Recognising the poor state of IT among healthcare non-government organisations (NGOs), Lien Foundation, an NGO that specialises in philanthropy, kickstarted an initiative to implement an enterprise resource planning (ERP) system across 11 such agencies.
While IT remains virtually non-existent in these organisations, Lien Foundation also knew of the prevalent attitude of resisting changes brought by technology. Besides installing a comprehensive application, the project team knew it had to engage and win over the hearts and minds of people from the NGOs that include more than 750 doctors and nurses and over 1,000 non-clinical staff.
It then embarked on an extensive change management programme to ensure buy-in and support from personnel of all levels, from board member to the nurse in the clinic. The success of this initiative convinced MIS Asia’s panel of expert judges to bestow upon Lien Foundation an IT Excellence Award for Best Change Management last year.
Poor state of IT
NGOs in the healthcare sector generally have fragmented IT structures and IT adoption is somewhat poor. Many organisations do not even have IT staff.
These agencies tend to be wary and hence resistant to changes that technology might bring. Many of them lack technologically savvy board members to drive adoption of IT. Also, donors supporting the NGOs tend to prefer having the bulk of their funds directed towards beneficiaries, instead of investment in IT.
Donors and non-profits often fail to grasp the value of technology that could help advance their cause, increase capacity and improve services, says Lee Poh Wah, programme director, Lien Foundation.
Even those with existing IT systems and personnel in place sometimes fare no better. “Most of the time what we see is the fragmented IT infrastructure; ‘islands’ in a way not talking to one another, while the doctors and nurses are all bogged down with paper-based processes, requiring a heavy amount of manual data entry,” says Lee.
Repeating questions
There was little or almost no information sharing of patients’ healthcare records and history among the NGOs, he adds. Doctors have to ask the same questions repeatedly of the same patient as he or she visits the various NGOs.
These NGOs are often overlooked by the private and public sector as the IT industry favours those with funds and commercially profitable projects. Most policies and governmental efforts in IT are geared towards the benefit of the masses, rather than NGOs with unique needs.
NGOs nowadays are operating in a tougher environment. The overall image of NGOs in Singapore has taken a beating since the National Kidney Foundation (NKF) fiasco. Malfeasance by the former NKF board and management was discovered in 2005 following a failed defamation trial. This led to public backlash and falloff in donations to the organisation. And there was increased competition for funds among NGOs. The new corporate governance policy set by the Charities Council meant that NGOs had to review their operations and reporting standards to meet the new regulations.
Each NGO constantly faces the strain of coping with growing demands as well as battling with reduced manpower, funds and resources. Lee estimates that the high staff turnover rate of 10 to 20 per cent across the NGOs makes the situation of poor expertise even worse.
The answer is IngoT, a collaborative effort to build a healthcare-specific ERP system that can be integrated across a host of NGOs.
Conceived and driven by Lien Foundation, with PulseSync as its solution architect and developer, the project helps optimise resources, raise productivity, improve patient care, assist in research and sharpen corporate governance, Lee says. The system is now shared across 11 NGOs in Singapore; each operates in specialised areas ranging from homecare and renal dialysis to hospice care and community hospital care.
The system comprises modules for accounting, human resources management, financial and inventory management, volunteer management, donor management, patient administration, clinical management, management dashboard and electronic medical records.
One of the objectives of the project is to enable member NGOs to increase productivity, create better workflow and smoothen processes.
“There is an urgent need for resources to be well-optimised in view of the increased competition for donor dollars as well as rising operational costs. By optimising resources, the NGO can maximise the results for every donor dollar spent,” says Lee. To address the new requirements by the Charities Council, higher levels of corporate governance, transparency and accountability can be attained by using IT to improve financial reporting and oversight.
The new system will help meet the new RAP 6 reporting and corporate governance standards set by the Council for Charities, Lee explains.
Integrated system
With the integrated ERP system installed across the NGOs, Lee and his team are looking to facilitate information-sharing across the agencies. “This will enable better research and reduction of medical errors as well as achieve higher productivity, more informed and better decision-making and ultimately, improved care delivery to patients,” he says.
The project team first worked to overcome the IT-resistant NGOs with Lien Foundation’s incentive of bearing the bulk of IT investments for Project IngoT. The funding helped to defray the costs typically associated with IT projects of this kind. Each NGO was able to afford the ERP solution as it was a fraction of what it would have cost if it had embarked on such an exercise alone.
Agencies that are more IT savvy—HCA Hospice Care (HCA) and Home Nursing Foundation (HNF)—are tapped to become ‘examples’. The two organisations had recently implemented a successful mobile medical informatics solution and were keen to take on the ERP solution. With them on board, other NGOs were also attracted to join the consortium for running Project IngoT.
The project team met the 11 NGOs’ board members and senior management to pitch the vision and benefits of the ERP solution. The agencies’ finance and IT personnel were also approached for their feedback and support. This way, buy-in was obtained from the top management to the staff at the ground level.
Central to the project’s success is the ability to effect change from bottom up. The project obtained the feedback and experiences of nurses, doctors and finance staff for the system’s design and solutions. This meant that these stakeholders were able to influence the processes and outcome of the ERP positively.
The close participation of these stakeholders also helped them respond to change positively. Having been involved in the design process, they understood the project’s strategic benefits and objectives. This knowledge helped to forge a stronger acceptance of the new system.
So instead of being impeded by scepticism and resentment, the project progressed smoothly.
Working the trenches
In formulating the processes for the IngoT project, the team adopted a participatory approach to ensure optimal user buy-in. Medical and finance workgroups were formed with representatives from the NGOs. The issues and problems identified by these teams contributed to charting the project’s vision and mission, as well as ensuring that each organisation could identify with the common objectives.
Before implementation, all the objectives and plans have to be approved by the respective NGO’s management and board members. The project team also worked closely with the NGOs’ IT personnel right from the start of the project.
“Together, we defined the IT management strategies and what is needed to meet the NGO’s objectives. For example, in the case of these healthcare NGOs, extra care must be taken to ensure patient data privacy,” says Lee. As patient medical records are confidential, the access matrix and security was designed to ensure that only authorised personnel could access such data.
To promote acceptance and ensure success, a champion and mentoring programme was implemented. Key nodal, charismatic and influential personnel were identified and trained specifically to be project champions in their departments and network. “This meant that change came from ‘within’, rather than top down. The ‘peer pressure’ and enthusiasm for the new project was ‘infectious’, as these champions and mentors led the way to embrace welcomed changes,” says Lee.
Changes in stages
The project team also ensured that changes were made in stages. Project trails of the modules were run in a test environment so as to avoid any major reorganisation or restructuring. This also helped the users view and experience change positively, as the benefits of the new solution won them over. For example, they could experience for themselves how the new system helped reduce their paperwork.
The project has since changed the way IT is being perceived and used within the NGOs. Lee recalls the instance where a 70-year-old nurse in HCA embraced the mobile component of IngoT and now proudly brandishes her newfound IT expertise and PDA daily.
The tangible benefit brought by the new system is productivity, Lee points out. “Suddenly, they cut down the reporting paperwork. Now it’s just a series of clicks. In terms of time saving, we cut down on one third. We can provide more attention to the patient, talk to them or see more patients,” he says. After one month of deployment, the medical and administrative personnel are saying productivity went up by at least 15 per cent.
HNF and HCA Hospice Care have also said they are now able to see more patients on a daily basis, from a previous average of six patients to about seven to eight patients.
Sharing notes
The doctors and nurses from various agencies are now able to share case notes and patients’ medical history and data. The updated information from the systems means that doctors and nurses do not need to ask patients repeated questions about their condition or medication.
The successes of the NGOs using IngoT have emboldened other NGOs to also scale up. PulseSync has received enquiries from other NGOs looking to harness IT.
The new system has also met its objective of ensuring greater transparency and better corporate governance.
Board members are now better informed of the state of donations, finances and expenditure through the management dashboard module, which summarises this data at a glance.
Fund-raising drives can be better co-ordinated, as the management dashboard module allows for a bird’s eye view of all fund-raising activities.
“To me what is more valuable is the intangible ROI [return on investment] component. You don’t have to carry two to three kilogrammes of paper.
“Now you have a sexy, very slick PDA that you can put inside your pocket. As and when there is a last minute appointment, you can just pull it out and get to your patient,” says Lee.
