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Bridging the gap between documents and practice in medication management “Documents Vitalization”

Ahmed Mohamed Elsheikh (Security Forces Hospital Program Makkah, Makkah, Saudi Arabia)
Mohamed S. Emam (Security Forces Hospital Program Makkah, Makkah, Saudi Arabia)
Sultana Ali AlShareef (Security Forces Hospital Program Makkah, Makkah, Saudi Arabia)

Business Process Management Journal

ISSN: 1463-7154

Article publication date: 3 July 2017




Health care is a complex system, mandating adoption of unrelenting updates of guidelines and best practices. Securing a balanced system of current practice and matching documentation has always been a challenge due to impaired connection between traditional forms of documentation (e.g. policies, procedures, and guidelines) and users. Departmental manuals always find their way back to shelves away from the workplace, and continuous interaction with customers and complexity of business processes hinder timely update and consequently sustainable improvement. The paper aims to discuss this issue.


In late 2014, the corresponding author visited Japan as part of Kaizen benchmark tour that introduced the concepts and applications of “Kaizen,” the Japanese word for continuous improvement, in Toyota factory and health care institutes in Fukuoka, Nagoya, and Tokyo. Soon thereafter, the authors adopted Kaizen to be the organizational theme for improvement. QPS team launched several initiatives throughout 2015 to improve the quality of documentation. Documents submitted had one thing in common, all participants used flowcharts, diagrams, and even drawings to simplify hard-to-understand processes. This challenge highlighted the utilization of diagrams, well-organized forms, infographics, and other methods to simplify processes and to vitalize documents.


Since the hospital utilizes the paper-form prescribing system, prescription errors lead to delays in dispensing time, affecting patient satisfaction in emergency room’s pharmacy. Pharmacy team launched a project using document vitalization as an improvement strategy. Aggregate results showed 16.7 percent reduction in average time per prescription in inpatient pharmacy and 20.0 percent reduction in emergency room pharmacy. Although measurements did not continue over a longer period or were statistically analyzed, they provide a crude indication of possible improvement using document vitalization.

Research limitations/implications

Lack of a sound measurement system with proper statistical analysis prevented the provision of reliable evidence of improvement. Moreover, lack of previous case studies has been an obstacle. It is the authors’ plan to provide measurable evidence of improvement for multiple projects through measurement of process time, customer and employee satisfaction, the number of process errors, etc. Nevertheless, feedback from users provides a rough indication of possible improvement using document vitalization. It is the authors’ aim to incorporate “document vitalization” into the fabric of documentation process and SFHPM culture.

Practical implications

Empowerment creates an energy-filled work environment where staff members feel they are the real change factors and are actively contributing to the advancement and success of their organizations (Taylor 2013). This does not mean allowing chaos and unplanned changes to disrupt process flow but rather to leave room for trial and error in a controlled environment and pilot-testing significant changes before generalization.


The term vitalization itself is a brand new one used in this field, and the authors introduce it for the first time to be a solution that comes from frontliners and can bridge the gap between document and practice. If all document vitalization successes were a tribute to one factor, it would be “empowerment.” Once leaders have the courage to listen to frontline staff voice and allow them to do things differently, the staff members will surprise their organizations with the marvels of their creations.



The authors’ team would like to acknowledge continuous support from hospital administration – Dr Meshari Alotabi, Dr Dakhil AlSaedi, and Dr Khalid Alzahrani – for their endless support to improve work. The authors would also like to acknowledge the innovative pharmaceutical team: Dr Abdulkraim Essa “Former Director”, RPh. Saeed Jaweed, RPh. Majed Jaweed, and RPh. Samar Turkestani. The authors would like to thank Massaki Imai, Mark Graban, and Christian Wollcott for their shared experience and fruitful discussions during Japan trip and onward.


Elsheikh, A.M., Emam, M.S. and AlShareef, S.A. (2017), "Bridging the gap between documents and practice in medication management “Documents Vitalization”", Business Process Management Journal, Vol. 23 No. 4, pp. 830-841.



Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited

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