A.A.00058950

Scenario and Recommended Information System

At present the Eastern Regional Health Authority’s patient registration system is extremely dated. We utilize an alphabetic index card system. Each time a patient is new to a clinic the clerk assigned to that specific clinic must contact the patient via phone in order to acquire information such as the correct spelling of their name, date of birth and mother’s maiden name. This information is necessary to ensure that duplication of files does not occur. Even more importantly this is necessary to ensure that the medical history of no two patients with the same name becomes discombobulated, as in the health sector this can result in the administration of medication to the wrong patient and can also mean the difference between life and death. This registration process however can be an extremely time-consuming one as often times patients can possess the same name and date of birth. It therefore becomes the responsibility of the clerk to adequately search the filing index to ensure that said patient was not previously registered. In the event that proper procedures were followed and no filing index was located for said patient the clerk is responsible for registering that patient with a new file number. Each new file carries its own number which is then used to locate that particular patient’s files each time they attend clinic. Each number carries its own color which makes locating files easier. Each time a patient makes a new appointment this registration number is recorded in the appointment book to assist in the location of files. The patient registration number is recorded on the patient’s clinic card. The day before each clinic the clerk is responsible for going to the filing room and pulling each patient’s file to ensure that it is available for the doctor on that day. Whenever a file is pulled from its numerical location on a filing shelf it is replaced without tracer card. The purpose of the tracer card is to identify the location of the file at any given time since often time one patient can be registered to more than one clinic. In this case it is very possible for a number of medical personnel to require the file at the same time. There have however been many instances where one patient has two or more files registered to their name. This can result in duplication, however if this error becomes recognized the files are merged and the additional number reassigned to a new patient. One of the drawbacks to this system is that often times files are misfiled, it then become almost impossible for the file to be located. The clerk must now go through every file on the shelf of that particular row in hopes that the file is located. This is the only copy of the file and in the event that the file cannot be located the patient must be rescheduled with hopes that by that date the file will be found. This process often results in irate and dissatisfied patients as it is impossible for one file to be in two places at the same time and there are also instances where incorrect information is a represented on a tracer card. In that case it is almost difficult to locate the file since its last location its unknown. The clerk is also responsible updating each file. What this means is that the clerk must insert all medical reports into the file. Oftentimes this does not occur, resulting in a number of reports not being available when required by the medical stuff. This process often results in backlog and the clerk must now sort through hundreds of reports to located and requested report. What I would do to alleviate this problem is implement a system that electronically contains all the information of a basic file. Therefore instead of recording patient’s information through writing, all records will now be updated electronically. This will require the outfitting of all nurse’s and doctor’s room with computers and a software that makes accessing a patient’s file possible from all wards, clinics as well as Accident and Emergency regardless of the location. This will therefore mean that although a patient is registered at Sangre Grande Hospital their information can be accessed in the Mayaro District Health Facility (or any facility) should they visit seeking medical attention. Reports such as blood works, X-rays and so forth will now be electronically stored to each file as soon as the report is completed. Medical staff such as Doctors, Nurses and Nursing Assistance as well as clerical staff and the Medical Director will all have access to this system through a personalize account secured by a password of their choice. Therefore each time they access the system or make any changes to the file the system will record this information as well as the date and time this change was made. The lab will also have access to the file however they will not be able to read the patient’s medical records instead they will only be able to load reports based on the patients registration number. This system will eliminate the long and drawn out registration process and will make the use of the index card system obsolete. Staff will now be able to locate a patient by searching them through categories, such as their name, the clinic they are in, their date of birth or even through the date of last visit. This will drastically improve the patient registration system and improve the way managers make decisions since no longer have to wait long hours to gain access to a file.

Expected System Benefits

This system will improve the way patients are registered, therefore by eliminating the current procedure and implementing this new system a lot of time would be saved. It will also make accessing a patient file at any given time easier and by extension will improve the way the ERHA cares for patients. Additionally efficiency will also be improved since no longer will files be misfiled or difficult to find. This system will also save the region space since we will no longer have need for a large filing room to store files. This will mean additional space for expansion of some sort since the authority is extremely pressed for space. In the long run cost will also be reduced since no longer will the region have the need to purchase filing jackets, colour coded numbers and continuation sheets. They will also no longer be required to print thousands of medical reports on a daily basis since reports are saved directly to the file which also reduces cost. This system will also improve the way patients are cared for since at any given time their records can be accessed. Time wastage will therefore be reduced.  Security and confidentiality will also be improved since to access any file staff must do so through entering their password. Therefore it will mean that unlike having a hard copy file that anyone can take off the shelf and read individuals will now need to access the system to do so.

Anticipated Challenges to Implementation

There will be challenges in developing a system to accomplish what we require however it is quite possible to accomplish. It will also be quit costly in the front end. Staff will also need to be trained on how to use the system which will be time consuming since individuals have already grown use to the old system. Additionally everyone is not comfortable with technology. There is also the age group of staff that will prefer the old system therefore I anticipate resistance form some members of staff. It will also be a long process granting access to everyone to the system therefore the transition will have to be done in phases. There is also the issue of transferring the information form the old file into the new system which will also take time and effort. Staff may resist this since it will be perceived as additional work.

Scenario and Recommended Information System

At present the Eastern Regional Health Authority (ERHA) is the leading public health provider in Trinidad and Tobago. Although the region is not without its challenges providing quality health care is one of our main priorities. At present the region has suggestion boxes in all our facilities. Each suggestion box has copies of questioners which highlight the patient’s name, contact number and their complaints. These boxes are emptied by one of the customer service representatives (CSR) on a daily basis. Each facility depending on the size has a CSR to assist patients as problems arise. Complaints are highlighted and brought to the Quality Coordinator to address in the form of a excel spreadsheet. The Quality Coordinator contacts the client for the details of the report after which the supervisor of the staff being reported is contacted for their understanding of what occurred. In the event that the member of staff did not follow proper protocol corrective measures are taken however in the event that policies and procedures were followed the client is contacted and informed, however efforts are often times made to assist the client. This process can be an extremely long and drawn out one primarily because there are approximately twenty seven facilities with a number of departments within these facilities therefore keeping track of each department and complaints/suggestions of all can be a challenge. Instead of suggestion boxes at each facility there should be a device that clients can use to indicate how their stay at that facility was. This device will be similar to the suggestion box however an electronic version. If the client indicates their stay at a named facility to be a good one the question of why will be asked, this will help the region to understand the areas they are excelling to ensure that they continue along these lines, additionally by becoming aware of procedures that receive positive reactions from one facility can assist other facilities with similar issues. If the client’s stay was not a good one the question of why in addition to their contact information will be taken. All of this information will be sent directly to the Quality Coordinator. Each time a survey is completed an email informing the Quality Department of such will be sent to their ERHA email. Providing that there are a number of facilities complaints/comments will be assigned to CSRs responsible for that particular facility and the Quality Coordinator will be notified as reports are received and addressed from the system through their email. There will also be a rating as it pertains to the severity of the report (Severe, Moderate and Low) this will indicate what level of staff needed to address the problem. In the event that the issue is low it can be addressed by the CSR if the issue is moderate it will be addressed by the Quality Coordinator and in the event that the issue is severe the Manager of Quality will either choose to address the issue or delegate it to someone competent enough to handle it. This will ensure that the issues are addressed promptly and efficiently. As issues are concluded the system will indicate such and a report will be generated monthly in addition to which issues are still outstand. This report will be sent to the Manager and the Quality Coordinator. The system will also rate each facility with regards to their customer service capabilities. By so doing the manager will be aware of which facilities needs special attention to improve their customer service rating. This system will help the Quality Department to manage issues more effectively. It will also help the department identify which facilities are not customer friendly and resources can be deployed to improve this issue. Monthly reports and daily emails will also help with tracking and reduce redundancies while splitting the responsibilities based on severity will lighten the workload and help the response to be quick and effective.

Depicted System Benefits

One of the first benefits this system will bring to the region is improved efficiency. The monthly reports will help the manager and coordinator to track reports and the status of each report. The daily emails and reports/comments received will eliminate the process of reading each written report received, imputing the information to an excel sheet and bringing the report to the attention of the coordinator. The system will now be responsible for completing all these tasks while staff members attached to the department can channel their energy into addressing issues as they arise. There will be a lot of time saved and utilized in other areas. Additionally while the system may be costly to implement in the long run it can save the region a lot of money as there will no longer be the task of printing forms all of this information will now be stored and backed up on a system. The options of acquiring information at any time as it pertains to a facility, for a particular date and the actions taken will be accessed quickly and easily in appose to going through complaint forms and excel sheets which have become overpopulated over the years. Managerial incite will be drastically improved as they will now be able to see reports at they occur as well as how members of staff handle complaints. The quality of care received from each department will be improved primarily because if members of staff know that complaints are taken seriously and that there are consequences to their actions they may be more inclined to handle situations professionally. Additionally members of staff can also be commended for a great work done which will also serve as a motivation mechanism.   

Anticipated Challenges to Implementation

Some of the challenges I anticipate will include staff refusal to comply with the implementation of the system. Members of staff may feel as though this system is designed to keep track of and report them to their supervisors and as such they may choose to withhold critical information needed to effectively implement the system. There is also the challenge of training members of the Quality Department to utilize the system. This can be very time consuming as individuals all learn at a different paste. It will therefore take time for the department to adjust to this new system, and they too might resent the change as their response to reports will also be tracked. They may also look at this as additional work since it will now also be the responsibility of the CSRs, coordinator and the manger to handle reports whereas with the current system only the coordinator handles reports. Another challenge will include the fact that there are a variety of age groups as it pertains to clients. Not all clients will be teksavvy and it may be difficult for the older clients to understand and use this new system. This can therefore result in them either not using the system or becoming frustrated while using the system. To alleviate this problem CSRs assigned to the various facilities can assist clients as to how to use these electronic suggestion boxes.  

Scenario and Recommended Information System

Each department within the Eastern Regional Health Authority (ERHA) must electronically complete a Return of Personal (ROP) by the fifth of each month to ensure that all employees are paid. It also verifies the number of leave the employee has remaining and ensures that an employee returns from any leave taken. Every department has an Administrative Assistant or Clerk who has access to this format in word and must check the attendance register for each employee attached to that particular department and record any leave taken (sick, casual, vacation, maternity). It also captures information such as the employment status of an employee for example if employees are contracted, permanent or leave relief. Another aspect of the ROP is to capture employees on acting appointments. This is the period by which an employee is temporally promoted to act in the capacity that exceeds their current position. This can either be because an employee is on leave for an extended period of time or because said employee’s contracted period has ended, and as a result the region has appointed the most qualified employee to act in that capacity until said employee returns or a new person is contracted.  The ROP is then verified by the head of that department and forwarded to Human Resource for record keeping and to accounts for payment of salaries. This can be a challenge in a number of ways for example the Disaster Preparedness Coordinator (DPC) is often on the field or is sometimes engaged in training programs for external stakeholders or members of staff. In essence the DPC is not required to sign the attendance register. There is employees that are categorized as field workers and are also not obligated to sign the attendance register. We must therefore trust that an employee is honest and reliable enough to give accurate information about their work schedule. There is also the issue of time; the deadline for the submission of every department’s ROP is the fifth of every month primarily because the Accounts Department must have this information in order to meet their deadline for paying members of staff and also because this information helps the HR Department to keep track of an employee’s leave balance or any employee that is scheduled to proceed on an extended period of leave. Often time this deadline is not met and HR must now call each department with outstanding information individually to urge them to submit this information. Additionally the ERHA spans from Sangre Grande to Matelot and also covers areas such as Mayaro, Rio Claro and Guayaguayare. Therefore geographically we cover a large area and there are instances were an employee may be attached to a particular department however does not work there. For example the Occupational and Employee Development Department (O&ED) is located in the Human Resource Building Sangre Grande however some members of staff attached to that department works in the Mayaro Learning Resource Centre. This creates an issue when compiling the ROP primarily because we must now contact that employee to inquire if they have taken any leave, there is however no one to verify this information. To alleviate these problems the ERHA should implement a Badge System where by each member of staff is required to swipe their ERHA identification badge to access anyone of the regions facilities. This system will record the time and date each employee arrives or departs a location. This system will be linked to the Information Systems/Information Technology (IS/IT) Department to generate a report monthly and to maintain the system. This badge system will eliminate the uncertainty and can bring accountability as the system will also highlight habitual tardiness or absenteeism. The system will generate a monthly report of each employee’s clock in time and departure. Each report generated will flow through the HR department primarily because they need this information to keep track of employees and also because this information is necessary in the event that corrective action is required. The General Manager-Human Resource will have the capacity to access this information via his smartphone in the event that there is an emergency at anyone of these facilities he will be able generate a report of all employees that clocked in to that particular location on said day. The system will eradicate the need to sign an attendance register on a daily basis and will save time as some departments are larger than others therefore the time it will take one department to go through the attendance record to verify arrival and departure time of all employees may be more time consuming for a department like HR in appose to the Disaster Preparedness Department. Additionally often time you have to ask employees to sign out because they forgot to do so. By implementing this system this issue will be eradicated as employees will now have to swipe their badges to exit the building. Additionally in the event that employees are habitually declining to swipe their ID badges when departing the system will also generate a report to highlight this. This system will also act as a security mechanism in that it will limit access to employees for certain areas. The system will also have the capacity to grant access to members of staff to certain areas while limiting access to others. It will move the region from a pen and paper spreadsheet to a more electronic system, therefore the region will grow technologically and by extension increase efficiency and productivity. The Accounts Department will also have access to the information which will eliminate the dependency on each department to submit this information. Individuals that will have access to this information will include management level staff in the HR, ISIT and Accounts Department. Access will also be granted to lower level staff such as ISIT technicians responsible for generating the report or maintaining the database. Accounting Assistants will also have access to the database for payment of salaries. Each individual with access to the system will have to access it through their password which will ensure accountability. This can improve management’s decision in that it will provide a more accurate record of the arrival and departure of each employee. It will also assist management in ensuring that each employee fulfills their forty hour work week which is important to the authority and can increase productivity.  

Benefits of implementing the Badge System

There are a number of benefits that can be derived from implementing this system one of which includes the accuracy as it pertains to the arrival and departure of employees. Employees may therefore be more accountable as it relates to their attendance and arrival time if they are aware that this information cannot be manipulated. Often times, employees may record inaccurate arrival time; however with the use of the badge system this problem can be eradicated. This system will also save time as Administrative Assistants and Clerks will no longer be responsible for manually inputting the attendance of all employees assigned to their department. This report will now be electronically generated by a system creating more time for employees to engage in providing quality health care to its clients. It will also reduce the time in which it takes this information to reach the HR department and by extension the Accounts Department. These two departments will now have access to this information as soon as the report is generated at the end of each month. It will also assist in the tracking of habitual tardiness and absenteeism which will also encourage accountability if employees are aware that there are repercussions to this type of action. An increased insight in the number of employees that are either late or absent frequently can also give  management a better understanding of the number of hours that are wasted monthly due to lateness or absenteeism. There is also the aspect of security, this new badge system will have the capacity to restrict and or grant access to employees to different areas. This will provide information as it relates to any employee that accesses a particular area. It will also ensure that any employee that does not have access to an area is not allowed to enter. This system can also reduce cost as often times employees must copy the attendance register to confirm the days they worked as it relates to overtime. These overtime hours can sometimes be a lot and often times this information must flow through various departments, which results in duplication. By implementing this system employees will no longer have to photocopy attendance registers, instead this information will be accessed electronically via the badge system.

Anticipated challenges to implementing the Badge System

I anticipate that there will be challenges in implementing this system one of which includes the cost related to accessorizing each facility with the hardware and software for swiping badges. Additionally the region must ensure that every employee has a badge with the capacity to swipe in order to grant access to employees. At present finance is an issue and the ERHA might encounter issues in acquiring funding from ministry to implement this system. To combat this challenge the ERHA will have to present this information to the Board of Directors and once the Board approves it ministry my be more inclined to provide funding. However it is important to note that there is very little the region can do we are dependent on the board and ministry to implement this system. The region may also encounter challenges from employees as they may view this as a tracking mechanism and may initially refuse to comply. There is also the possibility that employees may misplace their badges which will result in the region having to replace them which is a cost that must be incurred by the region.

    SCENARIO AND RECOMMENDED INFORMATION SYSTEM

The Disaster Preparedness Department is a very new department to the Eastern Regional Health Authority and was established in 2017. One of the initiatives of the department was the establishment of the locator database. This database is designed to locate employees during disaster situations, because the nature of the health sector does not permit for down time. Therefore during disaster situations employees are redeployed to a facility closer to them to ensure continuity. It comprises of each employee’s personal information (name, date of birth, contact number, address, email address and the department they are currently attached too). The database also has the information of each employee’s next of kin to give each employee the reassurance that their family members are cared for while they are out serving members the public. The database also has the information of each shut in patient (any patient that is unable to walk or care for themselves) to ensure that during disaster situations if they are directly affect we can deploy our resources to assist them. However at present the Disaster Preparedness Department have experienced difficulties acquiring information from members of staff as they are reluctant to give their personal information (personal contact number, address etc.) for fear that the information may be leaked or that management may abuse this information. To alleviate this problem I believe that the database should tie into the Human Resource (HR) Department as well as the Accounts Department and their daily functions. HR currently has access to each member of staff’s personal information; however some of it is dated while accounts utilizes a GP system that needs to be kept live to accurately pay the salary of each staff member. This new version of the database will eradicate the process of going to twenty one different facilities to collect the personal information of over three thousand member of staff. The Disaster Preparedness Department will have access to information as it relates to an employee’s personal information as that is the only aspect of the database that is needed by this department. However by interconnecting the Disaster Department, HR Department and Accounts Department, information will be kept live. Additionally the HR side of the database will grant them access to the personal information that is required by the Disaster Department however the Disaster Department will not be able to access the information of the HR Department primarily because they have no need for this information. At present HR comprises of three departments, Employment and Employee’s Department (E&ES), Occupational and Employee Development (O&ED) and the Industrial Relation (IR) Department. This database will eradicate the thousands of employee files that are utilized by each department on a daily basis. For example the E&ES Department updates these hard copy files daily as it relates to contract information, leave application and resumption of duty application. This one employee files must also be shared between each department. However by updating the locator database to have information of each employee, a signed soft copy of every contract, leave application and resumption form stored on to the database. The database should also have the capability to send each contract, leave application and resumption form to the relevant heads of department to be electronically signed. The Accounts department works very closely with the HR department. They often liaise with each other to confirm if an employee returned from leave or if their contract was extended and things of that nature. Therefore by implementing the database they will be able to view this information as quickly as it is updated by the HR department. This database will save the region a lot of money as large sums of money goes into paying overtime to employees in order to clear the backlog of files that were not previously updated. Additionally hundreds of thousands of dollars goes into printing contracts, leave applications and assumption forms which is often duplicated and shared among departments as well as purchasing ink cartage and servicing photocopying machines. By so doing each employee information will be easily accessible. It takes hours to locate an employee file which is sometimes missed filed or is being utilized by a different department. However this database will include notifications that brings to the attention of the HR department when a contract is about to expire, whenever an employee applies for leave, if a leave relief is required, acting appointments and if the employee submitted an assumption of duty form. Not only will this system save lots of time it will also save space. At present the filing room takes up a lot of space that can otherwise be utilized. Additionally the IR department deals with a number of confidential employee files that are stored in the manager’s office, therefore by creating a section of the database which grants access to only the IR department will ensure that these files are easily accessible and secure.         This database must also be maintained by the Information System Information Technology (ISIT) department. The system must be backed up regularly therefore even if the system crashes or there is no internet access the last updated version will be accessible. Additionally because of the nature of the information all of management will be able to access the information however only employees attached to the HR, Accounts and Disaster department will be able to access this secured system. Any member of staff with access to the database will be tracked, which means any changes or update that is made by an employee can be tracked by the ISIT department.

EXPECTED SYSTEM BENEFITS 

This database will bring with it a number of benefits; firstly it will save a lot of time. It takes time away from the employee that can be otherwise utilized to find the file, update the folio sheet and return the file to the correct alphabetical, departmental location in the filing room. This process must be repeated for hundreds of employees throughout the day. Therefore by implementing this database all this information will be accessible in only a fraction of the time. Secondly it will save the region a lot on money that would have otherwise been spent on paper, ink, servicing machines and paying overtime to update files. Additionally this database will help keep the information that is necessary to the Disaster department live, eradicating the need to ask each employee for information that we already have in hard copy. Furthermore by interconnecting these various departments information will constantly be updated and accessing this information will become less stressful. The region is also pressed for space; therefore this system will eliminate the need to store files which will result in more space for employees to work comfortably. Moreover this will increase efficiency and the effectiveness of each department since the system will notify them of vital information such as contract expiration, leave application or acting appointments.

ANTICIPATED CHALLENGES TO IMPLEMENTATION

I anticipate a number of challenges to implementing this database. Firstly I expect employee resistance, since on the front end a lot of work will go into getting the database up and functioning. It will require team work from all the departments involved and employees may view this as additional work to their already hectic work schedule. It will require a lot of work to input the information into the database and it will also require a lot of work for ISIT to develop the database. Additionally we are often creatures of habit. Employees have already grown accustomed to doing things a particular way and drastically changing the way things were usually done can be quite challenging, however I believe that although it will require a lot of work up front, in the back-end it can be extremely beneficial, therefore by informing individuals of the benefits that can be derived in the long run they may become more inclined to undertake this project.

Secondly implementing this database will require approval from the board and if they do not see the need for this database it can be rejected. It is important to note that often times it is difficult for upper level management to understand the challenges experienced by employees on the lower level of the hierarchical structure, however once this information is properly presented to the board there is a high possibility for approval.