You are on page 1of 40

DELIVERING RESULTS: organization would have to be facing critical

EVOLVING BPR FROM business issues or have considerable

ART TO ENGINEERING problems to attempt a high-risk, highly


Kiros kidanu visible BPR project, given these significant
Summary chances of failing. However, a closer
Business Process Reengineering is a examination of this failure statistic must be
discipline in which extensive research has warranted to provide meaning into how to
been carried out and numerous reduce this statistic. We contend that there
methodologies churned out. But what seems are three primary reasons attributed to
to be lacking is a structured approach. failing BPR efforts. The first reason is the
Business Process Reengineering means not lack of an adequate business case resulting
only change -- but dramatic change. What in unclear, unreasonable, or unjustifiable
constitutes dramatic change is the overhaul expectations for what is wanted or expected
of organizational structures, management to result from a BPR effort. A second reason
systems, employee responsibilities and can be the absence of robust and reliable
performance measurements, incentive technology and methodologies for
systems, skills development, and the use of performing BPR so that there is a failing in
information technology. Successful BPR executing BPR efforts. A third reason is an
Model can result in enormous reductions in incomplete or inadequate implementation.
cost or cycle time. It can also potentially Re-orienting a traditional organization from
create substantial improvements in quality, a function to a process focus requires a
customer service, or other business major cultural change in the organization. It
objectives. The promise of BPR is not empty also requires major change to the
-- it can actually produce revolutionary information systems that support the
improvements for business operations. organization. The organization does not
On the other hand, BPR projects can fail to know what to expect and is often surprised,
meet the inherently high expectations of angered, or threatened by the change
reengineering. Recent surveys estimate the proposed. If the project does not correctly
percentage of BPR failures to be as high as manage the expectations of the organization
70 %( champy 95). The salient observation it will not be allowed to finish what was
about this statistic is that an enterprise or started. Finally, we contend that inadequate
carry forward of “lessons-learned” and The civil service system is one of primary
“how-to” knowledge from project to project and key tool in achieving these objectives.
significantly increases the chance of failure. Living with the old bureaucratic system of
Some organizations have put forth extensive civil service, the efforts will become futile
BPR efforts only to achieve marginal, or attempt. Therefore, transforming the civil
even negligible, benefits. Others have service system in order to support the
succeeded only in destroying the morale and building of good governance and democracy
momentum built up over the lifetime of the is primary issue that the government has
organization. been undertaking. Among the efforts is the
Many unsuccessful BPR attempts may have civil service reform which is aimed to
been due to the confusion surrounding BPR,
transform the system. This reality has
and how it should be performed.
Organizations were well aware that changes brought about the need for reengineering
needed to be made, but did not know which
(BPR) in the Ethiopian civil service
areas to change or how to change them. As a
result, process reengineering is a organizations.
management concept that has been formed
The concept of reengineering traces its
by trial and error -- or in other words
practical experience. As more and more origins back to management theories
businesses reengineer their processes,
developed as early as the nineteenth century.
knowledge of what caused the successes or
failures is becoming apparent The purpose of reengineering is to "make all
Introduction your processes the best-in-class." Frederick
Ethiopia is a country striving for building Taylor suggested in the 1880's that managers
good governance, democracy and economic use process reengineering methods to
development and improves the citizens' discover the best processes for performing
living standard. The last few years an work, and that these processes be
experience in building democracy and reengineered to optimize productivity.
economic development in the country is BPR echoes the classical belief that there is
promising. And now ahead, the government one best way to conduct tasks. In Taylor's
is seriously in charged to ensure good time, technology did not allow large
governance, develop democracy and socio companies to design processes in a cross-
economic development. functional or cross-departmental manner.
Specialization was the state-of-theart
method to improve efficiency given the increases in productivity, output, and income
technology of the time. that led to the creation of the middle class.
If BPR is not a theory, but a technique,
In the early 1900's, Henri Fayol originated Hammer and Champy are surprisingly vague
the concept of reengineering: To conduct the about the details. This paper attempts to fill
undertaking toward its objectives by seeking in the blanks. Despite their vagueness,
to derive optimum advantage from all Hammer and Champy are clear about who to
available resources. Although the blame when reengineering attempts fail; it is
technological resources of our era have the fault of the individual company. To the
changed, the concept still holds. About the steering committee, this sounds like a
same time, another business engineer, variation of blaming the victim. Cyert and
Lyndall Urwick stated "It is not enough to March, among others, point out that conflict
hold people accountable for certain is often a driving force in organizational
activities, it is also essential to delegate to behavior. BPR claims to stress teamwork,
them the necessary authority to discharge yet paradoxically, it must be "driven" by a
that responsibility." This admonition leader who is prepared to be ruthless. One
foreshadows the idea of worker executive with BPR experience warns not to
empowerment which is central to assume "you can simply issue directives
reengineering. from the center and expect it to happen."
Although Hammer and Champy are eager to
declare that classical organization theory is According to Thomas Davenport, "classical
obsolete, classical ideas such as division of reengineering" repeats the same mistakes as
labor have had an enduring power and the classical approach to management, by
applicability that reengineering has so far separating the design of work from its
failed to demonstrate. BPR does not appear execution. Typically, a small reengineering
to qualify as a scientific theory, because, team, often from outside the company,
among other things, it is not duplicate and it designs work for the many. The team is
has limited scope. The applicability of fueled by assumptions such as "There is one
classical management theories, such as best way to organize work; I can easily
division of labor, were widely duplicable understand how you do your work today; I
and portable. These ideas stimulated can design your work better than you can;
There is little about your work now that is performances and decided to undertake the
worth saving; You will do your work the reform further.
way I specify." Davenport suggests that the
engineering model/analogy that BPR is The real problem prevailed in our efforts of
based upon is flawed, both in terms of reengineering is knowledge and skill gap in
process design and information technology. those doers and leaders. Lack of knowledge
He proposes an "ethnographic" approach to and skill exist in planning and implementing
process design and an "ecological" approach BPR
to information systems, called participative We may think that our processes (now the
business make overs which is discussed later existing function based departments) are
in this paper. fine as they are. We use them every day and
For the last few years the concept of BPR they seem to work. Transactions are being
has been manifested, and tried to be used in processed. Questions are being answered.
many of federal and regional organizations. Problems are being solved. Clients are being
Even though the program has not been served.
evaluated formally, the assessment shows us However, many existing processes are “in
of two kinds. In a few of the organizations motion.” They were developed years ago
it seems good, but in many of the and have been tinkered with over time, but
organization it could not prevailed departure they have not been globally and nationally
or paradigm shift from the old traditional reviewed and updated since they were first
way of doing business. After the established. They get the job done but we
organization says that we have just done may not know how well. A Process
BPR, business as usual continues working Innovation (PI) program will help the health
on the old tradition ways and continuing sector grow into the future by changing how
living and working in existing system. The we achieve our mission and deliver service.
fact is that, the last few years experience of We will not only change our processes but
BPR has helped few organizations to make also create a forward thinking organization
some incremental changes in their work that embraces change.
environment. Now, the government has Process Innovation is a structured approach
given attention to capitalize these that creates opportunities for organizations
to reach higher levels of achievement by
removing barriers and enabling radically contemporary measures of performance,
new ways of achieving the mission, such as cost, quality, service, and speed."
delivering services, and “doing business.” -- Dr. Michael Hammer
The key to Process Innovation is the The activities identified by experts to be
structured methodology used by a team to necessary for success in performing BPR. The
radically redesign or streamline a process. methods commonly accepted by most BPR
experts as the core of successful BPR are

In today’s ever-changing world, the only illustrated. In addition, optional activities

thing that doesn’t change is ‘change’ itself. proposed by a variety of management

In a world increasingly driven by the three consulting firms who have had success
assisting their clients with BPR are also
Cs:Customer, Competition and Change,
included. These methods, procedures, and
companies are on the lookout for new
tasks are identified to help organizations
solutions for their business problems.
decide how they should perform BPR to meet
Recently, some of the more successful
the unique needs of their industry, people, and
business corporations in the world seem to
culture.
have hit upon an incredible solution:
"Reengineering is new, and it has to be
Business Process Reengineering (BPR).
done." -- Peter F. Drucker
What is “Reengineering is the fundamental
rethinking and radical redesign of business
reengineering? processes to achieve dramatic
In 1990 and again in 1993, some definitive improvements in critical, contemporary
works were put forth by Dr. Michael Hammer, measures of performance such as cost,
James Champy, and Thomas Davenport. quality, service and speed.” The key words
Hammer, named by Business Week as one of in the preceding definition are the italicized
the four preeminent management gurus of the ones.
1990s, together with Champy, chairman of Fundamental Rethinking
CSC Index, Inc.
 Is answering
"Business Reengineering is the
• Why do we do what we do?
fundamental rethinking and radical
• Why do we do it the way we
redesign of business processes to achieve
do?
dramatic improvements in critical,
 Is challenging the status quo and on goals & end results rather than the
assumptions of the current business actions and means.
process
 start with no assumptions; no givens BPR advocates that enterprises go back to

 Ignore what is now and concentrate on the basics and reexamine their very roots. It

what should be doesn’t believe in small improvements and

 Complete departure from the old or incremental improvements. Rather it aims


at total reinvention. As for results: BPR is
 “No pain” , “no gain”
clearly not for companies who want a 10%
Radical Redesign (Latin word ‘radix’
improvement. It is for the ones that need a
meaning root)
ten-fold increase. According to Hammer and
Radical redesign means getting to the root of
Champy, the last but the most important of
things; not making superficial changes or
the four key words is the word-‘process.’
fixing with what is already in place, but
BPR focuses on processes and not on tasks,
throwing away the old and beginning with
jobs or people. It endeavors to redesign the
the new one.
strategic and value added processes that
Dramatic Outcome
transcend organizational boundaries. Two
Reengineering is not about making
methodologies comprise Process Innovation:
marginal or incremental improvements but
Process Streamlining (PS) and Business
about achieving quantum leaps in
Process Reengineering (BPR). The main
performance; not 10% but 10x
theme here to clearly differentiate between
performance improvement. To say it is
process streamlining and Business process
dramatic, its performance improvement
reengineering Process Streamlining asks,
must be 50+ achieving large and
“How well are we doing the things we do?”
significant improvement
Business Process Reengineering asks the
Process
more fundamental question, “Are we doing
It is a set of interrelated steps (sequential
the right things?” Process Streamlining is
and/or related activities) that begins with an
focused on the improvement of an overall
input or trigger and end with an outcome
business process by improving its individual
that satisfies the end user. A process should
steps. The primary goal of Process
answer the question “what” and why not
streamlining is incrementally improving an
the question “how”. There should be focus
existing process by reducing the time, process. Consider the process of students
complexity and bureaucracy of the accessing academic information (e.g.,
individual steps. Working full time for eight grades, registration information, dorm
days over two weeks, a team of six-to-eight assignments, parking information, etc.). The
members is charged with streamlining a process occurs across many organizational
process. The team’s recommendations must units. When you reengineer that process, it
be implementable in 90-to-120 days. affects the people completing the process,
Business Process Reengineering is focused the skill factors required, and the
on fundamentally rethinking and radically organizational procedures for managing
redesigning a business process to bring those people. In other words, when we
about dramatic improvements in change a process, we are also changing the
performance (Hammer & Champy, The culture of our institution. We are not looking
Reengineering Revolution). The primary for new ways to perform existing functions
goals of BPR are radical change, dramatic (i.e., substitution, or Process Streamlining);
outcomes, and transformation or we are looking for totally new processes (i.e.
replacement of an overall existing process. transformation, or BPR). The first step of a
Working full time for eight weeks, a team of BPR project is to identify or verify the
10-to-12 members is charged with mission and vision of the organization
redesigning a process to meet End Results and/or institution. Next, the Case for Action
(that is customers need and demand). Team is drafted, outlining the compelling reasons
recommendations form a blueprint of the for pursuing the project, identifying the
new process. Multiple projects result from benefits, and detailing what will happen if
the recommendations. BPR looks at the process is not changed. Sponsors, team
redesigning significant business processes members and the overall organization must
that often span organizational units rather understand why change is being undertaken.
than redesigning the actual organizational End Results are then created to outline the
units. Thus, we don’t redesign Admissions – desired outcomes of the redesign. A major
we redesign the application process. We difference between Process Innovation and
don’t redesign Personnel – we redesign the other process change approaches is that the
hiring process. We don’t redesign Accounts team is not told "how" to achieve the End
Payable – we redesign the vendor payment Results. Rather, the project sponsor crafts
End Results that paint a picture of “what” tasks that together create value for a
the outcome should “look and feel like,” and customer. In simple terms, Process is whole
“what” the process should achieve. The jobs that together create end result that
team is responsible for redesigning the benefit the customer. For example
process to meet the End Results or the final procurement is a process that comprises
outcome that the customers of the process whole jobs of procuring such as request and
need/desire to have. The project sponsor plan, specification, purchasing, paying and
agrees to accept and implement the team’s then delivering.
recommendations as long as they meet the In industrial thought these jobs are
End Results. In addition to providing a organized fragmentally in different
structured approach for transforming department based on task based thinking.
processes, the unique Process Innovation Now in reengineering; i.e. the new
methodology has additional goals and approach, these whole jobs must be
benefits. Staffs who participate gain new organized in to one process from end to end
skills and perspectives. They embrace with no fragmentation to produce
change and don’t accept the status quo. breakthrough result and this is process
Quality service and the client become thinking. Process thinking mean, simply,
priorities. Focus turns to vision and the thinking in terms of whole jobs and end
process. Staffs have tools to address future result that value to customers. Looking at
challenges. Organizations that undertake the end result through the whole jobs in the
Process innovation understand a powerful courses
methodology that can be used to change Note that this new approach of process
processes and catalyze change in the future. thinking works in the new organizational

What to reengineer? : framework such as change in jobs and


structure management and measurement
According to many in the BPR field
system and change in people's value&
reengineering should focus on processes and
beliefs and the enabling role of
not be limited to thinking about the
information technology in which
organizations. After all the organization is
transforming in value system is central
only as effective as its processes, so, what is
theme.
a process? A process is a group of related
Generally, the 3cs - customer, competition specialization) involves providing
and change have created a new world for value to customer by passing through
business. The old way of doing business, different levels and among a lot of
the principles and techniques that succeeded different parts in the organization
the business yesterday are no longer fit to (departments, work units, bureaucratic
today's business world. The Adam Smith way of dividing works among
principles of organizing job around task- individuals and working groups).
orientation-division of labor and • The existing nature of providing
specialization, with it's a lot of reforms has service to customer involves many
been made do not address the need of steps and hand offs performed by
today's challenging world of business. That different people in different
orientation of managing business departments and fragmented work
(organizing work around Adam Smith's units. But now work is organized
division of labor -Task oriented job) in around out come that creates value to
today's world of customers, competition and customers. The other issue here is that
change are obsolete. performers/case teams will perform the
How exactly is the old way of doing job together and in group which
business Adam Smith's principle, of creates value to the end user.
division of labor and specialization and
The old principles of organizing work
organizing work around task do not fit to
around task entail:
the new business world? And how could,
the other way of doing business  Breaking work into its simplest tasks and

reengineering: organizing jobs around assigning each of these to a specialist

process able to respond the reality? What within bureaucratic system (command

are the difficulty factors that couldn't be -control, traditional to hierarchical

addressed in Adam's principles, but could structure, rule based motion etc).

be possible in reengineering?  This is task-based thinking-the


The paradigm Shift is here: fragmentation of work into its simplest
• The traditional way of doing business - components and their assignment to
organizing work around task-based specialist workers.
(Adam Smith's division of labor and
• Tasks are worked fragmentally in traditional way of doing business can not
different parts of the organization respond the need of flexibility,
which create handoffs. responsiveness and customer focus and did
• No one in the organization in charge of not give dramatic improvement in

the whole process and its result. performance (cost, quality, service, speed)

• No one can be in charge of customer within the new world.

as all looks inward toward their  However, reengineering could enable

department or work unit and their boss. organization the system to be

 This nature of work organizing critically responsive, flexibility and customer

hinders the organization's focus. Organizing jobs around

responsiveness, flexibility and customer process, with its new world of work

focus. could address the need of


responsiveness, flexibility and
 The cost of bureaucracy: hinders the
customer focus.
need of flexibility and responsiveness.
 Reengineering is critical for
 Task-based thinking hinders every one in
organizations (companies) to live
the organization to think on the task that
within the new business world.
they have assigned, tend to lose sight of
Therefore, organizations must start going
the larger objective - satisfying
toward the inevitable world. There is no
customer; not customer in focus.
way, except to confront the reality, otherwise
 Even if the best employee, experts and
the other way round is facing the chance of
leader exist in the organization with best
cease to exist.
rules, efficient working procedures, the
 Now, Reengineering Become the Top
all is nothing if the process doesn't work
agenda to survive unlearn the
(if the process doesn't deliver value to
yesterday's....., but learn reengineering to
the customer).
live; the Radical departure from the
 Task based thinking hinders to
whole organizational rationale that has
focus on customer.
prevailed for most of this century and is
Therefore, even though a lot of reform has
paradigm shift.
been made within bureaucracy
“A business process is a series of steps
(decentralizations, down sizing, etc to
designed to produce a product or a service. It
reduce the costs of bureaucracy), these
includes all the activities that deliver Q. How is BPR different from what we've
particular results for a given customer done before?
(external or internal).” Processes are currently A: Note very carefully in the definition what
invisible and unnamed because people think has to change to have BPR. Many people
about the individual departments more often stop at changing how people do their jobs:
than the process with which all of them are automation is the most frequent, although
involved. So organizations that are currently some get really radical and decide that some
used to talking in terms of departments such steps don't add value. Some make some
as marketing and manufacturing must switch superficial changes to the organizational
to giving names to the processes that they do structures. These two or three items give you
such that they express the beginning and end some process redesign, but not BPR. BPR
states. These names should imply all the work requires the next three changes as well:
that gets done between the start and finish. For changing the management systems, values,
example, order fulfillment can be called order and beliefs. What has been done is lots of
to payment process. process redesign and lots of reorganization,
Talking about the importance of processes but most of it has been an attempt to find a
just as companies have organization charts, more efficient or effective way of doing
they should also have what are called what we have always valued and believed
process maps to give a picture of how work had to be done. In some rare cases, there has
flows through the company. Process been the kind of fundamental change that
mapping provides tools and a proven produces radical improvement. BPR as a
methodology for identifying the current As- buzzword calls attention to the fact that the
Is business processes and can be used to high-performance organizations are doing
provide a To-Be roadmap for reengineering things in fundamentally different ways than
the product and service business enterprise most of the rest of us, and we have to call
functions. It is the critical link that the some things into question that are deeply
reengineering team can apply to better held if we are going to catch up with them.
understand and significantly improve your That is not to say that there cannot be useful
business processes and bottom-line gains from only doing the first three, but
performance. there will not be the dramatic improvements
that BPR is famous for. For example, you
can reduce administrative costs by five or We don't even know how to measure
maybe ten percent by redesigning some of knowledge work productivity. It is not
your processes: simplifying and combining number of pages typed or keystrokes
forms, eliminating redundant jobs, or captured or letters written or purchase orders
automating data entry. But you won't reduce processed or invoices paid. It is the amount
it by 40% with these approaches. That of labor required to purchase things, approve
requires changing your beliefs about what it things, plan and schedule things, budget
means to administer something, removing things, track things. That measure of
the value of absolute autocratic control and productivity is reduced every time we add a
placing value on empowering action at new control process or management system.
lower levels, and modifying your 2) Information. The organization works on
management systems to emphasize information. Traditional management
facilitation of actions of lower managers, not information systems grew up based on two
second guess them. Then and only then can facts: Information had to be communicated
80% of the administrative reports and verbally or on paper. Some people had to
actions be removed. have detailed information about a small area
Q: What are some of the areas where we of work and others had to have big-picture
should look for new beliefs? information about the whole organization.
A: 1) Management systems. This country is In the traditional organization, no one could
experiencing a management crisis. For the handle enough information to make detailed
last two hundred years, our productivity in decisions that met the strategic goals of the
making and moving things has been going organization without a lot of direction. So
up, and that increase is what fueled the management hierarchies grew up, with the
prosperity of the 50s, 60s, and early 70s. But layers serving as filters and amplifiers of
today, 75% of the cost of goods is not in information. Today the opposite is true.
making them, but in managing information. Things are changing so fast that we don't
Fully 75% of our work force is knowledge have time for things to flow up and down.
workers. The productivity of knowledge But electronic information systems can
work is going down, not up, and that decline provide instant access to all the information
is what is fueling today's recession. needed to make strategic decisions or take
front-line action.
The modern model has to be that of the Process Mapping
orchestra, the hospital. A symphony
orchestra has as many as 350 people under Process mapping is the use of a diagram(s)
one conductor; a patient care team may have that uses graphic symbols to depict the
20 or 30 professionals working as a self- nature and flow of the steps in a process.
managed team. These systems work because Another name for this tool is "flow
everyone knows what the objective is and diagram."
has the same sheet of music, the same
At the beginning of the process mapping
patient chart, or the same bible to work
stage for a service or process an as-is
from. Give people the information they need
process chart will need to be drawn up in
and point them in the right direction.
order to assist the team and others involved
3) People. If traditional control systems are
in the process to understand how it currently
too slow and too expensive, we need to
works. The team may find it helpful to
replace them. Most high-performance
compare this as-is process chart with a
organizations have found that the most
diagram of the way the process is supposed
effective replacement is employee trust and
to work. Later, the team will develop a
empowerment. Give people the ability to
process chart of the modified process—
focus outward on customer needs and
again, to record how it actually functions. At
overall organization aims, and they will.
some point, the team may want to create an
Management is basically about the control
ideal process chart to show how ultimately
of variances. Deming's revolution in
the process could be performed. Some of the
production-floor quality was to put the tools,
benefits of using the Process Mapping
information, and authority to control
technique are that they:
variances as close to where they occur as
possible. Doing the same for knowledge
 Promote understanding of a
work not only produces better control than
process
top-down management, it is also the only
 Provide a tool for training
way to increase the productivity of
employees.
knowledge workers.
 Identify problem areas and
opportunities for process
improvement
 Depict customer-supplier Process mapping can be undertaken at
relationships different levels of detail. When developing
a process chart, consideration will need to be
Symbols used in Process Mapping given as to how it will be used and the
Conventions on the symbols that should be amount and kind of information needed by
used for charting vary on the use for which the people who will use it. This will help
they are being created and the industry in determine the level of detail to include. The
which the review is undertaken. However, three levels of detail are considered below:
the symbols that are commonly used in
process mapping have specific meanings Macro level: Senior management may not
and are connected by arrows indicating the need the amount of detail required by the
flow from one step to another: others when attempting to improve a service
Ovals indicate both the starting / process. A "big picture," or macro-level,
point and the ending point of the view of the process may be enough for their
process steps. purposes. Generally, a macro-level process
Task / Process A box represents an chart has fewer than six steps.
individual step or activity in the process.
A diamond shows a decision Mini level: The term "mini" or "midi" is
point, such as yes/no or go/no-go. used for a process chart that falls between
Each path emerging from the diamond must the big picture of the macro level and the
be lapelled with one of the possible answers. fine detail of the micro level. Typically, it
A circle indicates that a particular
focuses on only a part of the macro-level
step is connected to another page or
process chart.
part of the process chart. A letter placed in
the circle clarifies the continuation. Micro level: The BPR Team trying to
A triangle shows where an in-process
improve the way a job is done need a
measurement occurs.
Sequential flow of goods detailed depiction of process steps. The
or information between processes micro-level, or ground level, view provides a
What are the levels of Process very detailed picture of a specific portion of
mapping detail? the service process by documenting every
action and decision. It is commonly used to
chart how a particular task is performed.
Many methods for constructing process work (by regulation), or as it could work in
charts have been developed and can safely an improved service delivery situation. Here
be used, as long as the following points are are a few basic rules:
considered:
• Start with the big picture. It is best to
• Identify the right people to draw a macro-level process chart first.
develop the chart. After this big picture of the process
• Determine what is expected from has been depicted, other diagrams with
producing the process chart. increased levels of detail can be
• Identify who will use it and how. developed.

• Define the level of detail needed. • Observe the current process. A good
way to start process mapping a process
• Establish the boundaries of the
is to walk through the current process,
service process to be improved.
observing it in actual operation.
Boundaries are the starting and ending • Record the process steps observed.
points for a process chart. For example, Record the steps as they actually
process boundaries for a workshop occur in the process as it is. Write the
maintaining a vehicle might be when the steps on index cards or post-it notes. A
vehicle enters the workshop and when it different colour can be used to
passes final inspection before leaving. The represent each individual or group
boundaries determine the number of involved if that will help to understand
activities to be studied and the number of and depict the flow more accurately.
people involved in the process, functionally • Arrange the sequence of steps.
and cross-functionally. Arrange the cards or post-it notes
exactly as the steps were observed.
Successful process mapping? Using cards lets the steps be
It is vital that the chart depicts the way the rearranged without erasing and
process really works, not the way the person redrawing and prevents ideas from
compiling the chart thinks it should work. being discarded simply because it’s too
The process needs to be charted as it is. much work to redraw the diagram.
Later it can be charted as it is supposed to
• Draw the Flowchart. Depict the sequence, and how they relate to one
process exactly as it was observed, another throughout the process.
recorded, and arrange the sequence of • Opportunity Flowchart: An
steps. Technology has made the Opportunity Process Chart is a variation
drawing of process charts much easier. of the basic linear type but differentiates
Computer software is now available process activities that add value from
for PCs that make the procedure far those that add cost only.
easier and enables correction to be  Value-added steps (VA): These
made with little or no loss of time. are essential for producing the
required product or service. In
What are the types of Process Charts?
other words, the output cannot be
produced without them.
Besides the three levels of detail used to
categorize process charts, there are three  Cost-added-only steps (CAO):

main types of charts—Linear, Deployment, Although not essential for

and Opportunity. The level of detail can be producing the required product or

depicted as macro, mini, or micro for each service they may be added to a

of these types. process in anticipation of


something that might go wrong,
• Linear Process Chart: A Linear Process or because of something that has
Chart is a diagram that displays the gone wrong. For example,
sequence of work steps that make up a inspection processes might be
process. This tool can help identify instituted because of errors, or
rework and redundant or unnecessary omissions in the service that
steps within a process occurred in the past.
• Deployment Flowchart: A Deployment
A process chart will assist in understanding
Process Chart shows the actual process
the process under review and uncover ways
flow and identifies the people or groups
to improve it only if it is used to analyze
involved at each step. Horizontal lines
what is happening. When a clear picture of
define customer-supplier relationships.
the current process is obtained then
This type of chart shows where the
decisions can be made.
people or groups fit into the process
Having identified and mapped the processes, • Select subject area- the entry
deciding which ones need to be reengineered point
and in what order is the million-dollar • Assess the current state of the
question. No company can take up the organization
unenviable task of reengineering all the • Explain the need for change
processes simultaneously. Generally they
• Illustrate the desired state
make there choices based on three criteria:-
• Create a communications
dysfunction: which processes are functioning
campaign for change
the worst?; importance: which are the most
The first step is to take a long, hard look at
critical and influential in terms of customer
how the organization operates. The focus of
satisfaction; feasibility: which are the
this examination is on the operating
processes that are most likely to be
procedures and the bottom-line results that are
successfully reengineered.
generated by them. The purpose of performing
Common Steps when Performing BPR
the analysis described below is to determine
Phases Required For Successful BPR: whether dramatic change by doing BPR is
1: planning phase really necessary. It may be that only marginal
• Begin Organizational Change change (the result of Continuous Process
• Build the Reengineering Organization Improvements, Total Quality Management,
• Identify BPR Opportunities and other similar programs) is needed -- which
2: Understand the Existing Process would expose the change initiative and the
3: Reengineer (Redesigning) the Process organization to much less risk.

• Blueprint the New Business System Aspects of the business that need to be

4: Implementation Phase evaluated are: how things are currently

• Perform the Transformation done, what changes may be occurring, and


what new circumstances exist in our
1. Planning phase
business environment. Next, a look at how
1.1 Begin Organizational Change
certain operating procedures within the
Activities:
organization have caused or will cause
• Understanding top level
irreparable damage to the organization’s
commitment
livelihood. What is the source of the
organization’s concern? Maybe the demands
of the marketplace are shifting. Perhaps confusion and uncertainty about the future can
competitors have made significant result in resistance strong enough to stop any
advancements in products and services. reengineering effort. BPR is most effective
Regardless of the reasons, it should be clear when everyone understands the need for

whether or not the organization, in its change, and works together to tear down old

current state, is able to meet the needs of the business systems and build new ones.

markets it serves. The consequences of In order for change to be embraced, everyone


must understand where the organization is
inaction should be identified and well
today, why the organization needs to change,
understood. In most cases, these
and where the organization needs to be in
consequences are the loss of jobs by shutting
order to survive.
down portions of the business, or perhaps
1.2 Build the Reengineering
the entire business. Finally, the proper future
Organization
direction of the organization should be
Activities:
decided. The future "vision" of how the
• Establish a BPR organizational structure
business must operate will serve as a clear
• Establish BPR governance
and concise guide with measurable goals for
employees to focus on. If an organization • Establish the roles for performing BPR

wishes to change the way it operates, it must • Choose the personnel who will

turn to its people to make it happen. People reengineer (Prepare TOR)


are the agents of change. Creating business An infrastructure must be established to

plans and strategies are important, but they support reengineering efforts. Although this

are only tools to guide the actions of people. phase consists of only a few tasks, it has a

Because BPR can potentially require tremendous impact on the success of a BPR

significant changes throughout an endeavor. Who are the people that will be

organization, it must begin with a chartered to reengineer the business? What

communications campaign to educate all those will their responsibilities be? Who will they

who will be impacted by this change. report to? These are the questions that must be

Communication to all levels of personnel must answered as the reengineering staff is gathered

remain active from start to finish to keep together to communicate, motivate, persuade,

everyone involved and working towards a educate, destroy, create, rebuild, and

common goal. Without a common implement. One of the most important

understanding about what is happening, members of the reengineering effort is the


executive leader (sponsor). The leader must be This qualification plays an important role in
a high-level executive (the Minister, Director, reducing the resistance by company personnel
executive manager etc) who has the authority to the new process.
to make people listen, and the motivational In some BPR initiatives it is helpful to
power to make people follow. Without the institute a steering committee. Especially in
commitment of substantial time and effort larger or multiple reengineering projects, a
from executive-level management, most BPR steering committee can control the chaos by
projects cannot overcome the internal forces developing an overall reengineering strategy
against them and will never reach and monitoring its progress. Besides, this it is
implementation. important to establish additional committee
A process owner is responsible for a specific and/or team that reduces the burden of the
process and the reengineering effort focused steering committee and also helps
on it. There should be a process owner for reengineering team in their day to day
each high-level process being reengineered. operation.
Allocating the responsibility of a process to a Lastly, a reengineering specialist can be an
specific person ensures that someone is in invaluable addition to the overall effort. A
charge of how that process performs. Process reengineering specialist can assist each of the
owners are usually appointed by the executive reengineering teams by providing tools,
leader. techniques, and methods to help them with
The process owner convenes a reengineering their reengineering tasks.
team to actually reengineer his or her process. 1.3.Identify BPR Opportunities
The team dedicated to the reengineering of a
Activities:
specific process should be made up of current
• Identify the core/high-level processes
insiders, who perform the current process and
(identification of core and support
are aware of its strengths and weaknesses,
processes that help to achieve the
along with outsiders who can provide
mission and vision of the sector)
objective input to spark creative ideas for
redesign. The team should be small, usually • Recognize potential change enablers
five to ten people. Since they will be the ones
• Gather performance metrics within the
who diagnose the existing process, and
organization
oversee the redesign and implementation, they
should be credible in their respective areas. • Gather performance metrics outside
the organization
• Select processes that should be In many cases, seeing the organization from
the customer’s point of view can help identify
reengineered
what these high-level processes might be. For
• Prioritize selected processes
example, when Texas Instruments outlined
• Evaluate pre-existing business their major processes for their semiconductor

strategies business, they came up with only six processes


as follows: Strategy Development, Product
• Consult with customers for their
Development, Customer Design and Support,
desires
Order Fulfillment, Manufacturing Capability
• Determine customer's actual needs Development, and Customer
Communications. Each of these processes
• Formulate new process performance
converts inputs into outputs. At this point, it is
objectives
helpful to begin thinking about potential
• Establish key process characteristics
change levers which may lead to dramatic

• Identify potential barriers to changes in the organization’s processes.


Change levers usually will fall under one of
implementation
three categories: the use of information, the
In this phase, we begin to break away from
use of information technology, and human
normal patterns of identifying business
factors. What new information is available and
opportunities. We start by dividing the entire
easily accessible to the organization? What
organization into high-level processes rather
new technologies have recently been
than the usual vertical business areas such as
introduced, or are on the horizon, that can
marketing, production, finance, etc. These
change how businesses and customers
processes, usually less than a dozen, are the
interact? What new ways of structuring cross-
major or core processes of the organization.
functional work teams, compensation systems,
This activity is not a time consuming task, but
and incentive methods have proven to be
it is difficult because it requires a shift in how
effective in improving operations within other
we think of ourselves. One goal here is to
organizations? In many instances, a
identify the process boundaries (where the
modification in one of these areas requires
process begins and where it ends), which will
changes in the other two areas to be the most
help set the project scope for those processes
effective.
that are to be reengineered.
Once the major processes have been defined, guides us in scheduling the order we will
we need to decide which of our high-level reengineer these processes.
processes needs to be reengineered. The most Going after the highest priority process first,
objective and accurate way is to compare the we assess the preexisting business strategy
performance of our high-level processes, which governed its component tasks. Most
identified earlier, with the performance of our likely, this existing business strategy is not
competitors as well as organizations outside of focused on driving a process; therefore, we
our organization. Even if we outperform our will have to define a new process strategy to
direct competition, there may be companies in reflect our new strategic goals for the process.
other industries which may be much more Process customers are an important source of
effective in performing a similar task -- such information to help set the new direction. We
as order fulfillment or product development. If must consult with them to not only discover
we fulfill orders in six months, while a their desires, but also to find out what they
competitor fulfills orders in two weeks, we actually need by watching what they do with
may consider this a process that needs to be our output. Process goals and objectives can
reengineered. What we are looking for here be determined by combining customer needs
are overall, bottom-line performance metrics with competitor benchmarks and "best of
for the high-level processes that will help us organization/institution" practices (metrics on
select which of these processes to reengineer. the best performers of a similar process in
Typically, organizations use the following other organization). In addition to goals and
three criteria: Dysfunction (which processes objectives, we need to complete the
are the most ineffective), Importance (which conception of the new process by identifying
processes have the greatest impact on our key performance measures, key process
customers), and Feasibility (which processes characteristics, critical success factors, and
are at the moment most susceptible to potential barriers to implementation.
accomplish a successful redesign, or which 2. Understand the Existing Process (the
ones are the "low hanging fruit" as many AS-IS)
experts call them). Picking the "low hanging Activities:
fruit" can show quick success and help build • Understand why the current steps are
the much needed momentum and enthusiasm performed
at all levels of the organization. Prioritizing • Model the current process
the processes we have chosen to reengineer
• Understand how technology is personnel, organizational structures,
currently used information requirements, and how
• Understand how information is technology is used. Information that should be

currently used included in the models are process inputs

• Understand the current organizational (such as task times, data requirements,

structure resources, demand, etc.) and process outputs


(such as data outputs, cost, throughput, cycle
• Compare current process with the new
time, bottlenecks, etc.).
objectives
Understanding how and why the current
Now that we know which process to
processes use information is also important.
reengineer, we need to take a look at why we
Do staff members have access to essential
currently perform the process the way we do.
information? Are some business areas wasting
Understand is a key word here. We may not
time and effort by creating duplicate
need to scrutinize every detail of how we are
information when it can be shared across
performing the process -- this effort has the
organizational boundaries? Why is technology
potential to go on indefinitely, sometimes
used to support some tasks and not others?
referred to as analysis paralysis, which can
How effective are the current interfaces? Are
weaken the momentum needed to carry the
they easy to use, or are they counter-intuitive
project all the way to implementation. What
and thus inhibit the effectiveness of current
we need to do is understand the underlying
tasks? In what way does the existing process
reasons why the existing process is carried out
take advantage of technology, and in what way
the way it is, so that we can question those
has technology imposed artificial restrictions?
assumptions during our reengineering sessions
We need to end up with an estimate of the
later on. When we have the new process
current cost, robustness, and functional value
objectives clearly defined above, we can
of each technology and information systems
measure our existing process in terms of the
currently being used.
new objectives to see where we are and how
3. Reengineer the Process (redesigning
far we have to go. Modeling the current
process is an significant part of this phase. It the To-Be process)

not only helps us to better understand the Activities:

existing process, but also helps with planning • Ensure the diversity of the

the migration from the old to the new process reengineering team

and executing the physical transformation of


• Question current operating obvious to the insider who might be too close
assumptions to the process to see this.
• Brainstorm using change levers Lastly, a technologist will provide insight as to

• Brainstorm using BPR principles how technology can be applied in new and
innovative ways. In other words, the
• Evaluate the impact of new
technologist will help to visualize how the
technologies
process can be performed outside the
• Consider the perspectives of
boundaries of the current implementation.
stakeholders
Including both outsiders and technologists on
• Use customer value as the focal
the team will help spark "out-of-box" thinking
point
(thinking creatively above and beyond the
During this phase, the actual "reengineering"
current restrictions - the walls of the box).
begins. We’ve moved from strategy and
Having developed a good understanding of
analysis phases into the redesign phase. The
how the existing processes work in the
Reengineering Team that was formed to take
previous phase, it is now necessary to question
part in the reengineering sessions should
the operating assumptions underlying the
consist of designers and implementers,
processes. Is there some (outdated) historical
including people well versed in technology.
reason why a process has been performed a
These team members should come from both
certain way? Are there customer requirements
inside and outside the existing process.
that dictate the steps in a process? Many times
The "inside" perspective may reveal
the operating assumptions can be thrown out
information about the existing process that
and new ones developed. However, it is
was not uncovered above. Having people who
important to evaluate the impact the
will be the future process owners, or those
assumptions have outside the process in
responsible for the new process, is a critical
question.
component of the Team. Including the future
The Reengineering Team is now tasked with
owners will help to ensure that the
brainstorming to create new process ideas.
reengineered process succeeds once it is
According to Hammer, brainstorming sessions
implemented.
are most successful when BPR principles are
Equally important is the "outside" perspective
considered.
of someone who will look at the process with
BPR Principles:
a "fresh eye" and raise questions about
operating assumptions that may not be
• Organize around outcomes not tasks (case Local service and decision-making to
management). Several jobs are combined respond to local conditions better. Provide
into one. Case management involves the Central coordination and processing to
use of a single manager or a small group achieve economies of
of people perform a series of tasks such as scale/scope/expertise.
the fulfillment of an order from beginning • The steps in a process are performed in a
to end. Try to have one person or group natural order; Link parallel activities
perform the whole life cycle associated instead of integrating their results.
with the provision of a service or the Perform activities in parallel. Sequential
completion of the response to an event activities occur in most projects.
Responsibilities are divided, tasks
• Work is performed where it makes the
assigned, subprojects are completed and
most sense. Work may cross
then an attempt is made to integrate the
organizational or institutional boundaries
results into the finished task/project.
boundaries. Work can be performed either
“Throwing the results over the wall” to the
by suppliers or by customers (co-
next group do not work! Coordinate using
producers). Having work done by
on-line databases, standard data formats,
outsiders may also involve risk. The
electronic mail, computer and video
company itself might be by-passed!
conferencing, Lotus Notes, etc.
• Workers make decisions; Empowerment.
• Capture information once and at the
Make decisions where the work is
source: Obvious goal. The technology to
performed. Remove the distinction
support this includes, on-line data entry,
between those that do and those that
bar-coding, OCR, imaging, EDI, databases
monitor and direct. Managers become
• Processes have multiple versions: Mass
facilitators and strategists. Flatter
production - all work is performed using
hierarchical structures with increases in
the same steps. Offices - there is a great
decision efficiency and responsiveness.
variety in the complexity of incoming jobs
Need: Tutoring systems, on-line databases,
Simple cases/jobs languish waiting for the
expert systems, Decision Support Systems
more complex cases Introduce several
(DSS
variants of the process to handle different
• Hybrid centralized/decentralized
classes of incoming work.
operations are prevalent. Use both
centralization & decentralization. Provide:
• Checks and controls are reduced; Control (between departments or functions),
the Release of Work into the Office: Two process (upstream & downstream
aspects of this principle are found useful processes and activities), and to process
in manufacturing: performers so that they know how well

• The Small Lot Concept: Small batch they are doing. Provide appropriate

sizes increase throughput and incentives (see below) Build tracking

increase accuracy. Related to JIT mechanisms for customers & managers

concept, this forces coordination • Reconciliation is minimized;

between upstream and downstream • A case manager provides a single


processes and prevents errors getting point of contact;
lost in large batches in in-trays or -- Dr. Michael Hammer
cast aside a by downstream worker.
• The Complete Kit Concept: A job
BPR Places the Customer at the Center
by Breaking down Organizational
should be submitted for processing Barriers
only when all parts of the job that Service organizations like the ministry of
Health can put their professed commitment
are required for processing are to customer satisfaction into action by
available. This simplifies the placing the customer at the center of the
reengineering process. Service workers are
process - jobs are not held up at often unable to satisfy the customer because
many different points waiting for they must follow strictly defined rules, and
they lack the authority to make exceptions
different kinds of information. Note:
or the resources to complete a transaction.
A workflow system can assist with Robert Janson points to three basic
principles that provide the foundation for
both of these concepts.
service organizations seeking to reengineer:
• Provide all the information needed to • Make the customer the starting point
perform, evaluate, and continuously for change -- by identifying customer
wants and creating the infrastructure
improve the process Digitize information to support these expectations
as soon as possible. Provide database • Design work processes in light of
organizational goals
access & external “soft” information
• Restructure to support front-line
Provide mechanisms for human performance.
communication & coordination around the 3.1Blueprint the New Business
work (e-mail, workflow, form teams, a System
coffee pot, … ) Measure performance & Activities:
provide feedback loops - at organizational • Define the new flow of work
• Model the new process steps The blueprints should also contain models of

• Model the new information the redesigned organizational structure.

requirements Instead of the traditional organization chart, a

• Document the new organizational different kind of chart is needed. This chart
will show the new process flow along with the
structure
process team members, the process owners,
• Describe the new technology
the case managers, the process facilitators.
specifications
The chart should also indicate parts of the
• Record the new personnel
organization which interact with the process
management systems (the human
personnel.
resource requirements)
In addition, detailed technology specifications
• Describe the new values and culture
required to support the new process should be
required
defined. Although minor changes, or fine
Blueprints are detailed plans required to build
tuning adjustments to the technical
something in accordance with the designer’s
configuration will probably occur during the
intentions. In BPR, blueprints must be created
implementation phase, an initial physical
to identify all the necessary details of the
description of the technologies used and their
newly reengineered business system and
physical specifications should be
ensure it will be built as intended. This phase
recommended in this phase, to set the stage for
of the project takes the reengineered process
rapid application development.
developed in the previous phase, and provides
Included in the blueprints should be the new
the details necessary to actually implement it.
management systems and values or belief
Blueprinting involves modeling the new
systems of this redesigned area of the
process flow and the information required to
business. New management strategies, along
support it. Just as we modeled the "as is"
with new performance measurements,
process and information requirements in
compensation systems, and rewards programs
Phase 2, we need to create "to be" models to
should be outlined. The reengineered process
illustrate how the workflow will be different.
may require a change in the values or belief
The information models, or data models, will
systems of the organization. The redesign may
indicate where the new process will use
require an entirely different culture, or
information that is shared across functional
atmosphere, than what is prevalent in the
areas of the business.
organization today. It is critical to have these
areas, and their responsibilities, defined as we Now we are ready to transform the
go into the implementation phase. organization. We have communicated,
strategize, analyzed, reengineered, and
4. Implementation( Perform the blueprinted our ideas for the new process. This
is where all of the previous efforts are
Transformation)
combined into an actual business system --
Activities:
something we can see and feel and use to
• Develop a migration strategy
enable our organization to meet the market
• Create a migration action plan
demands of today and tomorrow.
• Develop metrics for measuring The first step in transforming the organization
performance during implementation is to develop a plan for migrating to the new
• Involve the impacted staff process. We need a path to get from where the
• Implement in an iterative fashion organization is today, to where the
• Establish the new organizational organization wants to be. Migration strategies
structures include: a full cutover to the new process, a

• Assess current skills and capabilities phased approach, a pilot project, or creating an

of workforce entirely new business unit. An important point

• Map new tasks and skill to consider is the integration of the new
process with other processes. If only one
requirements to staff
process is reengineered, then it must interact
• Re-allocate workforce
with the other existing processes. If multiple
• Develop a training curriculum
processes are slated for reengineering, then the
• Educate staff about the new process
new process must not only integrate with
• Educate the staff about new existing processes, but also with the newly
technology used reengineered processes that will come on line
• Educate management on facilitation in the near future; therefore, the
skills implementation of the new process must be
• Decide how new technologies will flexible enough to be easily modified later on.
be introduced Successful transformation depends on
• Transition to the new technologies consciously managing behavioral as well as

• Incorporate process improvement structural change, with both sensitivity to

mechanisms employee attitudes and perceptions, and a


tough minded concern for results. BPR established to get all employees educated on
Implementation requires the reorganization, the business and, most important, on how their
retraining, and retooling of business systems jobs relate to the customer.
to support the reengineered process. An educational pyramid is an effective way to
The new process will probably require a new transfer knowledge of team building, self
organization, different in structure, skills, and mastery, and subject matter knowledge.
culture. The new management structure should System training is essential to understanding
result in the control paradigm being changed the use of new information systems and how
to the facilitation paradigm. The new process to take advantage of their capabilities. Process
team structure should result in the managed training may be needed to help employees
paradigm being changed to the empowered think beyond a linear process to a more
paradigm. Once the new structures are holistic interdependent process. Facilitation
established, we should map tasks in the training for management is critical to develop
process to functional skill levels, and their abilities to listen, allow mistakes, handle
ultimately to workers. disputes among process experts, and transition
Transforming the workforce will require an to a coach/facilitator role. Education may be
array of activities. It begins with an necessary for Total Quality Management
assessment of the current skills or capabilities (TQM), Statistical Process Control (SPC), or
of the workforce to include soft skills, Continuous Process Improvement (CPI) if
operational skills, and technical skills. This these mechanisms are designed into the new
inventory may require personal evaluations processes. Finally, a structured on-the-job
(including areas of interest), peer evaluations, training (OJT) program is instrumental in
and supervisor evaluations. Feedback should providing continuity of the new process during
be provided to all personnel to ensure periods of personnel turnover or attrition.
accuracy of current skills and interests for all As with any dramatic change, people will have
staff. Armed with the new process skill personal difficulties, to varying degrees, with
requirements and a current skills inventory, the paradigm shift that has taken place. Almost
the gaps can be assessed. Is the new process all new process implementations are
feasible with the current skill set? Which are surrounded by confusion, frustration, and
the areas to focus on to enhance personnel sometimes panic. The best transition strategy
skills to meet the requirements of the new is one that minimizes, as much as possible, the
process? An education curriculum needs to be interference caused to the overall
environment. Attempts should be made to Transitioning the information used to support
keep the new process chaos to a controlled the old process to become useful in the new
level, to maintain the focus of the process involves reducing some requirements
reengineering team and the faith of the while expanding others. Usually 30 to 40% of
employees. the old information can be discarded because
Transforming information systems to support it was administrative data needed to tie the old
the new process may involve retooling the disjointed, linear processes together. On the
hardware, software, and information needs for other hand, the old systems may have poor
the new process. One approach to this data integrity, incorrect data, or insufficient
transition could be a controlled introduction. data to support the new business needs. In
The method would ensure that each part of the these cases the data must be expanded to fill
system is operational for a segment of the the gaps in the existing data and supply the
business before going on to the next module to new information requirements of the
implement. Although the risk may be low reengineered process. The information
while the bugs in the new system are ironed blueprints help manage the development of the
out, it may be difficult to integrate the hybrid new information systems.
old/new systems in a step-wise manner. The The thoughts of management experts, the
flash cut approach is where the entire system experiences of management consulting firms,
is developed in parallel to the existing system, and the research conducted by academicians
and a complete transition occurs all at once. have resulted in the methods and procedures
This may put the organization at a higher risk outlined in this document. In order to establish
if the systems do not function properly at first, the dramatic change we are seeking, we need
but it is the more common approach due to the to dramatically increase our chances of
"all-or-nothing" nature of BPR. Most successful BPR. The phases and activities
reengineered processes function in an entirely described here must be considered, as a
different manner than existing processes; thus, minimum, when attempting to successfully
a step-wise introduction would, most likely, plan and perform Business Process
not be fully functional until all steps were Reengineering.
introduced anyway. An important reason to REENGINEERING IN THE HEALTH
justify the flash cut approach is that the SECTOR
reengineering benefits can be realized much Then the Federal Ministry of Health was on
sooner than with a controlled introduction. the way of changing the usual business of
work, which is fragmented and segmented in process. The Promotive and Preventive Sub-
process deals with all major health
different departments that are functionally
promotion and disease prevention activities.
organized in to process based. After On the other hand, the curative and
rehabilitative services sub-process addresses
extensive consultations between the FMOH,
all facility-based curative and rehabilitative
RHBs and the Ministry of Capacity services.
Building, the new BPR designs of the sector
Analysis of the existing health care delivery
are organized in 8 core processes and 5 system revealed several process-related
problems. Major problems identified include:
support processes that will create a paradigm
dysfunctional referral system, client-
shift in avoiding the fragmentation of work, unfriendly environment, delay in
management of emergency cases, neglected
task based work, poor customer focus in to
mental and rehabilitative services, ‘one-size
process based thinking and work which fits all’ type health service, long and
unjustified waiting time, centralized and
focuses on the needs and expectations of
compartmentalized intra-facility services,
customers. vertically oriented service delivery approach,
and supply-driven technical support. The
As a result, Currently the Eight core
new health care delivery process has been
processes selected for BPR include:- Health designed in a way that addresses the above
mentioned problems in a radical way. If
Care Delivery, Public Health Emergency
implemented properly, it is expected that
Management, Research and Technology dramatic improvements will be seen in the
Ethiopian health care delivery system. For
Transfer, Pharmaceutical Supply, Resource
instance, waiting time for cold admissions
Mobilization and Health Insurance, Health would decrease from 6 months to 2 weeks,
all emergency cases will receive the
and Health Related Services and Product
necessary care within 5 minutes of arrival
Regulatory Core Process Policy, planning (there will be separate gate for emergency),
and processing time for outpatient clients
and M&E core process and Health Facility
would be reduced from 16 to 2 hours.
Construction/Renovation/Infrastructure Core
An improved guideline on procedures
Process. Some details of the main core
governing the provision of medical
processes are presented as follows:- documents (sick leave, health certificate,
medical referral abroad, etc) by health
institutions has been prepared. It was decided
HEALTH CARE DELIVERY CORE-
that medical documents formerly given only
PROCESS
by government health institutions should be
given also by private health facilities.
The Health Care Delivery Core Process is
now in its final stage of re-designing. This
POLICY, PLANNING AND M&E CORE-
Core process has two sub-processes: 1)
PROCESS
Promotive and Preventive Sub-process 2)
Curative and Rehabilitative Services Sub-
The Policy, planning and M&E Core Process an integrated supportive supervision which is
is now in its final stage of re-designing. The designed to enhance performance and quality
process encompasses the three sub- by transferring knowledge through on job
processes: policy and planning sub training for less performers on the areas
processes, Enhancing efficient utilization of which they could not achieved better and for
resources and M&E sub process. The policy valid and accurate decisions and concrete
and planning sub processes starts from the evidence there will be an evaluation or
need to address health problems through operational research which solves the
integrated (harmonized) and aligned policy inherent problem that have been embedded
and planning that answers and satisfies the in the ground meaning the operational
needs and expectations of the general public research answers the why question of the
through an iterative and participatory implementation gap of the Health system.
development of policy and planning and ends The third sub process that is M&E major
up by developing the policy and planning activity of the data collection and
document for implementers. HSDP is the aggregation objective of this sub process is
health sector’s strategic plan developed using to design a system that will improve decision
the Strategic Planning and Management making at all levels of the health system
approach. RHBs, ZHDs, WorHOs, and through the utilization of complete, timely
facilities develop strategic plans every five and accurate health information. The design
years. In effect, these are localized versions of the M&E/HMIS BPR sub Process was
of the National HSDP. The contents of launched with the objective to review and
strategic plans follow the contents of national strengthen the existing HMIS at federal,
HSDP. The SPM and BSC approach regional, woreda, and health facility levels to
encourages the participation of stakeholders produce timely information for planning,
and developing consensus during the various management and efficient decision-making.
stages of the planning process. The visions, Its objective was also to standardize
goals and objectives jointly formulated (common definitions of indicators, data
through this process, and cascaded down, but collection instruments, and data processing
adapted to the realities of regions, zones and and analysis procedures), integrate
Woredas constitute the basis of the linkage (integrating data from different sources into
between the respective plans and this is an integrated channel from which all derive
explained in detail in the policy, planning their information) and simplify (collecting,
and monitoring and evaluation core analyzing, and interpreting only the
processes main document . The second sub information that is immediately relevant to
processes is designed to enhance/boost the performance improvement). The design of
performance of the implementation of the the HMIS was a consultative process with
planned activities which interpret the policy active participation of programs, Regions
in to actionable and concrete tasks that create and all stakeholders. Multiple consultations
and add value to the public, by enabling the were conducted on the selection of core set
performers to efficiently and effectively of indicators, the design and standardization
utilize the scarce resources in the most of recording and reporting formats and
decisive and relevant tasks which have value human resource requirements. The indicator
to customers and ends up with performance selection process took longer than
monitoring. The third sub processes starts anticipated as it was necessary that the need
from the data collection and aggregation of the health sector and all stakeholders was
based on the selected indicators and applies addressed and fulfilled. The HMIS reform
introduces radical changes in the way patient • Functional Early Warning System -
records are handled and health information is expansion of coverage/information base;
managed. Some of the significant changes The new system is designed to collect
include the introduction of an integrated information on diseases (information
patient/client folder. The use of integrated base which expands to the
folders is one of the innovations in reducing periphery/community level and collects
the accumulation of numerous records for the data/information from private, NGO and
same patient. Such fragmented other health facilities as well), nutrition,
recordkeeping have led providers to make various events from other sectors and
errors during diagnosis and treatment and from around the world.
hampered patient care. The new integrated • Epidemic Intelligence Service –
folder will ensure that the provider will have competent professionals to handle
the full information at hand to make the emergencies at the source, which would
appropriate decision. Moreover, the facilitate local action and yield a high
introduction by the HMIS of an alphabetized return;
master patient index makes locating re- • Health Alert Network and Epidemic
visiting patients' folders easy with improved Information Exchange (EpiX) are
access to patient’s medical records. One of considered to disseminate valuable
the primary goals of the HMIS is to ensure information at the right time to
that data is used for decision-making at the stakeholders; Robust communication and
point of collection. The HMIS introduces IT support are also considered in the new
not only the procedure but also the structure design.
for performance improvement. At all health
• A system that receives report on a
institutions, a performance monitoring team
24/7/365 basis to ensure 100% timely
will be created that will review service
and complete data flow. This in turn
achievements and addresses constraints
facilitates early detection of any unusual
monthly at facility level and quarterly at the
health events and institutionalization of
administrative structures based on selected
appropriate counter measures.
indicators and making adjustments in
operations as necessary. The HMIS has • Legal framework for coordination and
introduced an inbuilt mechanism by which collaboration as well as mandatory
reports are checked for accuracy, notification of priority diseases have
completeness and timeliness which facilities been worked out.
will assess and report on each quarter. • Flat structure, whereby workers are
empowered and can make decision has
PUBLIC HEALTH EMERGENCY been prepared,
MANAGEMENT CORE PROCESS
Since a decentralized early warning of and
Public Health Emergency Management core response to public health emergencies is the
process focuses on preparedness, alert, rapid key for effective and timely management;
detection and prompt response; capacity public health emergency management
enhancement, information and communications structures will be set up within the health
systems, structures and jobs needed to handle system at national, regional and woreda levels.
health hazards which are issues of national Epidemic-prone diseases pose serious public
importance. The major aspects of the new health threats in many parts of the country. The
design include :- prevailing problems associated with climate
change like epidemics of Meningitis, Malaria,
Rift Valley Fever and those associated with direct or indirect effect on the public health)
other natural and human made disasters like
such related services include, but not,
diarrhoeal diseases, measles, and food
intoxication/contamination are among the limited to, food services, rehabilitation
major challenges the country is facing. On top
services, environmental health and
of communicable diseases outbreaks,
nutritional emergencies due to recurrent sanitation, message services, gymnasium
drought and the vulnerability of Ethiopia to the
services and occupational safety e.t.c.
threats of pandemic Avian Influenza are major
priorities for the health sector. Rural This core process encompasses four sup
populations suffering from chronic malnutrition
processes and these are: Regulatory standard
are particularly vulnerable to any fluctuation in
food security or food price. Currently, the setting sub processes, inspection and
country is not sufficiently prepared to respond
licensing sub process, product quality
efficiently to these threats.
So that a new National Center for Public Health assessment and registration and regulatory
Emergency Management will be established
information delivery sub process. The
under the forthcoming Public Health Agency
(PHA). The mandate for this center will inspection and licensing sub process
encompass the entire cycle of emergency
incorporates four major activities/versions
management from the assessment and mapping
of health risks, to contingency planning, and these are: Inspection and licensing of
capacity building of the sector, issuance of
institutions, Health professionals and
early warning and rapid response/recovery.
traditional medical practitioners licensing
HEALTH AND HEALTH RELATED and practice inspection, food safety, hygiene
SERVICE AND PRODUCTS and environmental health inspection,
REGULATION CORE PROCESS entry/export inspection and narcotic and
Health and health related services and psychotropic substances control. Besides
products regulation core process is one of this, the product quality assessment and
the core processes identified to achieve the registration sub process also incorporates the
outcome stated as: “ public protected from following three major activities/versions:
health risks emerging from sub standard and Market authorization, clinical trial
poor quality health and health related authorization and monitoring and post
services and products” marketing surveillance. The fourth sub
When we see its scope it is only limited to processes also in compasses two versions
regulation of health services and products and these are: information development and
(medicine and medical products and other dissemination and Misuse and abuse
health related services which have either prevention information delivery. The
ultimate aim of this core process is Research under nutrition includes
undertaking the national nutrition survey to
protecting and promoting public health
identify the magnitude and distribution of
either by direct regulation through standard protein energy malnutrition, major
micronutrient deficiencies and determinants
setting, inspection and licensing and
and to develop strategies to tackle the
assuring the products quality or promoting problems. In this regard research on
micronutrients research on supplementations
the self regulatory capacity of the end
and fortification to control and prevent
Users(the public through regulatory VAD, IDD, IDA, Zinc deficiency are of
priority importance. Research to improve the
information delivery).
infants and young children and women of
RESEARCH AND TECHNOLOGY child bearing age through behavior changes,
breast feeding, complementary feeding are
TRANSFER CORE-PROCESS
also the different aspects. Improving the
Research begins with research agenda existing food processing and technology and
preparation followed by scientific and development of new food products for the
ethical review to make the research projects alleviation, control and prevention of
to satisfy priority health problems and to nutrition problems and of other diseases
keep the quality and the ethical standards to such as HIV/AIDS, diabetes mellitus,
acceptable limit. Research execution is the hypertensions, is also an important research
major undertaking which generates the area. Ensuring food hygiene, preventing
desired scientific results of the project. food contamination and harmful substances
Dissemination of research findings for for injuring human health, safeguarding the
policy and/ or community use is also an health of the people is also an important
essential duty that needs to be in place to research area. These research areas are in
maximize the utilization of any result for the line with the recent National Nutrition
benefit of the people. Strategy (NNP) set by the government and
priorities are focused accordingly.
Diseases research delivers knowledge on the
distribution, magnitude and trends of Traditional and modern medicine research is
specific health problem affecting the directed towards evaluating the safety and
community. With regard to infectious efficacy of drugs as well as investigating
disease appropriate uses of exiting drugs for new routes of administration and
treatment and vaccine for diseases development of new and improved
prevention are monitored through proper analytical methodologies. The existence of
research design to measure their impact. traditional medicine is strongly linked to the
New drugs for treating infectious diseases availability of natural products including
and improved or novel vaccines for disease plants, animals and minerals. Research on
prevention are developed through scientific traditional medicine therefore focuses on
investigation. This is very important area conservation and sustainable use of natural
because more and more microorganisms are products. One other aspect of traditional
becoming drug resistant and new diseases medicine is to generate scientific knowledge
are emerging that need to be prevented on traditionally claimed remedies and
through newly designed vaccines. development of phyto-medicines with
proved efficacy and safety. Such phyto-
medicals could be used for treatment of drug Now it is better to see the most radical one
resistant microorganisms and chronic of the sub processes that is Vaccine
diseases. The phyto-pharmaceuticals may be production technology transfer Sub-process,
added as new drugs for treatment of Technology transfer is important for
diseases. Now a days Global warming is one transferring technological methods of
of the burning issues that affect human unfinished biological products to make the
being directly or indirectly. This global production of the items possible in a country
warming is the result of man made where the method is transferred. This makes
hazardous substance that has adverse effects efficient use of resources and ensures
on human health. Environmental science is sustainable supply of the required product
the ultimate key to study health hazards of for the desired use of health care. In addition
and exposure to the environment in relation technology transfer can be made within the
to human health. Diseases like asthma, same country when a new product is
cancer, different respiratory ailments, developed in the laboratory through research
injuries, musculoskeletal disorders and other and when mass production is required to be
different occupational hazards are related to transferred to industries for mass production.
environmental pollution and unsafe working One of the major activities in this process is
conditions. In Ethiopia environmental and vaccine production technology transfer.
occupational research is not well addressed. About seven million children under the age
In Research and technology Transfer Core- of 5 die every year and 90% of these are in
process environmental and occupational developing countries. Many of the deaths
research which will be considered as one of are due to vaccine preventable diseases
the major public health problem to be which could have been avoided by the use of
addressed as a priority research undertaking. effective vaccination. Research for
developing vaccines is carried out mainly in
In addition to the above duties, through developed countries. And there are very few
technology transfer the Institute is bound to vaccine manufacturers to meet the global
produce vaccines locally for vaccine demand. This leads to shortage and high cost
preventable diseases. Research and of vaccines for use in developing countries
technology transfer core process is required where the need is very dire.
to produce research outcome that is required Oral polio, Tetanus Toxoid, and BCG
for health promotion, disease prevention and vaccines are available at relatively cheaper
control. Research on diseases, national and prices to immunize children in low income
environmental problems will provide countries. However, some vaccines like
evidence based research information or meningitis which are required for
products that enhance the capability to vaccination during disease outbreaks are
tackle the problems. Research and expensive and the supply may not be
Technology Transfer Core process, adequate or it may not be available at the
encompasses the following four sub- time of disease outbreaks. Continuous
processes: shortage and high price of the vaccines will
• Research agenda setting and result in uncontrolled transmission of
proposal review infectious diseases and increased mortality
• Research project execution and morbidity in children and adults. Local
• Research finding dissemination capacity to produce these vaccines will have
a significant contribution to minimize the
• Vaccine production and technology
impact of epidemics. Experiences of vaccine
transfer
production in Brazil, India and Cuba show from the activity based costing (ABC) of the
that this approach is feasible for developing
planned activities. It involves confirmation
countries which use vaccines for routine
mass vaccination or for control of disease of what is available for a particular year
outbreaks.
annual planning exercise and simple
FINANCIAL RESOURCE
MOBILIZATION AND HEALTH description of the gap compared to the cost
INSURANCE CORE PROCESS
of the annual plan. Here, we are putting
The Resource Mobilization and Health
strategic resource mapping and gap analysis
Insurance Core Process. is expected to
which entails resource mapping for a
address mobilization of resources from all
strategic plan and beyond as well as in-depth
sources i.e. domestic and external. Yet, the
review of sources and prospects of financing
dramatic redesign of the processes is
with formulation of strategies for mobilizing
implementation of health insurance which
resources. This is a major stepping stone for
ensure risk pooling and sharing between the
source identification and soliciting sub-
healthy and the sick and the rich and the
process.
poor. In the short term, all sources of finance
will continue to exist but in a more efficient Strategic resource mapping and
manner, while in the long-term, the new gap analysis sub-process,
design leads to their contribution to the
Gap analysis is a subsequent event after
strengthening of health insurance which will
Gap Identification of the planning process.
be the most sustainable mode of financing.
Planning process ends with a resource gap
The core process encompasses two sub-
by thematic and geographic areas for
processes and these are:
achieving target of annual planning. It is
• Strategic resource mapping and gap
very important to understand the
analysis sub-process,
complementarily and differences between
• Source Identification and soliciting gap identification and gap analysis
of financial resources sub-process. processes. Gap analysis involves receiving
the identified gap by geographic and
It is important to note that gap identification thematic areas on annual basis, classifying
has also been indicated in the planning sources of funds, digging into the prospect
process. However, in the policy, planning, of mobilizing funds from different sources
Monitoring and evaluation core process, the and producing an analytic document with
gap identification of the planning comes
suggested approaches to the different domestic trend of financing and
sources. This output is a more informative international aid architecture. This
and matured piece of document that exercise is done at the federal level.
demonstrates evidences and strategies for  Gap analysis for strategic plans:- HSDP
prospective resource mobilization. In is the health sector’s strategic plan
addition to this, this process describes developed using the Strategic Planning
strategic resource mapping. This is mapping and Management approach. Mapping of
of resources for strategic plan and MDGs. It resources and identification of gaps for a
is different from the resource mapping medium term plan will be conducted at
indicated in the policy; planning and M&E all levels of the health system following
core process in that this one is done on a the process indicated in the policy,
longer term basis and also serves as an input planning and M&E core process.
for the annual resource mapping exercise. However, analysis of medium-term
The exercise therefore, involves longer term resource gap would be done only at
resource mapping, gap analysis for MDGs Federal level since the picture of
(long-term), strategic plan and annual plan. available resources is not only clear but
However, the process that will be followed also accessible at this level.
is generic. Before describing the process, it  Mapping of resources and gap analysis
is important to describe that there are for annual plans:-Once Strategic Plans
important areas of gap analysis. are finalized; the next step is to develop
 Gap analysis for MDGs:- there are the annual plan. Annual plans show how
health related MDGs for which targets the broader objectives, priorities and
have been set for 2015. Ethiopia has set targets of the strategic plan will be
targets for reducing child mortality, translated into practical activities.
reduction of maternal mortality, and Annual plans are operational. Annual
halting and reversing of the spread of the resource mapping and gap identification
major communicable diseases. These serves as a mechanism of confirming
targets have also been costed by using medium term financing commitments of
the Marginal Budgeting for Bottlenecks stakeholders with a particular focus on
approach (MBB). Hence, resources need the year under consideration. Annual
to be mapped and analyzed based on resource mapping is done by FMOH,
RHBs, ZHDs and WorHOs. Annual requirements to make it available for use.
resource mapping and gap identification The source could be classified as domestic
is done by all levels of the health system. or external, obtained through traditional or
However, the analytic part is done at the innovative means. It involves producing
federal level for same reasons stated evidences and competing with various
above. The following are major activities sectors, countries and organization both in
of long-term resource mapping and gap country and outside the country.
analysis Identification of source of finance and
• Collect and review strategic plan soliciting is the nucleus of the core process
and long-term plan, and logically follows planning and
• List and map potential identification of gaps by category and level

stakeholders, of the health system.

• Request partners for their At the moment, the amount of financial

commitments, resource mobilized by the health sector is far


from the desired due to inadequacy of the
• Compare commitments with cost
funds as well as high transaction costs
of the long-term and strategic
associated with utilization of the available
plan,
funds which indirectly affect subsequent
• Produce the gap,
mobilization of resources.
• Collect track record of financing
by potential stakeholders, Source Identification and
• Formulate strategies of mobilizing Soliciting
funds, The source identification and soliciting sub
• Produce a comprehensive analytic process of the FRMHI core process will
report, follow a proactive strategy of resource
The first and foremost action in any effort of mobilization. This sub process will use the
mobilizing financial resources is having a identified and analyzed gap as an input. The
clear gap analysis and strategy for main activities in this sub process includes
mobilizing resources. Source identification • Identifying sources and hunting for
is the process of searching for sources of new funders through branding, and
finance and fulfilling the necessary
establishing a desk in Ethiopian satisfy the needs and expectations of
customers/stakeholders.
Mission

• Preparing project proposals Pharmaceuticals supply core process is


including readymade proposals sequential link of many sub processes.
These sub processes are grouped into four
and organized in such a way that the output
• Mobilizing financial resources from
of the first sub process is the input of the
UN agencies, Bilaterals and Global second sub process and the output of the
next sub process will be the input of the
Health Initiatives
subsequent sub process.

• Mobilizing budget from government Accordingly, the following four sub


at all levels of the health sector, by processes are identified:

preparing an evidence based • Forecasting and Capacity


proposal and letting public health Building Sub-process
• Procurement Sub-Process
facilities retain their revenues • Storage and Inventory
Management Sub-Process
PHARMACEUTICAL SUPPLY • Distribution Sub-Process
CORE- PROCESS The four sub processes have an inter linkage and
The pharmaceutical supply core process
interface ,Using the blood line MIS Process,
focus on the critical path that leads the
Agency in providing the product or service need based information is collected from health
that will leads to achievement of goals not facilities and appropriate consolidation and
actions. “The core process should answer
"what" to the customer not "How"”. Core summary report is produced by the concerned
process is most often found within the hub and forwarded to the central forecasting and
customer life cycle in an organization from
capacity building sub process. The central
the first interaction a consumer has to the
last interaction in the relationship. This life forecasting and capacity building sub process
cycle spans from the time of request to will consolidate the different requisitions
delivery of pharmaceuticals and/or related
received from hubs, consider health facility
service. In order PFSA achieve its mission
and objectives in providing product or expansion date, consumption data, unfulfilled
service to the customer, the critical path to demand of the private health sector, etc and
be re-engineered is the supply core
produce purchase request based on stock on
process. The Pharmaceutical Supply Core
Process represents key activities of hand, scheduled receipt, safety stock ,available
Planning, procurement, storage and fund, etc. Once the purchased request produced
distribution. It entails an end-to-end process
by forecasting and capacity building sub process
in order to provide product or service to
is received by the procurement sub process
appropriate procurement modality is selected pharmaceutical supply core process and delivery
and based on prior set action plan the whole of products to health facilities and assuring
procurement procedure from tender preparation rational drug use are out puts of this core
to receipt and delivery of the consignment to process.
PFSA store is carried out. Though out the
procurement sub process regular contact with
fund mobilization support process will be there
to effect payment, receipt of products, costing,
settlement of claims etc. Once quality of the
pharmaceuticals is assured and proper receiving
procedure is complete products are ready for
storage. Taking in to consideration good storage
practice indicated in the storage and distribution
guide line pharmaceuticals are put away to their
appropriate storage area. Based on distribution
plan pharmaceuticals will be delivered to major
hubs, secondary hubs or health facilities by
making use of efficient fleet scheduling so that
economy of scales is attained. At every stage of
distribution quality of pharmaceuticals will be
assured. In fact, it is always the fastest and
effective distribution and delivery schedule
option compatible with each situation which will
be considered. In coordinating the four sub
processes of the pharmaceuticals supply core
process the MIS Process will play enabling role.
The human resource and general service support
process will enhance the whole pharmaceutical
supply core process by proper recruitment,
motivation and development strategy. Moreover
relevant material and service inputs will be
fulfilled on time by this support process. In
general need based requisition from health
facilities is the major input for the

You might also like