The purpose of this research is to figure out why physician resist the SAP Health Care (SHC) new system, and what directors can do to help physician except it.
Saudi Aramco hospital is a big health organization it consist of a lot of departments and have around 18000 health staff having a different professional., also Aramco hospital serve around 30000 patient all are Saudi Aramco oil company employee and their families.
So with this big demand Aramco Cooperate management invest a lot on Aramco hospital by bringing the best health staff and provide them with the best instruments as well as the best computer system to give a good health care.
At the beginning of 2004 Aramco hospital add SHC system to it's information system, but some of health staff resist the new comer and look at it as a threaten to their career even that some of the physician preferred to resign than working with the SHC.
So instead of having the SHC smoothing work and make the life of medical staff easier and instead of providing better health service to patient Aramco Hospital start to lose a lot of it's best and experienced staff mostly physicians, the lose of staff made Saudi Aramco Cooperate management to ask from Aramco Health organization management to search for the reason that medical staff resist changes and how managers can reduce their resistance.
As a department practice coordinator this research is very important to me , it will help me to understand why physicians in my department Primary care Department are resistance SHC and it will give me some ides to help management in helping physicians at the new changes.
This research will have a survey and interview with physicians' describing why they resist SHC
2.0 What is the SAP System?
SAP (Systems, Applications, and Products in Data Processing) is the leading ERP (Enterprise Resource Planning) software package. SAP was the first to integrate a corporation's worldwide functions tightly into one application. Five former IBM programmers founded SAP AG in Germany, and released the first version of their software, SAP R/2, in 1979. Its domination of the market occurred during the 1980s, expanding first throughout Europe (early 1980s) and then North America (1988). SAP R/3, an advanced, client-server based version of the popular R/2 product, was released in 1992 and sparked a stunning takeover of America's largest businesses -- 44% of US companies were using it within five years of its expansion. In 1999, SAP introduced its newest major product upgrade. Named mySAP.com to emphasize its shift to an e- business focus, mySAP.com builds on the strengths of the SAP R/3 product in a fully Internet enabled architecture. MySAP.com also incorporates SAP's newest business applications for CRM, Supply Chain Management (SAP APO), and Data Warehousing (Business Information Warehouse or BW). Prior to the introduction of mySAP.com, these applications had been incorporated as add-ons to SAP R/3 and were known as New Dimension products.
Before Sap companies used to have a big number of program developers who do all the business application and move data back and forth, this process was costly and time consuming and can have a lot of human error, so Sap was the first and until now the only system that made all business process into one software solution for use in any business at any country.
Using SAP's products, companies can now integrate their accounting, sales, distribution, manufacturing, planning, purchasing, human resources, analysis and other transactions into one application. http://sap.ittoolbox.com/pub/sap_overview.htm
Also SAP become started to be used on Health centers under the name of SAP Health Care (SHC)
2.1 What is the SHC System?
SAP Health Care (SHC) is a computer system that will provide an end-to-end solution for administrative and clinical processes in Saudi Aramco Medical Services Organization (SAMSO).
SHC will replace the legacy Patient Care System (PCS) and provide for the business of managing and coordinating patient care, from pre-registration and bed assignments to patient management and education.
SHC will enable SAMSO to connect the many intricate work processes that are involved in the complex patient care environment. The healthcare team will be able to access patient information through SHC in real time, anywhere care is delivered in SAMSO.
FEATURES AND BENEFITS
Provides a care management system that will allow SAMSO to assess caseloads, develop and implement new treatment strategies, and manage and document clinical care.
Create functions for patient management and for diagnostics and therapy that will improve the coordination and documentation of patient services.
Provide access to critical patient care information on a real time basis wherever SHC can be accessed.
Provide an efficient reporting process by automating some data collection as part of the care process.
3.0 CONTEXTUAL CONTEXT
A- Literature Review:
A lot of articles and research were done on why people resist changes and how managers can help employee to cope with these changes, some of these theories are
1. James O.Keener at his book (10 Good reasons why people resist change: And practical strategies that win the day) wrote that people in general have 10 different reasons to resist any changes these reasons are
Loss of control,
Disruption of routines,
Lose of face,
Dangers are real
2. Dean Anderson and Linda Anderson (2002) at their internet article (Getting Smart about Employee Resistance to Change: part 1) they stated that resistance will be always their and they advised management to work with it if they need to have a good result at the end.
They also divided changing strategy into three areas:
1- Content (what changing)
2- Process (how the change will be planned and designed)
3- People (who will be affected and who will participate on the changes)
and employee resistance will target one of these areas like employee at a content stage will resist change when they think its wrong and they don't accept change because they feel its bad for their personality or for the business.
They also mentioned that resistance to changes is not only happened at the line employee but it also can happen at executive level.
3. Ken Hultman (1995) at his book (Removing Barriers to organizational change) which was published on the internet he looked at change resistance as diseases that have a symptoms and causes, he also divided resistance to two category Active and Passive resistance.
Beside that he identifies the good manager and supervisor as the one who can help his employee throw the change stages.
Hultman gave eight reasons for employee to resist changes these reasons are
They Believe The Change Process Is Being Handled Improperly
They Believe There Isn't Any Need For The Change
They Believe The Change Will Make It Harder For Them To Meet Their Needs.
They Believe The Risks Outweigh The Benefits.
They Lack The Ability To Make The Change.
They Believe The Change Will Fail
The Change Is Inconsistent With Their Values
They Believe Those Responsible For The Change Can't Be Trusted.
4. Albert F. Bolognese (2002) made a lot of research published at the internet (Employee Resistance to Organization Change)
His paper includes a lot of study made by old and new researcher like Hultman (95), Zander (1950), Jager (2001) and a lot more.
He stated that employee resist changes is a complex issue facing management in today's organization and that resistance is not always negative, he advised management to change their way and to look
Into it positive that they resistant employee can play an important role at the changes, he also advised management if they found a big resistance to rethink about the changes purpose.
Also he gave some of the reasons employees resist change is that they need to learn new thing and the fear that one will not be able to develop new skills and behaviors that are required for the new setting. Also he mentioned that organization must help employee excepting the changes
5. Fiorelli & Margolis (1993) at a study published in organizational development journal and published in the internet under the title of (Managing and understanding large systems change)
Stated that competition is very important in today's world and it means change, and any change the normal reflect to it is resistance from some employee they also mentioned that the reason for employee to resist is because change pushes them out of their comfort zone where they became comfort with their way of doing things.
At their study they gave questions to executives and mangers to answer it before start and change to say does it worth it or not.
7. Genene Koebelin from Suffolk University at his research paper (Human Performance Improvement) in 1999 he gave a case study about how to motivate workers and he studied the motivation theories and the types of motivation and come up with a conclusion that any company in order to work should have a motivated workers that they can be motivated throw in traditional program such as salary and benefit or throw increase the employee commitment to the job by training, leadership or teamwork.
8. Dent & Goldberg in study published at the internet with a title (Challenging A Resistance to Change @)
They challenged a lot of research done on change resistance some of these studies they argue with it and some they were against it like Kolter (95) study he said that people mostly resist change not because of obstacles inside them but because of obstacles from their organization, but Dent & Goldberg think that resistance as a mental model come from inside without releasing it and that the resistance have a phases an employee go throw it
Also suggest that managers should come over it and help employee throw the resistance phases
9. Joyce Rosenberg in a paper published in the internet under a title of (managers can help workers cope with changes) on 2004 he advised manger to communicate changes to their employee in this way employee will know what's going on and why the changes are for, he also gave some example from others experience were miscommunication lead to gossip and rumors that effected the organization
B- My own speculative thinking:
As a Primary Care (PCSD) Practice Coordinator I have a good reason to do this research it will give a clear idea to except the physician's resistance toward the SHC new computer system and it will help me to know the reasons for physicians to resist it, and finds way to help them go forward with the SHC
Also as Assistance to the Director of PCSD it will help me to advice him of the ways and the tools to help Physicians cope with the SHC instead of punishing them
1- it will help me to help physician toward SHC
2- It will give me ideas of their needs to cope with the SHC
3- It will prove to my management the important of communication and to introduce the new comer to our physicians
4- It will help me to know what kind of training the staff needs.
5- Also this research can be a good help for other department at SAMSO to understand why their employee are resisting SHC
4.0 The Research Questions
1- Why the physicians of Primary Care Department (PCSD) resist working with SHC?
2- What can the management of PCSD do to help physician understanding the need of the SHC and to work with it?
3- What training the physicians needs to make their life easer with the SHC?
The first question draw around expecting that resistance of the new comer is a normal reaction and understanding the fears that causes the resistance to the SHC, also it will help identify the reasons that as a management we may ignore it or don't look at it but it effect physicians badly which led them to resist the change
The second question will give the method that managers can do to help physicians at the introducing stage of the SHC as well as the on going time with the SHC, it will but a guideline for managers and director to do before starting the change as well as the whole stages of the change
The third question will help in targeting what courses or training physicians need to have for them to be able to work with the SHC instead of resisting it.
After I identify what are the questions I need to answer in this research , I have to know what methods I have to use in order to gather information.
5.0- Research Method
1- Sources of DATA collection:
"In a positivistic study a representative or good sample is one in which the result obtained for the sample can be taken to be true for the whole population "(Collis & Roger, 2003, pp155)
So a sample of 120 physicians out of 250 physicians from different divisions of PCSD (Dhahran, Abqaiq, Al Hasa and Ras Tanura) will be conducted in order to do the study.
These participants will be the nominated their Head physicians and the participant will be a mix of old and new generation of the physicians as well as male and female..
"A good sample must be:
Chosen at random (every member of the population must have a chance to be chose
Large enough to satisfy the need of the investigation being undertaken.
Unbiased " "(Collis & Roger, 2003, pp155)
2- Methods of DATA collection:
At the research, first the 120 physicians will be interviewed face to face to find their information about SHC, The questions of these interviews some of it will be prepared in advance and asked to all participants and other will depend on each one level of resistance and how much they think SHC is threatening their job.
Then they will be divided into two groups one group will participate on the introduction stage of the SAP as well as implementing it and the other group will work direct with the SAP after having a few training course.
After that a Questionnaires will be distributed to both groups at their clinics for completion, then they Send it back to researcher or their Head physician even throw electronics mail or a hard copy, the questionnaires will get the physicians feedback after using the SHC, this questioner will be the same for the two groups, the group that participate on implementing the SHC as well as took the training session and the group that only took the training session.
Sample of the questions:
Unsatisfied Normal Satisfied Question
The quality of training you received to help you learn to use SAP Procurement.
the level with which you were involved and informed about the SAP procurement implementation
the level of support the managers in your agency devote to ensuring SAP procurement is effective on the job
Disagree Normal Agree
I like to do the same old things rather than try new and different ones.
Enjoy learning new things on my job.
I like being challenged to learn new skills on my job.
The way things are done with the SAP is very flexible and easy to change.
Generally, change is good.
Those questions will be examined first and more questions will be added to it
"A questionnaire is a list of carefully structured questions, chosen after considerable testing, with view to eliciting reliable responses from chosen sample. The aim is to find out what a selected group of participants do, think or feel""(Collis & Roger, 2003, pp173)
C- Observing participants:
After getting the participants feedback on the introduction stage, they will have to start working on the SHC by their own at the clinic while they will be monitored to see their quality of work and the time they need to examine a patient.
Then this observation will be done again after two weeks to see how much they become familiar with the SHC and if they still feel it's a stranger for them and if there are any problems they are facing with it.
3- Analyzing the Data
That data will be gathered from interviews, questioners and the percentage of the quality of work done at the clinic, will be only numbers, so these numbers will be analyzed and will be putting in chart and graphs to make it easier for management to understand the findings
6.0 Time Resource & Schedule
The time for this research will be three months and a week
The first 2 weeks
it will be gathering data of how much physicians PCSD is losing as well as whole SAMSO , based on this data a letter will be addressed to the manager explaining the need for this research to have all the others cooperation.
Explore further literature on the subject.
Interviews with participants to get their feedback about SHC and their expectation
Week 5, 6
Enroll participants at the introduction stage, and then give them the questioner to answer.
Week 7, 8&9
Observe the participants working with SHC.
Analyzing data and compare it with literature
Week 11 &12
Write the research report
Draw conclusion and finalize the report to be ready for the management
Keener, J 1999"10 Good reasons why people resist change: And practical strategies that win the day" Grand River Pub
Research Skills & Project preparation An MBA Study Guide, ,University of Hull Business School, Hull
Collis,J & Hussey, R 2003 " Business Research' Second Edition Palgave Macmillan