Towards an organisation-wide process-oriented organisation of care: A literature review (original) (raw)
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Hospital-wide Process-oriented Organization of Care: The Case of Turku University Central Hospital
J. Inf. Technol. Theory Appl., 2018
In reaction to the productivity challenges that hospitals around the world have faced, some hospitals have begun to move towards a process-oriented organization of care in order to enhance productivity. Existing research on processoriented organization emphasizes severe challenges along the implementation process. However, the literature contains only a small number of documented cases of hospital-wide process-oriented reorganization. Against this background, in this case study, we explain how hospitals can successfully implement organization-wide process orientation. To do so, we conducted an exploratory single case study with semi-structured, face-to-face interviews and document analyses as our primary data-collection methods. We developed a theoretical framework of antecedents, interventions, enablers, barriers, and consequences that explain the trajectory of this successful hospitalreorganization project. We contribute a substantive theory on which other researchers can build and can extend in future studies. Further, in analyzing our unique case, we identify factors that the extant literature has not yet discussed, such as the blackboxing of diagnosis and treatment activities as an enabler. In line with existing literature, we also found that, even in this case, inflexible healthcare IT represented a barrier that hindered the case study in implementing process orientation.
Managing a changing health care environment: aligning hospital processes to the nature of care
2015
CONTEXT Hospitals worldwide face challenging times and are consistently under pressure to control costs and improve quality of care. Research into improving health care should deal with seeking and defining the best methods of organizing and delivering services. In health care, there are two types care processes: sequential (the process is an orderly sequence of steps) and iterative (being composed of multiple cycles of hypothesis propositions and testing, where each cycle builds upon previous ones). These are very different, but both types could benefit if their organization were aligned with a tailored configuration of the operating system adjusted to the specific characteristics of both types of processes. The main purpose of this dissertation is to assess how the design of the operating system impacts efficiency in hospitals. In this dissertation we focus specifically on the sequential care process. METHODS The first part (chapter 2), presents a systematic literature review of t...
Process management in healthcare: investigating why it's easier said than done
Journal of Manufacturing Technology Management, 2010
Purpose -The purpose of this paper is to investigate what happens when a new management idea with manufacturing origin is implemented in a healthcare organization. In this paper, it is focussed on process management: what happens when the processes are highlighted, process owners are appointed and more power is allocated to the process dimension of the organization. Design/methodology/approach -The paper uses the case of a hospital group in Sweden to investigate difficulties in implementing process management. The studied hospital group has been involved in systematic fundamental change to the system for nearly a decade. The research project was conducted using a collaborative management research approach in which academic researchers worked together with the development director. Findings -The paper shows that the organization itself in many ways becomes an obstacle to the achievement of a process-oriented management style. In the empirical story, voices from the healthcare staff reveal conflicts over organizing principles and structures such as budgeting and reimbursement systems -systems obviously built on a more functional view from an organizational perspective. It is not completely evident that the two alternative perspectives are able to co-exist easily -managing them seems to be an advanced balancing act. Originality/value -The paper provides an illustration of knowledge transfer from manufacturing to service industries. It focuses on the meeting between a Swedish healthcare organization and the idea of process management.
Transition to hospital process orientation: the case of regional hospitals in Latvia
Journal of Hospital Administration, 2015
Management of processes instead of functions has growing importance into the health care. Transition to hospital process orientation (HPO) changes the way physicians and other health professionals have used to practice before. Study was performed to explore factors affecting introduction of HPO in Latvian hospitals responding to significant external pressures during the years of economic crisis to detect the best practices used for process management implementation in clinical setting. To reach the research goal dissimilarities between current performance and management of hospitals were explored. As changes in hospital reimbursement system demand improved efficiency, hospital's performance was measured by decrease in avoidable hospitalisations, and increase in usage of more cost effective alternatives to a full hospitalisation. A regression analysis was performed to evaluate correlations of hospitalisation rates in Latvian hospitals to various outpatient health services utilisation indicators. This was done to exclude influence of external factors on hospital performance and to prove the positive impact of HPO initiatives on hospitalisation rate. Afterward the performance of all regional hospitals was compared and the two most distinct hospitals were selected for further in depth analysis. Operational data of the selected hospitals and a set of structured interviews outlined the differences between both hospital's managerial practices and factors affecting the introduction of process oriented initiatives. The theoretical research together with comparative analysis of approaches used in both hospitals served as a basis for elaboration of recommendations towards development of HPO and facilitation of the development of self-management competence of health professionals.
Process management in healthcare. Sant Camil hospital case study.
Nowadays due to the crisis, some government measures are aimed at reducing healthcare spending, affecting in some level or another the quality offered. Process management is said to be a useful tool for reducing healthcare costs by improving management without any additional economic investment. That is doing more with the same resources and without reducing the quality offered. In this study an empirical case of a Catalan hospital is presented. Overall, the usefulness of process management in the healthcare sector is shown and some tips are provided for those managers that want to implement this management system in their hospitals. This work is also interesting for those managers responsible for the National Healthcare System due to a big question is stated: what would happen if process management was implemented in the whole healthcare system?
International Journal of Healthcare Management, 2016
Hospitals face increasing pressure to reduce costs, improve efficiency, and guarantee a quality of services. This is perhaps the main reason why hospital process orientation (HPO)a view on a hospital being a group of processes organized around patients with similar needs is a growing field of interest among hospital managers and researchers. The theoretical research of the content of hospital activities was performed in order to determine the main distinct characteristics in hospital organization that determine the specifics for a process-oriented knowledge system. A conceptual proposal of a technological tool was elaborated taking into account the limited control of hospital management over clinical process dominated by the doctor's decision-making and self-regulating activities.
Applying process management in healthcare–investigating implementation difficulties
This paper focuses on the meeting between a Swedish healthcare organization and the idea of process management. It is evident that the organization itself in many ways becomes an obstacle to the achievement of a process oriented management style. The empirical story that gives voices from the healthcare staff reveals conflicts about the organizing principle and structures such as budgeting and reimbursement systems -obviously built on a more functional view of an organization. It is not completely evident that the two alternative perspectives are easily able to co-exist, and managing seems to be an advanced balancing act.
Public Money & Management
A systematic literature review identified 41 studies, including four reviews, reporting on process redesign interventions in hospitals. Success factors for the changes included mechanisms to facilitate participation throughout the process, clearly documented protocols and expectations for the health professionals which were supported by education, mechanisms to audit and provide feedback on behaviours and performance, as well as being able to hold the participating health professionals accountable. The success of process redesign methodologies is found to be highly dependent on these performance-based human resource management (HRM) practices.
Integration and coordination in healthcare: an operations management view
Journal of Integrated Care, 2012
Purpose -The purpose of this paper is to present a definition of integration and coordination in health service production, and to derive basic design rules. Design/methodology/approach -The paper is based on an operations management perspective and applies a design science methodology to identify purposes, contexts, and design rules. Findings -Integration and coordination need to be conceptually separated, as the former means the merger of various service contributions into a common understanding, while the latter means the arrangement of service elements into processes.
Process improvement in healthcare: overall resource efficiency
Quality and Reliability Engineering International, 2011
This paper aims to develop a unifying and quantitative conceptual framework for healthcare processes from the viewpoint of process improvement. The work adapts standard models from operation management to the specifics of healthcare processes. We propose concepts for organizational modeling of healthcare processes, breaking down work into micro processes, tasks, and resources. In addition, we propose an axiological model which breaks down general performance goals into process metrics. The connexion between both types of models is made explicit as a system of metrics for process flow and resource efficiency. The conceptual models offer exemplars for practical support in process improvement efforts, suggesting to project leaders how to make a diagrammatic representation of a process, which data to gather, and how to analyze and diagnose a process's flow and resource utilization. The proposed methodology links on to process improvement methodologies such as business process reengineering, six sigma, lean thinking, theory of constraints, and total quality management. In these approaches, opportunities for process improvement are identified from a diagnosis of the process under study. By providing conceptual models and practical templates for process diagnosis, the framework relates many disconnected strands of research and application in process improvement in healthcare to the unifying pursuit of process improvement.