Managing a variable acute patient flow – categorising the strategies

Abstract

Purpose – This paper aims to explore if actions used at a hospital to manage a variable acute patient flow can be categorised using the concepts of lean, agile and leagile. Design/methodology/approach – Empirical evidence from a university hospital was gathered by interviews, internal documents, shadowing and participation in meetings. Identified actions used at both hospital level and departmental level are categorised as lean or agile, while combinations of actions are compared with different leagile approaches. Findings – Actions from every lean and agile category derived from literature are used at the hospital, however in varying extent. Many agile actions are reactive, indicating a lack of proactive measures. Actions that directly manage external variation are also few in numbers. Leagile approaches of all three combinations derived from literature are also used at the hospital. Research limitations/implications – As a single-case study is used, empirical generalisation to other hospitals cannot be deduced. Future research assessing the appropriateness of different actions for managing a variable acute patient flow is encouraged. Practical implications – The use of actions within both lean and agile categories indicate the possibility of combining these process strategies in hospitals, and not only focusing on implementing lean. By cleverly combining lean and agile actions, leagile approaches can be formed. Originality/value – The use of lean in health care has been a topic of research, while the use of agile has been sparsely researched, as well as the combination of the two.

Logistics management operationalised in a healthcare context : Understanding care chain effectiveness through logistics management theories and systems theory

“…Some examples of concepts from logistics management operationalised in a healthcare context can be found. Examples include cellular operations to provide seamless patient flows , the decoupling point concept , supply chain as a unit of analysis , process-chainnetworks (Sampson et al, 2015), and lean and agile to categorise managing of patient flows (Olsson and Aronsson, 2015). Although fruitful in specific concepts associated with logistics management, the presentation of research in journal articles is limited by space constraints.…”

“…Previous work shows superficial operationalisation of logistics management to a healthcare context. It is done by conceptual reasoning as well as operationalisation of specific concepts such as lean and agile (Olsson and Aronsson, 2015) and decoupling point or is based on a production unit perspective ). The exploratory design of this dissertation in combination with the literary volume as a monograph gives affordable advantageous opportunities.…”

“…Similar to supply chains, sub-optimisations can thus be found in care chains. Accordingly, healthcare organisations face the challenge of delivering highquality services at affordable costs, necessitating management of care chains to fulfil patients' needs , Allder et al, 2010b, Eriksson et al, 2011, Villa et al, 2014, Olsson and Aronsson, 2015, The Health Foundation, 2013a.…”

“…It is argued specifically that logistics management in terms of effectiveness applied to care chains can lead to lower costs, better patient service, and shorter waiting times, i.e. both clinical and financial benefits (Olsson and Aronsson, 2015, Sampson et al, 2015. A contextual adaptation along with a systems approach are thus critical to get maximum benefit from these improvement opportunities , Villa et al, 2014).…”

Middle management involvement in handling variable patient flows

“…In addition, healthcare managers claim that the inherent variability discussed above means that they cannot control their service production or predict patient inflow (Jarret, 1998;Vissers et al, 2001). However, variability can be handled by working smarter, through strategies such as capacity management systems (Proudlove et al, 2003, Adan et al, 2009, Vissers et al, 2012, standardized patient processes for homogenous sub-groups of patients (Olsson and Aronsson, 2015) and matching capacity to demand (Walley et al, 2006). Villa et al (2014) points to the fact that the lack of coordination between different pipelines and production units is critical for understanding problems with the handling of variability in patient flows.…”