Advanced topics: SCM in healthcare
1st lesson
Part A: Patient chain management
1. Flows in healthcare: examples in the Dutch context
1.1 Traditional SCM: managing physical flows
1.2 Flows in Dutch healthcare: the borderline between GP and
hospital
− There is a borderline between GP and hospital
• In the Netherlands, the general practitioner is the "gatekeeper”
• So: without a referral from the general practitioner, no access to the specialist or
hospital
1
, 1.3 Back-office role for medical specialists?
− It can also happen that a primary care physician may seek hospital advice on behalf of the
patient.
− Example: at your annual checkup at the primary care center down the street from where
you live, a single blood value does not track with what is normal on average. Should you
start worrying about something? While you have no complaints, do not smoke and regularly
run 10 km.
− You don't have to go to the hospital yourself right away, but two days later you get an
answer directly from the family doctor based on his phone call with the specialist. From a
patient experience point of view, this has advantages.
− However, not all specialties are open to such a back-office role. It can be time-consuming
without the health insurance company paying the hospital for it.
1.4 Who tracks the patient?
− In the hospital, there are specialties that continue to “follow up” a once-referred patient
proactively or allow the patient to ring the bell directly until the problems are completely
resolved. But in other specialties, the patient starts all over again with the general
practitioner despite the fact that the problem is "already under treatment."
− Each time the question arises: who (GP or specialist) is going to do what for the patient at
what point?
− This is a coordination issue and clearly has organizational aspects in addition to clinical
ones.
− It occurs at the operational level, i.e. between the professionals involved, but also at the
inter-organizational level, i.e. between primary care center and hospital
1.5 Example: Care chain for CVA
− Three separate phases
• Acute phase
• Revalidation
• Chronical phase
2
, 1.6 Challenge!
− “Although patients are in need of coherent care, we are often not able to supply coherent
care.”
2. What SCM can contribute
− Demand-based care provision: Building an integrated chain
2.1 Integrated Care (in Dutch: ketenzorg)
− Beside clinical also organizational challenges:
• Specialisation in health care (Meijboom et al., 2011)
▪ multidisciplinary collaboration
▪ multiple health care providers
• Increasing emphasis on demand-based care (de Blok et al., 2010), e.g.
▪ Client involvement
▪ Joint delivery
− Moreover, increasing pressure to cut costs
2.2 Often a broken chain…
− ... yielding problems in the areas of (Meijboom et al., 2011):
• Communication
• Patient safety
• Waiting times
• Integration
− Schoen et al. (2007, p. 717): “Patient errors are high for those [patients] seeing multiple
doctors or having multiple chronic diseases.”
2.3 “…instead of a “linked” chain”
− How can notions from Supply Chain Management help in improving the organisational
dimension of integrated care provision?
− So, this is about Patient Chain Management rather than goods chain management
3
, 3. Organization of healthcare chains
3.1 Improving patient handover moments in healthcare chains
− For each patient, coherence in care provision is a ‘must’
− If multiple professionals and/or providers are indispensable, then this diversitycannot be an
excuse for missing or badly connected links in the healthcare chain
− Thus, handover moments in the healthcare chain are central in my research projects
− Preferably in collaboration with healthcare experts!
3.2 How to organize healthcare chains?
− In case of ‘sequential care’:
• Supply Chain Management (SCM) inspired patient care
➢Patient chain management; example: clinical pathways
− In case of ‘iterative care’:
• Opportunities for service modularity
4. More examples
4.1 Example 1: Care chain for CVA
4
1st lesson
Part A: Patient chain management
1. Flows in healthcare: examples in the Dutch context
1.1 Traditional SCM: managing physical flows
1.2 Flows in Dutch healthcare: the borderline between GP and
hospital
− There is a borderline between GP and hospital
• In the Netherlands, the general practitioner is the "gatekeeper”
• So: without a referral from the general practitioner, no access to the specialist or
hospital
1
, 1.3 Back-office role for medical specialists?
− It can also happen that a primary care physician may seek hospital advice on behalf of the
patient.
− Example: at your annual checkup at the primary care center down the street from where
you live, a single blood value does not track with what is normal on average. Should you
start worrying about something? While you have no complaints, do not smoke and regularly
run 10 km.
− You don't have to go to the hospital yourself right away, but two days later you get an
answer directly from the family doctor based on his phone call with the specialist. From a
patient experience point of view, this has advantages.
− However, not all specialties are open to such a back-office role. It can be time-consuming
without the health insurance company paying the hospital for it.
1.4 Who tracks the patient?
− In the hospital, there are specialties that continue to “follow up” a once-referred patient
proactively or allow the patient to ring the bell directly until the problems are completely
resolved. But in other specialties, the patient starts all over again with the general
practitioner despite the fact that the problem is "already under treatment."
− Each time the question arises: who (GP or specialist) is going to do what for the patient at
what point?
− This is a coordination issue and clearly has organizational aspects in addition to clinical
ones.
− It occurs at the operational level, i.e. between the professionals involved, but also at the
inter-organizational level, i.e. between primary care center and hospital
1.5 Example: Care chain for CVA
− Three separate phases
• Acute phase
• Revalidation
• Chronical phase
2
, 1.6 Challenge!
− “Although patients are in need of coherent care, we are often not able to supply coherent
care.”
2. What SCM can contribute
− Demand-based care provision: Building an integrated chain
2.1 Integrated Care (in Dutch: ketenzorg)
− Beside clinical also organizational challenges:
• Specialisation in health care (Meijboom et al., 2011)
▪ multidisciplinary collaboration
▪ multiple health care providers
• Increasing emphasis on demand-based care (de Blok et al., 2010), e.g.
▪ Client involvement
▪ Joint delivery
− Moreover, increasing pressure to cut costs
2.2 Often a broken chain…
− ... yielding problems in the areas of (Meijboom et al., 2011):
• Communication
• Patient safety
• Waiting times
• Integration
− Schoen et al. (2007, p. 717): “Patient errors are high for those [patients] seeing multiple
doctors or having multiple chronic diseases.”
2.3 “…instead of a “linked” chain”
− How can notions from Supply Chain Management help in improving the organisational
dimension of integrated care provision?
− So, this is about Patient Chain Management rather than goods chain management
3
, 3. Organization of healthcare chains
3.1 Improving patient handover moments in healthcare chains
− For each patient, coherence in care provision is a ‘must’
− If multiple professionals and/or providers are indispensable, then this diversitycannot be an
excuse for missing or badly connected links in the healthcare chain
− Thus, handover moments in the healthcare chain are central in my research projects
− Preferably in collaboration with healthcare experts!
3.2 How to organize healthcare chains?
− In case of ‘sequential care’:
• Supply Chain Management (SCM) inspired patient care
➢Patient chain management; example: clinical pathways
− In case of ‘iterative care’:
• Opportunities for service modularity
4. More examples
4.1 Example 1: Care chain for CVA
4
