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This article aims to describe the thinking behind MASSE, a project in Finland that helps address the fragmentation of care and patient journey disruptions for long-term care. It outlines the conceptualization of an information technology (IT)-assisted solution and presents preliminary findings and research problems in this ongoing project.

The project employs a service engineering and design science approach with the objective of addressing chronic and multimorbid patients in specialized multiprovider environments. It does this by applying information and communication technologies and organizational design. The project has been a cocreative effort with ongoing interviews and workshops with various stakeholders to inform the conceptualization of a solution, an intermediary step before the implementation phase.

Patient journey disruptions occur when caregivers do not know what to do in specific situations. A potential solution is a virtual care operator (VCO) with a personalized patient card that would enable service ecosystem actors to integrate and coordinate their tasks. This article presents the basic design principles of such a solution.

Conceptual ideas and preliminary results only indicative.

Systemic integration efforts like those ongoing in Finland can benefit from the VCO concept encouraging a more collaborative way of thinking about integrative solutions and opening up new avenues of research on business implications and ecosystem strategies.

The VCO concept answers to the continuity of care, the rising costs of health care and the growing numbers of patients with chronic disease and multimorbidity whose care remains fragmented and uncoordinated.

Taking an ecosystem approach to care integration and addressing interoperability issues are on the cutting edge of healthcare system transformation.

This study aims to report the design and testing of a maturity model for information and knowledge management in the public sector, intended for use in frequent monitoring, trend analysis and in-depth analysis of the contemporary information and knowledge management practices of an organization.

A design science approach was used to develop the proposed model. Creation of the model was based on an extensive literature review. Testing of the model was implemented as a survey receiving 37 responses from nine organizations organizing and purchasing public services.

The study presents four alternative profiles for an organization’s status, novice, experimenter, facilitator and advanced exploiter, and investigates the differences between these profiles on the basis of the empirical data gathered. The model was found to be both a valid and practical way to determine the state of an organization’s information and knowledge management and identify development needs.

Testing was conducted in the Finnish public sector and further studies applying the model could be implemented in other countries. The model presented was designed specifically for the public sector and more research is needed to test its applicability in the private sector.

Maturity models are useful when evaluating information and knowledge management status in an organization, and beneficial for improving organizational performance. The proposed maturity model combines the fields of knowledge management and information management and contributes to the literature with an overarching maturity model that includes a dimension of satisfaction with the organizational maturity level. While many earlier models originate from the consultancy business, the model presented here was also designed for research purposes and tested in practice.

In healthcare, there is limited knowledge of and experience with patient choice management. The purpose of this paper is to focus on patient choice, apply and test demand-supply-based operating (DSO) logic integrated with clinical setting in clarifying choice contexts, investigate patient’s choice-making at different contexts and suggest context-based choice architectures to manage and develop patient choice.

Prenatal screening and testing in the Helsinki and Uusimaa Hospital District (HUS), Finland, was taken as an example. Choice points were contextualized by using the DSO framework. Women’s reflections, behaviors and experience at different choice contexts were studied by interviewing women participating in prenatal screening and testing. Semi-structured interview data were processed by thematic analysis.

By applying DSO logic, four choice contexts (prevention, cure, electives and continuous care) were relevant in the prenatal screening and testing episode. Women had different choice-making in prevention and cure mode contexts regarding choice activeness, information needs, social influence, preferences, emotion status and choice-making difficulty. Default choice was widely accepted by women in prevention mode and individual counseling can help women make informed choice in cure mode.

The authors apply the DSO model to contextualize the patient choice in one care episode and compare patient choice-making at different contexts. The authors also suggest the possible context-based choice architectures to manage and promote patient choice

Modularity promises to relieve problems of complexity in service systems. However, limited evidence exists of its application in specialized hospital services. The purpose of this paper is to identify enablers, constraints, and outcomes of modularization in specialized hospital services.

A qualitative comparative study of a hematology unit with modular service architecture and an oncology unit with integral service architecture in a university hospital is performed to analyze the service architectures, enablers and constraints of modularization, and outcomes.

A framework and five propositions combining the characteristics of specialized hospital services, enabling activities, and outcomes of modularization were developed. Modular service architecture was developed through limiting the number of treatment components, reorganizing production of standardized components into a separate service unit, and standardizing communication and scheduling in interfaces. Modularization increased service efficiency but diluted ownership of services, decreased customization, and diminished informal communication. This is explained by the specific characteristics of the services: fragmented service delivery, professional autonomy, hierarchy, information asymmetry, and requirement to treat all.

Modularization can increase efficiency in specialized hospital services. However, specific characteristics of specialized care may challenge its application and limit its outcomes.

The study identifies enabling activities and constraints that hospital managers should take into account when developing modular service systems.

This is the first empirical study exploring the enablers, constraints, and outcomes of modularization in specialized hospital services. The study complements literature on service modularity with reference to specialized hospital services.

Healthcare productivity is a growing issue in most Western countries where healthcare expenditure is rapidly increasing. Therefore, accurate productivity metrics are essential to avoid sub-optimization within a healthcare system. In this article, we focus on healthcare production system productivity measurement.

Traditionally, healthcare productivity has been studied and measured independently at the unit, organization, and system level. Suggesting that productivity measurement should be done in different levels, while simultaneously linking productivity measurement to incentives, this study presents the challenges of productivity measurement at the different levels. The study introduces different methods to measure productivity in healthcare. In addition, it provides background information on the methods used to measure productivity and the parameters used in these methods. A pilot investigation of productivity measurement is used to illustrate the challenges of measurement, to test the developed measures, and to prove the practical information for managers.

The study introduces different approaches and methods to measure productivity in healthcare.

A pilot investigation of productivity measurement is used to illustrate the challenges of measurement, to test the developed measures, and to prove the practical benefits for managers.

We focus on the measurement of the whole healthcare production system and try to avoid sub-optimization. Additionally considering an individual patient approach, productivity measurement is examined at the unit level, the organizational level, and the system level.

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.

Previous studies approach surgery scheduling mainly from the mathematical modeling perspective which is often hard to apply in a practical environment. The aim of this study is to develop a practical scheduling system that considers the advantages of both surgery categorization and newsvendor model to surgery scheduling.

The research was carried out in a Finnish orthopaedic specialist centre that performs only joint replacement surgery. Four surgery categorization scenarios were defined and their productivity analyzed by simulation and newsvendor model.

Detailed analyses of surgery durations and the use of more accurate case categories and their combinations in scheduling improved OR productivity 11.3 percent when compared to the base case. Planning to have one OR team to work longer led to remarkable decrease in scheduling inefficiency.

In surgical services, productivity and cost‐efficiency can be improved by utilizing historical data in case scheduling and by increasing flexibility in personnel management.

The study increases the understanding of practical scheduling methods used to improve efficiency in surgical services.

The purpose of this paper is to provide a framework for analysing and modelling detailed workflow of image‐guided interventions to facilitate simulation and the re‐engineering process for the development of new procedures in multi‐modal imaging environments.

The methodology presented includes a literature review on workflow simulation in surgery, focussing on radiology environments, an assessment of simulation tools, a data gathering and management framework and research on methods for conceptual modelling of the processes.

The literature review reveals that few authors attempted to analyse the phases within image‐guided interventions, and those that did, only did so partially. The framework developed for this work intends to fill the gap found in the survey. It allows the maintenance and management of large amounts of data, one of the most critical factors when modelling detailed workflow. In addition, selecting the appropriate simulation software plays an important role, saving time in later stages of the project.

The framework presented for endovascular interventions can be extended to other types of image‐guided interventions. Moreover, modelling the workflow processes in a modular way facilitates the re‐engineering process when integrating different imaging modalities during the same procedure.