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Article
Publication date: 11 November 2013

Mattias Elg, Klara Palmberg Broryd and Beata Kollberg

– The purpose of this study is to contribute to the knowledge base on how performance measurement drives improvements in healthcare practice.

Abstract

Purpose

The purpose of this study is to contribute to the knowledge base on how performance measurement drives improvements in healthcare practice.

Design/methodology/approach

The study is based on a single in-depth case study. The critical incident technique (CIT) has been applied in order to identify significant occurrences of performance measurement in terms of events, incidents, processes, and issues identified by respondents from the case organization. These critical incidents have been analysed and interpreted using a theoretical framework suggesting that performance measurement may be applied for exploratory or regulatory purposes as well as ad hoc or continuously in healthcare practice.

Findings

The study suggests that performance measurement may be a versatile method for driving improvement in healthcare organizations. Six types of activities directly or indirectly drive improvement in the clinical department: continuous follow-up in formal arenas and meetings; improvement work; professional efforts; goal deployment; reporting based on external demands; and creating awareness in everyday clinical work. Healthcare organizations that strive to practice performance measurement as a driver for improvement need to find infrastructures in which it is being integrated into the daily life of organizational healthcare practice.

Originality/value

The study provides an original account of the prerequisites and actions for driving improvement through performance measurement in a healthcare setting. Since the operations management perspective in healthcare is significantly lacking, the study offers a unique perspective which may be the basis for both practice development and further scholarly inquiry and theory development.

Details

International Journal of Operations & Production Management, vol. 33 no. 11/12
Type: Research Article
ISSN: 0144-3577

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Article
Publication date: 10 June 2019

Ehab Seed Ahmed, Mohammad Nazir Ahmad and Siti Hajar Othman

According to the literature concerned with this study, less than satisfactory outcomes have been achieved through implementing business process improvements methods…

Abstract

Purpose

According to the literature concerned with this study, less than satisfactory outcomes have been achieved through implementing business process improvements methods (BPIMs) in industries, in general, and in healthcare, in particular. The existing methods used need to be enhanced in order to create more effective outcomes. There has also been a lack of studies documenting gaps or shortfalls in implementing BPIMs, to be presented to the BPI research community. Therefore, researchers of this paper have attempted to fill gaps between theory and practice. On the contrary, there is also a need to link practical outcomes in the healthcare domain with those of the BPI research community. The purpose of this paper is to review popular BPIMs, techniques and tools applied in the healthcare domain; it seeks to examine and highlight their significant roles, clarify their pros and cons, and find opportunities to enhance their impact on the achievement of more sustainable improvements in the healthcare domain.

Design/methodology/approach

This study has been carried out by using a methodology combining an in-depth literature review with a comparison framework, which is called as the “Framework for Comparing Business Process Improvement Methods.” The framework is composed of seven dimensions and has been adapted from four recognized, related frameworks. In addition to the in-depth review of related literature and the adapted comparison framework, researchers have conducted several interviews with healthcare BPI practitioners in different hospitals, to attain their opinions of BPI methods and tools used in their practices.

Findings

The main results have indicated that significant improvements have been achieved by implementing BPIMs in the healthcare domain according to related literature. However, there were some shortfalls in the existing methods that need to be resolved. The most important of these has been the shortfall in representing and analyzing targeted domain knowledge during improvement phases. The tool currently used for representing the domain, specifically flowcharts, is very abstract and does not present the domain in a clear form. The flowchart tool also fails to clearly present the separation of concerns between business processes and the information systems processes that support a business in a given domain.

Practical implications

The findings of this study can be useful for BPI practitioners and researchers, mainly within the healthcare domain. The findings can help these groups to understand BPIMs shortfalls and encourage them to consider how BPIMs can be potentially improved.

Originality/value

This researchers of this paper have proposed a comparison framework for highlighting popular BPIMs in the healthcare domain, along with their uses and shortfalls. In addition, they have conducted a deep literature review based on the practical results obtained from different healthcare institutions implementing unique BPIMs around the world. There has also been valuable interview feedback attained from BPI leaders of specific hospitals in Saudi Arabia. This combination is expected to contribute to knowledge of BPIMs from both theoretical and practical points of view.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 5
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 January 2021

Sharon J. Williams and Zoe J. Radnor

Worldwide, healthcare systems struggle to sustain the delivery of services at a time of increasing demand, limited resources and growing expectations from users, coupled…

Abstract

Purpose

Worldwide, healthcare systems struggle to sustain the delivery of services at a time of increasing demand, limited resources and growing expectations from users, coupled with dealing with the aftermath of the Covid-19 pandemic and the threat of other outbreaks. There has never been a more important time to sustain innovation and improvements. Using an illustrative case, the authors assess the application of two existing frameworks to identify the key propositions and dimensions required to deliver sustainable services.

Design/methodology/approach

This illustrative case study focuses on a service provided by a chronic disease, multidisciplinary community healthcare team in the UK. Experienced-based interviews were conducted with health professionals, patients and relatives to provide a rich account of a care pathway design. A high-level process map is used to visualise the key touch points.

Findings

The authors identify all seven propositions of the SERVICE framework being present along with additional dimensions relating to sustaining innovation and improvement.

Research limitations/implications

This research is limited to a chronic disease care pathway. However, the authors believe the results could be applicable to other medical conditions, which are supported by a similar multi-disciplinary service delivery model.

Practical implications

The authors provide a sustainable public service operations SERVICES framework for health professionals and managers to consider when (re)designing care pathways.

Originality/value

This research contributes to the emerging discipline of public service operations research by empirically testing for the first time the SERVICE framework within healthcare. The authors have included additional factors associated with innovation and improvement and recommended further development of the framework to include factors, such as economic sustainability, highly relevant to the context of universal healthcare systems.

Details

International Journal of Productivity and Performance Management, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1741-0401

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Article
Publication date: 13 May 2014

Erik Drotz and Bozena Poksinska

The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare

Abstract

Purpose

The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations.

Design/methodology/approach

The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies.

Findings

The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers.

Practical implications

Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations’ working environment, staff development, and organizational performance.

Originality/value

In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.

Details

Journal of Health Organization and Management, vol. 28 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 7 September 2015

Andreas Hellström, Svante Lifvergren, Susanne Gustavsson and Ida Gremyr

– The purpose of this paper is to study critical practices when adopting improvement knowledge as a management innovation in a professional organization.

Abstract

Purpose

The purpose of this paper is to study critical practices when adopting improvement knowledge as a management innovation in a professional organization.

Design/methodology/approach

This paper is based on an action research approach, in which practitioners and researchers are seen as a part of a participative community generating actionable knowledge. Research involved gathering data over a five-year period through more than 250 interviews and 25 focus groups.

Findings

This paper identifies five critical practices for adopting a management innovation in a professional context: first, focussing on labeling and theorizing to create an organization’s own vocabulary; second, focussing on the role of internal change agents; third, allowing for an evolutionary adoption process; fourth, building new professional competence through the change agents; and fifth, adopting a research-driven approach to the adoption of a management innovation.

Practical implications

For healthcare practitioners, this paper points to practices to consider when adopting improvement knowledge – for example, identifying the patient as the guiding principle and encouraging involvement and local change initiatives. For practitioners in other professionally driven organizations, this paper identifies critical practices for adopting a management innovation – for example, focussing on theorizing and labeling in order to create an organization’s own vocabulary related to the professional context.

Originality/value

On a generic level, this paper contributes to the understanding of critical aspects when adopting management innovations in a professional organization. In a healthcare context, this paper points to the value of improvement knowledge for improving quality of care. Improvement knowledge is relatively new in healthcare, and this study provides an example of a hospital in which this management innovation helped transform the organization.

Details

Business Process Management Journal, vol. 21 no. 5
Type: Research Article
ISSN: 1463-7154

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Article
Publication date: 16 April 2018

Patrick John Harnett

Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that…

Abstract

Purpose

Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care.

Design/methodology/approach

This study is based on an integrative literature review on systemic improvement in healthcare.

Findings

A central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics.

Practical implications

Accommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process.

Originality/value

Shared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 3
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 11 February 2019

Melanie A. Meyer

The purpose of this paper is to examine the competencies that US healthcare organizations require for quality and performance improvement positions.

Abstract

Purpose

The purpose of this paper is to examine the competencies that US healthcare organizations require for quality and performance improvement positions.

Design/methodology/approach

A US healthcare improvement job posting content analysis was conducted using the HQ Essentials competency framework.

Findings

The HQ essentials competencies most desired for improvement positions include project management, training, data analysis and applied performance improvement methods. Competency requirements varied somewhat by job focus area: performance, quality, or process improvement, and Lean and Six Sigma.

Practical implications

Healthcare leaders may use the author’s results to understand what competencies may be required for various improvement roles and to identify any gaps in required skills and knowledge areas that may need to be addressed. Educators and policy-makers should consider how these competencies align with employers’ needs and what resources or professional development may be needed to address gaps.

Originality/value

This is the first healthcare improvement competencies analysis based on job postings.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 17 December 2013

Mark White, John Wells and Tony Butterworth

This paper reviews the Lean Healthcare and Productive Ward: releasing time to care (RTC) literature and extracts the reported effects and impacts experienced by employees…

Abstract

Purpose

This paper reviews the Lean Healthcare and Productive Ward: releasing time to care (RTC) literature and extracts the reported effects and impacts experienced by employees who implement it. The purpose of this paper is to identify and investigate the strength of the connection between the two models and explores the implications for leadership and implementation.

Design/methodology/approach

This study reviewed the Lean Healthcare and Productive Ward: RTC literature using strict systematic inclusion criteria. A qualitative content analysis was used to identify key characteristics of reported employee experience, effect or impact. Themes and categories were ranked by the number of citations and presented.

Findings

This study outlines the similar employee effects and impacts that exist between Lean-type improvement initiatives and the Productive Ward: RTC programme. It discusses the three top themes of: Empowerment, Leadership and Engagement and explores the opportunities for leadership. It also identifies one key difference between the two initiatives, the socio-cultural effect and impact which is strongly reported with Lean-type improvement initiatives. The socio-cultural element is discussed and presented as one of the fundamental aspects of Lean and the original Toyota production system.

Originality/value

This study brings new insights for leaders involved in Lean-type improvement initiatives which are currently being imported into healthcare and provides a comprehensive list of reported employee impacts and effects of value to healthcare leaders attempting to establish an environment and culture of improvement.

Details

The International Journal of Leadership in Public Services, vol. 9 no. 3/4
Type: Research Article
ISSN: 1747-9886

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Article
Publication date: 8 July 2014

Gangaraju Vanteddu and Charles D. McAllister

The purpose of this paper is to propose an integrated framework to simultaneously identify and improve healthcare processes that are important from the healthcare

Abstract

Purpose

The purpose of this paper is to propose an integrated framework to simultaneously identify and improve healthcare processes that are important from the healthcare provider's and patient's perspectives.

Design/methodology/approach

A modified quality function deployment (QFD) chart is introduced to the field of healthcare quality assurance. A healthcare service example is used to demonstrate the utility of the proposed chart.

Findings

The proposed framework is versatile and can be used in a wide variety of healthcare quality improvement contexts, wherein, two different perspectives are needed to be considered for identifying and improving critical healthcare processes.

Practical implications

The modified QFD chart used in conjunction with the stacked Pareto chart will facilitate the identification of key performance metrics from the patient's and the hospital's perspectives. Subsequently, the chief contributory factors at different levels are identified in a very efficient manner.

Originality/value

Healthcare quality improvement professionals will be able to use the proposed modified QFD chart in association with stacked Pareto chart for effective quality assurance.

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 6
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 15 November 2019

Åsa Robinson, Caterina Finizia and Susanne Gustavsson

The purpose of this paper is to illuminate strengths and limitations in quality improvement work, when involving patients.

Abstract

Purpose

The purpose of this paper is to illuminate strengths and limitations in quality improvement work, when involving patients.

Design/methodology/approach

The experience-based co-design (EBCD) method was used when improving care for patients undergoing otosclerosis surgery. Individual interviews and focus groups were interpreted using qualitative content analysis.

Findings

Strengths mentioned by patients were that their participation made a difference. The first steps were found effective in giving an in-depth view of patients’ experiences and the staff got an increased understanding about specific patient needs. However, weaknesses were found in the latter phases, those of improving and follow-up, health care staff had difficulties to keep their focus on patients’ experiences and invite patients to be involved. Patients’ participation decreased, and there was a lack of tools to support the process.

Research limitations/implications

The content in this paper is mainly based on one case. However, the findings are in congruence with earlier research and add further knowledge to the research area.

Practical implications

The findings can be used in healthcare when involving patients in improvement work.

Originality/value

There is no earlier study which involves patients with otosclerosis when using EBCD. Furthermore, this paper illuminates that there is a need to increase collaboration with patients. The latter phases often seem to be handled by health care professionals without involving patients; this paper suggest a development using dedicated quality tools.

Details

The TQM Journal, vol. 32 no. 2
Type: Research Article
ISSN: 1754-2731

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