Changing hearts

Changing hearts

IT implementation is not just about technology but also about winning over people.

Recognising the poor state of IT among healthcare non-government organisations (NGOs), Lien Foundation, an NGO that specialises in

philanthropy, kickstarted an initiative to implement an enterprise

resource planning (ERP) system across 11 such agencies.

While IT remains virtually non-existent in these organisations, Lien

Foundation also knew of the prevalent attitude of resisting changes

brought by technology. Besides installing a comprehensive application,

the project team knew it had to engage and win over the hearts and

minds of people from the NGOs that include more than 750 doctors and

nurses and over 1,000 non-clinical staff.

It then embarked on an extensive change management programme to ensure

buy-in and support from personnel of all levels, from board member to

the nurse in the clinic. The success of this initiative convinced MIS

Asia's panel of expert judges to bestow upon the Singapore-based Lien Foundation an IT

Excellence Award for Best Change Management last year.

Poor state of IT

NGOs in the healthcare sector generally have fragmented IT structures

and IT adoption is somewhat poor. Many organisations do not even have

IT staff.

These agencies tend to be wary and hence resistant to changes that

technology might bring. Many of them lack technologically savvy board

members to drive adoption of IT. Also, donors supporting the NGOs tend

to prefer having the bulk of their funds directed towards

beneficiaries, instead of investment in IT.

Donors and non-profits often fail to grasp the value of technology

that could help advance their cause, increase capacity and improve

services, says Lee Poh Wah, programme director, Lien Foundation.

Even those with existing IT systems and personnel in place sometimes

fare no better. "Most of the time what we see is the fragmented IT

infrastructure; 'islands' in a way not talking to one another, while

the doctors and nurses are all bogged down with paper-based processes,

requiring a heavy amount of manual data entry," says Lee.

Repeating questions

There was little or almost no information sharing of patients'

healthcare records and history among the NGOs, he adds. Doctors have

to ask the same questions repeatedly of the same patient as he or she

visits the various NGOs.

These NGOs are often overlooked by the private and public sector as

the IT industry favours those with funds and commercially profitable

projects. Most policies and governmental efforts in IT are geared

towards the benefit of the masses, rather than NGOs with unique needs.

NGOs nowadays are operating in a tougher environment. The overall

image of NGOs in Singapore has taken a beating since the National

Kidney Foundation (NKF) fiasco. Malfeasance by the former NKF board

and management was discovered in 2005 following a failed defamation

trial. This led to public backlash and falloff in donations to the

organisation. And there was increased competition for funds among

NGOs. The new corporate governance policy set by the Charities Council

meant that NGOs had to review their operations and reporting standards

to meet the new regulations.

Each NGO constantly faces the strain of coping with growing demands as

well as battling with reduced manpower, funds and resources. Lee

estimates that the high staff turnover rate of 10 to 20 per cent

across the NGOs makes the situation of poor expertise even worse.

The answer is IngoT, a collaborative effort to build a

healthcare-specific ERP system that can be integrated across a host of


Conceived and driven by Lien Foundation, with PulseSync as its

solution architect and developer, the project helps optimise

resources, raise productivity, improve patient care, assist in

research and sharpen corporate governance, Lee says. The system is now

shared across 11 NGOs in Singapore; each operates in specialised areas

ranging from homecare and renal dialysis to hospice care and community

hospital care.

The system comprises modules for accounting, human resources

management, financial and inventory management, volunteer management,

donor management, patient administration, clinical management,

management dashboard and electronic medical records.

One of the objectives of the project is to enable member NGOs to

increase productivity, create better workflow and smoothen processes.

"There is an urgent need for resources to be well-optimised in view of

the increased competition for donor dollars as well as rising

operational costs. By optimising resources, the NGO can maximise the

results for every donor dollar spent," says Lee. To address the new

requirements by the Charities Council, higher levels of corporate

governance, transparency and accountability can be attained by using

IT to improve financial reporting and oversight.

The new system will help meet the new RAP 6 reporting and corporate

governance standards set by the Council for Charities, Lee explains.

Integrated system

With the integrated ERP system installed across the NGOs, Lee and his

team are looking to facilitate information-sharing across the

agencies. "This will enable better research and reduction of medical

errors as well as achieve higher productivity, more informed and

better decision-making and ultimately, improved care delivery to

patients," he says.

The project team first worked to overcome the IT-resistant NGOs with

Lien Foundation's incentive of bearing the bulk of IT investments for

Project IngoT. The funding helped to defray the costs typically

associated with IT projects of this kind. Each NGO was able to afford

the ERP solution as it was a fraction of what it would have cost if it

had embarked on such an exercise alone.

Agencies that are more IT savvy-HCA Hospice Care (HCA) and Home

Nursing Foundation (HNF)-are tapped to become 'examples'. The two

organisations had recently implemented a successful mobile medical

informatics solution and were keen to take on the ERP solution. With

them on board, other NGOs were also attracted to join the consortium

for running Project IngoT.

The project team met the 11 NGOs' board members and senior management

to pitch the vision and benefits of the ERP solution. The agencies'

finance and IT personnel were also approached for their feedback and

support. This way, buy-in was obtained from the top management to the

staff at the ground level.

Central to the project's success is the ability to effect change from

bottom up. The project obtained the feedback and experiences of

nurses, doctors and finance staff for the system's design and

solutions. This meant that these stakeholders were able to influence

the processes and outcome of the ERP positively.

The close participation of these stakeholders also helped them respond

to change positively. Having been involved in the design process, they

understood the project's strategic benefits and objectives. This

knowledge helped to forge a stronger acceptance of the new system.

So instead of being impeded by scepticism and resentment, the project

progressed smoothly.

Working the trenches

In formulating the processes for the IngoT project, the team adopted a

participatory approach to ensure optimal user buy-in. Medical and

finance workgroups were formed with representatives from the NGOs. The

issues and problems identified by these teams contributed to charting

the project's vision and mission, as well as ensuring that each

organisation could identify with the common objectives.

Before implementation, all the objectives and plans have to be

approved by the respective NGO's management and board members. The

project team also worked closely with the NGOs' IT personnel right

from the start of the project.

"Together, we defined the IT management strategies and what is needed

to meet the NGO's objectives. For example, in the case of these

healthcare NGOs, extra care must be taken to ensure patient data

privacy," says Lee. As patient medical records are confidential, the

access matrix and security was designed to ensure that only authorised

personnel could access such data.

To promote acceptance and ensure success, a champion and mentoring

programme was implemented. Key nodal, charismatic and influential

personnel were identified and trained specifically to be project

champions in their departments and network. "This meant that change

came from 'within', rather than top down. The 'peer pressure' and

enthusiasm for the new project was 'infectious', as these champions

and mentors led the way to embrace welcomed changes," says Lee.

Changes in stages

The project team also ensured that changes were made in stages.

Project trails of the modules were run in a test environment so as to

avoid any major reorganisation or restructuring. This also helped the

users view and experience change positively, as the benefits of the

new solution won them over. For example, they could experience for

themselves how the new system helped reduce their paperwork.

The project has since changed the way IT is being perceived and used

within the NGOs. Lee recalls the instance where a 70-year-old nurse in

HCA embraced the mobile component of IngoT and now proudly brandishes

her newfound IT expertise and PDA daily.

The tangible benefit brought by the new system is productivity, Lee

points out. "Suddenly, they cut down the reporting paperwork. Now it's

just a series of clicks. In terms of time saving, we cut down on one

third. We can provide more attention to the patient, talk to them or

see more patients," he says. After one month of deployment, the

medical and administrative personnel are saying productivity went up

by at least 15 per cent.

HNF and HCA Hospice Care have also said they are now able to see more

patients on a daily basis, from a previous average of six patients to

about seven to eight patients.

Sharing notes

The doctors and nurses from various agencies are now able to share

case notes and patients' medical history and data. The updated

information from the systems means that doctors and nurses do not need

to ask patients repeated questions about their condition or


The successes of the NGOs using IngoT have emboldened other NGOs to

also scale up. PulseSync has received enquiries from other NGOs

looking to harness IT.

The new system has also met its objective of ensuring greater

transparency and better corporate governance.

Board members are now better informed of the state of donations,

finances and expenditure through the management dashboard module,

which summarises this data at a glance.

Fund-raising drives can be better co-ordinated, as the management

dashboard module allows for a bird's eye view of all fund-raising


"To me what is more valuable is the intangible ROI [return on

investment] component. You don't have to carry two to three

kilogrammes of paper.

"Now you have a sexy, very slick PDA that you can put inside your

pocket. As and when there is a last minute appointment, you can just

pull it out and get to your patient," says Lee.

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