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Helping Siriraj Hospitals Faculty of Medicine Achieve High Performance through the Implementation of a New SAP System

Bangkoks Siriraj University Hospital is the leading non-profit health care provider for Thailands poor and middle classes. With a total of 2,636 beds, the hospital serves 1,600,000 out-patients and 80,000 in-patients annually. The hospitals faculty of medicine is the countrys first accredited medical school and currently comprises schools of medicine, physiotherapy, medical iIIustration and audiovisual technology and transfusion medicine, as well as schools for the training of nurse anesthetists, medical science technicians, medical science technicians (radiological technology) and nurse assistants.

Business challenge
Thanks to the financial support of the Thai government and Royal Family, as well as numerous private donors, the faculty of medicine at Siriraj hospital is able to limit charges for its patients to a maximum of 30 baht (less than US$1). Indeed, the 30-baht program is the lynchpin of the non-profit organizations ability to provide high quality health care services to the countrys poor and middle class.

With Accentures help, Siriraj Hospitals Faculty of Medicine has instituted new operational processes and support systems that help it to really understand its underlying financial situation. The hospital now complies with the governments three-dimensional accounting requirement and because it knows the precise extent of its funding at any given time, the hospital can plan spending much more effectively.

Over the years, however, Siriraj hospitals finance and accounting function has come under increasing strain especially since 2000 when the Thai government mandated a move from a cash to an accrual basis for accounting standards. The change placed great strain on the hospitals in-house and largely manual system. Moreover, while costs were increasing, government financial support had stagnated and even decreased. Accentures ongoing research into the characteristics of high performance health care organizations shows that operational excellence in all core functions will be key to the delivery of the patient-centric health care model of the future. As part of a long-term project to achieve operational excellence, Siriraj hospital had initiated a pilot program to implement SAP in part of the back office for its 30-baht clinic. This pilot

SAP program, which was implemented with the help of a local vendor, was interfaced to the standalone front office system, called MedTrak. Process design problems, however, meant that the hospitals doctors had problems capturing key patient data. Separately, the hospital also knew that it needed to strengthen its internal IT capabilities in general in the interests of good corporate governance. So in 2003 Siriraj put out a tender for the services of a professional consulting firm to assess what it would take to effectively automate and improve the accuracy of the hospitals finance, accounting, HR, budgeting, purchasing and inventory management functions. Accenture won the bid because of the depth of its experience in software and systems integration and the high quality of its presentation, which included detailed responses to interview questions from individual Accenture specialists.

How Accenture helped


Working jointly with the hospitals finance and accounting, inventory and HR departments, the Accenture project team set about developing an SAP R/3 4.7 implementation on a Microsoft platform (MS Windows and SQL server) for the Faculty of Medicines finance and accounting and HR systems. At its peak, the Accenture team numbered 50 people from systems integration, solutions workforce and human performance. During the design phase, which began in September 2003, the team devised a plan for moving the hospitals manual and departmental legacy systems to an automated, on-line platform. This involved tackling a number of challengesnot least, the poor quality of data available in the legacy system. The conversion team had to spend many hours with the hospitals pharmacists, consolidating the medicine inventory. The team also had to tailor the SAP solution to comply with specific,

government-mandated requirements. These included the provision of a three-dimensional financial statementshowing the funding view, the functional area view and the accounting viewas well as ensuring a smooth transition from cash to accrual basis accounting. Historically, the hospital had operated without any kind of accounts payable or accounts receivable processes. Revenue was only recorded when cash was actually received. Indeed, the whole operation reengineering process required plenty of change management expertise as the hospital struggled to develop proper policies and the skill sets necessary to sustain them. Further complicating the migration, the team had to ensure that the standardized design and tool set used for pointto-point interfaces between the front-office and SAP back-office application worked perfectly in order to satisfy doctors demands that the solution would deliver new interface capabilities of the highest standards.

This involved simulation tests with all departments throughout the hospital. It took about one year to prepare for the implementation phase, which had to incorporate ongoing changes in government requirements, as well as cope with a change in the composition of the hospital management team. New doctor managers, who are elected to the management team every four years, meant new policiesand thus, of course, design changes in mid-project. The absence of formal written statements about processes and regulations greatly complicated the implementation process. The team had to rely on what operators could remember and since new requirements and regulations were constantly unearthed, the overall design and solution had to be continually modified. The new system for finance and accounting, material management and HR went live in April 2005, although it took another nine months before all the details were in place.

High performance delivered


With Accentures help, Siriraj Hospitals Faculty of Medicine has instituted new operational processes and support systems that help it to really understand its underlying financial situation. The hospital now complies with the governments three-dimensional accounting requirement and because it knows the precise extent of its funding at any given time, the hospital can plan spending much more effectively. There is also more accurate inventory information at department and ward level. And perhaps most importantly for Siriraj, the finance function in the 30 baht program and other clinics now runs much more smoothly. Accenture now is working with the Siriraj Hospital Faculty of Medicine to provide IT support services, as well as to train and build a new, internal IT support team all of which contribute towards Siriraj becoming a highperformance health care organization.

Copyright 2009 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture.

About Accenture
Accenture is a global management consulting, technology services and outsourcing company. Combining unparalleled experience, comprehensive capabilities across all industries and business functions, and extensive research on the worlds most successful companies, Accenture collaborates with clients to help them become high-performance businesses and governments. With approximately 177,000 people serving clients in more than 120 countries, the company generated net revenues of US$21.58 billion for the scal year ended Aug. 31, 2009. Its home page is www.accenture.com.

About Accentures Health Industry Practice


Accentures health service group provides innovative solutions to both the private and public sectors of the health care industry, including integrated health care providers, health insurers, managed care organizations and public health organizations. The company has thousands of resources dedicated to helping organizations in the health industry achieve and sustain high performance.

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