Process performance indicators in redesigning the patient care process

Abstract

Purpose -The purpose of this paper is to investigate the regulator's attempt at redesigning the patient care process (PCP) -a core business process in public hospitals -by introducing dichotomous process performance indicators as an innovative management tool intended to align the State health care policy with the everyday management of operations at a hospital ward. Design/methodology/approach -The paper presents an ethnographic case study of redesigning the PCP according to the strategy originating outside the organization. The study employs competing theories that represent alternative epistemological and ontological views of the world in order to produce a tentative explanation of why the intended redesign of the PCP has not fully eventuated. Observational data and opportunistic interviewing are used to answer the research question of whether and how the information and operational flows on the ward were affected by introduction of process performance indicators. A business process redesign framework was employed for data analysis since it better reflects the objectives of the State-wide initiative and offers a convenient tool in dealing with data complexity. Findings -Introduction of the process performance indicators did not result in redesigning of the PCP as intended by health care authorities. Out of four process performance indicators, only one was consistently implemented, which merely produced a duplication of the previously collected information, therefore adding no value to the PCP. On a theoretical level, the results indicate that the emergent theory rather than the rational agent theory demonstrated a greater fidelity to the empirical observations. Originality/value -The paper assessed the feasibility of using innovative dichotomous process performance indicators as a tool for redesigning the business process at the ward level, in order to achieve macro-level policy objectives. The failure to successfully implement a top-down universal approach to redesigning business processes in health care is likely to reflect a lack of appreciation of emergent rationality that characterizes essential aspects of the PCP.

Testing success factors for manufacturing BPR project phases

“…The more recent BPR implementations in the manufacturing area, in general, seem more successful than the reports from the last decade [19,24,52]. But risks and implementation problems still abound [9,[33][34][35]48].…”

“…The literature contains personal opinions and case studies prescribing one or more factors deemed important for BPR success. Most are common sense, such as driving BPR projects using customer demand, competitive pressures, and to improve financial performance [18,19,35,41,46]. Bringing in industry specialists, employee education, and reeducation are widely recognized.…”

“…More specifically, many managers stated that the actual project benefits fell short of expectations along the dimensions of customer service, process timeliness, quality, cost reduction, competitiveness, improved technology, and revenues [25]. Despite the recognized importance of creating an environment in which reengineering will succeed [19,[33][34][35], some companies in the past have had great difficulty successfully completing their BPR projects [21,35]. Succumbing to the pressure to produce quick results, many managers who implemented BPR have ignored the massive changes in organizational structure, misused and alienated subordinates, sold off solid businesses, neglected important research and development, and hindered the necessary modernization of their facilities [11,32,35].…”

“…Traditionally, the definition for a BPR project calls for substantial changes to one or more business processes, in contrast with small incremental changes over time through smaller and many times more informal projects. BPR within the manufacturing sector has received considerable attention from researchers [12,19,35,39,[44][45][46] as to its benefits and success factors. BPR projects deal with "dramatic changes" to business processes, in contrast with a wide variety of methods which are mostly based on "continuous improvement."…”

Mapping lean experiences and emerging connections with clinical risk management in Italian context

“…First researches have been conducted pursuing partially these aims (e.g. Snyder et al, 2005;Gospodarevskaya and Churilov, 2011). In Snyder et al (2005) through value stream mapping (VSM) job functions interrelations and connections among entities have been identified and with the support of a software, interfaces problems have been reduced.…”