Summary of HSOM lectures
Lectures
Lecture 1: Introduction & Process modelling.........................................................................................2
Lecture 2: health service operations management; Units - process - network......................................9
Lecture 3: Quantitative analyses of units.............................................................................................15
Lecture 4: Variability.............................................................................................................................23
Lecture 5: Continuous improvement, Theory of constraints & Six Sigma.............................................26
Lecture 6: Value based healthcare & Lean management.....................................................................33
Health service operations management (Erasmus University)
Written by: Dana Bechan
,Lecture 1: Introduction & Process modelling
HSOM: the analysis, design, planning and control of all the steps necessary to deliver
services to clients in healthcare.
Trend seen: agriculture manufacturing service.
Operation: something that transforms input into output.
- You apply regulations.
- You use resources.
- Example:
o Materials (input) are used for the table, you cannot use the same
materials for the next table.
o Tools (resources) can be used again for assembling the next table.
Types of operations:
- Alteration: changing things into something else
- Transportation: movement of goods to another place.
- Inspection: non-inspected goods to inspected goods, output is some kind of
quality issue.
- Storage: BUT in services storage is seen as a delay between operations.
Hierarchy from operations:
- Operations exist of different activities. In between those activities there can be some waiting
times.
o Difference with operation? In an operation there is a transformation from input to
output. In an activity this is not by definition so; it can be activity without a specific
transformation!
- An activity can be subdivided in tasks.
- Tasks can be divided in subtasks.
- Hierarchy: Operations Activities Tasks Subtasks.
HSOM; Unit - Process - Network:
- Unit: a department in a health organization that performs operations of the same operation
type.
- Operation: is a set of activities used to transform input into output.
o Example: MRI department (unit), providing MRIs for all kinds of patients. But the
operation is doing MRI examinations.
- Process/chain: series of operations that need to be performed to produce a particular
service.
o Usually, a unit or operation is part of a process.
o The process is the thing delivering a service (e.g. patient with complaint gets
different examinations/operations followed by a diagnosis).
, - Network: combination of units and chains performing operations for services for several
groups of clients.
Differences:
- Unit: looks at resource utilization and efficiency,
and workload. (how are they working together
within the department?)
o You look at capacity of the specific unit
and how it can be improved.
o It is not process orientated. Looks at a specific unit, so not what comes before or
after.
- Process: e.g. you look at the throughput time or waiting time between all operations.
o You do not look at optimizing the different units/operations, but at how to combine
the operations into the process, in such a way that the service is best delivered.
- Network: e.g. you combine unit and process approach. Trade-off between service level and
resource utilization.
o E.g. higher resource utilization at expense of service level. Or higher service level,
lower resource utilization.
o More difficult.
Service: “a service is an activity or series of activities of more or less intangible natural that normally,
but not necessarily takes place in interactions between the customer and service employees and/or
physical resources or goods and/or systems of the service provider, which are provided as solutions
to customer problems”.
- A service is ‘an operation’.
- Intangible.
- Takes place in interaction (between customer and deliverer).
- A solution to a problem or question or request.
Characteristics of services:
- Customer participation (e.g. doctor and patient, doctor explains and patient asks questions,)
- Simultaneous creation and use (you cannot have a doctor consultation without the patient
being in the room; within the interaction the service is created)
- Heterogeneity (a doctor consultation will look different for different patients, even with the
same complaints)
- Perishable (you cannot keep it, you have a service at a particular time and after that it is not
there anymore)
- Intangible (you cannot grab it, store it, give it)
- Non-transferrable ownership (if you receive a service, you cannot give it to someone else
(like you can with a book))
The service package:
- Explicit services: benefits that are readily observable.
, o Hair looks good, new hairdo/colour, cup of coffee as extra.
o No pain after treatment, nice food.
- Implicit services: more difficult to see, you feel and experience it but it is not easily
observable. Psychological benefits that the customer may sense only vaguely.
o Friendly hairdresser (happier when leaving from friendly hairdresser).
o Comfortable temperature, friendly staff, feeling safe.
- Facilitating goods: you can ‘grasp’ it.
o Gel used in your hair, the cup of good/bad coffee you are getting.
- Information:
o E.g. information about waiting time and options.
- Supporting facility: you will not take it away with your service, but it is part of the service
experience.
o Chair, shop, mirror at the hairdresser.
A service doesn’t stand on its own. Service is part of a package. The experience of the service
is in the centre of the service package.
These things together make the way the receiver experiences the service.
Cup of coffee can be both an explicit service and a facilitating good!
Part 2: Process operations management, introduction & pathways.
Patient care process: a series of operations that need to be performed to produce a particular
service.
- In most processes, different departments are included as multiple
operations are included as well.
- The process is focussed on a specific group of patients.
Process: regularly different operations within an organization.
Chain: series of operations crossing the boundaries of providers/organizations.
- E.g. patient starts with GP, referred to ambulatory care, hospital ward and home care
etc.
Forms of multidisciplinary processing:
- Serial processing: patient starts with specialty 1 and then after
that he is transferred to specialty 2 which is then responsible
for the care delivery.
- Parallel processing: two specialties are working on a related
topic at the same time. Orthopaedic department wants to do
surgery, but has some doubts about the lung capacity needed
Lectures
Lecture 1: Introduction & Process modelling.........................................................................................2
Lecture 2: health service operations management; Units - process - network......................................9
Lecture 3: Quantitative analyses of units.............................................................................................15
Lecture 4: Variability.............................................................................................................................23
Lecture 5: Continuous improvement, Theory of constraints & Six Sigma.............................................26
Lecture 6: Value based healthcare & Lean management.....................................................................33
Health service operations management (Erasmus University)
Written by: Dana Bechan
,Lecture 1: Introduction & Process modelling
HSOM: the analysis, design, planning and control of all the steps necessary to deliver
services to clients in healthcare.
Trend seen: agriculture manufacturing service.
Operation: something that transforms input into output.
- You apply regulations.
- You use resources.
- Example:
o Materials (input) are used for the table, you cannot use the same
materials for the next table.
o Tools (resources) can be used again for assembling the next table.
Types of operations:
- Alteration: changing things into something else
- Transportation: movement of goods to another place.
- Inspection: non-inspected goods to inspected goods, output is some kind of
quality issue.
- Storage: BUT in services storage is seen as a delay between operations.
Hierarchy from operations:
- Operations exist of different activities. In between those activities there can be some waiting
times.
o Difference with operation? In an operation there is a transformation from input to
output. In an activity this is not by definition so; it can be activity without a specific
transformation!
- An activity can be subdivided in tasks.
- Tasks can be divided in subtasks.
- Hierarchy: Operations Activities Tasks Subtasks.
HSOM; Unit - Process - Network:
- Unit: a department in a health organization that performs operations of the same operation
type.
- Operation: is a set of activities used to transform input into output.
o Example: MRI department (unit), providing MRIs for all kinds of patients. But the
operation is doing MRI examinations.
- Process/chain: series of operations that need to be performed to produce a particular
service.
o Usually, a unit or operation is part of a process.
o The process is the thing delivering a service (e.g. patient with complaint gets
different examinations/operations followed by a diagnosis).
, - Network: combination of units and chains performing operations for services for several
groups of clients.
Differences:
- Unit: looks at resource utilization and efficiency,
and workload. (how are they working together
within the department?)
o You look at capacity of the specific unit
and how it can be improved.
o It is not process orientated. Looks at a specific unit, so not what comes before or
after.
- Process: e.g. you look at the throughput time or waiting time between all operations.
o You do not look at optimizing the different units/operations, but at how to combine
the operations into the process, in such a way that the service is best delivered.
- Network: e.g. you combine unit and process approach. Trade-off between service level and
resource utilization.
o E.g. higher resource utilization at expense of service level. Or higher service level,
lower resource utilization.
o More difficult.
Service: “a service is an activity or series of activities of more or less intangible natural that normally,
but not necessarily takes place in interactions between the customer and service employees and/or
physical resources or goods and/or systems of the service provider, which are provided as solutions
to customer problems”.
- A service is ‘an operation’.
- Intangible.
- Takes place in interaction (between customer and deliverer).
- A solution to a problem or question or request.
Characteristics of services:
- Customer participation (e.g. doctor and patient, doctor explains and patient asks questions,)
- Simultaneous creation and use (you cannot have a doctor consultation without the patient
being in the room; within the interaction the service is created)
- Heterogeneity (a doctor consultation will look different for different patients, even with the
same complaints)
- Perishable (you cannot keep it, you have a service at a particular time and after that it is not
there anymore)
- Intangible (you cannot grab it, store it, give it)
- Non-transferrable ownership (if you receive a service, you cannot give it to someone else
(like you can with a book))
The service package:
- Explicit services: benefits that are readily observable.
, o Hair looks good, new hairdo/colour, cup of coffee as extra.
o No pain after treatment, nice food.
- Implicit services: more difficult to see, you feel and experience it but it is not easily
observable. Psychological benefits that the customer may sense only vaguely.
o Friendly hairdresser (happier when leaving from friendly hairdresser).
o Comfortable temperature, friendly staff, feeling safe.
- Facilitating goods: you can ‘grasp’ it.
o Gel used in your hair, the cup of good/bad coffee you are getting.
- Information:
o E.g. information about waiting time and options.
- Supporting facility: you will not take it away with your service, but it is part of the service
experience.
o Chair, shop, mirror at the hairdresser.
A service doesn’t stand on its own. Service is part of a package. The experience of the service
is in the centre of the service package.
These things together make the way the receiver experiences the service.
Cup of coffee can be both an explicit service and a facilitating good!
Part 2: Process operations management, introduction & pathways.
Patient care process: a series of operations that need to be performed to produce a particular
service.
- In most processes, different departments are included as multiple
operations are included as well.
- The process is focussed on a specific group of patients.
Process: regularly different operations within an organization.
Chain: series of operations crossing the boundaries of providers/organizations.
- E.g. patient starts with GP, referred to ambulatory care, hospital ward and home care
etc.
Forms of multidisciplinary processing:
- Serial processing: patient starts with specialty 1 and then after
that he is transferred to specialty 2 which is then responsible
for the care delivery.
- Parallel processing: two specialties are working on a related
topic at the same time. Orthopaedic department wants to do
surgery, but has some doubts about the lung capacity needed
