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As healthcare reform takes shape, many challenges face hospital pharmacists. An opportunity exists to combine the principles of patient‐focused care and pharmaceutical care to redesign the role of pharmacy. To achieve this objective, pharmacy departments should adopt business concepts such as process re‐engineering. Process re‐engineering is a change management tool which aims to produce dramatic improvement in performance measures by re‐designing the process. The goal of restructuring is to increase the amount of time pharmacists spend providing pharmaceutical care to patients. The pharmaceutical care concept is a method of delivering pharmaceutical care services that match individual patient needs with the services provided. This article describes many hospital pharmacy department transitions to a patient focused care environment by adopting the patient focused care concept and the process re‐engineering to improve the quality of patient care through systems improvement.

Examines the concept of patient‐focused care and how it fits into hospital process re‐engineering. Describes the project undertaken at the Derbyshire Royal Infirmary, to implement patient‐focused care and care pathway development in accident and emergency, and trauma and orthopaedics. Concludes with an insight into how care pathways have been used to improve hospital documentation, reduce duplication of information and provide a rich source of data for effective clinical audit.

The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations.

First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies.

The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes.

Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination.

Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organization’s strategy and key performance indicators.

Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care.

Highlights the importance of responding to the individual needs of patients, from a personal and general viewpoint. The reforms to health care organization have provided one mechanism for reconciling both patients′ and the community′s need for quality services, but not necessarily the individual. Within a hospital, a philosophy centred on individual patient needs; “patient focused care” provides a way of making explicit quality choices for the individual as well as the community served. While patient focused care is open to many interpretations, argues that in quality terms it is an important milestone as is the first quality approach which makes explicit reference to the patient.

Drawing on the author’s personal experience within the UK National Health Service, outlines at the macro level what information is needed, and why, in facilities management. Suggests that top‐level data gathering is a priority, describes the processes required, and finally considers the advantages of sharing information with competitors and others.

The purpose of this paper is to report on a study investigating the limits of the applicability of the focused factory concept (FFC) in health care. The case setting comes from the Dutch obstetric care system, which is organised by principles in sync with the FFC; the organisation for “simple” pregnancies (independent midwifery practices) is fully separated from that for “complex” pregnancies (obstetric departments in hospitals). The paper investigates the degree of fit between how the Dutch obstetric care system is organised and how it operates (internal fit).

This study analyses one year of patient data from one obstetric hospital department and from one midwifery practice in its immediate geographical proximity. Data were collected regarding the medical condition, consultations, and delivery. These data were used to test the degree to which the obstetric care system operates in line with the FFC; one would expect the midwifery practice to operate as a “line process”, and the obstetric department as a “jobbing process”.

Findings suggest that the Dutch obstetric care sector is designed in line with the FFC, but does not operate accordingly. Root causes for this misalignment can be found in the characteristics of the medical condition of pregnancy.

The fact that the data concern only one region must raise caution for generalisation. However, the fact that medical conditions, which can be assumed to be universal, lead to an intrinsic mismatch between the FFC organisation and medical operational reality, suggests that this paper may have broad implications for theory and practice.

For the Dutch obstetric case system, this paper is one in a series that casts doubts on the sustainability of the two‐tiered system. For obstetric care in general, integrated care seems preferable to the FFC. For health care in general, this paper suggests that caution is required in applying the FFC. Moreover, in OM research for health care, more efforts should be made to understand how medical conditions affect the daily operational processes and, hence, the organisational design.

Most of the studies focusing on the applicability of the FFC look at financial and medical outcomes. This paper is original in that it looks at what drives these outcomes, i.e. the degree of fit between strategy, organisational design and operational performance.

Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred care, particularly under conditions where patients are emotionally distressed. Misunderstood distress has negative implications for patient well-being and hospital resources. The purpose of this study is to use the expertise of nurses to recommend ways to care for the emotional well-being of patients with dementia that are achievable within the current hospital setting.

A qualitative study was conducted in two long-stay wards providing dementia care in a UK hospital. Nursing staff (n = 12) were asked about facilitators and barriers to providing emotion-focused care. Data were analysed using thematic analysis.

Nursing staff said that resources existed within the ward team, including ways to gather and present personal information about patients, share multidisciplinary and personal approaches, work around routine hospital tasks and agree an ethos of being connected with patients in their experience. Staff said these did not incur financial cost and did not depend upon staffing numbers but did take an emotional toll. Examples are given within each of these broader themes.

The outcome is a short-list of recommended staff actions that hospital staff say could improve the emotional well-being of people with dementia when in hospital. These support and develop previous research.

In this paper, frontline nurses describe ways to improve person-centred hospital care for people with dementia.

The success ofIn recent years, there has been significant interest in the application of continuous quality improvement (CQI) and total quality management (TQM), and patient‐focused care (PFC) in health care organisations around the globe. The hospital industry has substantially embraced the concepts of CQI and TQM with the belief that these concepts and programmes will lead to an improvement in both the quality and efficiency with which health services are delivered. The objective of this article is to achieve better outcomes in health care services with fewer resources by studying the implementation of patient‐focused care in the health care provision context and particularly in the area of pharmaceutical care management as an integrated process in the delivery of health care in a hospital setting. The changes in health care provision have in many instances meant that the provision of pharmaceutical services needed re‐assessing.

Discusses five elements of patient‐focused care (PFC). Clarifies issues surrounding the first element ‐ aggregating patients ‐ and debates the strengths and weaknesses of the second element ‐ centralizing services in PFC units. Explores arguments for and against the third element ‐ multiskilling and cross‐training ‐ including staff activity in conventional hospitals and PFC units, in depth. Discusses the structure of PFC teams and their management. Describes the main components of the fourth PFC element ‐ integrated carepaths ‐ and explores their role in clinical audit, computerization and seamless care. Examines the costs of PFC by comparing actual with expected costs. Makes managerial, clinical, educational and research implications throughout for staff working in or with PFC units.

Older adults with atrial fibrillation (AF) have put growing demands on a poorly integrated healthcare system. This is of particular concern in rural communities with rapid population aging and few healthcare resources elevating risk of stroke and mortality. The purpose of this paper is to explore healthcare delivery risks for rural older adults with AF.

This qualitative study collected data from AF patients, healthcare providers and decision makers. Ten patients participated in six-month care journeys involving interviews, logs, photos, and chart reviews. In total, 13 different patients and ten healthcare providers participated in focus groups and two decision makers participated in interviews.

Three key health service risks emerged: lack of patient-focussed access and self-management; unplanned care coordination and follow-up across the continuum of care; and ineffective teamwork with variable perspectives among patients, providers, and decision makers.

This study extends the understanding of risks to the health system level. Results provide important information for further research aimed at interventions to improve health service delivery and policy change to mitigate risks for this population.