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Despite widespread adoption of business process reengineering (BPR) for better delivery efficiency of public services, a structured approach continues to elude the most value-adding phase of BPR: business process redesign. From another viewpoint, the rising currency of Whole-of-Government (WoG) and “shared services” initiatives signal an unmissable trend toward resource reuse across public service agencies (PSAs) through business process standardization (BPS). This research invokes BPS into process redesign to produce a process redesign framework (PRF) and deploys the same to build a standard process model (SPM) for services of the government of Albania (GoA).

The methodology follows the design science research (DSR) paradigm, wherein best practices extracted from literature are synthesized with stakeholder inputs to design the PRF and SPM, both of which are then evaluated with case study research.

Adoption of PRF/SPM on a WoG basis will not only reduce service lead time but also enable a variety of public services to share the same process, thereby further saving costs for GoA. The research outputs will accelerate reengineering and subsequent digitalization of public service operations.

Implementing SPM will maximize resource reuse and help offer uniform and integrated public services to GoA's customers. It will also enable demand-driven staff mobilization across GoA agencies. The proposed PRF/SPM have limitations in that they consider only flow aspects of service processes with aspects of conversion being ignored.

This research fulfills the need for a systematic approach to process redesign and prepares GoA for a WoG treatment to its BPR efforts.

Patient-centred care and patient involvement are increasingly central concepts in health policy in the UK and elsewhere. However, there is little consensus regarding their definition or how to achieve “patient-centred” care in everyday practice or how to involve patients in service redesign initiatives. The purpose of this paper is to explore these issues from the perspective of key stakeholders within National Health Service (NHS) hospitals in the UK.

Semi-structured interviews, covering a range of topics related to service redesign, were conducted with 77 key stakeholders across three NHS Trusts in the West Midlands. In total, 20 of these stakeholders were re-interviewed 18 months later. Data were managed and analysed using the Framework Method.

While patient-centred care and patient involvement were regularly cited as important to the stakeholders, a gap persisted between values and reported practice. This gap is explained through close examination of the ways in which the concepts were used by stakeholders, and identifying the way in which they were adapted to fit other organisational priorities. The value placed on positive subjective experience changed to concerns about objective measurement of the patients as they move through the system.

Increased awareness and reflection on the conceptual tensions between objective processes and subjective experiences could highlight reasons why patient-centred values fail to translate into improved practice.

The paper describes and explains a previously unarticulated tension in health organisations between values and practice in patient centred care and patient involvement in service redesign.

Process redesign refers to the intentional change of business processes. While process redesign methods provide structure to redesign projects, they provide limited support during the actual creation of to-be processes. More specifically, existing approaches hardly develop an ontological perspective on what can be changed from a process design point of view, and they provide limited procedural guidance on how to derive possible process design alternatives. This paper aims to provide structured guidance during the to-be process creation.

Using design space exploration as a theoretical lens, the authors develop a conceptual model of the design space for business processes, which facilitates the systematic exploration of design alternatives along different dimensions. The authors utilized an established method for taxonomy development for constructing the conceptual model. First, the authors derived design dimensions for business processes and underlying characteristics through a literature review. Second, the authors conducted semi-structured interviews with professional process experts. Third, the authors evaluated their artifact through three real-world applications.

The authors identified 19 business process design dimensions that are grouped into different layers and specified by underlying characteristics. Guiding questions and illustrative real-world examples help to deploy these design dimensions in practice. Taken together, the design dimensions form the “Business Process Design Space” (BPD-Space).

Practitioners can use the BPD-Space to explore, question and rethink business processes in various respects.

The BPD-Space complements existing approaches by explicating process design dimensions. It abstracts from specific process flows and representations of processes and supports an unconstrained exploration of various alternative process designs.

This paper describes the first year of a national programme supporting implementation of one of the key policy initiatives forming part of the programme of health reform in England, practice‐based commissioning (PBC). The paper presents an audit of service redesign initiatives based on the first six months' work of 27 sites in the first wave of the programme, and discusses the early practical learning about the implementation of PBC by both participants and stakeholders. The role of the programme in facilitating two‐way links between policy development and practical implementation is highlighted, and the development of the programme, and other parallel learning routes, to meet the emerging needs of particular groups in relation to practice‐based commissioning is described.

The purpose of this paper is to present the findings arising from a three year research project which investigated a major system-wide change in the design of the NHS in England. The radical policy change was enshrined in statute in 2012 and it dismantled existing health authorities in favour of new local commissioning groups built around GP Practices. The idea was that local clinical leaders would “step-up” to the challenge and opportunity to transform health services through exercising local leadership. This was the most radical change in the NHS since its inception in 1948.

The research methods included two national postal surveys to all members of the boards of the local groups supplemented with 15 scoping case studies followed by six in-depth case studies. These case studies focused on close examination of instances where significant changes to service design had been attempted.

The authors found that many local groups struggled to bring about any significant changes in the design of care systems. But the authors also found interesting examples of situations where pioneering clinical leaders were able to collaborate in order to design and deliver new models of care bridging both primary and secondary settings. The potential to use competition and market forces by fully utilising the new commissioning powers was more rarely pursued.

The findings carry practical implications stemming from positive lessons about securing change even under difficult circumstances.

The paper offers novel insights into the processes required to introduce new systems of care in contexts where existing institutions tend to revert to the status quo. The national survey allows accurate assessment of the generalisability of the findings about the nature and scale of change.

The way change occurred at a strategic level and in four clinical services in three hospitals was examined. The purpose of this paper is to report how the hospitals designed and delivered change at organisational and clinical service level to improve services for patients, and the role of clinical leadership in this process.

A comparative case study involving semi-structured interviews was undertaken. These involved a range of senior managers in 2009 (n=77), 2011 (n=21) and 2012 (n=29). Interviews with staff involved directly in service delivery were also carried out in 2011 (n=92). The interviews were recorded digitally, transcribed verbatim, and analysed thematically using the Framework Method.

The value of, and approach taken to clinical leadership varied across the hospitals and over time. This was affected by the culture and priorities of the organisation. Some strategies for developing clinical leadership were developed, however they were limited. It was expected that capable clinical leaders would emerge, and be supported. Effective clinical leadership during organisational and service change required direct executive or managerial support and relied on clinical “champions”.

The paper demonstrates that despite the importance of clinical leadership being widely recognized in policy and research, there were no established programmes in place at the hospitals that were studied to support it. Rather there was a reliance on clinical staff coming forward to take on leadership roles as part of organizational efforts to bring about change.

The purpose of this paper is to describe a study which aims to provide an alternative approach to clinical governance. This involves patients in redesigning services based on their actual experiences of health services. This will be of interest to front line health care staff and public and patient involvement leads.

The paper illustrates Experience Based Design (EBD) as a structured, formal methodology with clearly defined roles, actions and timescales. A case study approach is used to describe the implementation of this model in a District General Hospital.

This study demonstrates how three theoretical components of good design: functionality, engineering and aesthetics can be used as a framework to improve performance, safety and governance and in addition, actual experience of the service for patients and staff.

The case study approach used has provided a good range of learning and transferable information; however, the results are currently based on a single site.

The use of the EBD approach will ensure that healthcare services truly reflect the needs of patients and carers based on their specific experience. It provides a mechanism whereby patients' views contribute fully to the change process leading to safer, more effective and reliable care. This approach will require the application of the non‐clinical competencies included in the Medical Leadership Competency Framework and specific health and wellbeing dimensions in the Knowledge and Skills Framework.

This paper offers a new model that can be incorporated into service redesign. The model enables greater understanding of clinical governance as described by patients through narrative of their actual experiences.

The purpose of this paper is to discuss outcomes of a service redesign, involving an Intensive Support Team (IST) for adults with learning disabilities and challenging behaviour, working in conjunction with a Community Learning Disability Service (CLDS).

Two IST staff were physically based as “Inreach workers” within a CLDS for six months. Inreach workers provided support with existing resources and consultation for specific clients presenting with challenging behaviour. CLDS staff confidence, understanding and implementation of existing challenging behaviour resources was evaluated before and after service redesign. An online questionnaire was used to gather further data relating to experiences of the Inreach project.

CLDS staff confidence, understanding and implementation of existing challenging behaviour resources increased over the six-month inreach period. Questionnaire results indicated CLDS staff found Inreach support to be beneficial, having a perceived positive impact for clients, and providing clarity on the skills and resources provided by the IST.

The long-term effects of this pilot have yet to be established. Consideration is given to how demand characteristics may have influenced CLDS responses.

Careful consideration should be given in terms of how ISTs interface with CLDSs. ISTs may consider being based physically within CLDSs, to provide more readily accessible support.

Providing CLDS staff with more accessible support from ISTs may increase the effective implementation of available resources for adults with learning disabilities and challenging behaviour.

The discrepancy between increasing demand and limited resources in public mental health is putting pressure on services to continuously review their practices and develop innovative models of care that redress this discrepancy. To ensure the service models continue to meet the needs of all stakeholders, children and young people’s mental health (CYPMH) conducts regular reviews of its service models. Accordingly, the youth mental health (YMH) model at CYPMH has evolved significantly over time in response to the needs of young people and service demand. The purpose of this paper is to outline the findings of a recent review of the YMH service, and the subsequent changes to the service model.

Informed by a participatory action philosophy, feedback was sought from staff on the service model through a range of methods including a questionnaire, staff consultations through a working party and interviews. This feedback was used to redesign the model, which was then evaluated again.

Staff identified a number of challenges with the service model and a range of service improvement solutions. The key issues included exceedingly high caseloads, workplace tensions, and fragmentation of the client journey. This paper outlines the primary solution to these key concerns, namely, the introduction of brief intervention (BI) as the entry point to the service.

BI approaches provide a solution to overly high caseloads as the direct and focussed approach of BI generally reduces the number of sessions people need. BI is an important addition to other treatment options and should be seen as a valid component of the continuum of mental healthcare.

Presents an empirical stuFinancial institutions are accelerating change by seeking radical improvements in processes such as credit approval, new product development, claims processing and insurance underwriting. Describes an investigation of recent business process redesign (BPR) projects in North American and international institutions ‐ including banks, insurance companies and brokerages. Considers improvements in customer service quality, cycle‐time, head‐count, and cost measures. Develops and tests propositions about the organizational, technological and environmental factors which determine success or failure of BPR projects. Executive interviews and a mail survey revealed the importance of strategic planning practice, project organization, team organization, new technology and benchmarking. Different success factors were found to be associated with different types of BPR projects. Although the results of BPR are frequently less dramatic than claimed by its advocates, well‐conceived and managed projects can help the firm on a path of corporate transformation.