Literature
Vissers, Elkhuizen and Proudlove - Operations Management for
Healthcare
Chapter 1: Introduction
Operations management (OM):
● = planning and control of processes that transform inputs into outputs
● In healthcare:
○ Input of consultation process = patient with request for healthcare
○ Output = patient is diagnosed and referred or cured
○ Resources must be managed: eg how they use time and services; OM ensures
resources are there at the right time and place so people dot hae to wait too long
and avoiding waste
○ Model for healthcare delivery system (Roth, 1993)
■
■ Transforming processes
● Clinical = most important, primary processes in which
transformation takes place
● Management = supporting clinical through planning and control of
resources required for diagnosis/cure
○ Operational level: pts are scheduled for appointments; or
admission needing a bed or operating theatre
○ Tactical level: availability of resources for coming weeks is
checked strategically, so amount of resources needed for
long term
, ● Ancillary = supporting general functioning of hospital; eg cleaning
wards and departments and maintaining equipment
● → what is needed at each level: staff, materials,
equipment
■ Outputs:
● Health status: markers (eg mortality rates, levels of morbidity and
disability, to view success rate)
● Client experience: with family and pt themselves; but also doctors
requiring a service from a diagnostic department
● Resource performance: efficiency (patient lengths of stay,
response times of ancillary support services, resource utilisation)
and effectiveness (use of appropriate or modern procedures) with
which resources have been used to transform inputs into outputs
■ → there are relationships and potential conflicts between
different types of output; so if you try to increase pt satisfaction
it may be more costly; so you need to find an acceptable
balance between things
● HSOM and value based healthcare: gives it a new dimension
○ Value based healthcare: relates the value for customers to the costs of delivering
services; pt is on the foreground
○ So instead of focus on individual encounters such as in the model of Roth, there
is now a focus on the total process of the pt leading to output/outcomes
○ New nature of HSOM: analysis, design, planning and control of all the steps
necessary to provide services for pt’s in such a way that their needs are met, that
service standards are met and resources are used efficiently
● Context of HSOM: so how external/internal factors influence HSOM decision making;
○ External factors:
■ Most important ex factor affecting behavior or individuals is overall
healthcare system setting:
● For profit setting: emphasis for providers on profit
maximization → maximize number of patients that they
can treat at acceptable standards of quality, but at
minimum costs per case
● Market environment (such as USA): creates incentives for
providers to ensure the processes for transforming
input/output are effective and efficient → must continually
review and invest in their transforming processes as a
means of maintaining their market share, attracting new
pt’s and reducing costs
○ Eg invest in new healthcare tech to attract new pts and
reduce costs
● National health system/government-regulated system: providers
are budgeted by contract annually arranged with purchasers
(government bodies or insurance organizations)
, ○ Main incentive is to ensure budgetary costs are not
exceeded → so providers must invest in
mechanisms monitoring use of key resources such
as beds and theatres + not a big but there is a view
on client perception/satisfaction besides costs
○ → this is changing: NHS is making frameworks for
key disease areas (cancer/diabetes) and specific
target groups (older/chronic illness) → direct
influence on pt care/clinical processes +
Treeknormen (acceptable waiting times)
● ⇒ irrespective of healthcare system, they all adopt a
value based HC perspective (value of customer is key,
and value is defined as health per dollar OR benefits vs
costs)
○ Problem: value must be defined more precisely:
what is value for customer? How can we measure
it? How can we improve our delivery systems? →
value chain customer perspective must require
collaboration with other providers (so how is it
managed and how does it relate to internal
management of processes of individual providers?)
○ → must be clear that in VBC knowledge of clinical
processes and use of resources (so OM) is
important → helps optimize healthcare delivery
systems
■ Changing demographic of populations in western countries:
older people → scale and nature of hospital resources must be
adjusted to meet demands
● Eg expand services for home based care as alternative to
hospital care
■ Advances in medical tech → providers must adopt this
■ Due to internet and other media outlets → more pt knowledge of
treatments and other expectations → providers must adjust
through SDM
○ Internal factors:
■ Roles and responsibilities in decision making are not clearly
defined or are overlapping ⇒ we now have dual management
(eg doctors who are managers) with parallel hierarchies of
different staff groups → tensions
■ Actors participating in decision making (nurses, doctors,
administrative staff, paramedical disciplines, managers) all have
different interests and priorities → tradeoff between costs vs
quality or efficiency vs effectiveness
● HSOM model:
, ○ Subsystems: grouping of elements
○ Aspect systems: grouping of relationships
■ → eg a hospital consists of several departments (subsystems)
and the aspect system is the relationship between timing of
operations of referring physician and timing of operations of
radiology department
■
● Abstraction = selecting relevant subsystems + aspect systems
● Model provides expected performance of system under
study → must validate model → then interpret results in
terms of meaning for real world
■
● Design cycle (van aken, 2012): use to solve a problem
encountered in the operations of an organization and design a
solution of the problem with use of evidence based approach
(research)
Chapter 3: models and data presets
Chapter 4: units; tradeoff between service level and efficient use of resources
Chapter 6: improvement approaches, eg lean management, six sigma, theory of constraints
Chapter 7: conceptual framework of operations to outcomes (performance analysis of DM2 care
in regional setting)
Vissers, Elkhuizen and Proudlove - Operations Management for
Healthcare
Chapter 1: Introduction
Operations management (OM):
● = planning and control of processes that transform inputs into outputs
● In healthcare:
○ Input of consultation process = patient with request for healthcare
○ Output = patient is diagnosed and referred or cured
○ Resources must be managed: eg how they use time and services; OM ensures
resources are there at the right time and place so people dot hae to wait too long
and avoiding waste
○ Model for healthcare delivery system (Roth, 1993)
■
■ Transforming processes
● Clinical = most important, primary processes in which
transformation takes place
● Management = supporting clinical through planning and control of
resources required for diagnosis/cure
○ Operational level: pts are scheduled for appointments; or
admission needing a bed or operating theatre
○ Tactical level: availability of resources for coming weeks is
checked strategically, so amount of resources needed for
long term
, ● Ancillary = supporting general functioning of hospital; eg cleaning
wards and departments and maintaining equipment
● → what is needed at each level: staff, materials,
equipment
■ Outputs:
● Health status: markers (eg mortality rates, levels of morbidity and
disability, to view success rate)
● Client experience: with family and pt themselves; but also doctors
requiring a service from a diagnostic department
● Resource performance: efficiency (patient lengths of stay,
response times of ancillary support services, resource utilisation)
and effectiveness (use of appropriate or modern procedures) with
which resources have been used to transform inputs into outputs
■ → there are relationships and potential conflicts between
different types of output; so if you try to increase pt satisfaction
it may be more costly; so you need to find an acceptable
balance between things
● HSOM and value based healthcare: gives it a new dimension
○ Value based healthcare: relates the value for customers to the costs of delivering
services; pt is on the foreground
○ So instead of focus on individual encounters such as in the model of Roth, there
is now a focus on the total process of the pt leading to output/outcomes
○ New nature of HSOM: analysis, design, planning and control of all the steps
necessary to provide services for pt’s in such a way that their needs are met, that
service standards are met and resources are used efficiently
● Context of HSOM: so how external/internal factors influence HSOM decision making;
○ External factors:
■ Most important ex factor affecting behavior or individuals is overall
healthcare system setting:
● For profit setting: emphasis for providers on profit
maximization → maximize number of patients that they
can treat at acceptable standards of quality, but at
minimum costs per case
● Market environment (such as USA): creates incentives for
providers to ensure the processes for transforming
input/output are effective and efficient → must continually
review and invest in their transforming processes as a
means of maintaining their market share, attracting new
pt’s and reducing costs
○ Eg invest in new healthcare tech to attract new pts and
reduce costs
● National health system/government-regulated system: providers
are budgeted by contract annually arranged with purchasers
(government bodies or insurance organizations)
, ○ Main incentive is to ensure budgetary costs are not
exceeded → so providers must invest in
mechanisms monitoring use of key resources such
as beds and theatres + not a big but there is a view
on client perception/satisfaction besides costs
○ → this is changing: NHS is making frameworks for
key disease areas (cancer/diabetes) and specific
target groups (older/chronic illness) → direct
influence on pt care/clinical processes +
Treeknormen (acceptable waiting times)
● ⇒ irrespective of healthcare system, they all adopt a
value based HC perspective (value of customer is key,
and value is defined as health per dollar OR benefits vs
costs)
○ Problem: value must be defined more precisely:
what is value for customer? How can we measure
it? How can we improve our delivery systems? →
value chain customer perspective must require
collaboration with other providers (so how is it
managed and how does it relate to internal
management of processes of individual providers?)
○ → must be clear that in VBC knowledge of clinical
processes and use of resources (so OM) is
important → helps optimize healthcare delivery
systems
■ Changing demographic of populations in western countries:
older people → scale and nature of hospital resources must be
adjusted to meet demands
● Eg expand services for home based care as alternative to
hospital care
■ Advances in medical tech → providers must adopt this
■ Due to internet and other media outlets → more pt knowledge of
treatments and other expectations → providers must adjust
through SDM
○ Internal factors:
■ Roles and responsibilities in decision making are not clearly
defined or are overlapping ⇒ we now have dual management
(eg doctors who are managers) with parallel hierarchies of
different staff groups → tensions
■ Actors participating in decision making (nurses, doctors,
administrative staff, paramedical disciplines, managers) all have
different interests and priorities → tradeoff between costs vs
quality or efficiency vs effectiveness
● HSOM model:
, ○ Subsystems: grouping of elements
○ Aspect systems: grouping of relationships
■ → eg a hospital consists of several departments (subsystems)
and the aspect system is the relationship between timing of
operations of referring physician and timing of operations of
radiology department
■
● Abstraction = selecting relevant subsystems + aspect systems
● Model provides expected performance of system under
study → must validate model → then interpret results in
terms of meaning for real world
■
● Design cycle (van aken, 2012): use to solve a problem
encountered in the operations of an organization and design a
solution of the problem with use of evidence based approach
(research)
Chapter 3: models and data presets
Chapter 4: units; tradeoff between service level and efficient use of resources
Chapter 6: improvement approaches, eg lean management, six sigma, theory of constraints
Chapter 7: conceptual framework of operations to outcomes (performance analysis of DM2 care
in regional setting)
