Summary Literature Health Service Operations
Management
Week 1...................................................................................................................................................2
Bowers, M.R., et al. (1994). What attributes quality and satisfaction with health care delivery........2
Ahaus, K. (2018). Perceptions of practioners and experts on valuebased healthcare: a mixed-
methods study....................................................................................................................................3
Book Vissers & Beech.........................................................................................................................6
Chapter 1 ‘introduction, p. 1-10’....................................................................................................6
Chapter 3 ‘Basic concepts and approaches, p. 39-49’.....................................................................9
Book Fitzsimmons & Fitzsimmons (9th edition).................................................................................12
Chapter 1 ‘The service economy, p. 11-22’...................................................................................12
Chapter 3 ‘New Service Development, p. ‘72-73’.........................................................................16
Chapter 6 ‘Service quality, p. 149-163’.........................................................................................17
Week 2.................................................................................................................................................20
Book Vissers & Beech.......................................................................................................................20
Chapter 4 ‘Unit Logistics’..............................................................................................................20
Veen van-Berkx E, et al. (2016) "Benchmarking operating room departments in the Netherlands:
Evaluation of a benchmarking collaborative between eight university medical centres"................23
De Bruin, AM, et al. (2010). Dimensioning hospital wards using the Erlang loss model...................26
Zhang, Y., Puterman, M. L., & Atkins, D. (2012). Residential long-term care capacity planning: The
shortcomings of ratio-based forecasts.............................................................................................28
Special Delivery Unit 2007. Technical Guidance Introducing Demand and Capacity Planning.pdf.
pages 8-26........................................................................................................................................30
Week 3.................................................................................................................................................33
Book Vissers & Beech.......................................................................................................................33
Chapter 5 ‘Chain logistics’.............................................................................................................33
Book Fitzsimmons & Fitzsimmons (9th edition).................................................................................37
Chapter 3 ‘New Service development, p. 74-76, until Taxonomy of..’).........................................37
Vanhaecht K, De Witte K, Panella, M, Sermeus, W, 2009. Do pathways lead to better organized
care processes?................................................................................................................................38
Lovelle, J., 2001, Mapping the Value Stream, IIE Solutions, vol 33, issue 2, p. 27-33.......................39
Bredenhoff, Eelco; van Lent, Wineke A. M.; van Harten, Wim H. Exploring types of focused
factories in hospital care: a multiple case study...............................................................................41
Hyer, N.L., Wemmerlöv, U., and Morris Jr, J.A. (2009). Performance analysis of a focused hospital
unit: the case of an integrated trauma center..................................................................................43
Week 4.................................................................................................................................................46
Book Fitzsimmons & Fitzsimmons (9th edition).................................................................................46
1
, Chapter 13 ‘Capacity planning and queuing models’....................................................................46
Song, H., Tucker, A. L., & Murrell, K. L. (2015). The diseconomies of queue pooling: An empirical
investigation of emergency department length of stay....................................................................51
Song, H., Tucker, A. L., Graue, R., Moravick, S., & Yang, J. J. (2020). Capacity pooling in hospitals:
The hidden consequences of off-service placement.........................................................................53
Week 5.................................................................................................................................................55
Book Fitzsimmons & Fitzsimmons (9th edition).................................................................................55
Chapter 6 ‘Service Quality, p. 163-174’........................................................................................55
Chapter 7 p.187-200, until Lean Services’.....................................................................................57
Watson, K. J., Blackstone, J. H., & Gardiner, S. C. (2007). The evolution of a management
philosophy: The theory of constraints..............................................................................................60
Nave, D. (2002). How to compare six sigma, lean and the theory of constraints.............................63
Week 6.................................................................................................................................................66
Roemeling, O., Land, M., & Ahaus, C. (2017). Does lean cure variability in health care?.................66
Bijl, A., Ahaus, K., Ruël, G., Gemmel, P., Meijboom, B. (2019). Role of lean leadership in the lean
maturity-second-order problem solving relationship: a mixed methods study................................68
Week 1
Bowers, M.R., et al. (1994). What attributes quality and satisfaction
with health care delivery.
These days it is important to understand how consumers evaluate health services. Patient-based
determinants of quality and satisfactions play an important role in choosing a health care provider.
There are mainly two research streams on evaluative attributes:
o Ware, Snyder et al., main conclusion: in practice, some of the attributes that research
suggest determine satisfaction have received insufficient attention and healthcare
management need to know what attributes patients in use in evaluating healthcare providers
o Second is about SERVQUAL, which is about discovering attributes which are relevant for
services in general. There has been an question whether the set of attributes that were
originally developed for services outside of healthcare are sufficient for healthcare
applications. It didn’t include attributes that have received considerable empirical support.
The attributes of SERVQUAL: Tangibles, reliability, responsiveness, assurance and empathy
Research about using in SERVQUAL in practice is contradictory
10 generic quality attributes from focus group interviews: tangibles, reliability, responsiveness,
competency, courtesy, communication, credibility, security, access and understanding.
Research-questions in this study:
2
,This study therefore looks at additional dimensions which might be important to define patient
evaluations. They found 6:
o Caring: implies a personal, human involvement in the service situation, with emotions
approaching love for the patient
o Patient outcomes: reflected relief from pain, saving of life, or anger or disappointment with
life after medical intervention.
o Communication: between patient and caregiver is important in determining satisfaction with
healthcare, but not captured in SERVQUAL.
o Responsiveness
o Empathy
o Reliability
! Patients have a lack in ability to assess technical quality, consumers and purchasers and therefore
base their satisfaction on the delivery of healthcare. This are human dimensions and not technical
ones. Healthcare administrators are therefore advices to determine which attributes are the most
important for their own institutions.
Strict attention tot the provision of technical quality will result in consumer complaints of
tardy, unresponsive and uncaring service. The result will be a decline in volume and difficulty
in attracting new patient groups. Providers who do look at these things will secure an
important competitive advantage, and therefore are financial more stable.
Four advises for institutions:
1. Establishing measurement for those attributes
2. Developing operational definitions and specify levels of appropriate performance
3. Incorporating the delivery of quality dimensions into job descriptions, evaluations and
compensation structures
4. Managing customer expectations concerning level of performance; lower too high
expectations of patients communication Is key
Ahaus, K. (2018). Perceptions of practioners and experts on
valuebased healthcare: a mixed-methods study
This article gives a comprehensive framework of value-based healthcare: distinctive approach that
adds to existing approaches by its focus on outcomes and costs, data-driven improvement and better
ways to pay for healthcare We identified four categories: Patient value; Costs; Organisation of
care; and, Steering of quality. In addition, we included 29 elements that are considered as (very)
important by the experts.
Introduction
Michael Porter started the inspiration of value-based healthcare. At present, in most healthcare
systems worldwide, healthcare providers are paid predominantly by volume (on a basis of fee-for-
service), instead of by value. While unintended, this has turned out to be one of the drivers of rising
costs in healthcare. This is why Porter accentuates that we needed a shift in focus from volume to
value. Value is defined as “health outcomes achieved per dollar spent”.
The need for transparency of the quality of care has led to excessive data collection and data
delivery to various stakeholders. As a consequence, this leaves little room to use these
measurements for improvements. The attention for accountability and improvement
respectively seems to be considerably out of balance
Focussing on value requires reforming the fragmented, siloed organisation of healthcare delivery
governed by an equally partitioned healthcare purchaser. It calls for a transformation to an
organisation of “orchestrated multidisciplinary teams”
3
, Porter’s prior work offers profound notions on measuring value. Outcomes and costs should cover
the full care cycle for diagnosing and treating a medical condition, involving multiple specialties from
different care providers in the patient’s journey. This journey could be organised into “integrated
practice units”.
Aim of value-based healthcare: Elg et al. (2013) argue to achieve a balance between the dimensions
of regulation (e.g. the pressure of public transparent reporting) and exploration (e.g. the need to
improve clinical practice). Value-based healthcare might help to restore this balance.
Theoretical background
Measuring value
Porter argues that outcomes should be related to health gain and to what matters for patients
concerning their health and proposes “three-tiered hierarchy” with the tiers 2 and 3 being
dependent on tier 1:
o Tier 1: the health status achieved or retained (tier 1)
o Tier 2: the process of recovery
o Tier 3: the sustainability of health
It is about both the clinical status as functional status (patient reported outcome measures, PROMs)
Both clinical (on tiers 1, 2 and 3) and patient reported or experienced indicators are
considered as outcomes in valuebased healthcare.
Costs can be measured based on the activities performed in the full cycle of care. An analysis
of the process might reveal non-value-added activities, which can be eliminated without any
reduction of value
Value agenda
Porter and Lee (2013) discuss a strategic value agenda, which is a roadmap basically about
transformation in:
- The way healthcare is organised into IPUs (including their support)
- The way we measure quality and costs
- The way the healthcare provider gets paid for the value delivered.
IPUs are organised around a group of patients with similar needs. Based on these needs, their care
can be explicated in a clinical programme or care pathway. They need to be supported by an IT
platform, data support and implementation expertise.
! The transformation toward a valuebased healthcare system according to Bohmer needs an
“orchestrated team-based redesign”, where the redesign emerges in “a long series of local
experiments”. The teams take care of delivering the right care for the patient at the right place in the
supply chain. Preferably, volume will be concentrated, as concentration is considered to indicate
quality.
Other thing: In healthcare, the dominant way of paying the providers is fee-for-service. This
transparent way to pay for healthcare is considered as fair and helps in reducing a possible gap
between demand and supply. However, it rewards quantity, instead of quality. This leads to under-
investment in non-reimbursed care delivery and might perpetuate poor outcomes.
Porter and Kaplan (2016) suggest a shift away from fee-for-service and propose a capped,
risk-adjusted bundled payment for the full cycle of care. When linked to outcomes, such a
bundled payment will incentivise collaboration and reduce inefficiency.
Method see article
Results
4
Management
Week 1...................................................................................................................................................2
Bowers, M.R., et al. (1994). What attributes quality and satisfaction with health care delivery........2
Ahaus, K. (2018). Perceptions of practioners and experts on valuebased healthcare: a mixed-
methods study....................................................................................................................................3
Book Vissers & Beech.........................................................................................................................6
Chapter 1 ‘introduction, p. 1-10’....................................................................................................6
Chapter 3 ‘Basic concepts and approaches, p. 39-49’.....................................................................9
Book Fitzsimmons & Fitzsimmons (9th edition).................................................................................12
Chapter 1 ‘The service economy, p. 11-22’...................................................................................12
Chapter 3 ‘New Service Development, p. ‘72-73’.........................................................................16
Chapter 6 ‘Service quality, p. 149-163’.........................................................................................17
Week 2.................................................................................................................................................20
Book Vissers & Beech.......................................................................................................................20
Chapter 4 ‘Unit Logistics’..............................................................................................................20
Veen van-Berkx E, et al. (2016) "Benchmarking operating room departments in the Netherlands:
Evaluation of a benchmarking collaborative between eight university medical centres"................23
De Bruin, AM, et al. (2010). Dimensioning hospital wards using the Erlang loss model...................26
Zhang, Y., Puterman, M. L., & Atkins, D. (2012). Residential long-term care capacity planning: The
shortcomings of ratio-based forecasts.............................................................................................28
Special Delivery Unit 2007. Technical Guidance Introducing Demand and Capacity Planning.pdf.
pages 8-26........................................................................................................................................30
Week 3.................................................................................................................................................33
Book Vissers & Beech.......................................................................................................................33
Chapter 5 ‘Chain logistics’.............................................................................................................33
Book Fitzsimmons & Fitzsimmons (9th edition).................................................................................37
Chapter 3 ‘New Service development, p. 74-76, until Taxonomy of..’).........................................37
Vanhaecht K, De Witte K, Panella, M, Sermeus, W, 2009. Do pathways lead to better organized
care processes?................................................................................................................................38
Lovelle, J., 2001, Mapping the Value Stream, IIE Solutions, vol 33, issue 2, p. 27-33.......................39
Bredenhoff, Eelco; van Lent, Wineke A. M.; van Harten, Wim H. Exploring types of focused
factories in hospital care: a multiple case study...............................................................................41
Hyer, N.L., Wemmerlöv, U., and Morris Jr, J.A. (2009). Performance analysis of a focused hospital
unit: the case of an integrated trauma center..................................................................................43
Week 4.................................................................................................................................................46
Book Fitzsimmons & Fitzsimmons (9th edition).................................................................................46
1
, Chapter 13 ‘Capacity planning and queuing models’....................................................................46
Song, H., Tucker, A. L., & Murrell, K. L. (2015). The diseconomies of queue pooling: An empirical
investigation of emergency department length of stay....................................................................51
Song, H., Tucker, A. L., Graue, R., Moravick, S., & Yang, J. J. (2020). Capacity pooling in hospitals:
The hidden consequences of off-service placement.........................................................................53
Week 5.................................................................................................................................................55
Book Fitzsimmons & Fitzsimmons (9th edition).................................................................................55
Chapter 6 ‘Service Quality, p. 163-174’........................................................................................55
Chapter 7 p.187-200, until Lean Services’.....................................................................................57
Watson, K. J., Blackstone, J. H., & Gardiner, S. C. (2007). The evolution of a management
philosophy: The theory of constraints..............................................................................................60
Nave, D. (2002). How to compare six sigma, lean and the theory of constraints.............................63
Week 6.................................................................................................................................................66
Roemeling, O., Land, M., & Ahaus, C. (2017). Does lean cure variability in health care?.................66
Bijl, A., Ahaus, K., Ruël, G., Gemmel, P., Meijboom, B. (2019). Role of lean leadership in the lean
maturity-second-order problem solving relationship: a mixed methods study................................68
Week 1
Bowers, M.R., et al. (1994). What attributes quality and satisfaction
with health care delivery.
These days it is important to understand how consumers evaluate health services. Patient-based
determinants of quality and satisfactions play an important role in choosing a health care provider.
There are mainly two research streams on evaluative attributes:
o Ware, Snyder et al., main conclusion: in practice, some of the attributes that research
suggest determine satisfaction have received insufficient attention and healthcare
management need to know what attributes patients in use in evaluating healthcare providers
o Second is about SERVQUAL, which is about discovering attributes which are relevant for
services in general. There has been an question whether the set of attributes that were
originally developed for services outside of healthcare are sufficient for healthcare
applications. It didn’t include attributes that have received considerable empirical support.
The attributes of SERVQUAL: Tangibles, reliability, responsiveness, assurance and empathy
Research about using in SERVQUAL in practice is contradictory
10 generic quality attributes from focus group interviews: tangibles, reliability, responsiveness,
competency, courtesy, communication, credibility, security, access and understanding.
Research-questions in this study:
2
,This study therefore looks at additional dimensions which might be important to define patient
evaluations. They found 6:
o Caring: implies a personal, human involvement in the service situation, with emotions
approaching love for the patient
o Patient outcomes: reflected relief from pain, saving of life, or anger or disappointment with
life after medical intervention.
o Communication: between patient and caregiver is important in determining satisfaction with
healthcare, but not captured in SERVQUAL.
o Responsiveness
o Empathy
o Reliability
! Patients have a lack in ability to assess technical quality, consumers and purchasers and therefore
base their satisfaction on the delivery of healthcare. This are human dimensions and not technical
ones. Healthcare administrators are therefore advices to determine which attributes are the most
important for their own institutions.
Strict attention tot the provision of technical quality will result in consumer complaints of
tardy, unresponsive and uncaring service. The result will be a decline in volume and difficulty
in attracting new patient groups. Providers who do look at these things will secure an
important competitive advantage, and therefore are financial more stable.
Four advises for institutions:
1. Establishing measurement for those attributes
2. Developing operational definitions and specify levels of appropriate performance
3. Incorporating the delivery of quality dimensions into job descriptions, evaluations and
compensation structures
4. Managing customer expectations concerning level of performance; lower too high
expectations of patients communication Is key
Ahaus, K. (2018). Perceptions of practioners and experts on
valuebased healthcare: a mixed-methods study
This article gives a comprehensive framework of value-based healthcare: distinctive approach that
adds to existing approaches by its focus on outcomes and costs, data-driven improvement and better
ways to pay for healthcare We identified four categories: Patient value; Costs; Organisation of
care; and, Steering of quality. In addition, we included 29 elements that are considered as (very)
important by the experts.
Introduction
Michael Porter started the inspiration of value-based healthcare. At present, in most healthcare
systems worldwide, healthcare providers are paid predominantly by volume (on a basis of fee-for-
service), instead of by value. While unintended, this has turned out to be one of the drivers of rising
costs in healthcare. This is why Porter accentuates that we needed a shift in focus from volume to
value. Value is defined as “health outcomes achieved per dollar spent”.
The need for transparency of the quality of care has led to excessive data collection and data
delivery to various stakeholders. As a consequence, this leaves little room to use these
measurements for improvements. The attention for accountability and improvement
respectively seems to be considerably out of balance
Focussing on value requires reforming the fragmented, siloed organisation of healthcare delivery
governed by an equally partitioned healthcare purchaser. It calls for a transformation to an
organisation of “orchestrated multidisciplinary teams”
3
, Porter’s prior work offers profound notions on measuring value. Outcomes and costs should cover
the full care cycle for diagnosing and treating a medical condition, involving multiple specialties from
different care providers in the patient’s journey. This journey could be organised into “integrated
practice units”.
Aim of value-based healthcare: Elg et al. (2013) argue to achieve a balance between the dimensions
of regulation (e.g. the pressure of public transparent reporting) and exploration (e.g. the need to
improve clinical practice). Value-based healthcare might help to restore this balance.
Theoretical background
Measuring value
Porter argues that outcomes should be related to health gain and to what matters for patients
concerning their health and proposes “three-tiered hierarchy” with the tiers 2 and 3 being
dependent on tier 1:
o Tier 1: the health status achieved or retained (tier 1)
o Tier 2: the process of recovery
o Tier 3: the sustainability of health
It is about both the clinical status as functional status (patient reported outcome measures, PROMs)
Both clinical (on tiers 1, 2 and 3) and patient reported or experienced indicators are
considered as outcomes in valuebased healthcare.
Costs can be measured based on the activities performed in the full cycle of care. An analysis
of the process might reveal non-value-added activities, which can be eliminated without any
reduction of value
Value agenda
Porter and Lee (2013) discuss a strategic value agenda, which is a roadmap basically about
transformation in:
- The way healthcare is organised into IPUs (including their support)
- The way we measure quality and costs
- The way the healthcare provider gets paid for the value delivered.
IPUs are organised around a group of patients with similar needs. Based on these needs, their care
can be explicated in a clinical programme or care pathway. They need to be supported by an IT
platform, data support and implementation expertise.
! The transformation toward a valuebased healthcare system according to Bohmer needs an
“orchestrated team-based redesign”, where the redesign emerges in “a long series of local
experiments”. The teams take care of delivering the right care for the patient at the right place in the
supply chain. Preferably, volume will be concentrated, as concentration is considered to indicate
quality.
Other thing: In healthcare, the dominant way of paying the providers is fee-for-service. This
transparent way to pay for healthcare is considered as fair and helps in reducing a possible gap
between demand and supply. However, it rewards quantity, instead of quality. This leads to under-
investment in non-reimbursed care delivery and might perpetuate poor outcomes.
Porter and Kaplan (2016) suggest a shift away from fee-for-service and propose a capped,
risk-adjusted bundled payment for the full cycle of care. When linked to outcomes, such a
bundled payment will incentivise collaboration and reduce inefficiency.
Method see article
Results
4
