INTRODUCTION

Companies need to be aligned with information systems to achieve innovation, competitivity and a better position in the market. This is possible through the application of agile processes and activities that enable operational efficiency and effectiveness, which result in the acquisition of optimal information for good decision-making and continuous improvement.

This study presents the knowledge acquisition of the enterprise resource planning (ERP) systems implemented at a clinic in the city of Lima. This study also shows the way in which these systems contribute (1) to the work executed by each employee or user, since ERP is an easy and comfortable work tool for good performance of the tasks assigned, and (2) to production improvements of the clinic through information integration.

When observing and analyzing the enterprise resource planning system implemented at the clinic, it becomes evident that it enables planning each activity in an orderly manner while respecting established procedures; improves the flow of documents; and optimizes time to comply with the requirements of supervisorial bodies, such as SUNAT (Peruvian National Superintendency of Tax Administration). In this way, control of the cash process is achieved, which has an impact on the results of money collections.

ERP systems were created for companies that handle manufacturing or stock inventories; however, the novelty of this study resides in the fact that it shows that this system can also be applied to a service company. In the same way, this study will make it possible to expand knowledge of the ERP system by proposing its applicability in a company in the health services sector, which is demonstrated by processing the information provided by the users of the clinic's cash register module on the benefits from the ERP system.

According to ^{Duke, Navarro, Díaz, Pérez, and Vargas-Lombardo (2016}), “los principales retos que presentan las organizaciones hoy, es enfrentar los constantes cambios al mercado actual, con la necesidad de implementar sistemas que ayuden a la buena comunicación e integración entre las distintas áreas de una organización [the main challenges faced by the organizations these days is to face the continuous changes in the current market and the need to implement systems that help good communication and integration among the different areas of an organization]” (p. 87).

Therefore, the need arises to integrally organize activities and processes, since it is necessary for each department, division or area of every business to always maintain fluid and accurate communication. At the same time, each operational area must interact with each unit of the organization to search for improved control that enables decision-making based on correct information.

Undoubtedly, the proper functioning of the ERP system will depend on an adequate configuration, the predisposition of the personnel, as well as their experience. Given the investment cost that this type of system requires, there is no doubt that benefits will be obtained in the medium and long term. Therefore, improvements must be made on the proper processing or transfer of information so that the relevant or specialized area has the correct data; otherwise, the information provided will not be accurate.

In view of the above, the general objective was “to implement an ERP system to improve the control of cash register collections in an important clinic located in the city of Lima”. Likewise, the specific objectives were “to demonstrate that the automation of operations through the Spring ERP system/cash register module will contribute to the control of cash register collections in an important clinic located in the city of Lima”, “to corroborate that the improvement of the information process by means of the Spring ERP system/cash register module will increase the control of the cash register collections of an important clinic located in the city of Lima” and “to prove that cash counts by means of the Spring ERP system/cash register module will generate an adequate control of the cash register collections of an important clinic located in the city of Lima”.

An advantage of the ERP system is that it contributes to the fulfilment of objectives through parameterization.

As defined by ^{Suárez (2016}):

La parametrización de un ERP permite adaptar el funcionamiento del sistema a las necesidades concretas de cada empresa, así como incorporar nuevas funciones o modos de funcionamiento a medida que la empresa en cuestión lo requiere, sin requerir de desarrollos específicos o a medida del cliente [The parameterization of an ERP allows to adjust the functioning of the system to the specific needs of each company and also to incorporate new functions or modes of operation as the company in question requires it, without requiring specific or client-customized developments]. (p. 25)

METHODOLOGY

This research is applied and descriptive. It is applied because it will determine and verify the benefits of the implementation of the ERP system in a company in the health sector; and it is descriptive because it mentions the attributes of the ERP system implementation in the accounts receivable of the cash register module.

According to ^{Lozada (2014}), applied research aims to generate knowledge with direct and medium-term application in society or in the productive sector.

For ^{Hernández, Fernández and Baptista (2010})

con frecuencia, la meta del investigador consiste en describir fenómenos, situaciones, contextos y eventos; esto es, detallar como son y se manifiestan. Los estudios descriptivos buscan especificar las propiedades, las características y los perfiles de personas, grupos, comunidades, procesos, objetos o cualquier otro fenómeno que se someta a un análisis [the researcher often aims to describe phenomena, situations, contexts and events, that is, to detail what they are like and how they are shown. Descriptive studies seek to specify the properties, characteristics and profiles of people, groups, communities, processes, objects or any other phenomenon that is subjected to analysis]. (p. 80)

As for the research design, it is non-experimental since the variable, the object of study, will not be manipulated.

Data collection instruments such as interviews and surveys were applied to the users of the Spring ERP system/cash register module.

In the case of the interviews, performance measurements and comparisons were applied to the Spring ERP system and the Msante system to determine the number of patients that a user could attend to in each case and thus determine the improvement with the ERP system.

In the case of the surveys, the benefits of implementing the Spring ERP system/cash register module were tested, corroborated, and demonstrated.

RESULTS

The following Tables and Figures represent the results obtained from the fieldwork of the independent variable applied to the universe of fifteen users of the cash register module, through interviews and surveys.

The unit of measurement used was the time (minutes) required by both the Spring ERP system and the Msante system to attend to a patient.

Also, to determine the number of patient services supported by each system, the answers obtained from the users interviewed were averaged. For example, in question 1 of the interview, the following was stated: “Has the Spring ERP system improved operations by reducing or eliminating manual work? How much time did you spend per patient in each system?”

Thus, the time needed per patient in each system was determined, which is reflected in Table 1:

It must be considered that an hour equals sixty minutes; therefore:

Spring = 60/3.75 = 16 patients per hour

Msante = 60/22.50 = 2.66 patients per hour

Man-hours during the week are also included, which are 12 work hours from Monday to Saturday. Sundays were not considered since they are not working days.

After applying these calculations, the following results are obtained:

Total hours spent per cashier/user in a day = 12 hours

Total working days = 26 days

Total hours worked in a month (26 days x 12 hours) = 312 hours

Table 2 details the degree of efficiency according to the time it takes a user to run each system when attending to a patient; first, it shows the minutes it takes per patient, then, the number of patients attended per hour and per month.

The calculation per month is obtained after the following procedure:

Spring = 16 patients x 312 hours = 4992 patients.

Msante = 2.66 patients x 312 hours = 830 patients.

Figura 1 shows the results of monthly services per user and per system. The current Spring ERP/cash register module shows an improvement in the work per cashier, since it increases its monthly throughput by more than 4000 patients, while the Msante system only allowed up to 830 patients per user.

The comparison shows a percentage increase of 501.45%.

Based on interviews conducted, Table 3 shows the efficiency based on the time a user spent working in each system by examining the collection capacity per patient in minutes, hours, and month.

Figure 2 shows the throughput in the number of patients served that each system could offer per cashier in the cash register collection task. The ERP system improves the monthly service capacity by serving up to 6808 patients, while the previous system supported up to 2203 patients, which translates into a percentage increase of 209.03%, as detailed below:

Likewise, when asked how this ERP system contributed to the control, the following results were obtained from the most experienced users, who established nine benefits of this system Figura 3:

The dependent variable was also analyzed to measure the productivity of each computer program, selecting four users of the cash module with knowledge of both systems and who remained in the clinic after the activation of the new system.

According to ^{Argota and Argota (2018}) “La prueba t-Student es una de las más utilizadas para la comparación de dos muestras en diferentes escenarios de interés [The t-Student test is one of the most commonly used tests to compare two samples in different scenarios of interest]” (p. 2).

The scenarios were determined based on the general hypothesis “The implementation of an ERP system improves the control of the cash register collections in an important clinic located in the city of Lima”.

The hypothesis was tested by means of the t-Student test; the minutes spent in serving each patient were examined before and after the implementation, as shown in Table 4:

Where:

H₀ = µd ≤ 0

H₁ = µd > 0

After denoting:

H₀ = Does not improve the control of cash register collections.

H₁ = Improves the control of cash register collections.

Also:

If p-value < α → H₀ is rejected.

If p-value ≥ α → H₀ is accepted.

Based on the information in Table 4, the following results of the hypothesis testing analysis are obtained:

Calculation of the mean: d = 18.75

Users: n = 4

Degree of freedom: df = (n-1) = 3

Standard deviation: Sd = (𝑑1−𝑑)^2/𝑛−1 = 9.53502316

Test statistic: t = d Sd/√n = 3.93286931

Critical value: t(1-α)(n-1) = 2.35336343

Significance level: α = 0.05 → 5%

p-value: 0.01463716

Decision: The null hypothesis must not be used.

After analyzing the hypothesis test, it was verified that the test statistic is greater than the critical value and the p-value result is less than the α value; therefore, the null hypothesis (H₀) is rejected, and the alternative hypothesis (H₁) is accepted. In addition, it was observed that the mean is 18.75, so the skewness is to the right.

Moreover, other types of analysis were taken in order to demonstrate the hypotheses, in which post-implementation improvements were corroborated by means of surveys conducted with ERP system/cash register module users, who gave positive responses regarding the implementation.

Measurement scales were established to determine the degree of acceptability; the results are shown in Table 5:

The general hypothesis was tested through surveys applied to 11 users of the cash register module. This test obtained an average score of 49 points out of 55, representing 89%, which showed that the implementation of the ERP system in the clinic is acceptable, as shown in Figure 4:

Additionally, to determine its degree of acceptability, the three specific hypotheses with their respective indicators were contrasted.

The first specific hypothesis elaborated was “The automation of operations by means of the Spring ERP system/cash register module will contribute to the control of cash register collections in an important clinic located in the city of Lima”.

Eight indicators were established; the acceptability measure of each one exceeded 80%, which resulted in the first specific hypothesis being accepted, as shown in Figure 5:

The second specific hypothesis elaborated was “The improvement of the information process by means of the Spring ERP system/cash module will increase the control of cash collections in an important clinic located in the city of Lima”.

Six indicators were established; the acceptability measure of each one exceeded 80%, which resulted in the second specific hypothesis being accepted, as shown in Figure 6:

The third specific hypothesis elaborated was “The cash counts by means of the Spring ERP system/cash register module will generate an adequate control of cash register collections in an important clinic located in the city of Lima”.

Ten indicators were established; the acceptance measure of each one exceeded 80%, which resulted in the third specific hypothesis being accepted, as shown in Figure 7:

DISCUSSION

Once the results of this research, obtained from field work through surveys and interviews, have been presented, it is corroborated that the implementation of an ERP system for the improvement of control has been successful, which is reflected in the degree of acceptability.

Undoubtedly, the use of the ERP system has resulted in significant changes in the clinic, since improvements were observed in maximizing productivity and a better support and service platform.

The automation, the improvement or ordering of the information processes and the various cash register reports for an adequate cash count have improved control and have been pleasantly received by the cash register users, since they have shown that the attention times have reduced, and users are able to complete their work at the established time.

CONCLUSIONS

The implementation of an ERP system in the clinic has given the expected results, as it has been demonstrated, since it improves aspects not only related to cash register collection control, but related to service times per patient, activities, and processes, since it is a system adaptable to the environment.

The implementation of the ERP system in the clinic has allowed to discover that this system offers a capacity or support platform for the maximum use of resources, since it is possible to optimize time and enhance the operation of users.

The automation of activities through the Spring ERP/cash register module has proven to be user-friendly, allowing users to perform their tasks without difficulty, facilitating the issuance of payment vouchers and currency conversion and contributing to the accuracy of collections; it also provides information on the availability of doctors and offices and enables the reservation and payment collection of medical appointments not booked on time.

The improvement of the information process through the Spring ERP system/cash register module makes it possible that the issuance of credit notes by supervisors does not hinder the work of the users; it has made it possible to avoid incidents with the accounting area; it makes it easier to transfer the documentation of a debt, or credit collection, to the credit and collection area; and it leaves evidence of transaction rebates.

The Spring ERP system/cash register module allows a better functioning of the progress of collections, since it allows the identification of the collected amount according to the payment method; it allows the correction of payment methods without difficulty; it facilitates the collection transactions by type of currency; it facilitates the cash supervision; and it allows that a reconciliation and presentation report is generated at cash closing. In addition, this system has contributed to improved cash reconciliation since it allows to adjust and correct payment methods. As for the issuance of the reconciliation reports, the system makes it possible to know the total collected by payment method, to adequately support each operation and to print vouchers that were not printed at the time of issuance.