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Business Process Reengineering [BPR]
Business Process Reengineering [BPR] is the fundamental rethinking and radical redesign of business processes to achieve improvements in critical, contemporary measures of performance, such as cost, quality, service, and speed to achieve substantial gains in the overall organizational performance (Sturdy 2010:3). It is a business management strategy focusing on the analysis and design of workflows and processes within an organization. BPR relies upon questioning, challenging, evaluating, and redesigning every element of an institution‟s operational process (Goksoy et al 2012:90). BPR in the context of this study implies the business management model the Ethiopian FMoH has been applied to intensify the health sector reform of public health sectors in the country.
Health care reform
Health care reform is a sustained, purposeful change to improve the efficiency, equity, and effectiveness of the health sector (Senkubuge, Modisenyane & Bishaw 2014:1). It is a gradual process that resulted in significant changes in the formation and delivery of health care services and health care financing (Ghosh 2014:125). Health care reform in this study implies reengineering health care policies, systems, or strategies.
Effectiveness
Effectiveness is a measure of how well the outputs of a program or service achieve the stated objectives (desired outcomes) of that program or service (Productivity Commission 2013:13). It is the impact of the activities or services of interest on outcome which is consistent with desired effect (Bowling 2009:10). Effectiveness in this study implies the capability of BPR health care reform to produce the desired results.
Health care reform initiative
Initiative is an act or strategy intended to resolve a difficulty or improve a situation; a fresh approach to something (Oxford Dictionary 2013). In this study, health care reform initiative stipulates the country-wide health care reform initiative the Ethiopian government newly initiated and implemented in the form of BPR with the goal of improving the performance of the Ethiopian health care system and advancing the health status of the Ethiopian people.
THEORETICAL GROUNDING
The driving theoretical grounding of this study was the “Dimensions of health system performance” proposed by Knowles, Leighton & Stinson (1997:1). This approach presents indicators for five key dimensions of health system performance, namely: access, equity, quality, efficiency, and sustainability, which maps the linkages between health sector reform, changes in health system performance, and changes in health status. The approach provides a rationale for focusing on system performance as one of the principal ways to measure the results of health sector reform (Knowles et al 1997:1). The five key dimensions of health system performance indicated in the theoretical grounding have major requirements that health care reform initiatives should achieve. In the same way, the current study has taken those requirements as the major criteria which should be achieved in public hospitals of Addis Ababa as a result of implementation of the BPR health care reform. The five key dimensions and their constructs which determine the effectiveness of the BPR reform are explained as follows:
Access
Access is the opportunity to reach and obtain appropriate health care services in situations of perceived need for care (Levesque, Harris & Russell 2013:4). It refers to the presence of physical (availability & accommodation), economic (affordability), temporal (appropriateness), cultural (acceptability), and approachability dimensions in using health services (Fortney, Burgess, Bosworth, Booth & Kaboli 2011:643; Comber, Brunsdon & Radburn 2011:9; Levesque et al 2013:5). Physical dimensions represent access to general health care supplies and the ease of travelling to healthcare provider locations, while economic dimensions are those related to the cost of seeking and obtaining health care in relation to a patient‟s or household‟s income (Fortney et al 2011:643; Knowles et al 1997:15). Temporal dimension of access is the time required to receive services, such as an appointment wait-time, time spent while waiting in reception, receiving treatment, and waiting for the next appointment. The cultural dimension of access signifies the acceptability of health services, such as delivering services using languages and mode of communication suitable to patients, and indiscrimination of patients (Fortney et al 2011:643: Polluste, Kallikorm, Meiesaar, & Lember 2012:7). The approachability dimension relates to the awareness of the people that some form of health service exists, can be reached, and have an impact on their health (Levesque et al 2013:5).
According to Knowles et al (1997:15), a priority of health care reform is expanding access to cost-effective health services that maximize impact on health outcomes. Improving access may imply providing services free of charge or even paying consumers an incentive, or bringing services to the consumers, thus reducing time and travel costs to zero.
CHAPTER 1 ORIENTATION TO THE STUDY
1.1.INTRODUCTION
1.2. BACKGROUND TO THE RE SE ARCH PROBLEM
1.3. STATEMENT OF THE RES EARCH PROBLEM
1.4. AIM OF THE STUDY
1.5. SIGNIFICANCE OF THE STUDY
1.6. DEFINITION OF TERMS
1.7. THEORETICAL GROUNDINTHEORETICAL GROUNDINGG
1.8 RESEARCH DESIGN AND RESEARCH DESIGN AND METHODSMETHODS
1.9. ETHICAL CONSIDERATIOETHICAL CONSIDERATIONSNS
1.10. CONCLUSIONCONCLUSION
1.11. CHAPTER LAYOUTCHAPTER LAYOUT
CHAPTER 2 LITERATURE REVIEW
2.1. INTINTRODUCTIONRODUCTION..
2.2. HEALTH CARE REFORMHEALTH CARE REFORM
2.3..BUSINESS PROCESS REEBUSINESS PROCESS REENGINEERING (BPR)NGINEERING (BPR)
2.4. THE ROLE OF BPR IN HTHE ROLE OF BPR IN HEALTH CARE REFORMEALTH CARE REFORM
2.5. MANAGEMENT IN THE BPMANAGEMENT IN THE BPR HEALTH CARE REFORMR HEALTH CARE REFORM PROCESSPROCESS.
2.6. INFORMATION TECHNOLOINFORMATION TECHNOLOGY AND BPR HEALTH CAGY AND BPR HEALTH CARRE REFORME REFORM
2.7. BPR FRAMEWORK IN HEABPR FRAMEWORK IN HEALTH CARE SYSTEM MANALTH CARE SYSTEM MANAGEMENTGEMENT
2.8. CONCLUSIONCONCLUSION
CHAPTER 3 RESEARCH DESIGN AND METHODS
3.1.INTRODUCTIONINTRODUCTION.
3.2. RESEARCH DESIGNRESEARCH DESIGN
3.3. RESEARCH METHODRESEARCH METHOD
3.4. ETHICAL CONSIDERATIOETHICAL CONSIDERATIONSNS
3.5. DATA MANAGEMENT ADATA MANAGEMENT AND ANALYSISND ANALYSIS
3.6. DESIGN AND DATA QUALDESIGN AND DATA QUALITYITY
3.7. CONCLUSIONCONCLUSION
CHAPTER 4 ANALYSIS, PRESENTATION AND DISCRIPTION OF THE RESEARCH FINDINGS
4.1. INTRODUCTIONINTRODUCTION.
4.2. DATA MANAGEMENT AND DATA MANAGEMENT AND ANALYSISANALYSIS
4.3. SOCIOSOCIO–DEMOGRAPHIC PROFILESDEMOGRAPHIC PROFILES
4.4. RESULT I RESULT I — THE EFFECTS OF BPR HTHE EFFECTS OF BPR HEALTH CARE REFORM ONEALTH CARE REFORM ON HEALTH SERVICE HEALTH SERVICE QUALITY, ACCESS, EQUQUALITY, ACCESS, EQUITY, EFFICIENCY, ANDITY, EFFICIENCY, AND SUSTAINABILITYSUSTAINABILITY .
4.5. RESULT II: FACTORS IRESULT II: FACTORS INFLUENCING IMPLEMENTNFLUENCING IMPLEMENTATION OF BPR HEALTH ATION OF BPR HEALTH CARE CARE REFORM IN ADDIS ABABREFORM IN ADDIS ABABA, ETHIOPIAA, ETHIOPIA
4.6. RESULT III: THE RELARESULT III: THE RELATIONSHIP BETWEEN BPRTIONSHIP BETWEEN BPR HEALTH CARE REFORM AHEALTH CARE REFORM AND HEALTH ND HEALTH CARE PROVIDERSCARE PROVIDERS’’ JOB SATISFACTIONJOB SATISFACTION
4.7. RESULT IV: CURRENT HRESULT IV: CURRENT HEALTH CARE DELIVERY EALTH CARE DELIVERY PERFORMANCE OF PUBLIPERFORMANCE OF PUBLIC C HOSPITALSHOSPITALS
4.8. CONCLUSIONCONCLUSION
CHAPTER 5 PROPOSED STRATEGIES TO STRENGTHEN IMPLEMENTATION OF THE BPR HEALTH CARE REFORM IN ADDIS ABABA, ETHIOPIA
CHAPTER 6 DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS
