Temporal pacing of outcomes for improving patient flow: Design science research in a National Health Service hospital

Abstract

Improving patient flow in hospitals is a contemporary challenge in the UK National Health Service (NHS). When patients remain in a hospital bed for longer than clinically necessary, hospital performance is dramatically impacted, quality of care is reduced, and elective surgeries are cancelled at great cost to both hospital and patient. This research explains how one UK hospital employed design science research to improve patient flow after other process improvement techniques had failed. The work focused on improving patient flow through the creation of a set of interconnected, temporally paced routines that successfully engaged doctors and nurses in new, outcome-specific ways of working. These routines were both independent and interdependent, were relationally coordinated through time, and systematically and unambiguously engaged all levels of staff at specific temporal junctures. We discover that the successful adoption of these routines was cumulative rather than iterative and was aligned with ongoing efforts supporting the social aspects of change.Through this work, our case hospital saw performance improvements that moved them from being below average to the best in the country, combining improvements in patient care with savings of over £3 million in the first 12 months. The contribution of this research is twofold; first, we explain how the development of outcome-specific routines can facilitate process improvement, and second, we illustrate how design science research can successfully bridge theory and practice to promote swift and even flow in healthcare. K E Y W O R D Sdesign science, healthcare, hospitals, patient flow, process improvement, routines

Sustainable process improvements: Evidence from intervention‐based research

“…Based on the organizational learning perspective, processes should have adherence requirements that are meaningful so that their execution is not ad hoc (Johnson, Burgess, & Sethi, 2020); at the same time, processes should not be so inflexible that they fail to add value to their underlying objectives (Ansari et al, 2014). If processes are designed to be overly restrictive and do not allow requisite adaptability by the user, employees may not adopt such processes (Nissinboim & Naveh, 2018).…”

Coping with no-show behaviour in appointment services: a multistage perspective

“…Inspired by design science in the study of Peffers et al (2007), we employed a three-phase method to answer our research questions, depicted in Figure 1. Design science is widely applied in the fields of operations management and information system research and is recognised as an instrumental method in designing and implementing actions, processes and systems to realise desired results in practice (Johnson et al, 2019;Lim et al, 2018;Rai, 2017). Our approach contains three phases, that is, a thematic analysis of no-show reasons for patients' no-show behaviour, a Delphi method for proposing no-show coping strategies for no-show reasons, and a priority calculation.…”

Editorial: Delivering effective healthcare at lower cost: Introduction to the special issue

“…The second paper examines how a hospital changed its process in agreement with the theory of swift and even flow (Schmenner & Swink, 1998). This paper, "Temporal pacing of outcomes for improving patient flow: Design science research in a national health service hospital," by Johnson et al (2020) examines a process redesign's effect on patient flow and timely patent discharge. The research team partnered with a medium-sized hospital in the United Kingdom to iteratively redesign the patient-care process to achieve consistent patient flow.…”

“…Two papers (Dreyfus, Nair, & Rosales, 2020;Mukherjee & Sinha, 2020) examine perioperative services. Two papers examine operations at the level of the entire hospital (Johnson, Burgess, & Sethi, 2020;Tucker, Zheng, Gardner, & Bohn, 2020). In addition, two papers (Mukherjee & Sinha, 2020;Stevens & van Schaik, 2020) use the lens of new-technology implementation to examine how technology affects care delivery.…”