Health Service Operations Management 2021/2022 | Joyce Rommens
Lecture 1: Introduction and fundamentals of HSOM; process OM (S.
Elkhuizen)
Learning goals:
- Can describe the development of HSOM as field of research and is able to link it to neighbouring fields of
research.
- Can formulate the characteristics of services as opposed to products in manufacturing.
- Can apply concepts from Service Management to the field of Health Services.
- Can apply different process mapping techniques: a flow map, a service blueprint, and a value stream map.
- Can analyse processes, care pathways and care chains from an operations management perspective.
Introduction, research field and concepts
Health Service Operations Management (HSOM) = the
analysis, design, planning and control of all the steps
necessary to deliver services to clients in healthcare.
The field of service operations management is composed of
two things: service and operations management.
Production, operations, and service has developed quite recently as there is a movement from
agriculture towards factors/production, and service industry. People need less time and effort to
produce their food, which makes that manufacturing and producing foods is getting more important.
Operations Management (Vissers and Beech, 2008):
Is service the input or the output? What kind of resources do we need and what kind of regulations?
® You could say service is more in the middle, doing the process of going from input to output. for
example, a healthcare service as good output, with having good healthcare professionals as input
(with their knowledge), resources (like tools for surgery etc.) and regulations (e.g., guidelines).
Types of operations (Vissers and Beech, 2008):
- Alteration (e.g., changing wood in a table)
- Transportation (e.g., wood in a specific place and the movement to another endpoint, the
table)
- Inspection (e.g., the expectation is to get a table, so this can be inspected)
- Storage
- As an operation or as a delay in operations? ® in production it is seen as type of
operations, but in services storage it is seen as a delay in different operations.
Hierarchy from Operations Management perspective (Vissers and Beech, 2008):
1
, Health Service Operations Management 2021/2022 | Joyce Rommens
You can also look at operations from a hierarchy, it can consist of different activities. In between
those activities there can be some waiting times. Difference between both level: on level of
operation there is transformation of input to output and on the level of activity this is not always, it
can always be an activity without a transformation. It can be divided in tasks and tasks can also be
divided. So, a hierarchy in operations – activities - tasks
Unit – Process – Network (Vissers and Beech, 2008):
Unit = a department in a health organization that performs operations of the same operation type
(e.g., in a hospital there is an MRI department, the task is to perform an MRI).
Process/chain = series of operations that need to be performed to produce a particular service. In
most cases, a unit is part of a process (e.g., a process in helping the patient).
Network = combination of units and chains performing operations for services for several groups of
clients.
Differences between the unit, process, and network approaches Vissers and Beech, 2008):
Unit OM approach: focussing on e.g., efficiency, for workers to work efficient. We see it as a single
component, so it does not have a view on the whole process. ® In network approach we combine
both approaches (process and capacity approach). This is difficult, it’s easier to optimize a unit or
process, but it’s more difficult to optimize a combination where 1 might decrease the other.
A service is an activity or series of activities of more or less intangible nature 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.
In this definition a service is an activity, which can be part of an operation so it can also be seen as an
operation. It’s intangible; you cannot grab it and put it somewhere else. It normally takes place in
interaction (between customer and the one who is delivering the service). It must also deliver
solutions to deliver real service (e.g., a restaurant serving food is also service).
2
, Health Service Operations Management 2021/2022 | Joyce Rommens
Characteristics of services (p. 14-18):
- Customer participation (e.g., a consult with patient and physician both answering and asking
questions)
- Simultaneous creation and use (due to the process of customer participation, they are in the
same room and in their interaction of the doctor, consultation is created)
- Heterogeneity (consult can be different between patients)
- Perishable (you cannot keep it, after consultation it is not there anymore)
- Intangible (you cannot storage it, like e.g., a book)
- Non-transferrable ownership (you can’t give a service to someone else)
Example: Felix scooter rent
The service package (Fitzsimmons et al., 2014, p. 18-19):
The service does not stand on its own.
Explicit: hair is looking good at the hairdresser’s.
Implicit: more difficult to see, experiences are not observable. Hairdresser can be friendly.
Supporting facility: chair of the hairdresser.
Information: on waiting time or options.
Facilitating: the gel for the hair or the coffee.
® Together service as experienced. Together they determine if a customer is happy or not.
Operations Management introduction and pathways
Patient Care Process = series of operations that need to be performed to produce a particular
service.
Value: processes define/describe how patients flow through health service provider organisations to
obtain health value.
However, a complex process in a hospital involving many units might also be considered as an
internal chain.
Forms of multidisciplinary processing; relations between processes and specialties (Vissers and Beech,
2008, p. 77):
3
, Health Service Operations Management 2021/2022 | Joyce Rommens
Serial: chronically.
Parallel: 2 specialities are working at the same time, related topic (orthopaedic surgery and he has
some doubt about the lungs, he refers the patient to lung consultation).
Team: a team around the patient is working together, with different specialities (e.g., cancer
patients).
Cyclical: specialities are working together, but this is more with chronic conditions. Some specialities
are incidental, others are periodic (regularly check-up).
A care pathway is a "complex intervention for the mutual decision making and organization of care
processes for a well-defined group of patients during a well-defined time period”.
It’s focussing on a specific group of patients; well defined and limited. It also limiting the time-period,
care pathways can focus on the whole care of it can be a specific part of it, but there is always a
specific beginning and ending.
Care pathway, characteristics of the method:
- Key interventions based on scientific evidence
- Coordination of the care process by coordinating the roles, and determining the order of
activities (who is responsible for what?)
- Recorded in patient documentation
- Standardized care ® with monitoring, evaluation of deviations, and giving feedback (specific
way of working for a specific patient which is known as the best evidence for this patient
group/disease)
So, it’s standardized care, but it doesn’t mean there are not deviations. By documenting everything,
you can see what goes wrong and you can act upon it ® you can improve it.
Aims of a care pathway:
- Improving the quality of care
- Improving patient outcomes
- Increasing patient safety
- Increasing patient satisfaction (for a lot of pathways, a patient version is created: what is
going to happen when etc., so you can inform patients and then they will be more satisfied)
- Coordinating care
- Optimizing capacity utilization (if you have your standardized way of working from the
pathways, you know what must be done, when, and by who)
Every care pathway is a patient process, however not every patient process is a care pathway.
Creating a pathway takes some time, and only is valuable if you have a well-defined patient group.
Also, if there are no guidelines for a specific patient group, that it is not possible to provide a care
pathway.
4
Lecture 1: Introduction and fundamentals of HSOM; process OM (S.
Elkhuizen)
Learning goals:
- Can describe the development of HSOM as field of research and is able to link it to neighbouring fields of
research.
- Can formulate the characteristics of services as opposed to products in manufacturing.
- Can apply concepts from Service Management to the field of Health Services.
- Can apply different process mapping techniques: a flow map, a service blueprint, and a value stream map.
- Can analyse processes, care pathways and care chains from an operations management perspective.
Introduction, research field and concepts
Health Service Operations Management (HSOM) = the
analysis, design, planning and control of all the steps
necessary to deliver services to clients in healthcare.
The field of service operations management is composed of
two things: service and operations management.
Production, operations, and service has developed quite recently as there is a movement from
agriculture towards factors/production, and service industry. People need less time and effort to
produce their food, which makes that manufacturing and producing foods is getting more important.
Operations Management (Vissers and Beech, 2008):
Is service the input or the output? What kind of resources do we need and what kind of regulations?
® You could say service is more in the middle, doing the process of going from input to output. for
example, a healthcare service as good output, with having good healthcare professionals as input
(with their knowledge), resources (like tools for surgery etc.) and regulations (e.g., guidelines).
Types of operations (Vissers and Beech, 2008):
- Alteration (e.g., changing wood in a table)
- Transportation (e.g., wood in a specific place and the movement to another endpoint, the
table)
- Inspection (e.g., the expectation is to get a table, so this can be inspected)
- Storage
- As an operation or as a delay in operations? ® in production it is seen as type of
operations, but in services storage it is seen as a delay in different operations.
Hierarchy from Operations Management perspective (Vissers and Beech, 2008):
1
, Health Service Operations Management 2021/2022 | Joyce Rommens
You can also look at operations from a hierarchy, it can consist of different activities. In between
those activities there can be some waiting times. Difference between both level: on level of
operation there is transformation of input to output and on the level of activity this is not always, it
can always be an activity without a transformation. It can be divided in tasks and tasks can also be
divided. So, a hierarchy in operations – activities - tasks
Unit – Process – Network (Vissers and Beech, 2008):
Unit = a department in a health organization that performs operations of the same operation type
(e.g., in a hospital there is an MRI department, the task is to perform an MRI).
Process/chain = series of operations that need to be performed to produce a particular service. In
most cases, a unit is part of a process (e.g., a process in helping the patient).
Network = combination of units and chains performing operations for services for several groups of
clients.
Differences between the unit, process, and network approaches Vissers and Beech, 2008):
Unit OM approach: focussing on e.g., efficiency, for workers to work efficient. We see it as a single
component, so it does not have a view on the whole process. ® In network approach we combine
both approaches (process and capacity approach). This is difficult, it’s easier to optimize a unit or
process, but it’s more difficult to optimize a combination where 1 might decrease the other.
A service is an activity or series of activities of more or less intangible nature 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.
In this definition a service is an activity, which can be part of an operation so it can also be seen as an
operation. It’s intangible; you cannot grab it and put it somewhere else. It normally takes place in
interaction (between customer and the one who is delivering the service). It must also deliver
solutions to deliver real service (e.g., a restaurant serving food is also service).
2
, Health Service Operations Management 2021/2022 | Joyce Rommens
Characteristics of services (p. 14-18):
- Customer participation (e.g., a consult with patient and physician both answering and asking
questions)
- Simultaneous creation and use (due to the process of customer participation, they are in the
same room and in their interaction of the doctor, consultation is created)
- Heterogeneity (consult can be different between patients)
- Perishable (you cannot keep it, after consultation it is not there anymore)
- Intangible (you cannot storage it, like e.g., a book)
- Non-transferrable ownership (you can’t give a service to someone else)
Example: Felix scooter rent
The service package (Fitzsimmons et al., 2014, p. 18-19):
The service does not stand on its own.
Explicit: hair is looking good at the hairdresser’s.
Implicit: more difficult to see, experiences are not observable. Hairdresser can be friendly.
Supporting facility: chair of the hairdresser.
Information: on waiting time or options.
Facilitating: the gel for the hair or the coffee.
® Together service as experienced. Together they determine if a customer is happy or not.
Operations Management introduction and pathways
Patient Care Process = series of operations that need to be performed to produce a particular
service.
Value: processes define/describe how patients flow through health service provider organisations to
obtain health value.
However, a complex process in a hospital involving many units might also be considered as an
internal chain.
Forms of multidisciplinary processing; relations between processes and specialties (Vissers and Beech,
2008, p. 77):
3
, Health Service Operations Management 2021/2022 | Joyce Rommens
Serial: chronically.
Parallel: 2 specialities are working at the same time, related topic (orthopaedic surgery and he has
some doubt about the lungs, he refers the patient to lung consultation).
Team: a team around the patient is working together, with different specialities (e.g., cancer
patients).
Cyclical: specialities are working together, but this is more with chronic conditions. Some specialities
are incidental, others are periodic (regularly check-up).
A care pathway is a "complex intervention for the mutual decision making and organization of care
processes for a well-defined group of patients during a well-defined time period”.
It’s focussing on a specific group of patients; well defined and limited. It also limiting the time-period,
care pathways can focus on the whole care of it can be a specific part of it, but there is always a
specific beginning and ending.
Care pathway, characteristics of the method:
- Key interventions based on scientific evidence
- Coordination of the care process by coordinating the roles, and determining the order of
activities (who is responsible for what?)
- Recorded in patient documentation
- Standardized care ® with monitoring, evaluation of deviations, and giving feedback (specific
way of working for a specific patient which is known as the best evidence for this patient
group/disease)
So, it’s standardized care, but it doesn’t mean there are not deviations. By documenting everything,
you can see what goes wrong and you can act upon it ® you can improve it.
Aims of a care pathway:
- Improving the quality of care
- Improving patient outcomes
- Increasing patient safety
- Increasing patient satisfaction (for a lot of pathways, a patient version is created: what is
going to happen when etc., so you can inform patients and then they will be more satisfied)
- Coordinating care
- Optimizing capacity utilization (if you have your standardized way of working from the
pathways, you know what must be done, when, and by who)
Every care pathway is a patient process, however not every patient process is a care pathway.
Creating a pathway takes some time, and only is valuable if you have a well-defined patient group.
Also, if there are no guidelines for a specific patient group, that it is not possible to provide a care
pathway.
4
