Literature Week 5 HSOM
Bredenhoff et al. (2010) Exploring types of focused factories in hospital
care: a multiple case study. BMC Health Services Research.
Implementing ‘focus factories’, aimed at specific treatments or diseases, is proposed as a
way to increase the efficiency of hospital care. It is a concept from manufacturing, which
focuses on a limited, manageable set of products. This prevents trade-offs that hinder the
fulfillment of product requirements and deteriorate the competitiveness of the
organization. For services, focus requires organizations to segment their markets and
develop focused delivery systems for each segment. These segments identify relatively
homogeneous groups of customers. This often reveals smaller, more predictable and
manageable patterns in demand.
Different types of focus:
- Products (product lines or markets)
- Processes (internal capabilities)
- Competitive priorities (‘order winners’)
2 focus dimensions:
- Variety in product or customer requirements
- Variety in the processes or technologies used in the delivery system
The literature on focus in hospital care describes focus as a diffuse mix of treatment
characteristics, patient characteristics, specialty characteristics and organizational aspects.
Examples of focused factories: trauma centers, specialty hospitals.
Closest definition of focused factory in hospital setting: focused factories are organisations
based on common objectives (treatment for specific group of patient e.g.) (Herzlinger).
Need to go from a professional-centered to patient-centered organisations. This might solve
some problems associated with traditional hospital organization (professional
bureaucracies), like work-around culture, coordination problems, lack of teamwork and
handovers. However, the definition and requirements of focused factories for hospitals
remain unclear. Benefits however include patient satisfaction, decreased mortality rates and
less adverse outcomes on hospital level.
There is variety in hospitals, depending on the experience and expertise of the staff, the
patient needs, the infrastructure and medical technologies. So different focused factories
might exist, these might differentiate depending on e.g. the degree of customization or
variation in services needed.
The fit between strategic focusing decisions and the design of the care delivery system
appears especially important for delivery and procedure based focused factories. It is not
clear however if the benefits gotten from a certain type of hospital, needs more research.
Focus relates to limitations on the patient group treated and the service/treatments
offered. Process focused more related to strategic choices considering the organizational
structure and design of care delivery system. Product focus related to limiting the patient
groups treated, having implicit consequences for the organizational structure. Based on
1
, these differences in degree focus, three main types of focused factories: specialty based,
delivery based and procedure based focused factories.
Focus can lead to higher productivity and utilization, but only when clear strategic focusing
decisions are made. Applied strategic choices and their consequences for the design of the
care delivery system seem more important in explaining differences in operational
performance than focus scores as such, that’s why studies might be getting such mixed
results.
Silander et al. (2015) Modularizing specialized hospital services:
constraining characteristics, enabling activities and outcomes.
Health care sector faces big challenges, like tailoring care to patient preference, and
fragmentation into narrow specialties. Two megatrends colliding: demand for increasing
service volumes (increase in variety) and demand for customization. Modularization and
mass customization seem to be good solutions to this, while exploiting the advantages of
mass production and standardization.
Modularization reduces complexity through fragmented systems, having benefits such as
enhanced flexibility and cost savings. Design aspects of service modularization:
- Customer involvement during the service process
- Managing heterogeneity of customer requests
- Decomposition of service offerings
- Standardization of interfaces with design and planning rules
- Mixing and matching of components
Characteristics of specialized hospital services:
- High information asymmetry
- Professional autonomy
- Heterogeneous demand (requirement to care all needs)
- Fragmented delivery
- Hierarchy
Modularity (Baldwin & Clark): constructing complex products or processes from
independently designed smaller subsystems that function together as a whole. Core
concept: decomposability – the division of a larger system into smaller parts (modules). The
interdependencies between the modules is minimized compared to the ones inside the
modules, this enables simplification of interfaces because interactions within modules are
more frequent or complex than between. Between modules there is reusability and sharing,
and modules can be recombined to create different configurations without losing
functionality. Being able to copy/repeat it, enables mass production which leads to
reduction of coordination costs. Nearly all systems have modularity to some extent, there
are few systems which have completely inseparable components. Some tradeoffs: it
requires higher efforts during the design and development phases of services, the
standardization might reduce variety in services, and benefits might not always outweigh
costs.
2
Bredenhoff et al. (2010) Exploring types of focused factories in hospital
care: a multiple case study. BMC Health Services Research.
Implementing ‘focus factories’, aimed at specific treatments or diseases, is proposed as a
way to increase the efficiency of hospital care. It is a concept from manufacturing, which
focuses on a limited, manageable set of products. This prevents trade-offs that hinder the
fulfillment of product requirements and deteriorate the competitiveness of the
organization. For services, focus requires organizations to segment their markets and
develop focused delivery systems for each segment. These segments identify relatively
homogeneous groups of customers. This often reveals smaller, more predictable and
manageable patterns in demand.
Different types of focus:
- Products (product lines or markets)
- Processes (internal capabilities)
- Competitive priorities (‘order winners’)
2 focus dimensions:
- Variety in product or customer requirements
- Variety in the processes or technologies used in the delivery system
The literature on focus in hospital care describes focus as a diffuse mix of treatment
characteristics, patient characteristics, specialty characteristics and organizational aspects.
Examples of focused factories: trauma centers, specialty hospitals.
Closest definition of focused factory in hospital setting: focused factories are organisations
based on common objectives (treatment for specific group of patient e.g.) (Herzlinger).
Need to go from a professional-centered to patient-centered organisations. This might solve
some problems associated with traditional hospital organization (professional
bureaucracies), like work-around culture, coordination problems, lack of teamwork and
handovers. However, the definition and requirements of focused factories for hospitals
remain unclear. Benefits however include patient satisfaction, decreased mortality rates and
less adverse outcomes on hospital level.
There is variety in hospitals, depending on the experience and expertise of the staff, the
patient needs, the infrastructure and medical technologies. So different focused factories
might exist, these might differentiate depending on e.g. the degree of customization or
variation in services needed.
The fit between strategic focusing decisions and the design of the care delivery system
appears especially important for delivery and procedure based focused factories. It is not
clear however if the benefits gotten from a certain type of hospital, needs more research.
Focus relates to limitations on the patient group treated and the service/treatments
offered. Process focused more related to strategic choices considering the organizational
structure and design of care delivery system. Product focus related to limiting the patient
groups treated, having implicit consequences for the organizational structure. Based on
1
, these differences in degree focus, three main types of focused factories: specialty based,
delivery based and procedure based focused factories.
Focus can lead to higher productivity and utilization, but only when clear strategic focusing
decisions are made. Applied strategic choices and their consequences for the design of the
care delivery system seem more important in explaining differences in operational
performance than focus scores as such, that’s why studies might be getting such mixed
results.
Silander et al. (2015) Modularizing specialized hospital services:
constraining characteristics, enabling activities and outcomes.
Health care sector faces big challenges, like tailoring care to patient preference, and
fragmentation into narrow specialties. Two megatrends colliding: demand for increasing
service volumes (increase in variety) and demand for customization. Modularization and
mass customization seem to be good solutions to this, while exploiting the advantages of
mass production and standardization.
Modularization reduces complexity through fragmented systems, having benefits such as
enhanced flexibility and cost savings. Design aspects of service modularization:
- Customer involvement during the service process
- Managing heterogeneity of customer requests
- Decomposition of service offerings
- Standardization of interfaces with design and planning rules
- Mixing and matching of components
Characteristics of specialized hospital services:
- High information asymmetry
- Professional autonomy
- Heterogeneous demand (requirement to care all needs)
- Fragmented delivery
- Hierarchy
Modularity (Baldwin & Clark): constructing complex products or processes from
independently designed smaller subsystems that function together as a whole. Core
concept: decomposability – the division of a larger system into smaller parts (modules). The
interdependencies between the modules is minimized compared to the ones inside the
modules, this enables simplification of interfaces because interactions within modules are
more frequent or complex than between. Between modules there is reusability and sharing,
and modules can be recombined to create different configurations without losing
functionality. Being able to copy/repeat it, enables mass production which leads to
reduction of coordination costs. Nearly all systems have modularity to some extent, there
are few systems which have completely inseparable components. Some tradeoffs: it
requires higher efforts during the design and development phases of services, the
standardization might reduce variety in services, and benefits might not always outweigh
costs.
2
