Since the late eighties, BPR has established itself as one of the attractive radical change management option for coping and adapting to the new competitive market environment and become popular both in the public and private organisations throughout the world . Cognizant of this fact, all Ethiopian public (government owned) institutions including the public financial institutions have embarked on large-scale change projects since 2004 in which Business process re-engineering(BPR) is a central element . This research examined whether implementation of Business Process Reengineering (BPR) projects have improved operational performance of the selected case public commercial banks in Ethiopia by collecting and analyzing both quantitative and qualitative comprehensive data set, using mixed research approach through questionnaires, interviews, observations and review of secondary sources of information. The operational performance measures utilized in this study are cost reduction, speed of service delivery, service quality, customer satisfaction as well as innovation. A total of 837 (84% response rate) questionnaires were returned from respondents of the selected branches and head offices. In addition, in-depth interviews were conducted with eight senior managers of the respective banks, who were also members of their respective banks reform team and were involved in the design and implementation of BPR. The third method that was used to collect qualitative data was personal observation of the selected bank branches in order to measure the speed of service delivery and convenience of the waiting places. The researcher measured the service delivery time of selected busy bank branches for five consecutive days, for half an hour spent in each branch. This study found that the introduction of BPR in the case banks was met with mixed reactions from employees and some managers. The main achievements of BPR were: service delivery time reduced dramatically as a result of the new process redesign and introduction of information and communication technology services(introduction of e-banking); introducing a single customer contact point through employee empowerment to make all the necessary decisions at that point of contact which resulted in improving the satisfaction of employees and customers. The challenge was that resistance from employees and some managers (labelled the initiative as “Blood pressure raiser” due to their assumptions it will result in employee lay off or the change brings increased workloads for some remaining employees without compatible rewards following the new process redesign. The study also revealed that telecom infrastructure and power interruption considered as main problem areas in providing banking services efficiently and effectively through branch net workings. The researcher recommends that for a better BPR design and implementation as well as sustainability of improvement gains in the banking sector, a forum should be established to discuss and share good practices and technology in the banking sector ; establish strong change management offices to continuously assist and monitor results; and continuously involve and communicate key stakeholders in the design and implementation of change initiatives. / Business Management / D.B.L.

Since the late eighties, BPR has established itself as one of the attractive radical change management option for coping and adapting to the new competitive market environment and become popular both in the public and private organisations throughout the world . Cognizant of this fact, all Ethiopian public (government owned) institutions including the public financial institutions have embarked on large-scale change projects since 2004 in which Business process re-engineering(BPR) is a central element . This research examined whether implementation of Business Process Reengineering (BPR) projects have improved operational performance of the selected case public commercial banks in Ethiopia by collecting and analyzing both quantitative and qualitative comprehensive data set, using mixed research approach through questionnaires, interviews, observations and review of secondary sources of information. The operational performance measures utilized in this study are cost reduction, speed of service delivery, service quality, customer satisfaction as well as innovation. A total of 837 (84% response rate) questionnaires were returned from respondents of the selected branches and head offices. In addition, in-depth interviews were conducted with eight senior managers of the respective banks, who were also members of their respective banks reform team and were involved in the design and implementation of BPR. The third method that was used to collect qualitative data was personal observation of the selected bank branches in order to measure the speed of service delivery and convenience of the waiting places. The researcher measured the service delivery time of selected busy bank branches for five consecutive days, for half an hour spent in each branch. This study found that the introduction of BPR in the case banks was met with mixed reactions from employees and some managers. The main achievements of BPR were: service delivery time reduced dramatically as a result of the new process redesign and introduction of information and communication technology services(introduction of e-banking); introducing a single customer contact point through employee empowerment to make all the necessary decisions at that point of contact which resulted in improving the satisfaction of employees and customers. The challenge was that resistance from employees and some managers (labelled the initiative as “Blood pressure raiser” due to their assumptions it will result in employee lay off or the change brings increased workloads for some remaining employees without compatible rewards following the new process redesign. The study also revealed that telecom infrastructure and power interruption considered as main problem areas in providing banking services efficiently and effectively through branch net workings. The researcher recommends that for a better BPR design and implementation as well as sustainability of improvement gains in the banking sector, a forum should be established to discuss and share good practices and technology in the banking sector ; establish strong change management offices to continuously assist and monitor results; and continuously involve and communicate key stakeholders in the design and implementation of change initiatives. / Business Management / D.B.L.

The purpose of this research was to explore and describe the effectiveness of the health care reform implemented in Ethiopia in the form of Business Process Reengineering (BPR) and develop strategies to strengthen its implementation. The research was conducted in two phases. In phase I, the effectiveness of the BPR health care reform was explored and described through gathering quantitative information from health care providers (n=406) using a structured questionnaire. All public hospitals of Addis Ababa, Ethiopia which have been implementing the reform from its inception (n=5) were included. In Phase II, in-depth strategies aimed at strengthening implementation of the reform were developed. Two-rounds of Delphi study were conducted to seek the opinions of senior health policy experts (n=10) and arrive at consensus on the developed strategies. Cronbach's alpha, descriptive statistics, Chi-square, logistic regression analysis, principal component analysis, weighted median score, adjusted and standard satisfaction scores, Mann-Whitney U test, and Kruskal-Wallis test were conducted for data analysis. The BPR health care reform was able to restructure the hospitals’ departments into case teams, with the goal of adopting a “one-stop shopping” approach. However, 50% of the health care providers reported that the reform was not effective to satisfy the perceived health service needs. Limited effects were reported in favour of health care quality (48%), access (50%), efficiency (51%), sustainability (53%), and equity (61%). While poor effects were reported in patient-provider (41%) and provider-management (32%) interactions. The most important predictors that influenced implementation of the reform were financial resources (AOR=3.54, 95%CI: 1.97, 6.33), top management commitment and support (AOR=2.27, 95%CI: 1.15, 4.47), collaborative working environment (AOR=1.77, 95%CI: 1.00, 3.11), and information technology (AOR=3.15, 95%CI: 1.57, 6.32). The overall job satisfaction in the public health sectors remained poor, with only 25% job-satisfied providers engaged. Moral satisfaction (AOR=177.654, 95%CI: 59.539, 530.08), management style (AOR=4.017, 95%CI: 1.490, 10.828), workload (AOR=2.422, 95%CI: 0.925, 6.342), and task (AOR=5.491, 95%CI: 2.307, 13.069) were the most significant factors. Job satisfaction results were significantly different among the study hospitals (2 = 30.557, p < 0.001). The current health care delivery performance of the public hospitals was 60% when weighed against the World Health Organization’s health system framework which required a minimum of 80% score. However, there existed a significant difference in performance at least between two hospitals (2 = 571.902, p < 0.001). Five strategies that could disrupt the status quo and strengthen the BPR health care reform are proposed based on their strategic priority, which were: reinforce patient-centred quality of care services; foster a healthy and respectful workforce environment; efficient and accountable leadership and governance; efficient use of hospital financing; and maximize innovations and the use of health technologies. The strategies could be used to enrich the quality of health care interventions through continuous review, refinement and adjustment of the reform as required. Key words: Health care reform; Business Process Reengineering; quality; access; equity; efficiency; sustainability; job satisfaction; health system; patient-centred care; workforce; leadership and governance; hospital financing; health technologies; Ethiopia. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to explore the level of integration of health promotion and disease prevention services with the curative care provided at hospitals and health centres in Addis Ababa, and to propose recommendations that could improve such an integrated health service. A quantitative approach, using an exploratory and descriptive design was applied at 22 public health facilities in Addis Ababa followed by the Delphi technique to reach consensus on ways to improve the integration of health promotion, preventive and curative care. An integrated health service (IHS) framework was used as the conceptual framework upon which the study was based. Multistage sampling involving stratified simple random sampling was applied to select hospitals and health centres while a systematic sampling technique was used to sample patients from the outpatient and inpatient medical departments. Data was collected by means of two questionnaires from patients and health service managers, respectively, following which two Delphi rounds with experts resulted in agreement on a contextually accepted integrated framework. The findings revealed that promotive and preventive services for chronic diseases were not optimally integrated in the routine health care services of the health facilities. Most health facilities lacked skilled health professionals, adequate medication and equipment to provide a comprehensive integrated service. The study emphasized the need for health service providers to undergo a paradigm shift and additional training in order to provide a comprehensive, patient-centred, integrated health service instead of only treating patients’ complaints. To assist this approach, the study affirmed the Integrated Health Service (IHS) framework as a tool which comprehensively demonstrates the cause, effect and progression of chronic diseases and the appropriate interventions which health professionals can apply in managing diseases or their risk factors. Recommendations for effective, integrated promotive and preventive health care, included the development of guidelines, protocols and policy documents for cultivating a healthy lifestyle, adopting effective disease prevention approaches, re-designing medical school curriculums, and staffing health facilities with trained and specialized staff, capacitating health facilities with the necessary equipment, medication and supplies that would enable the provision of an integrated health care service. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this research was to explore and describe the effectiveness of the health care reform implemented in Ethiopia in the form of Business Process Reengineering (BPR) and develop strategies to strengthen its implementation. The research was conducted in two phases. In phase I, the effectiveness of the BPR health care reform was explored and described through gathering quantitative information from health care providers (n=406) using a structured questionnaire. All public hospitals of Addis Ababa, Ethiopia which have been implementing the reform from its inception (n=5) were included. In Phase II, in-depth strategies aimed at strengthening implementation of the reform were developed. Two-rounds of Delphi study were conducted to seek the opinions of senior health policy experts (n=10) and arrive at consensus on the developed strategies. Cronbach's alpha, descriptive statistics, Chi-square, logistic regression analysis, principal component analysis, weighted median score, adjusted and standard satisfaction scores, Mann-Whitney U test, and Kruskal-Wallis test were conducted for data analysis. The BPR health care reform was able to restructure the hospitals’ departments into case teams, with the goal of adopting a “one-stop shopping” approach. However, 50% of the health care providers reported that the reform was not effective to satisfy the perceived health service needs. Limited effects were reported in favour of health care quality (48%), access (50%), efficiency (51%), sustainability (53%), and equity (61%). While poor effects were reported in patient-provider (41%) and provider-management (32%) interactions. The most important predictors that influenced implementation of the reform were financial resources (AOR=3.54, 95%CI: 1.97, 6.33), top management commitment and support (AOR=2.27, 95%CI: 1.15, 4.47), collaborative working environment (AOR=1.77, 95%CI: 1.00, 3.11), and information technology (AOR=3.15, 95%CI: 1.57, 6.32). The overall job satisfaction in the public health sectors remained poor, with only 25% job-satisfied providers engaged. Moral satisfaction (AOR=177.654, 95%CI: 59.539, 530.08), management style (AOR=4.017, 95%CI: 1.490, 10.828), workload (AOR=2.422, 95%CI: 0.925, 6.342), and task (AOR=5.491, 95%CI: 2.307, 13.069) were the most significant factors. Job satisfaction results were significantly different among the study hospitals (2 = 30.557, p < 0.001). The current health care delivery performance of the public hospitals was 60% when weighed against the World Health Organization’s health system framework which required a minimum of 80% score. However, there existed a significant difference in performance at least between two hospitals (2 = 571.902, p < 0.001). Five strategies that could disrupt the status quo and strengthen the BPR health care reform are proposed based on their strategic priority, which were: reinforce patient-centred quality of care services; foster a healthy and respectful workforce environment; efficient and accountable leadership and governance; efficient use of hospital financing; and maximize innovations and the use of health technologies. The strategies could be used to enrich the quality of health care interventions through continuous review, refinement and adjustment of the reform as required. Key words: Health care reform; Business Process Reengineering; quality; access; equity; efficiency; sustainability; job satisfaction; health system; patient-centred care; workforce; leadership and governance; hospital financing; health technologies; Ethiopia. / Health Studies / D. Litt. et Phil. (Health Studies)