In this paper, we apply a design science approach to help a Northern European city improve the efficiency of its home care delivery system. Our proposed solution emerges as a synthesis of applying Goldratt's Theory of Constraints and the principles of variable-demand inventory replenishment. The improved system exhibits both more level resource utilization and higher productivity due to more efficient capacity utilization. In addition to improving system efficiency, we gain insights into how authentic operations management problems can be addressed through design research. A crucial aspect of empirically-rooted practical problems is that they always involve multiple stakeholders with only partially overlapping preferences. Consequently, one must not assume or ascribe an a priori system objective, instead, it must arise from explicit empirical analysis of the relevant stakeholders. Another characteristic of authentic problems is that they are always embedded in an institutional context that sets significant boundary conditions to the feasibility of solutions. These boundary conditions are an important reminder of the complexity of empirically-rooted managerial problems.

PurposeThe purpose of this paper is to explore different units of analysis applicable to the analysis of healthcare service supply chains.Design/methodology/approachThe paper is based on a literature review, conceptual analysis and two case studies based on process mapping and longitudinal analysis of patient episodes.FindingsProcess management is appropriate in situations where there is a structured flow with a sufficient volume of similar repetitions. In the case where there are significant amounts of exceptions, a process can be decomposed into service events that can be defined and managed as part of a supply chain.Research limitations/implicationsThe cases are based on data sets that do not allow empirical generalization.Practical implicationsThe use of longitudinal patient episode data elicits problems in the process flow, such as delays and variable sequences. The use of events as a unit of analysis enables routinization in situations with exceptions and irregular sequences.Originality/valueThe service event is an original concept that links healthcare operations management to service‐oriented architectures and the service‐dominant logic.

Applying assessment methods commonly used in healthcare, such as randomized controlled trials (RCT) and financial analysis, often proves challenging in health technology assessment (HTA). Procurement and implementation of process improving information and communication technology (ICT) is traditionally sought to be based on financial estimates. These are often difficult to produce and may be misleading. There is a need for a more pragmatic managerial solution. This paper suggests an alternative approach, based on the theory of constraints (TOC), arguing that the primary focus of technology assessment should be on technologies' ability to break or alleviate organizational constraints, in order to increase throughput rather than reduce cost. Ultimately the latter will become as a consequence of the former. This paper presents a conceptual contribution. The suggested approach is illustrated through a case study of a home care unit.

Mobile healthcare services exist to improve outcomes, but they have the potential to improve output of service provision as well. Operations management research on remote and mobile healthcare interventions tends to focus solely on output efficiency and leaving the questions of output-outcome relations to clinical medicine. However, with preventive interventions output-outcome relation plays a critical role in defining life-cycle long costs, outcomes and production effects of the technological intervention. Healthcare operations management can offer a valuable framework for better understanding remote mobile service systems and their effects. In this paper we explore different types of efficiency implications using mobile phone based solutions as an interesting example. We discuss time and location constraints of traditional service provision and how mobile services can impact them. We conclude by defining a new approach to studying mobile interventions from an operations management perspective.

We present a service element conceptualization for home care -a growing, but largely undermanaged sector. In home care, a visit is the basic service element, which consists of several service tasks performed during the visit. These tasks determine the essential characteristics of the visit regarding resource planning, resource optimization and scheduling. We propose a typology to define the various tasks performed during the home care visits according to three attributes; purpose, time criticality and type of activities. Each attribute also has two states. This classification produced eight different visit types. The typology was tested in a field study by observing 67 visits to 18 customers in a mid-size European municipality. As the time-critical tasks in the current mode of operation are dominant, capacity management cannot focus on leveling but needs to use a chase capacity approach. As most visits require personal service, there were insignificant possibilities to efficiency improvement through ICT-mediated services.