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 youThe Impact of BPR  on Health Care Sector Efficiency

Applying on "medical equipment maintenance department"

Abd Elmoniem Ahmed El-Tohamy

Mervat Al-Samman

Mena Shaker Habib


The study was conducted to bring the attention to the importance of applying the concept of Business Process Reengineering (BPR) to healthcare, specifically , to estimate the effect of the BPR approach on the healthcare sector efficiency in Egyptian hospitals. Also, the study investigates the importance of the Reengineering on the maintenance processes which relevant to healthcare delivery system and their effects on organizational efficiency. Particularly, in the hospitals efficiency, Specifically,  in the department of medical equipment maintenance.

The main objective of the present study was to investigate the impact of applying BPR on the Egyptian hospital efficiency in in a specific way in medical equipment. The study population represented all health care professionals working in the medical equipment department in the  hospitals.

The study  depends on studying ( 21 ) hospitals in Egypt from the different types. The data covers the fields of engineering staff rather than the medical staff from.

Study sample included ( 151 ) participants . The response rate was (95.56 % ) of the total questionnaires distributed. The implementation of BPR  concept consists of  six stages were  : preparation , analysis , redesign , implementation , evaluation  & improvements .

Study results showed a significant impact of all BPR concept implementation on the hospital efficiency at (p < 0.05).

The study findings state that the approach of Business Process Reengineering can be used in supporting medical equipment department in hospitals for helping in delivering the optimal medical service efficiency. Also, the study findings were represent a great impact of BPR approach on healthcare efficiency that this concept can save cost , time & efforts .



Keywords:  Business Process Reengineering, Reengineering, organizational efficiency, Hospital Efficiency, Efficiency, Health Sector, Egyptian  Hospitals.

1- Introduction:

Business process reengineering is a complicated process of analysis, optimization and reorganization of the business processes with the aim to achieve higher rates of production and as a result profit. Business process reengineering is a difficult process which requires high experience and knowledge.

This study is about the measuring of the effect of business process reengineering (BPR) on Health care sector Efficiency and it aims to determine its impact on the health care sector performance, specially, in the field of medical equipment maintenance programs.

Otherwise, A professional businessman should involve the most talented experts to create the best model of reengineering and compose the documentation which will be the basis of the necessary changes. Business process reengineering uses all the useful and effective facilities which can process and analyze the problematic data and help managers and all the qualified design engineers of the information systems catch the most appropriate way of reorganization of the business.

Business process reengineering can be observed in two phases. First of them is the analysis which helps to understand the image of the ideal business in the chosen area .

The second phase is based on the analysis of the methods which can be used to change the existing form of the business into the ideal one. It is obvious that reengineering should be conducted without enormous expenditures, but the change should be fast and effective.

2-Literature Review :

2-1 What is reengineering?

'Reengineering is the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical, contemporary measures of performance such as cost, quality, service and speed.'

According to Hammer and Champy , the last but the most important of the four key words is the word-'process.' BPR focuses on processes and not on tasks, jobs or people. It endeavors to redesign the strategic and value added processes that transcend organizational boundaries.

2-2 What to reengineer?

According to many in the BPR field reengineering should focus on processes and not be limited to thinking about the organizations. After all the organization is only as effective as its processes  So, what is a process? 'A business process is a series of steps designed to produce a product or a service. It includes all the activities that deliver particular results for a given customer (external or internal).

So companies that are currently used to talking in terms of departments such as marketing and manufacturing must switch to giving names to the processes that they do such that they express the beginning and end states. These names should imply all the work that gets done between the start and finish.

2-3 The Conception & Evolution of BPR:

Since its conception in the 1990s, BPR has been adopted by several firms rapidly and BPR discourses have grown exponentially (Wang 2008). However, in addition to the success stories, the BPR literature shows that several BPR projects have failed to achieve the anticipated results, due primarily to difficulties meeting the demand of radical redesign that reengineering should begin with a 'clean slate' and challenge the status quo (Feller and Bentley 2001; Wang 2008).

In response to cases of BPR project failures, researchers began to question and criticize the BPR principles. In particular, it was argued that the principles forgot the human element of a business, and that the clean slate approach was unrealistic (Feller and Bentley 2001; Wang 2008).

This generated the first term which  three BPR-related conceptualizations: business process change (BPC) (Guha et al. 1997; Kettinger, Teng and Guha 1997; Grover and Kettinger 2000), business process transformation (BPT) (Grover and Markus 2008;Zwass 2008), business process management (BPM) (Alsaigh 2010; Hammer 2010; Rosemann and Brocke 2010).

Fianally, BPR comprises six core principles/concepts (Hammer and Champy 1993; Davenport and Stoddard 1994; Linden 1994).  These are:

(a) Fundamental rethinking,

(b) Radical redesign (clean slate),

(c) Business process orientation,

(d) Top-down (strategy led) management,

(e) Dramatic improvement,

(f) IT enablement.

4- Methodology :

4-1 Study problem : The problem of the study defined as:  there is a gap between the aimed performances efficiency from the medical devices maintenance department in healthcare organizations and the actual status of its performance.

4-2 Study Approach: the research approach followed in conducting the study can be positioned within the descriptive analytical approach .

The researcher will collect data and information about the phenomenon under study as it is from its sources, thus, it will be analyzed and explained with the usage of questionnaire as a tool for study.

4-3 Study field :The study will be applied in the healthcare sector only specially, in case of the most common types of Hospitals in great Cairo ,

4-4 Study society: The study field contents of staff of managers & employees and engineers whose works in contact with medical devices maintenance and preparation in Cairo hospitals.

4-5 Study population: the study population was addressed to the sector of Medical Equipment Department members :

Such as : staff of medical equipment managers, employees, engineers & technician who work  in contact with medical devices maintenance and preparations in the hospitals which belongs to the Ministry of health , University  hospitals & private  in Great Cairo governorate .

4-6 Study tools: the questionnaires were used as study tools which designed scientifically to adapt this study. Design of structured questionnaire was done, the target group involved the Medical equipment team for each hospital in the study site (greater Cairo cosmopolitan provinces ) .

So , the questionnaire was designed to survey this point with the maintenance team in hospitals who in charge to keep medical equipment working efficiently and if the normal working cycle help them for achieving this efficient performance for medical equipment or need to reengineer the working routines to achieve  more best.

4-7 Study hospital Sample:  Study sample was non randomized purposeful sample , because it was a non- randomized one .The research sample is (21) hospitals which represented the different types of hospitals   (the governmental , university & private hospitals ) which be located  in the study field in the Great Cairo.

4-8 The study site:  The research sample is (21) hospitals which represented the three types of hospitals   (the governmental , university & private hospitals ) which be located  in the study field in the Great Cairo .

organization serial Belongs to Name

Hospitals of

Ministery of health 1. General Alharam

2. Specialized inst. Inst . of Naser  

3. Specialized inst. Inst. of heart

4. Educational Almatarya

5. Educational Alsahel

6. Curative Gomhourya

7. Health insurance Sednawi


Hospitals 8. C.U. Kasr el einy (french)

9. C.U. Kasr el einy (manial )

10. A.S. Ain shams

11. A.S. Demerdash

12. MOH- HELWAN Sheikh zaid

13. HELWAN Badr

14. ALAZHAR Alhussein


Hospitals 15. Private Dar Alfouad

16. Private Saudi -German

17. Private Alsalam

18. Private Dar-assalam

19. Private Misr international

20. Private Dar alhikma

21. Private Alshrouk

Table (1): the research site

Source: prepared by the researcher.

Seven hospitals were chosen from each sector of the different types of hospitals, In order to represent the case study clearly , because seven hospitals was the sufficient number of hospitals which belongs to one of the representative hospitals from each sector to assure equal representation of each sector in the chosen sample .

4-9 Inclusion criteria :

The following participant are included in the study :

'Medical equipment team : selected  from each hospital in study site (greater Cairo cosmopolitan provinces) which working in the medical equipment department who in charge of maintenance and keep quality of medical devices, Such as:  Medical equipment department managers, Biomedical engineers, Technicians, Technician assistant and Artisan & administrator employees .

4-10 Research Sample Size :The sample size according to their locations was explained in details in the next table (2 )  :

The sector Total

Hospitals of Ministry of health 93

University Hospitals 35

Private  Hospitals 30

Total 158

Table (2) the sample size .

Source : prepared by the researcher .

Actual sample size : As mentioned in table (2) the actual size of the selected sample according to the returned data tool was reached a percentage of (95.56%) from the total selected participants to share in the data tool which was 151 participants as declared in table (3)

No of questionnaire 1 Returned back

158 151

Total actual sample    ( 151) questionnaire   :   

Percentage of accepted : (95.56%)

Table (3) Actual sample size according to the returned data tool

Source :  prepared by the researcher .

5- Testing tool consistency :

For the purpose for testing the consistency of the questionnaire in order to determine to what extent the researcher can rely on it in testing the research hypothesis and achieving the research objectives , The validity  was tested through calculating Cronbach's Alpha coefficient which the method for measuring the internal consistency for summated scale measurements such as Likert scale .

Alpha interpreted as a confidence acceptable value for the Alpha coefficient     (especially in social science) are 0.6 and above ( George and Mallery,2003).

Two dimensions questionnaire was evaluated for reliability and internal consistency . The reliability determined by Cronbach's Alpha coefficient of (0.7), the initial reading gave an average of (0.7683), then after making the modifications as suggested by the experts, the Cronbach's Alpha coefficient was reached to (0.8845) , which was better than the initial conditions .

6- The general characteristics of participants :

The percentage of 54.3% of participants were males ,and 45.7% of females  as shown in table (4),  it is meaning that the most technician in maintenance field was male  . and females mostly working in following and mentoring and paper-working in the engineering department .


Frequency Valid Percent Cumulative Percent

Valid MALE 82 54.3 54.3

FEMALE 69 45.7 100.0

Total 151 100.0

Total 151

Table(4) The sample gender

On the other hand , A percentage of 52.3% of participants were recently hired and their experience less than 5 years and they present the major ratio in the sample  ,and 42.4% of medium experience such as 6 years to 10 years that represent a moderate experience , But the experts  who has an experience more than 20 years represent only a percentage of 2% from the technical sample .Otherwise the staff who has an experience from 11 years to 20 years were represent  3.3.% from the total sample . this data mentioned statistically in table (5).


Frequency Valid Percent Cumulative Percent

Valid 1:5 79 52.3 52.3

6;10 64 42.4 94.7

11:20 5 3.3 98.0

21;35 3 2.0 100.0

Total 151 100.0

Total 151

Table(5) The sample experience levels

Moreover , A percentage of 73.5% of participants were technician , assistant technician and artisan from the total sample . while , the mangers were the least percentage of the sample that presented in 2.6% only from the total sample . in case of engineers they were represent less than 18% from the sample , the previously mentioned data according to table (6).


Frequency Valid Percent Cumulative Percent

Valid tech 111 73.5 73.5

eng 27 17.9 91.4

dept.head 9 6.0 97.4

manager 4 2.6 100.0

Total 151 100.0

Total 151

Table (6) The sample titles

While, Expert participants were take share in the questionnaire as percentage of only 1.3% , the  percentage of 56.3% of participants were  more younger  who represented in 37.1 % from the total sample .

7- The study analysis:

The  results of the respondents answers about the efficiency which can be affected by implementing the approach steps of Reengineering to test the impact of BPR on their work efficiency , The questions went in three sections, which the efficiency can effect on , the cost ,the time and the efforts .

7-1 Studying the variable (Cost):

The first variable for testing is "the cost", the respondents answered a five questions about this variable , in first place, "the combination for some process "had come by a value of mean equal to 4.653 , followed by the " the financial &technical committee for monitoring the arguments, contacts , and supplying orders" which reached a mean of 3.975  , lastly the " paperwork types " had come by a value of mean equal to 2.361.

Table (7) summarized the mean of each variable in each question.   

Process combination Paperwork Good controlling Fin.&tech. committee Maintenance shortage

N Valid 151 151 151 151 151

Missing 0 0 0 0 0

Mean 4.6538 2.3611 3.0993 3.9751 3.4371

Table ( 7) : the cost

7.2  Studying the variable (Time):

The time as a second variable for testing , the respondents were asked to answer another five questions about this variable , the disagreement was appeared in the first question which asked about " the department present a quick solution for the technical problems more over the administrative problems " , because the mean value was declined under 3 . notably , the other questions were over 3 which give a meaning of agreement such as the questions  about " centralization in decision making , a large paper cycle , the routinely work and a repeated arguments " , with values of  3.27 , 3.41 , 3.74 ,3.75  respectively , which represented the actually case of working which let them have a great desire for reengineering ; aiming for  improvement and development . Table (8) summarized the mean of each variable in each question.    

Quick solving Repeated argument Routinely work Large paperwork cycle Centralization

N Valid 151 151 151 151 151

Missing 0 0 0 0 0

Mean 2. 3658 3.2753 3.4161 3. 7431 3. 7591

Table ( 8) : the Time

7-3  Studying the variable (Efforts):

Furthermore, the third variable which the data tool asked about was " the efforts".   The five results value expressed statistically in table (9) as shown below about this variable expressing a majority agreement of the question about "the importance of IT "This is attributable to the desire of the respondents to have a benefits of technology for saving efforts according to the well-known principal of Reengineering that confirms the usage of IT for obtaining a dramatic change in work cycle. As well the respondents ensured their need for reconstructing the work cycle purposefully to save efforts expressed that by a value of mean equal to (3.36 ). Otherwise, they presented a disagreement by a mean value of (2.65 )for question one about "  a coexistence of best arrangement in work cycle " , that due to the importance of Reengineering to be implemented in this sector .   

Best arrangement Repeated data Roles overlapping Importance of IT Reconstructing  need

N Valid 151 151 151 151 151

Missing 0 0 0 0 0

Mean 2.6538 3. 3741 3.8893 4.5751 3.3611

Table ( 9) : the Efforts

Finally , as shown in table (10) , there is a general question in the questionnaire as a data tool for testing a desire of the participants about Implementing the Reengineering Approach in their field , Significantly , they showed up a large intention towards this implementing  describing this intension by a great value of answering the question by ( full agreement & agreement )  with a mean value of (4. 8818) , according to  Likert model which the data tool was designed .

The approach of Reengineering could affect the performance efficiency  

N Valid 151

Missing 0

Mean 4. 8818

Table ( 10) : The effect of Reengineering on The Performance Efficiency

8- Findings & discussion of the study variables :

8-1 The characteristics for the efficiency variable  (the cost)

In five questions asking about the sub-variable ( the time ) of the dependent variable which be ( the Efficiency ) included in the organizational characteristics for the BPR impact on the organization  , the lowest  value (2.31) was for the item  (quick solution)  and the highest mean was (3.75) for the item (centralization) , which express a highly ratio of centralization in daily works which can handicap the work series and delay the decision , thus , the process can take more time for achieving

the hospital goals that the department seeking for.

These findings clearly showed that participants (agreed) by an average value of mean equals to 3.26 about the recent variables which can the time be reduced by implementing BPR approach according to the its principals. This findings agreed with studies for (Nattapan,2010) and also  they confirmed the view of  (Migahid , 2011).

8-2 The characteristics for the efficiency variable  (the time)

In five questions asking about the sub-variable ( the time ) of the dependent variable which be ( the Efficiency ) included in the organizational characteristics for the BPR impact on the organization  , the lowest  value (2.3) was for the item  (quick solving)  and the highest mean was (3,75) for the item (centralization ) , which express a highly centralized management  for making decision,  which can increase the expended time  and  delaying the achieving for targets that the department goes through ,

Otherwise, the minimum value of mean interprets the delay solving for the problems that is raising the time .

These findings clearly showed that participants (agreed) by an average value of mean equals to 3.26 about the recent variables which can the time be reduced by implementing BPR approach .

The study findings agreed with  some previous studies as reported in literature such as ( Kassaba,2004), (Agha, 2006) & (khong , 2003).

8-3 The characteristics for the efficiency variable  (the efforts)

In five questions asking about the sub-variable ( the efforts ) of the dependent variable which be (Efficiency) included in the organizational characteristics for the BPR impact on the organization  , the lowest  value (2.6) was for the item  (arrangement)  and the highest mean was (4.56) for the item (importance of IT ) , which express a highly realization for the potentiality of this variable which can lead the department forward  , moreover saving many efforts and reducing a lot of waste efforts .

Otherwise, the minimum value of mean interprets the arrangement of the processes need to redesign seeking for reduce the wasted efforts and saving the work better without extra efforts.

These findings clearly showed that participants (agreed) by an average value of mean equals to 3.59 about the recent variables which can the efforts be decreased by implementing BPR approach according to the its principals.

The findings also identified that the arrangement of the processes should be developed and improved by redesign them using the approach of BPR foe saving the efforts and preventing others from waste efforts.

These findings agreed researchers as (Migahid,2011),(Agha, 2006),(Nattapan ,2010 ) and also the view of  (Kassaba, 2004)

9- Recommendations:

Based on the previous mentioned findings of the study, these recommendations could be derived as follow :

' The healthcare sector top management should be aware by the importance of the approach of business process reengineering and promoting this methodology for improving the healthcare providing services.

' Hospital leaders have to track their financial transactions to produce the auditable statements on a timely basis within the hospitals, to access, and consider the effect of Business Process Re-engineering and its moderating factors: integration and complexity of the system on the successful implementation of BPR. Besides they should not forget integration with medical equipment suppliers and external maintenance provider.

' It is good to look at indicators of egalitarian leadership in the organization. They can facilitate things for better employee performance. Conversely, their existence alone will never assure the desired level of employee performance. Employees are responsible and training need assessment. This is a preset to get jobs done and meet fair performance standards. Moreover, employees should be empowered. This improves employees' psychological strength and makes them confident while making decisions and performing their responsibilities in order to keep their work efficiently and keep the work goals achieved up.  

' Many scholars described BPR and related information technology issues as natural partners. The healthcare organizations; specifically, the Egyptian hospital   have to install new information system equipment and update the existing IT related accessories.

In addition, the organization have to use  a modern and an efficient communication channel that could make sure for the effective and the efficient transfer of information to respective workforces of the organization.


' The use of up to date tools of  communication channels that like e-mail, e-voice, telephone and related products may contribute hugely for a better workforce performance. The BPR projects have to be designed to establish information and communication technology and easy work and easy contact each other. therefore , it should be completed and begin its duty in time, and for simplification the maintenance procedure which now can be done cordlessly overseas.

' Finally, medical equipment maintenance team should work too much on the attitude of employees that may change intentions of resisting change related issues of the organization. In the absence of attitudinal change, it is very difficult to determine the expected level of employee performance. Modifying the related awareness training and conference are useful to change the pessimistic points of views of the labor staff against the change. Otherwise, the workforce intentions to resist changes will be aggravated.

10- Conclusion :

Accordingly . BPR is an approach to continuously raising for the efficiency of performance for all organizations, processes & services several studies have investigated the impact of BPR principals on organizational performance , many studies have found a strong and positive relationship between BPR with performance ,there is a general agreement that a successful implementation of BPR is leading to a quick and radical change .

So , BPR can improve organization according to raising its efficiency by reducing time , saving efforts and decreasing cost , as concluded in many previous studies such as ( Ozdemiri ,2010),(Kassahun.2012) .


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