- 14 March, 2009 22:00
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
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.
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
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.
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
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.
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.