. It was a good find that employees do care about their

work and they show their commitment in working for NHS.

Option A had 34%, Option B had 45% and option C had 21% response. It

is visible that 79% respondents had positive response.

Question 6: Is your work divided into several smaller objectives

which you must achieve?

A. YesB. No

67%

33%


AB

50

One of the major characteristic of BPR implementation in NHS is

seeing the service as a business process. If the whole business can

be divided into smaller segments then it is becomes easier to

handle. It is also easier to improvise on segments rather than the

whole organisation. In a segmented organisation normally the work

load is divided into smaller timely achievable objectives. This is

very important in case of NHS as this will ensure the quality is met

without any foreseeable barrier.

67% response was for Option A and 33% was for Option B. This proved

in NHS organisations the workload is subdivided into smaller

objectives which ensures there is existence of BPR which replaced

the traditional time consuming process.

Question 7: How well these objectives are shared in the department?

(Think of top to bottom communication)

A. Regularly shared B. Randomly sharedC. Never shared

67%

33%


AB

51

To maintain good service throughout it is important for the members

of the department to work as team. To achieve this the objectives

must be shared from top to bottom of the organisation.

Option A was chosen by 58% where B was chosen by 34%. A mere 8%

chose Option C. It is really a good sign that the objectives are

shared among the employees who then will be well aware of what is

required from them.

Question 8: In terms of achieving objectives is there clearly set of

strategies?

A. Yes

A B C0

10

20

30

40

50

60

43

51

6


52

B. NoC. Not sure

In order to achieve the objectives there must be set strategies.

After implementation of BPR, now in NHS there is a custom of setting

strategies to achieve the set objectives.

In response to this question 67% chose Option A, whereas 13% said

‘No’ and 20% wasn’t sure of such strategies. It is noticeable that

about 33% either think there is no such strategy or they are not

aware of them. This is alarming for the department and the

departments might take some initiative to spread their strategies

among the departments.

Question 9: How much priority the department gives on giving

customer service?

A. Top priorityB. Priority varies with task

loadC. No priority

A B C0

10

20

30

40

50

60

43

51

6


53

To sustain as successful as it should be there need to be

consistency in customer service. It is assumed that at the end

customer service should be the top priority of NHS.

As per the questionnaire most of the respondents think they give

more priority to customers. 43% said they give top priority to the

customer service where 51% varies their priority based on their

workload. This means if they have many things to do in a single work

day the service quality will be compromised. Only about 6% said

their priority is not giving customer service which is less

significant as this represents a very small number of staff.

Question 10: How quick is the appointment to service process in your

department?

A. Quick B. Moderate C. Slow

One important aspect of providing good service is the time lapses

between customer query and reception of the service. If the customer

is provided with an appointment in shorter time that will ensure

A B C0

10

20

30

40

50

60

43

51

6


54

that they are going towards getting the service they need. The

longer it takes it will affect the patient/customer in general.

About 25% of the respondent thought the appointment system is quick

whereas about 34% thought the time it takes is moderate. It might be

because of the fact that some centres are extremely busy as their

location is in the prime location. 41% thought the appointment to

service process takes time. This can be further improved by

redesigning the existing system.

Question 11: Do you think IT is integrated in your day to day

operation?

A. Yes B. No

In BPR, IT plays a significant role. Uses of varies IT tools enables

a business to save time in its day to day operations by optimizing

the workload in a rather efficient way.

A B C051015202530354045

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In response to this question 65% said they found it is to be true

and rest 35% thought they don’t find IT services enabled in their

work. 35% is a significant number. May be it is because they don’t

realise the involvement of IT services in the job design.

Question 12: How much of your task is technology assisted?

A. Most of the tasks B. Some of the tasks C. None of the tasks

Technology assisted work will lead to time saving operational

activities. When BPR was implemented in NHS there were several

issues addressed where the task load was redesigned to use

concurrent technology to speed up the process.

58%

42%


AB

A B C051015202530354045

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About 35% chose Option A and 33% chose Option B which clearly

indicates that they have technology assisted tasks. Those 32% who

responded that they don’t have such task might be deprived of using

those provisions in everyday job.

Question 13: Do you think use of IT in NHS operations saved work

time and made it simple?

A. Yes, definitely B. Yes, but could have been

better C. Not a technical person, I

don’t like it D. Disagree, created more

trouble

It is true that use of IT services saves time however it is

important to know how this is made possible by using the services.

Comparison between these factors are significant as these gives an

insight on time saved on using such technologies.

A

B

C

D

0 5 10 15 20 25 30 35


57

In response to the question 37% said they definitely thinks use of

IT services speeded up the whole work. There is about 33% staff who

acknowledges the positive changes it brings but thinks that there is

room for improvement. There is a significant proportion of staff who

are not used to using such technologies and finds it troublesome to

use in workplace. There was about 3% who said they think it created

more trouble in the way they do the job. Well this is particularly

suitable for those people who are old and thus have a negative

approach towards change.

Question 14: In case of implementing a new strategy what side you

normally take?

A. Positive-supportive B. Positive-resistive C. Neutral D. Negative

From Question 12 to question 13 has a chronological context. When

there is a new strategy to be implemented it is hard to follow as

because some staff will resist to change but later on adapt to new

changes. Optimistically there will be staff who will play supportive

role and take it as an adventure to do the same task in an

alternative way. The whole idea of BPR is to convert the time

consuming process into a new time saving process.

58

As per the answers 31% has given Option A as their answer and 29%

chose Option B. Both are positive but there is a bit of resistance.

31% were neutral, these are the people who will take a backseat when

the changes approach and wait for others for conformity. At the end

they will change but throughout this period they will be resistive.

Only 9% chose Option D which is a negligible amount that has less

significance.

Question 15: Are you aware of the cost cutting methods that your

department has?

A. Yes and I follow themB. Yes but I seldom follow themC. Don’t have clear idea about

them D. Don’t Know

Cost reduction is one of the prime objectives of BPR. As NHS is a

national system it will have a great boost if it can reduce

unnecessary costs from its operations. When the staff follows the

A

B

C

D

0 5 10 15 20 25 30 35


59

cost cutting policies it helps the new strategies to work in a

better way.

As for the question 17% chose Option A, these are dedicated people

who follows the set rules and works for company’s benefit. 49% a

huge proportion admits they know the procedures but in terms of

following them they are not really interested but they do follow

them occasionally. This is alarming which needs to be changed.

Question 16: Do you feel motivated to work in your organisation?

A. Yes very motivated B. Yes less motivated C. Not really

17%

21%

35%

27%


A B C D

60

Motivation is another important aspect of optimization of operations

in an organisational context. If staff is not motivated to adopt to

changes than it will create hurdle for any changes made for optimum

outcome.

In response to this question the researcher found a positive

response from NHS employees. With 84% having positive motivation.

Among this 84%, 43% said they are very much motivated to work in

their workplace, 41% are motivated but the amount of motivation is a

bit less. Perhaps this has to do with either intrinsic or extrinsic

motivation factors which needs to be overviewed.

16% said they are not really motivated. Again NHS has to look into

motivating its staffs and may be they can introduce or reinforce on

motivational strategies.

Question 17: How you would describe overall performance of your

department?

A. Extraordinary B. Satisfactory C. FairD. Disappointing

A B C

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Again this question intended to see how the department where the

participant is working is performing. This will link with successful

use of BPR strategies.

Again a rather positive response was received. With 64% saying the

performance is more than expected. 31% chose Option A and 33% chose

Option B. With 24% choosing Option D, there was this good amount of

people who thought the performance was just fair. Another 12%

thought the performance was disappointing. May be they haven’t met

their objectives in recent days.

Question 18: Do you think the overall services could be improved in

your workplace?

A. Yes B. No C. No comment

As for the research it was an idea to see what the staff feels about

changes that might bring good service or operations management. If

A

B

C

D

0 5 10 15 20 25 30 35


62

the staff is aware of changes that can be made then it will create

atmosphere to bring in changes and the adaptation time will be

faster.

49% thought there is room for improvement and 33% thought there is

no room for improvement. 18% excluded themselves from commenting.

Question 19: How you would describe overall operations of NHS?

A. Extraordinary B. Satisfactory C. Fair D. Disappointing

This was a generic question asked to see how the staff feel of NHS

operations. Positive feeling would represent positive changes after

implementation of BPR.

A B C051015202530354045

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33% of respondents found the performance to be extraordinary, 29%

found it to be satisfactory. Hence we have 62% of the population who

had a positive feeling about the operations of NHS. 31% said the

operations are fair and only 7% said it is rather disappointing.

Question 20: Do you support Privatisation of NHS?

A. Yes B. NoC. No Comments

This is an important question, as present government is pushing NHS

to transform into a private organisation.

A

B

C

D

0 5 10 15 20 25 30 35


64

45% of the population thinks NHS will perform better if it was

privatized. 33% denied it. There was a good proportion of people

(22%) who did not comment on this. Perhaps this issue needs more

time to think on.

Question 21: As Privatization process will be time consuming to you

think it will affect NHS services?

A. Yes B. No

This is no doubt a big process. With coalition government pushing

NHS to become private organisation.

A B C051015202530354045

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58%

42%


AB

65

As it can be seen 54% of the respondents thinks the process will be

time consuming so it might affect the overall quality of NHS

services. 46% of the respondents thought it might not affect NHS

services. Generally, as this coalition government is pushing towards

transforming NHS it might see light.

Question 22: Privatisation of NHS will see implementation of Health

Insurance. Do you believe Insurance companies will be fair with

quality assurance?

A. Yes B. No C. Prefer Not to Comment

Health Insurance companies are going to start operation as a result

of privatization. Whereas insurance companies are profit oriented

NHS was service oriented. Now obviously this will create issues as

for quality assurance and profit is concerned it will get affected

even if it’s by a smaller percentage.

In the survey it reflected as the professionals also thinks the same

only 15% said they believe there will be quality assurance. There

A B C051015202530354045

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was a good amount of people 67% said there will be no such

provision. There was 18% of people who didn’t comment on this.

Question 23: Aim to be profitable will be the key strategy with

healthcare services. How you see NHS services performing with that

strategy?

A. NHS will have no issue 23B. It will take time to operate

with profit 25C. Will face difficulty to make

profit 27D. Will fail to make profit 25

In order to make the business profitable NHS will go for extensive

changes. Now how the transformation will take place that will

determine the profitability of the business.

23% of the respondents said they believe with profitability in mind

NHS will have less issues. 25% of the people said it will take time

to get into a profitable position. There is another 27% of the

people said NHS will face difficulty to make profit. Another 25%

17%

21%

35%

27%


A B C D

67

thinks NHS will fail to make profit. So it is evitable that there

was a mixed response and it will take time to see how it will

progress as a profitable business.

Question 24: In a profit oriented setting how it might affect the

staff?

A. No noticeable impact 9B. Inefficient staff will lose jobs 30C. Low skilled people with less pay

will be hired 32D. Qualified staffs will struggle to

get decent pay 29

When the business turns to be a profit oriented venture it becomes

challenging for the workforce as because in that case slow progress

costs money and time frame is always structured.

The response from the question was really mixed. Option A got only

9% who thinks there will be no noticeable impact. Option B was

A

B

C

D

0 5 10 15 20 25 30 35


68

chosen by 30% of the population who thought staffs that are not

efficient for the position will lose their jobs. Option C was chosen

by highest 32% who thought to maximize profit less skilled people

will be hired and given less pay. Now Option B and C really

contradicts in a sense that whereas there is worry that less

efficient people will lose joss there is also fear that NHS might

try to save money by compromising the skills of the professionals.

There were another big 29% share of respondent who thought qualified

staff will struggle to get satisfactory pay.

Question 25: Do you think the transformation of NHS will be

successfully done?

A. Can’t say at this moment 33B. No 38C. Yes 29

This question was asked to see the level of optimism between the

professionals. This is more than motivation to drive to success. It

was more about looking into the way professionals perceive the

transformation.

A B C

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There were a huge 33% who was unable to say whether it will be

successful or not. 38% were rather pessimistic to choose to say it

will fail to transform successfully. 29% of the professionals

thought it will be successful. With 33% not giving their verdict

still it will remain exposed to change.

NHS Patients Survey

After careful consideration 100 NHS patients were chosen to conduct

the first survey. This survey was conducted to see the perspective

from patient’s side. Patients were chosen on the basis of Simple

Random Selection method and they were chosen from different NHS

organisations from 9 different boroughs of Greater London.

The collected data and analysis of the data is presented below:

Question 1:Which one best describes you?

A. Patient who needs continuous support from NHS B. Patient who needs moderate support from NHS C. Patient who rarely needs support from NHS

70

This question is asked to subdivide the population into smaller

segments considering the type of service they require from NHS.

23% chose Option A, who needs continuous support and there was 43%

who needed moderate support. A healthy population of 36% said they

rarely needs support. However as the number is higher it indicates

may be they came for monthly or quarterly check-up.

Question 2:How quickly you got appointment since you approached NHS?

A. It was quick B. Fairly quickly C. SlowD. Extremely slow

Appointment system has crucial value in terms of deciding how

satisfied the customers will be with the service. Also getting an

appointment on time indicates patient is given enough time for

treatment and treatment is starting in good time.

A B C0

5

10

15

20

25

30

35

40

45

22

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15% said the process is quick, 19% thought it is fairly quick. 66%

thought it was slow with 44% saying it is slow and 22% saying it is

extremely slow. Definitely here is chances for improvement.

Question 3:How you will rate NHS appointment system?

A. Excellent B. Good C. Fair D. Disappointing

A

B

C

D

0 5 10 15 20 25 30 35


72

A continuing question from question 2. In the previous question

there was 66% respondent saying the system was slow. Surprisingly

this question lead to another important observation

Here only 27% said it was disappointing and 73% of the patients were

more or less happy. There was 17% who chose Option A, 21% who chose

Option B and 35% said it was fair and chose Option C.

Question 4:How you will rate your experience with NHS doctors and

overall medical service?

A. Excellent B. Good C. Fair D. Disappointing

17%

21%

35%

27%


A B C D

73

Now from getting appointment to the actual service. Getting proper

treatment and exit routing for existing patient is of great

importance.

21% of patients chose Option A which is excellent experience. 19%

was happy, 32% thought it was fair experience and 28% thought it was

disappointing. Tough we have 40% having positive impact but also

there is another 60% who are not really happy. Here changes can be

made.

Question 5:Do you think the services provided by NHS can be

improved?

A. Yes, Definitely B. Maybe

A

B

C

D

0 5 10 15 20 25 30 35


74

C. No

This question is straight forward which leads to further

investigation on improvement of NHS services.

57% respondents thought definitely it can be improved. 23% thought

there may be scope for changes and another 20% thought there is no

scope for change.

Question 6:Do you think NHS makes a difference in healthcare?

A. Yes B. No This question again goes to the beginning of NHS. Using of BPR gave

NHS a great platform to perform and it was evident in the responses.

A B C0

510

15202530

354045

22

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58%

42%


AB

75

77% of the population thought indeed it makes a difference in the

way people perceives healthcare. 23% thought it doesn’t. As we have

a significant proportion on NHS’s favour we neglect that negligible

proportion.

Question 7:Do you support privatisation of NHS?

A. Yes B. No C. No Comments

This question was asked to see how patients will support NHS if it

was privatised.

39% chose option A which is yes they will support. There was 49% who

said they won’t support and another 12% said they are not ready to

comment yet. Tough 39% is a considerably high amount but there is

another 49% who were against privatization which was accompanied by

another 12% who did not comment on this. This leads to the

A B C051015202530354045

22

4137


76

conclusion that more public awareness will be needed before taking

forward initiatives.

Question 8:Do you know if privatization of NHS happens then you may

have to pay health insurance to get better service?

A. Yes B. No

This question intended to look into the patient’s understanding of

privatization. As for the services definitely they will want quality

service.

55% said they know that they will have to pay extra money if they

have to get better service. Another 45% said they are not aware that

how it will work. Perhaps they need to know a bit more about the

changes that will occur with privatization.

Question 9:What will you prefer?

A. Free NHS serviceB. Premium NHS service

58%

42%


AB

77

Even though patients will need to pay extra if they want to get

premium service, in this current economic context It is difficult to

spend money unnecessarily. With people trying to save money it is

difficult for patients to spent extra quid.

About 69% chose Option A that they will pretty much like to go for

free NHS service. Interestingly there were 31% who thought they will

go for premium service. So it means there are people who are willing

to pay for better service.

Question 10:If private insurance company takes over the GPs then do

you think the quality will be maintained?

A. Yes B. No C. Not sure

58%

42%


AB

78

This question again leads to the fundamental of all the proposed

changes. Quality is a big issue. Hence this question was asked.

There were 31% people who chose option A. They think the minimum

quality will be maintained. Option B was chosen by a huge 60% who

thought it is not possible to maintain the quality if the change

happens. Only 9% chose option C where they could not comment on the

service quality.

Question 11:Do you think strong leadership will be needed?

A. Definitely 58B. Not really 42

This is another important issue. Great leaders can lead successful

changes.

A B C0

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58% of respondents chose Option A which implicates definitely strong

leadership is needed. Next was Option B (42%) which implies that

they don’t think leadership will be needed.

Question 12:Do you think the present coalition government will be

able to privatize NHS successfully?

A. Yes 22B. No 41C. Not sure 37

With current coalition government is working towards privatizing NHS

the respondents were asked this question to see whether they have

faith in the leadership skills.

58%

42%


A B

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Option A was chosen by 22% of the respondents which implies they

think this government has the power to pull this project off. Option

B was chosen by 41%. This is an alarming number. This means patients

are not sure on the leadership skill. Option C was chosen by another

37% where people are not sure of the leadership. With most of the

respondents being not sure it means the government needs to

communicate a bit more with the public to boost their confidence.

A B C0

5

10

15

20

25

30

35

40

45

22

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Chapter 6

Discussion and Recommendations:

In the research the researcher had taken time to evaluate the

possibilities of implementing BPR in NHS. The research also focused

on current issues like privatization of NHS. Tough there is

certainly positive aspects of it however it has some worrying

concerns as well. There is no denying of the fact that all the major

challenges can be overcome if there is a thoughtful implementation

in place which will roll the changes systematically.

In this research the objectives were formulated in a positive way.

The research was carried out to randomly selected respondents from

the questioned population. Two questionnaire based surveys were

82

done. Both patients and service providers were surveyed. Some of the

question answer provided valuable insight in assessing the

implementation strategy.

There are scholarly argument on usability of BPR in public services.

After the survey data analysis it is evident that it does have

positive impact. One of them is the implementation of radical re

designing of the system which will allow the system to get organised

from the scratch that will enable it for some real change. BPR will

allow NHS to form a connection between services and processes by

making it more clear and transparent. The advantage of preventing a

compartmentalised way of working will ensure there is a methodical

work strategy in the institutes. This will stimulate further

discussion and lead to a collaborative environment between service

providers which will be innovative in its approach.

From the research it was also found that to have a successful

implementation NHS will need visionary leaders who will foresee the

barriers and take necessary steps to overcome them. They will also

unite the parties involved in this along with individuals to have a

smooth transition process. The leadership will also need to foster

collaboration throughout the sector. Even in the research it was

evident that not many healthcare professional is aware of the BPR

terminology hence implementation is a far later stage. If these

professionals are not being trained and guided to perform at their

best to learn and integrate their existing knowledge with the new

framework then the whole point of innovation in healthcare may fail.

IT plays significant role in any type of redesigning. The

challenging part is how people conceive it. Technology sometimes is

intimidating. From the research it was found out there has been

enormous work done in integrating IT services in NHS to foster

better service in general. However, still there is issues with

83

appointment system. There were a good amount of patients who thought

they had to wait longer than expected to get to see a doctor which

is certainly not a commending thing.

Strategies are there in place in every department but there are

still communication gaps as some the medical staff is not so

familiar with the strategies. A better communication channel is

important with respect to BPR implementation. If the communication

channel is absent or not performing at its best that will lead to

more mislead decision making.

BPR was identified as a very new way of working. It would break

with past habits such as incremental change, working in a

compartmentalised way and taking tasks or procedures for granted.

Thus training is a critical part of the whole process. Training

care providers to use the new systems. This is an issue as

because the healthcare professionals are already been over

pressured with their workload and they might find it troublesome

to get used another system without hampering their day to day

duties.

Next issue the research came across is quality control of services.

While BPR aims to bring on positive changes from business’s

perspective it is important to look into the quality assurance

aspect of the whole changes. There has to be independent evaluators

from national or international context who will be able to use their

experience and expertise to follow up on the whole progress.

The survey also looked into motivational factors. Motivation is

important. Some of the service organisation’s staffs lacked this

motivation. Why is that so? May be they are not well paid, may be

they are not well trained or perhaps they are in the wrong place.

This are key issues at the end as because, if non motivated people

84

are in a place where all the time best performance is needed gets

affected. NHS is such a big organisation that needs to work on its

staffs intrinsic and extrinsic motivational values. Perhaps it will

be a good idea to have frequent climate surveys to find out how they

are progressing with the new system’s implementation. Any doubt of

progress should be taken care of to ensure the overall integrity and

quality is maintained.

With privatization there were further issues as because this whole

privatization might jeopardise the progress so far. Privatization

will lead all the health insurers to start accumulating money on the

basis of health insurance. General public will have to face the

consequences as they will see ‘queue jumpers’ getting fast treatment

because of their insurance. This definitely was an alarming issue

among the survey respondents.

Conclusion:

Better operational model of enterprise and the goal of increasing

competence ability of organization through reengineering business

process can be achieved only with the combination of IT and

operations management in BPR along with mutual promotion of them.

Already NHS has come a long way in implementing changes in the way

they operate. BPR is re-shaping the healthcare industry. However

transition from public sector to private sector will be still

difficult. The scenario of privatization is still vague among the

healthcare professionals as well as patients. The research

successfully examined all the research objectives and found

significant insight on the current state of privatization of NHS.

85

Relevant recommendations were made regarding implementation

strategies of BPR in NHS organisations. Further studies will include

justification of currently used strategies and BPR model. Impact of

privatization decision of NHS will also be a good progression

research.

References:

Armistead, C. G., & Rowland, A. P. (1996). Managing business

processes: BPR and beyond. Chichester England: Wiley.

Babbie, E. R. (2004). The practice of social research (6th ed.).

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Belmont, Calif.: Wadsworth Pub. Co..

Bowns, I., Rotherham, G., & Paisley, S. (1999). Factors

associated with success in the implementation of

information management and technology in the NHS. Health

Informatics Journal, 5(3), 136-145.

Brown, I., Brown, L., & Korff, D. (2010). Using NHS Patient

Data for Research Without Consent. Law, Innovation and

Technology, 2(2), 219-258.

Chang, J. F. (2006). Business process management systems: strategy and

implementation. Boca Raton, FL: Auerbach Publications.

Ciborra, C. (1993). Teams, markets and systems: business innovation and

information technology. Cambridge [England: Cambridge

University Press.

Clegg, S. R. (1990). Modern organizations: organization studies in the

postmodern world. London u.a.: Sage Publ..

Comparing Quantitative and Qualitative Research. | Explore.

Test. Investigate.| Experiment-Resources.com. (n.d.).

Explore. Test. Investigate. | Experiment-Resources.com. Retrieved

August 14, 2012, from http://www.experiment-

resources.com/quantitative-and-qualitative-

research.html#ixzz23WbQZkoQ

Creswell, J. W., & Creswell, J. W. (2009). Research design:

qualitative, quantitative, and mixed methods approaches (3rd ed.).

Los Angeles: Sage.

Davenport, T. H., & Short, J. E. (1990, July 15). The New

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Industrial Engineering: Information Technology and

Business Process Redesign. Leadership and Organizational Studies,

3, 18-25.

Davidow, W. H., & Malone, M. S. (1994). Virtual Corporation.

London: HarperBusiness.

Eaton, G. (n.d.). New Statesman - Lansley opens the door to

full-scale NHS privatisation (Updated: no, he doesn't).

New Statesman - Britain's Current Affairs & Politics Magazine. Retrieved

August 10, 2012, from

http://www.newstatesman.com/blogs/politics/2012/07/lansle

y-opens-door-full-scale-nhs-privatisation-updated-no-he-

doesnt

Gerstein, M. S. (1995). The technology connection: strategy and change in

the Information Age. Reading, Mass.: Addison-Wesley.

Hammer, M., & Champy, J. (2003). Reengineering the corporation: a

manifesto for business revolution. New York: HarperBusiness

Essentials.

Harrington, J. (1991). Organizational structure and information

technology. New York: Prentice Hall.

Keen, P. G. (1991). Shaping the future: business design through information

technology. Boston, Mass.: Harvard Business School Press.

Klein, R. (2006). The new politics of the NHS: from creation to reinvention

(5th ed.). Oxford: Radcliffe.

London 2012 Olympics: Some Americans left baffled by tribute

to NHS and Mary Poppins during Opening Ceremony | Mail

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Online. (n.d.). Home | Mail Online. Retrieved August 14,

2012, from http://www.dailymail.co.uk/news/article-

2180227/London-2012-Olympics-Some-Americans-left-baffled-

tribute-NHS-Mary-Poppins-Opening-

Ceremony.html#ixzz23WYuZHbi

McBride, A., & Mustchin, S. (2007). Lifelong learning,

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APPENDIX A: BPR in NHS Questionnaire [For NHS organisations]

This questionnaire is designed to investigate into the impact of Business Process

Reengineering in NHS. Please read the questions carefully and tick the most suitable answer.

1. Which one of these best represents your organization?

2. Which Level you work

in the organization?

A

.

NHS Direct E

.

Hospital

B

.

NHS Walk in

Centre

F

.

Opticians

C

.

GP Practices G

.

Pharmacists

D

.

Dentists H

.

NHS Trusts

90

A. Top LevelB. Middle LevelC. Entry Level

3. Are you aware of the term Business Process Reengineering?

A. YesB. No

4. How you will rate your knowledge about the organization?


5. How you will rate your knowledge about the department you work?


6. Is your work divided into several smaller objectives which you

must achieve?

A. YesB. No

91

7. How well these objectives are shared in the department? ( think

of top to bottom communication)

A. Regularly shared B. Randomly sharedC. Never shared

8. In terms of achieving objectives is there clearly set of

strategies?

A. Yes B. NoC. Not sure

9. How much priority the department gives on giving customer

service?

A. Top priorityB. Priority varies with task

loadC. No priority

10. How quick is

the appointment to service process in your department?

A. QuickB. ModerateC. Slow

11. Do you think

IT is integrated in your day to day operation?

A. Yes B. No

92

12. How much of

your task is technology assisted?

A. Most of the tasksB. Some of the tasksC. None of the tasks

13. Do you think

use of IT in NHS operations saved work time and made it simple?

A. Yes, definitelyB. Yes, but could have been

betterC. Not a technical person, I

don’t like itD. Disagree, created more

trouble

14. In case of

implementing a new strategy what side you normally take?

A. Positive-supportiveB. Positive-resistiveC. Neutral D. Negative

15. Are you aware

of the cost cutting methods that your department has?

A. Yes and I follow themB. Yes but I seldom follow themC. Don’t have clear idea about

93

them D. Don’t Know

16. Do you feel

motivated to work in your organization?

A. Yes very motivatedB. Yes less motivatedC. Not really

17. How you would

describe overall performance of your department?

A. ExtraordinaryB. SatisfactoryC. FairD. Disappointing

18. Do you think

the overall services could be improved in your workplace?

A. YesB. NoC. No comment

19. How you would

describe overall operations of NHS?

A. ExtraordinaryB. SatisfactoryC. FairD. Disappointing

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20. Do you

support Privatization of NHS?

A. YesB. NoC. No Comments

21. As

Privatization process will be time consuming to you think it will

affect NHS services?

A. Yes B. No

22. Privatization

of NHS will see implementation of Health Insurance. Do you

believe Insurance companies will be fair with quality assurance?

A. Yes B. No C. Prefer Not to Comment

23. Aim to be

profitable will be the key strategy with healthcare services. How

you see NHS services performing with that strategy?

A. NHS will have no issue B. It will take time to operate

with profit C. Will face difficulty to make

profit

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D. Will fail to make profit

24. In a profit

oriented setting how it might affect the staff?

A. No noticeable impact B. Inefficient staff will lose jobs C. Low skilled people with less pay

will be hired D. Qualified staffs will struggle to

get decent pay

25. Do you think

the transformation of NHS will be successfully done?

A. Can’t say at this moment B. No C. Yes

==============================Thanks for your time.

===============================

This research is conducted in a regulated framework. Your details will be kept secret and

used for academic purpose only.

APPENDIX B: BPR in NHS Questionnaire [For NHS Patients]

96

This questionnaire is designed to investigate into the impact of Business Process

Reengineering in NHS. Please read the questions carefully and tick the most suitable answer.

1. Which one best describes you?

A. Patient who needs continuous support

from NHS B. Patient who needs moderate support from

NHSC. Patient who rarely needs support from

NHS

2. How quickly you got appointment since you approached NHS?

A. It was quickB. Fairly quicklyC. SlowD. Extremely slow

3. How you will rate NHS appointment system?

A. ExcellentB. Good C. FairD. Disappointing

4. How you will rate your experience with NHS doctors and overall

medical service?

A. ExcellentB. Good C. Fair

97

D. Disappointing

5. Do you think the services provided by NHS can be improved?

A. Yes, DefinitelyB. MaybeC. No

6. Do you think NHS makes a difference in healthcare?

A. YesB. No

7. Do you support privatization of NHS?

A. YesB. NoC. No Comments

8. Do you know if privatization of NHS happens then you may have to

pay health insurance to get better service?

A. Yes B. No

9. What will you prefer?

A. Free NHS service B. Premium NHS service

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10. If private

insurance company takes over the GPs then do you think the

quality will be maintained?


11. Do you think

strong leadership will be needed?

A. Definitely B. Not really

12. Do you think

the present coalition government will be able to privatize NHS

successfully?


==============================Thanks for your time.

===============================

This research is conducted in a regulated framework. Your details will be kept secret and

used for academic purpose only.

How implementing of BPR can help NHS to increase service efficiency

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