Academic journal article Journal of Information Systems Education

Hippi Care Hospital: Towards Proactive Business Processes in Emergency Room Services

Academic journal article Journal of Information Systems Education

Hippi Care Hospital: Towards Proactive Business Processes in Emergency Room Services

Article excerpt


1.1 Hippi Care Hospital

Hippi Country was a 700 square kilometer island with a population of five million people. It was a developed city with strong socio-economic growth. The city had well-developed roads and rail systems.

HCH, founded in 1988, was a government funded public hospital run by an establishment that had managed a chain of hospitals on Hippi Island for several decades. The hospital had recently set up a PIC lead by a newly appointed Chief Innovation Officer, Major Viz. His aim was to ensure that high service quality was provided to patients. Moreover, the centre had already seen success in its dynamic adoption of innovations in emerging decision-support technologies that helped better serve its patients.

1.2 The Emergency Department

As it was the only public hospital on the northeastern part of the island, home to some 600,000 residents, the hospital faced high demand in its ED. An ED typically served as an entry point for critically ill and major trauma patients, but also to patients with a wide range of non-traumatic conditions. It was a medical treatment facility specialising in acute care of patients who presented themselves without a prior appointment, either by their own means or by ambulance. The ED had to provide initial treatment for a broad spectrum of illnesses and injuries, some of which were life-threatening and required immediate attention. The ED operated 24 hours a day, although staffing levels could vary within that time.

Patients in the ED were classified into four levels of acuity, A1 to A4 (refer to Table 1 for detailed definitions of the levels of acuity). A1 and A2 patients were emergency patients while A3 and A4 patients are non-emergencies with moderate to mild symptoms respectively. The management had placed an emphasis on providing high service quality to all ED patients.

Patient care work was segregated into two areas: the critical care area managing critically ill patients with acuity levels A1 and A2 and the ambulatory area managing non-emergency patients with acuity levels A3 and A4 (refer to Figure 1 for how the patients were segregated according to acuity levels). Although A3 and A4 patients in the ambulatory area were considered lesser emergencies in comparison to A1 and A2 patients, the demand at the ambulatory area represented 70% of the workload in the hospital's ED. This presented a pressing challenge for HCH to meet its service level targets for A3 and A4 patients within a 90 minute length-of-stay. The length-of-stay for a patient was defined from the time-of-arrival to departure from the ED. Departing from the ED could either mean being discharged from the hospital or being admitted as an inpatient.


2.1 Manual Processes to Proactive Processes

When HCH first started operations, many of its processes were paper-based and manual. Only a single Patient Care System was used to keep patient information and dates and times of visits to the ED.

Before automation, business processes were mostly manual and included multiple paper documents pushed across various departments in the hospital (refer to Figure 2 for process improvement progression). With the emergence of workflow and business process management systems, the focus was on executing specific business processes by using technology to integrate various information systems with very little human intervention. Early approaches focused on analysing existing business processes, identifying bottlenecks, and improving these processes. The emphasis was on one-off efforts to improve processes by removing manual tasks, automating decisions and eliminating error-prone re-entry of information. Enterprise Resource Planning (ERP) systems and integration technologies helped to achieve information integration and business process automation. For example, workflow in a health care organisation such as that involving nurses' leave applications, procuring medical supplies, and bed management, were conducted using the integrated information systems (Shankararaman et al. …

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