The redesign of business processes has a huge potential in terms of reducing costs and throughput times, as well as improving customer satisfaction. Despite rapid developments in the business process ...management discipline during the last decade, a comprehensive overview of the options to methodologically support a team to move from as-is process insights to to-be process alternatives is lacking. As such, no safeguard exists that a systematic exploration of the full range of redesign possibilities takes place by practitioners. Consequently, many attractive redesign possibilities remain unidentified and the improvement potential of redesign initiatives is not fulfilled. This systematic literature review establishes a comprehensive methodological framework, which serves as a catalog for process improvement use cases. The framework contains an overview of all the method options regarding the generation of process improvement ideas. This is established by identifying six key methodological decision areas, e.g. the human actors who can be invited to generate these ideas or the information that can be collected prior to this act. This framework enables practitioners to compose a well-considered method to generate process improvement ideas themselves. Based on a critical evaluation of the framework, the authors also offer recommendations that support academic researchers in grounding and improving methods for generating process improvement ideas. Next to the framework and its critical evaluation, this review investigates the research procedures of the studies that were used to create the framework. Related to this investigation, academic researchers can find additional guidance regarding procedures for building and evaluating new methods.
Rationale
While theoretical frameworks for optimization of the outpatient processes are abundant, practical step‐by‐step analyses to give leads for improvement, to forecast capacity, and to support ...decision making are sparse.
Aims and objectives
This article demonstrates how to evaluate and optimize the triad of demand, (future) capacity, and access time of the outpatient clinic using a structured six‐step method.
Methods
All individual logistical patient data of an orthopaedic outpatient clinic of one complete year were analysed using a 6‐step method to evaluate demand, supply, and access time. Trends in the data were retrospectively analysed and evaluated for potential improvements. A model for decision making was tested. Both the analysis of the method and actual results were considered as main outcomes.
Results
More than 25 000 appointments were analysed. The 6‐step method showed to be sufficient to result in valuable insights and leads for improvement. While the overall match between demand and capacity was considered adequate, the variability in capacity was much higher than in demand, thereby leading to delays in access time. Holidays and subsequent weeks showed to be of great influence for demand, capacity, and access time. Using the six‐step method, several unfavourable characteristics of the outpatient clinic were revealed and a better match between demand, supply, and access time could have been reached with only minor adjustments. Last, a clinic specific prediction and decision model for demand and capacity was made using the 6‐step method.
Conclusions
The 6‐step analysis can successfully be applied to redesign and improve the outpatient health care process. The results of the analysis showed that national holidays and variability in demand and capacity have a big influence on the outpatient clinic. Using the 6‐step method, practical improvements in outpatient logistics were easily found and leads for future decision making were contrived.
Many hospitals have taken actions to make care delivery for specific patient groups more process-oriented, but struggle with the question how to deal with process orientation at hospital level. The ...aim of this study is to report and discuss the experiences of hospitals with implementing process-oriented organisation designs in order to derive lessons for future transitions and research.
A literature review of English language articles on organisation-wide process-oriented redesigns, published between January 1998 and May 2009, was performed.
Of 329 abstracts identified, 10 articles were included in the study. These articles described process-oriented redesigns of five hospitals. Four hospitals tried to become process-oriented by the implementation of coordination measures, and one by organisational restructuring. The adoption of the coordination mechanism approach was particularly constrained by the functional structure of hospitals. Other factors that hampered the redesigns in general were the limited applicability of and unfamiliarity with process improvement techniques.
Due to the limitations of the evidence, it is not known which approach, implementation of coordination measures or organisational restructuring (with additional coordination measures), produces the best results in which situation. Therefore, more research is needed. For this research, the use of qualitative methods in addition to quantitative measures is recommended to contribute to a better understanding of preconditions and contingencies for an effective application of approaches to become process-oriented. Hospitals are advised to take the factors for failure described into account and to take suitable actions to counteract these obstacles on their way to become process-oriented organisations.
For efficient utilization of operating rooms (ORs), accurate schedules of assigned block time and sequences of patient cases need to be made. The quality of these planning tools is dependent on the ...accurate prediction of total procedure time (TPT) per case. In this paper, we attempt to improve the accuracy of TPT predictions by using linear regression models based on estimated surgeon-controlled time (eSCT) and other variables relevant to TPT. We extracted data from a Dutch benchmarking database of all surgeries performed in six academic hospitals in The Netherlands from 2012 till 2016. The final dataset consisted of 79,983 records, describing 199,772 h of total OR time. Potential predictors of TPT that were included in the subsequent analysis were eSCT, patient age, type of operation, American Society of Anesthesiologists (ASA) physical status classification, and type of anesthesia used. First, we computed the predicted TPT based on a previously described fixed ratio model for each record, multiplying eSCT by 1.33. This number is based on the research performed by van Veen-Berkx et al., which showed that 33% of SCT is generally a good approximation of anesthesia-controlled time (ACT). We then systematically tested all possible linear regression models to predict TPT using eSCT in combination with the other available independent variables. In addition, all regression models were again tested without eSCT as a predictor to predict ACT separately (which leads to TPT by adding SCT). TPT was most accurately predicted using a linear regression model based on the independent variables eSCT, type of operation, ASA classification, and type of anesthesia. This model performed significantly better than the fixed ratio model and the method of predicting ACT separately. Making use of these more accurate predictions in planning and sequencing algorithms may enable an increase in utilization of ORs, leading to significant financial and productivity related benefits.
Despite the widespread use of quality improvement collaboratives (QICs), evidence underlying this method is limited. A QIC is a method for testing and implementing evidence-based changes quickly ...across organisations. To extend the knowledge about conditions under which QICs can be used, we explored in this study the applicability of the QIC method for process redesign.
We evaluated a Dutch process redesign collaborative of seventeen project teams using a multiple case study design. The goals of this collaborative were to reduce the time between the first visit to the outpatient's clinic and the start of treatment and to reduce the in-hospital length of stay by 30% for involved patient groups. Data were gathered using qualitative methods, such as document analysis, questionnaires, semi-structured interviews and participation in collaborative meetings.
Application of the QIC method to process redesign proved to be difficult. First, project teams did not use the provided standard change ideas, because of their need for customized solutions that fitted with context-specific causes of waiting times and delays. Second, project teams were not capable of testing change ideas within short time frames due to: the need for tailoring changes ideas and the complexity of aligning interests of involved departments; small volumes of involved patient groups; and inadequate information and communication technology (ICT) support. Third, project teams did not experience peer stimulus because they saw few similarities between their projects, rarely shared experiences, and did not demonstrate competitive behaviour. Besides, a number of project teams reported that organisational and external change agent support was limited.
This study showed that the perceived need for tailoring standard change ideas to local contexts and the complexity of aligning interests of involved departments hampered the use of the QIC method for process redesign. We cannot determine whether the QIC method would have been appropriate for process redesign. Peer stimulus was non-optimal as a result of the selection process for participation of project teams by the external change agent. In conclusion, project teams felt that necessary preconditions for successful use of the QIC method were lacking.
The lack of systematic research on the assessment of patient payment policies emphasizes the need to evaluate the mechanisms of official patient charges. This paper aims to contribute to this ...research area by outlining a comprehensive framework for the assessment of patient payment policies, and by validating it on data for six CEE countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). Three broad groups of assessment criteria are included in the framework: policy context, policy content and policy effects. Within each of these groups, several sub-groups of criteria are defined. Our application of the assessment framework to the six CEE countries shows its relevance for the comparison of patient payment policy across countries, and for outlining common policy options. At the same time, it also reveals the need of collecting data on other relevant indicators that are not included in this paper, as well as for updating indicators already included. Research on patient payments will be essential for a continuous monitoring of patient payment policies (e.g. those in CEE) and their prompt adjustment.
This paper describes an evaluation method for the assessment of hospital building design from the viewpoint of operations management to assure that the building design supports the efficient and ...effective operating of care processes now and in the future. The different steps of the method are illustrated by a case study. In the case study an experimental design is applied to assess the effect of used logistical concepts, patient mix and technologies. The study shows that the evaluation method provides a valuable tool for the assessment of both functionality and the ability to meet future developments in operational control of a building design.
The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+) has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have ...combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarizes the journey of developing this system and its most important aspects. Special attention is paid to the role of the operating rooms and the improvements that have taken place there, because of their central role in the working of the hospital. The MUMC+ is the leading tertiary healthcare center for the South-East region of The Netherlands and beyond. Regional, national, and international developments encouraged the MUMC+ to start significantly reorganizing its care processes from 2009 onward. First experiments with Lean Six Sigma and Business Modeling were combined with lessons learned from other centers around the world to form the MUMC+'s own type of Operational Excellence. At the time of writing, many improvement projects of different types have been successfully completed. Every single department in the hospital now uses Operational Excellence and design thinking in general as a method to develop new models of care. An evaluation in 2014 revealed several opportunities for improvement. A large number of projects were in progress, but 75% of all projects had not been completed, despite the first projects being initiated back in 2012. This led to a number of policy changes, mainly focusing on more intensive monitoring of projects and trying to do more improvement projects directly under the responsibility of the line manager. Focusing on patient value, continuous improvement, and the reduction of waste have proven to be very fitting principles for healthcare in general and specifically for application in a university hospital. Approaching improvement at a systems level while directly involving the people on the work floor in observing opportunities for improvement and realizing these has shown itself to be essential.
Implementation of medical interventions may vary with organization and available capacity. The influence of this source of variability on the cost-effectiveness can be evaluated by computer ...simulation following a carefully designed experimental design. We used this approach as part of a national implementation study of ultrasonographic infant screening for developmental dysplasia of the hip (DDH).
First, workflow and performance of the current screening program (physical examination) was analyzed. Then, experimental variables, i.e., relevant entities in the workflow of screening, were defined with varying levels to describe alternative implementation models. To determine the relevant levels literature and interviews among professional stakeholders are used. Finally, cost-effectiveness ratios (inclusive of sensitivity analyses) for the range of implementation scenarios were calculated.
The four experimental variables for implementation were: 1) location of the consultation, 2) integrated with regular consultation or not, 3) number of ultrasound machines and 4) discipline of the screener. With respective numbers of levels of 3,2,3,4 in total 72 possible scenarios were identified. In our model experimental variables related to the number of available ultrasound machines and the necessity of an extra consultation influenced the cost-effectiveness most.
Better information comes available for choosing optimised implementation strategies where organizational and capacity variables are important using the combination of simulation models and an experimental design. Information to determine the levels of experimental variables can be extracted from the literature or directly from experts.
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