Summary of the course HPI4004 Patient logistics in health care, including all essential elements of week 1, 2, 3 and 4 to study for the exam:
- Summary per week
- Learning goals per week
- Online lectures and the discussed mind maps as a guide for the summary
- Additional information from the lectu...
Maastricht University – Master Healthcare Policy, Innovation and Management 2016-2017
HPI4004 Patient logistics in healthcare
Summary
Week 1 System thinking, flow and process
Logistics
Logistics in health care
System theory: An organization with 3 types of systems
Designing structures
Applying structural design rules to hospital care
Week 2 Lean thinking (managerial approach)
Open system: the internal and external environment
Approaching process management: Lean
Approaching process management: Other approaches for process improvement techniques
Comparison of approaches on process management
Week 3 Socio-technical thinking (organizational approach)
Organizing
Division of labour and organizational complexity
Stressed organizations
Socio-technical thinking
Organizational stress loop
Organizational sustainability loop
Socio-technical design sequence
Week 4 Data and information (informational approach)
Information processing
Galbraith’s view on information processing
Quality of information
Managing information flow: Monolithic, tsunami, neurotic and Archipelago
Lean, socio-technical thinking, and information and control
Information and control with regard to flow
, Week 1 System thinking, flow and process
Learning goals:
1. Introduction of logistics (in health care).
Logistics
Logistics:
- Definition (used in this course): A systematic approach to organize and manage the
production process and flow of products/services of a social system (an organization).
o Flow always needs a production process (transformation).
But within such a process, there is not automatically flow.
(So: No flow without a process, but there is process without a flow possible)
o A process can work very efficient, without being effective.
o The flow is influenced by 2 aspects:
§ When both (sub)tasks use the same resources: The negative effect might not
be that big when there is a lot of that resource.
§ The frequency of interactions: Many interactions could give more problems.
- Definition (Oxford English Dictionary): The detailed organization and implementation of a
complex operation. This can be the activity of organizing the movement, equipment, and
accommodation of troops, or the commercial activity of transporting goods to customers.
- Different terms related to logistics:
o Logistics: Also called operations management, or primary process (in health care the
cure and care).
o Operations: Focussed on what an organization is producing, on manufacturing.
o Manufacturing: Producing products.
- Types of logistics in health care:
o Inbound: One of the primary processes of logistics, concentrating on purchasing and
arranging the inbound movement of materials, parts, and/or finished inventory from
suppliers to manufacturing or assembly plants, warehouses, or retail stores. E.g.
managing flow of patients, human resources, materials and info at health providers.
o Outbound: The process related to the storage and movement of the final product,
and the relation information flows from the end of production line to the end user.
E.g. in healthcare the process around purchasing and storing medication.
Operations research and design:
- Operations research: The ground for logistics. E.g. about queuing and scheduling.
- Operations design (the focus of this course): The integral concept for logistics.
o First structure. Then an organization can decide whether to accept and manage the
situation, or to research and redesign.
o This unit argues that a holistic understanding is required of four interconnected key
topics:
§ Topic 1: the importance of a focus on the care delivery process (‘the basics
and importance of flow’).
, § Topic 2 (see week 3): the organizational (socio technical) features of that
process (‘production structure of the flow’).
§ Topic 3 (see week 2): the managerial (lean) features of that process (‘control
structure of the flow’).
§ Topic 4: information provision within that process (‘information structure for
the flow’).
Visser’s model in a framework
The logistics concept (Visser): The design for the way in which an organization wants logistics to
function. It defines how the flow of goods, money, and data are related to one another.
- 3 main functions of developing logistics concept in an organization:
o To fully understand the management of the flow of goods.
o To provide a framework for a coordinated action plan.
o To stimulate full awareness of logistics throughout the company.
- The structure of the logistics concept:
o One of the core tasks of logistics management is finding a balance between the
realization of external and internal objectives.
o E.g. The external objective is defined as the flexibility to be able to respond quickly to
changes in customer demand. Internal objectives are focused on realizing the
external objectives at the lowest possible cost, e.g. the extent to which available
capacity is used in production, storage and transport.
- 4 elements of an integral logistics concept: They are interconnected and vital to the
successful realization of the logistic objectives. They are extensions of each other and this is
why they should be taken in this same sequence. The 4 elements form the basis for assessing
or adapting the logistics functions in an organization.
o The logistic/physical structure: The physical characteristics of facilities that directly
influence the internal processing, transport, and storage of goods. E.g. layout of the
, factory machinery into logical processing locations (in other words, setting up the
primary processes.
o The control system: The way in which the primary processes are managed and
monitored. E.g. planning.
o The Information system/provision: An adequate information system. E.g. to calculate
material requirements.
o Organization of personnel: Achieving effective coordination between logistics and
other functions in the organization. E.g. responsibilities of personnel.
2 ways of looking at logistics: Both looking at an organization, but from a different perspective.
- Lean thinking: Focusses on managerial features. (week 2)
- Socio-technical thinking: Focusses on organizational features. (week 3)
Logistics in health care
Logistics in health care:
- Manufacturing (producing products) in health care means providing services.
- Differences/contingencies between manufacturing and health care:
o Products vs. service
o Workers vs. professionals
o Products vs. patient
- Similarities between manufacturing and health care:
o The possibility of flow: Flow is the key issue of logistics. This can be a flow of
products and/or a flow of patients.
o These 2 can learn from each other.
Why learn from manufacturing? To deal with challenges. 10 challenges in health care for the hospital
of the future (Ribera):
1. Triple-challenge context: Leading hospitals will strive in a challenging context with a combi-
nation of increase in healthcare needs, decrease in resources, and changing social values.
, 2. Smaller and more complex hospitals: Leading hospitals will be expected to focus on high-
value and highly complex services and to become highly efficient organizations, without
requiring high activity volumes.
3. New scope of services: Leading hospitals will embrace new services such as personalized
medicine and genome-based diagnosis, with a broader scope of services, which may include
chronic care management.
4. Dual orientation: Tertiary and territorial: Leading hospitals will provide complex services to
referred patients and also manage the provision of acute services in a catchment area.
5. Knowledge-driven redesign of services: Public health systems will carry out a reconfiguration
of services geared toward efficiency and quality, which must be evidence-based and driven
by knowledge. The required knowledge for this redesign could be based at leading hospitals
where professionals treat and interact with patients. Leading hospitals will have a critical role
to play in achieving the triple aim in public healthcare systems: improving the patient
experience of care – including quality and satisfaction – as well as improving the health of
populations and reducing the per capita cost of healthcare.
6. Open and distributed organizations: Leading hospitals will not be defined by the physical
structures and will be organized so they deliver services at different locations.
7. Innovation centres of technology and services: Leading hospitals will be reference centres for
process and technology innovation and healthcare service design.
8. Research and education as key results: Leading hospitals will continue to be the main centres
for research and for the education of new professionals, which means generating knowledge
and capabilities.
9. Risk-sharing models with all stakeholders: Leading hospitals will develop new risk-sharing
models with insurers, industry and/or other providers. The framework of the relationship
with hospital providers will change and introduce risk-sharing models, e.g. in the provision of
pharmaceutical products.
10. Professionals in hospital governance: Hospital professionals will actively participate in the
strategy and leadership of the organization.
11. Integrated care and process-oriented teams: Leading hospitals will be organized into process-
oriented teams and seek to create integrated care models (either virtually or merging
companies).
12. Connected hospital: Improvement of the patient experience will lead to connected hospitals
where case managers will reach out to coordinate care for patients at home.
13. New professional roles: Leading hospitals will need health coaches, genetic counsellors,
disease specific case managers, information management experts and med-engineers.
14. Patient-centered innovation: Leading hospitals will systematically redesign the service
experience with innovation to become really patient centered.
All these challenges are combined within triple operational excellence, which is
an organization in which 3 aims are combined:
- Management of scientific knowledge.
- The need to implement agile and effective processes.
- The provision of excellent service experience, as perceived by the
hospital stakeholders, primarily patients and their families.
, System theory: An organization with 3 types of systems
Organizations can be seen as social systems conducting experiments with meaningful survival. So,
organizations have a social and experimental character, both working towards meaningful survival.
Meaningful survival:
- In general, the goal of an organization is to survive. But actually survival is not the goal of an
organization, because survival itself is meaningless (e.g. an organization that exists for
combatting malaria doesn’t want to survive, because that would mean malaria still exists).
Therefore, value has to be added. So, the goal is to have meaningful survival.
o Value: The meaning has to do with value, a population, or particular products.
- Meaningful survival as a concept:
o The meaning is the reason why an organization survives.
o In order to produce meaning, the organization needs to
survive.
- 2 modalities of meaningful survival (2 extremes)
o Rich meaningful survival: Maintaining a separate and meaningful existence by
selecting and realizing goals to contribute to the creation of societal conditions
enabling human beings to develop and realize their humanity because this is
considered to be the meaningful thing to do.
§ Striving to contribute to live a fulfilled life.
§ It comes from Aristoteles, who questions what is means to be a person,
which can be translated to: What is the meaning of the organization? Why
contribute to life?
§ The answer is: Because it is the right thing to do as an organization. The
organization has to create conditions for the employers to work.
§ The vision is not impossible to realise, even in a competitive market. It is a
realistic perspective.
o Poor meaningful survival: Maintaining a separate meaningful existence by selecting
and realizing in whatever way, whatever goals, considered meaningful for whatever
reason.
§ The goals and reasons are contingent (mogelijk), any goal or reason is good.
§ Being not so much interested in the goals, because everything is good.
§ E.g. patients are seen as an object to achieve organizational goals, or as a
way to make money (e.g. as an insurance company, or because there is good
money in it), or because patients want it.
§ This sense of survival is widely accepted in management literature and
management practices.
Experiments:
- With experiments, all activities are a kind of selections (e.g. structure or the design of the
organizations). It is not sure if these selections (e.g. selecting persons to work in the
organization) help the organization to reach their goals/meaning. The selections are made
under conditions of uncertainty. Therefore, they are a kind of experiments of the
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