PEST And SWOT Analysis Of Royal Adelaide Hospital

Internal and External Factors Affecting Business Operations of Royal Adelaide Hospital

The business operations of Royal Adelaide Hospital are affected from various internal and external factors. PEST analysis and SWOT analysis can be used to analysis the internal and external factors which are affecting business operations.

Political:

• Employment and social legislation in Australia
• Taxation policies on medical equipment (Royal Adelaide Hospital, 2017)
• Protective legislation for consumers and environment

Economical:

• Unemployment across the region
• Labour costs due to globalization (Royal Adelaide Hospital, 2017)
• Changes in income distribution and disposable income

Social:

• Growth in population
• Changes in lifestyle (Royal Adelaide Hospital, 2017)
• Changes in pharmaceutical prices due to variations in demographic

Technological:

• Advancement in medical equipment or technologies
• Implementation of electronic records for medical
• Use of cloud services to store patient data (Royal Adelaide Hospital, 2017)
• 3-D printing in medical care

Strengths:

• Best facilities for patients to control their privacy, infection or comfort
• Latest innovations in health care with automated distribution system for pharmacy
• Digital tracking system for instruments or equipment (Royal Adelaide Hospital, 2017)
• Effective management strategies for disaster

Weaknesses:

• Overcrowding at hospital premises
• Poor communication within medical staff (Royal Adelaide Hospital, 2017)
• High medical prices
• Inadequate IT support

Opportunities:

• Coordination with leading NGOs
• Development of IT infrastructure (Royal Adelaide Hospital, 2017)
• Improved system of patient safety

Threats:

• Reducing reimbursements
• Lack of alliances
• Costly services (Royal Adelaide Hospital, 2017)
• Advancement in medical tools or equipment

From the case, it has been analyzed that Royal Adelaide Hospital is focused to provide hospital and health care services to its patients with integration of central local health network of Adelaide. The effective implementation of IT within the hospital premises will also enable it to provide quality and error free medical services at very nominal costs (Government of South Australia, 2017). On the basis of business needs or requirements of Royal Adelaide Hospital, IT will enable to implement various important modules in the hospital infrastructure. This mainly includes,

• Administration system for patients related to registration or discharge process
• Appointment scheduling is related to patient or resource scheduling (South Australia, 2015)
• Financial accounting system to manage business transactions
• Management system for equipment in order to maintain quality and efficiency
• Management information system for nursing related to orders tracking, bed management, or patient assessment (CIMIC, 2017)
• Information system for laboratory related to medications and setting of inpatient care
• Management system for pharmacy
• Information system for clinical
• Administration systems

The main mission of Royal Adelaide Hospital is to provide quality hospital and health care services to the patients at affordable prices. The hospital is also incorporated with initiatives which are economically sustainable in nature by providing innovative medical solutions (South Australia, 2015). The hospital has effectively implemented vision of leading professionals in order to incorporate innovative and practical design solutions which easily integrate with modern technology in the field of health care. On the basis of business needs, priorities for business of Royal Adelaide Hospital can be defined which are aligned with IT,

• Automated system for pharmacy distribution
• Tele-health facilities to consult at remote location as well (South Australia, 2015)
• Tracking system for instruments or equipment
• Way finding kiosks based on touch screen
• Digital technology for imaging
• Wireless call system for nurse / patients (South Australia, 2015)
• Electronic records for health care

From the business needs and priorities, it has been analysed that CEO, CIO, CFO, CFO, CHRO, CCO and customers are the key stakeholders for the Royal Adelaide Hospital.

From the above chart, CEO has the responsibility to manage all the health care services of the hospital. CIO manages the informational system and control IT system of the hospital. CFO has the responsibility to control and manage overall business transactions (South Australia, 2015). CHRO manages the staff and adequate doctors within the hospital and always focused to hire best talent for the organization. CCO handles all the compliance and legislative issues held within or outside the organization and control the security of hospital premises in effective manner.    

On the basis of business operations, different challenges can be faced by Royal Adelaide Hospital,

• Financial challenges related to equipment, building, energy costs, staff or consumables
• Reduced rates for reimbursements (South Australia, 2015)
• Challenge of value based reimbursement instead of volume
• Regulatory standards
• Patient satisfaction
• Deal with large amount of data (Mignone et al, 2016)
• Integrated systems within the hospitals

There are various risks witnessed in business operations of hospitals which can be resolved by effective approaches or strategies.

• Cyber risk can be reduced by implementation of efficient information system with skilled IT staff
• Healthcare infections can be mitigated by adequate infection controls and adequate training to the staff (Hunt et al, 2016)
• Privacy or security issues can be resolved with efficient management of health records
• Disaster risks can be mitigated with effective strategies for disaster management
• Technical risks can be mitigated with effective implementation of IT infrastructure within the hospitals (South Australia, 2015)
• Epidemic risks can be diagnosed with adequate medicines or health care solutions
• Violence activities can be reduced using efficient security staff
• Medical errors can be reduced using effective medical tools or equipment

On the basis of business operations of Royal Adelaide Hospital, it can face various major IT challenges that can affect the operational efficiency of the hospital.

• Increasing costs for IT projects within the hospital industry (South Australia, 2015)
• Increased demand for the data
• Communication gaps within the health care systems
• Inadequate capacity for data storage (De Koning and Andrews, 2016)
• Data privacy
• Health management of population
• Business intelligence with advanced analytics
• Digital system for health

Role of IT Infrastructure in Providing Quality Healthcare Services at Nominal Costs

The different risks can be observed in hospital industry which can include,

• Information exchanges of health can be resolved with efficient security framework
• Meaningful use by using adequate audit activities for medical services
• Data warehousing by using efficient interfaces to handle large data South Australia, 2015)
• Biomedical devices need to be secured with reliable patches
• Software licensing can be resolved with regular update of system software
• Network security can be controlled using firewalls or access restrictions
• Prevention of data losses can be treated by using adequate storage devices (De Koning and Andrews, 2016)
• Mobile devices need to be managed using effective policies to protect confidential data of staff or patients
• Shadow IT can be avoided using IT security policies
• Interface issues need to resolved using effective implementation of IT system within the hospitals 

The different processes can be categorised in the IT related to business operations of hospitals. This may include,

• Process to identify the patients using their unique Ids
• Data security process for securing the confidential data
• E-prescription process for the remote patients
• Compliance process to secure the data using rules and policies
• Cloud storage process to record the data on electronic basis
• Automated systems to distribute the pharmacy (Schwalbe, 2015)
• Tracking system process for managing the medical tools and equipment
• Imaging technology process to allow clinical digital images
• Financial accounting process to manage business transactions on online basis using different payment modes

Information technology of Royal Adelaide Hospital has enabled the hospital to record medical history of the patients on online or electronic basis. The IT infrastructure of hospital is based on the cloud technology using which data can be accessed from remote locations as well (Haux et al, 2013). Desktop, communication as well as collaboration, mobile apps, platforms, security, and business process are key elements for IT infrastructure of the Royal Adelaide Hospital.

The IT operations can be effectively managed by the Royal Adelaide Hospital using various steps,

• Design and plan stage enables the Royal Adelaide Hospital to design, develop and optimize support systems as well as business applications, systems and network including recovery, back up, etc. (Kuperman et al, 2013)
• Build stage enables evaluation of technology, implementation or integration of networks, development of applications for end users and support systems for the hospitals
• Hosting stage enables to outsource infrastructure of IT using the network provider for the services (Baird, 2013). This helps to improve the performance level of IT system within the organization.  
• Operate stage manages all the functions and manages databases or applications, server or storage systems and network security.

The information system of Royal Adelaide Hospital mainly consists of several systems which enable the hospital to operate its business operations in more effective manner. This mainly includes,

• Administration system which provide user registration information by which information of hospital can be accessed effectively from remote location as well. This also describes the registration and discharge process related to the patients
• Financial accounting system to manage and handle business transactions on online basis
• Appointment scheduling system provides the information related to patient as well as resource scheduling (Mills et al, 2014).
• Management system for the equipment or tools in order to ensure their quality as well as efficiency.
• Management information system of nursing that provides information related to bed management, orders tracking as well as patient assessment.
• Information system of the laboratory provides all medications and settings for inpatient care (Yoo et al, 2015).
• Management system for pharmacy ensures effective supply of medical facilities to the patients.
• Information system of clinical provides clinical summary, patient’s lists, medical record on online basis, etc.
• Management system of inventory manages purchasing orders for all required resources for the hospital
• Order management system processes all the information related to the patients in terms of medication, prescriptions, etc.   

The architecture for enterprise defines the conceptual framework for the IT system of Royal Adelaide Hospital by which IT operations of the organization can be processed in more effective manner. 

The budget is an important section for the business operations in order to effectively implement or develop new system for the organization (Schwalbe, 2015). The cost for implementation of IT system within the organization requires huge amount of investment in order to effectively process and manage the project.

1. What is the role of CIO in this organisation? (Brief) 

The CIO is responsible for Information Communications and Technology at the RAH as well as across all SA Health. The CIO is part of the executive suite and provides leadership and oversight to health in South Australia (Le Blanc, 2017). 

The CIO leads all the ICT staff and is responsible for all technology implementations in health, not just for the RAH.  

1. How did this role evolve in this organisationover the years? (Brief) Example: Was the role CIO from the beginning, or did it start from a small MIS manager role? 

Bill Le Blanc has been CIO for SA Health since the end of 2013 (Nott, G). In 2014/15, Bill Le Blanc held the position of eHealth Systems Executive Director and reporting to the Deputy Chief Executive of Finance and Corporate Services (SA Health, 2015).  During his time in this role (circa 2012) a complete reform of IT structure for hospitals in South Australia occurred, where prior to this each hospital had its own IT departments with their own staff trying to provide its hospital with entire ICT solutions. The reform meant that all ICT was now centralised and managed/controlled by the CIO at the time (Lee, 2012).  

Note that this means the RAH does not have its own CIO, as with the rest of the C-suite and governing body, they are responsible for more than just the RAH facility.  

1. What does the top-management of organization expect from IT / IS? (Explain) 

Challenges Faced by Royal Adelaide Hospital in Managing IT Operations

Technology that enables the business, supports the stakeholders, aligns with the Strategic Vision of RAH and SA Health, and works towards the improving the overall quality of health and health services across the hospital.  

1. In your opinion, is the CIO influential in this organisation? How much? (Explain) Hint: look at how much has IT contributed to the business during the past few years.  

The current CIO has been most influential in this organisation. It is evident as originally, he was responsible for the e-Health implementation and was a director during that program, however was then promoted the CIO after the merging of IT for SA Health. This indicates that he must have placed a pivotal role at SA Health during that time. Furthermore, the need for technology in medicine and hospitals has grown exponentially. The innovation at the new RAH is leading the way, with robotics, medical imaging, and other important technologies as well as securely storing patient records, medical prescription, test results, etc. there is a high importance on the accuracy, speed and quality of information and how it is presented.

1. In your opinion, has IS/IT performed good in view of the ‘expectations’? How much? (Explain) Hint: look at how much has IT contributed to the business during the past few years.  

As the hospital has only just been opened, and much of the technology is innovative and new, there are teething issues and change management issues with acceptance of change.  There will always be problems whilst new technologies and processes are being used for the first time, particularly in a new building. The RAH has outsources many of its services and therefore reliance on other companies, whilst transferring some risk, does come with risk of not being able to clearly control some outcomes. I believe given the circumstances that they have performed well.

Overall, RAH is referred to as the most technological advanced hospital in Australia, with many automated systems such as Automated Guided Vehicles (AGVs), Automated Pharmacy Distribution Systems and Cabinets to help provide efficient and quicker processing of patients.

1. In your opinion, what important deliveries or functions have IT/IS missed out in this organisation? What are the ‘perceived’ weaknesses of IT/IS in this organisation?

There has been some controversy regarding the Electronic Patient Administration System (EPAS) which was implemented years earlier and has been adopted at the new RAH. There were complaints by doctors in 2016 that the system was clunky and hard to use (Fedorowytsch, 2016), and further controversy around delays of the new RAH build to cover up its failings. This is not specific to the RAH IT Strategy, but as the IT is consolidated over SA Health, the importance of offering a sound, secure and reliable patient records system is paramount to the RAH delivery of services.

1. In your opinion, what IT/IS, in general and CIO in specific, can do to improve the situation?

Review the IT Outsourcing policies and processes and ensure the RAH has a sound strategy in place to ensure expectations from vendors are agreed on and action can be taken to rectify any issues swiftly and effectively without impacting the patient care.

Strategies to Overcome IT-related Challenges and Improve Patient Care

Ensure to keep innovating, however with thorough testing and security in place due to critical, often life-threatening nature of health systems.

Invest in improvement or redevelopment of the EPAS to ensure trust between patient and doctors can be regained.

Data strategy to ensure quality capture and analysis of data. The past is the best predictor of the future and data analytics and business intelligence could enable improvements in capacity planning, resource utilization etc. across the RAH and other hospitals for the overall improvements in provisions of care to patients.

1. What are the important challenges and risks in your proposed improvement actions? What are the resolutions or mitigations of those challenges or risks? (Explain) Looking at your proposal from the previous question and current state of the business, what will be the challenges, risks or difficulties to implement your ideas? 

Data Strategy:

A solid data strategy is required to ensure that the correct data is collected and in a manner, that is useful for analysis, and stored so that it is extremely secure but easily integrated with various systems/applications. The risk here is that data is not collected properly could cause invalid data analysis and decisions made on this data could be incorrect. Again, given this the RAH is responsible for health at worst the risk is extreme/life threatening. At best, the risk is a waste of valuable resources (people, time and money) which could be better served elsewhere. Furthermore, security of data storage is paramount, as breaches exposing patient information or sensitive hospital information could result in privacy breaches or malicious attacks.

eHealth and the electronic patient records are critical to the efficient processing and service of patients and building trust between health services, the providers of care and the patients. Failure can result in extreme risks being life threatening if incorrect information is given out, or even if delays in care result in that or other patients not getting prompt care. Given the history of mistrust and issues with the EPAS, a sound strategy to improve this and develop other systems to support critical operations in eHealth are imperative.

A robust digital strategy could encompass the improvement to the eHealth Systems including building of a new and future proofed digital platform that will support all future initiatives as they come about.

Data Strategy

The main point of emphasis when relating to the concept of the data processing is to collect, present and justify the use of data. This can directly help in improving the standard of the working of the organisation and better service to the patients. The data can be very important part of the overall working of the organisation.

Digital Strategy

The strategy which is involved in the concept of the digital strategy mainly states the improvement and the factor related to the health care of the patients, doctor and the health care professional through the digital transformation.

Proposed Strategy relating to data and digital strategy

Big data and analytics have majorly climbed the top of the sector which are related to the business. Together the concept promises to transform the way any organisation do business and their approach towards reaching the goal. some of the points that should be covered in the concept are:

• Choose the data which is right: The concept of the data and modelling have changed considerable in few years. The volume of data which is generated is growing up in a huge amount, the control of the data is very much needed in order to achieve standards in which the data is secure and are received when needed.
• Building up of model: The concept of data is very much important and competitive advantage. Most importantly the most effective approach is to build a model which mainly starts not with the data only but also identifying an opportunity which is related to the business and determining the model that can directly improve the performance.
• Transform the company’s capability: The main problem which arise in the concept of the transformation is the mismatch between the concept of the organisations existing culture and the capability and the capabilities and the emerging tactics. In order to comprehend the aspect, the big data requires throughout change of the organisations and three action area of the action that can get the goal of the organisation (Wang, Zhang and Dudley 2016)

Importance of proposed Strategy

• Cost saving: Some of the tools like Hadoop and the cloud based analytics can bring about major advantages when encountering huge amount of data.
• Time reduction: The high speed of the tools for example Hadoop and the memory analytics can easily identify new data which helps business analyzing data immediately and make quick decisions which is based upon learning
• Control Reputation Online: Big data tools can directly implement sentiment analysis. Therefore, the business body can get feedback from the customer which can help in improving the business standard (Schmitt et al. 2016)

3Vs

• Volume: the concept can observe and track the data from the various source of the data. In this way, the tracking concept of the data is very much applicable and be easily achieved.
• Velocity: The data stream is very much high and must be dealt according to time. This mainly includes the transaction of the business, social media and the information from the aspect of machine to machine or the data sensor.
• Variety: The data can come in many formats numeric in the traditional data base. The support format of the data can be audio, video, email and stock ticker (Horrocks et al. 2017).

Conclusion

The RAH could benefit from an IT Strategy which looks to the future and continues to innovate and find better, more secure and more efficient ways of doing things to ultimately provide better health care to our patients and be a leader in the community.

A digital strategy will ensure we look at more efficient ways of serving our clinicans and our community in a way that they would like to work.

A data strategy will ensure that we are using the vast amount of data that is available to the RAH in a beneficial way. We can use this data to look at what we have previously done, and using that knowledge what we can do better to serve our community, including decrease waiting times, particularly for emergency health and surgery wait lists.

Overall, the IT department at the RAH should continue to operate in a highly innovative way, being a technology leader in health and supporting the clinicians and community to provide the best healthcare possible.

Reference 

Baird, A. (2013) The new Royal Adelaide Hospital: the age of the digital hospital dawns in South Australia. In Proceedings of the Sixth Australasian Workshop on Health Informatics and Knowledge Management-Volume 142 (pp. 3-6).

CIMIC (2017) Royal Adelaide Hospital. [Online]. Available at: https://www.cimic.com.au/our-business/projects/new-royal-adelaide-hospital (Accessed: 09 October, 2017).

De Koning, M. and Andrews, J. (2016) Early clinical experience with vedolizumab in the treatment of patients with Crohn’s disease and ulcerative colitis: The Royal Adelaide Hospital experience. Journal of Gastroenterology and Hepatology, 31, p.138.

Fedorowytsch, T 2016, ‘What is South Australia’s EPAS patient record system?’, ABC News, 8 November, viewed 26 October 2017 <https://www.abc.net.au/news/2016-11-08/what-is-south-austrailas-epas-patient-record-system/8005334> 

Government of South Australia (2017) Australia’s most advanced hospital. [Online]. Available at: https://s3-ap-southeast-2.amazonaws.com/sahealth-rah-assets/general-downloads/New-RAH-Most-Advanced-Hospital_Fact-sheet.pdf (Accessed: 09 October, 2017).

Haux, R., Winter, A., Ammenwerth, E. and Brigl, B. (2013) Strategic information management in hospitals: an introduction to hospital information systems.USA: Springer Science & Business Media.

Hunt, J., Holloway, R., Tippett, M. and Kuo, P. (2016) Referral pattern and outcomes of oesophageal manometry and ph studies: the Royal Adelaide Hospital motility laboratory experience. Journal of Gastroenterology and Hepatology, 31, p.171.

Kuperman, G., Gardner, R. and Pryor, T. (2013) HELP: a dynamic hospital information system.USA: Springer Science & Business Media.

Le Blanc 2017, “Bill Le Blanc”profile, LInkedIn, viewed 12 October, <https://www.linkedin.com/in/leblancbill/> 

 Lee M, 2012, “SA Health’s journey to e-Health”, ZDNet, 23 May,  viewed 19 October 2017 <https://www.zdnet.com/article/sa-healths-journey-to-e-health/> 

Nott G, 2016, “SA Health’s Bill Le Blanc hits back at EPAS critics”, CIO,  25 November, viewed 19 October 2017 <https://www.cio.com.au/article/610684/sa-health-bill-le-blanc-responds-epas-critics/> 

SA Health, 2015, “Annual Report 2014/15”, viewed 19 October, <https://www.sahealth.sa.gov.au/wps/wcm/connect/622f6d804ac65b1289dbdd0b65544981/15107+SA+Health+Annual+report+2014-15%28v6%29WEbS.pdf?MOD=AJPERES&CACHEID=622f6d804ac65b1289dbdd0b65544981> 

Groves, P., Kayyali, B., Knott, D. and Kuiken, S.V., 2016. The’big data’revolution in healthcare: Accelerating value and innovation.

Horrocks, S., Wilkinson, T., Schnier, C., Ly, A., Woodfield, R., Rannikmäe, K., Quinn, T.J. and Sudlow, C.L., 2017. Accuracy of routinely-collected healthcare data for identifying motor neurone disease cases: A systematic review. PloS one, 12(2), p.e0172639.

Schmitt, J., Arnold, K., Druschke, D., Swart, E., Grählert, X., Maywald, U., Fuchs, A., Werblow, A., Schemken, M., Reichert, J. and Rüdiger, M., 2016. Early comprehensive care of preterm infants—effects on quality of life, childhood development, and healthcare utilization: study protocol for a cohort study linking administrative healthcare data with patient reported primary data. BMC pediatrics, 16(1), p.104.

Wang, F., Zhang, P. and Dudley, J., 2016, August. Healthcare Data Mining with Matrix Models. In Proceedings of the 22nd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining (pp. 2137-2138). ACM.