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Summary Literature Health Service Operations Management
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Summary of the mandatory literature for each week of the subject Health Service Operations Management.
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Health Service Operations ManagementWhat attributes determine quality and satisfaction with health care delivery? – Bowers, Swan &
Koehler (1994)
SERVQUAL (services quality): instrument developed to measure service quality that leads to
satisfaction.
- Tangibles: physical facilities, equipment and appearance of personnel
- Reliability: ability to perform the promised service dependably and accurately
- Responsiveness: willingness to help customers and provide prompt service
- Assurance: knowledge and courtesy of employees and their ability to inspire trust and
confidence
o Competence: possessing required skills and knowledge to perform the service
o Courtesy: politeness, respect, consideration and friendliness of contact personnel
o Communication: keeping customers informed and listening to them
o Credibility: trustworthiness, believability, honesty
o Security: freedom from danger, risk or doubt
- Empathy: caring, individualized attention the firm provides its customers
o Access: approachability and ease of contact
o Understanding/knowing the customer: making the effort to understand the
customer’s needs
SERVQUAL may not completely cover dimensions of healthcare services that are important to
patients. The nature of healthcare services is different from the services from which SERVQUAL was
developed (more intensive provider-consumer interaction in healthcare). Also, patient satisfaction
literature suggests additional dimensions beyond those found in SERVQUAL.
What dimensions of service quality are important for consumers of healthcare?
There are two additional dimensions that represent aspects of service quality that weren’t captured
by the generic quality dimensions:
- Caring on the part of physicians and nurses: personal/human involvement in the service
situation, with emotions approaching love for the patient
- Patient outcomes: relief from pain, saving of life or anger or disappointment with life after
medical intervention
Increases in patient ratings of quality will, in the long run, lead to increased financial returns.
Consumers of health services are not capable of assessing the technical quality of care they receive,
to they utilize quality attributes associated with the delivery of healthcare. Patients define healthcare
quality in terms of empathy, reliability, responsiveness, communication and caring.
In order to manage consumer perceptions of quality in healthcare, administrators should focus on
the human components of delivery:
- Determining the specific attributes of quality customers use to judge quality and attempt to
prioritize these attributes
- Establishing a means by which these attributes may be measured
- Developing operational definitions and specifying levels of appropriate performance (e.g.
responsiveness answering phone calls within five rings)
- Incorporating the delivery of quality dimensions into job descriptions, evaluations and
compensation structures
- Managing customer expectations concerning level of performance lowering customer
expectations to realistically providable levels should raise quality perceptions
,Strict attention to technical quality will result in consumer complaint of tardy, unresponsive and
uncaring service. The result will be a decline in volume and difficulty in attracting new patient groups.
Providers who satisfy consumer quality perceptions will secure an important competitive advantage.
Health Operations Management – Vissers & Beech (2005) – Chapter 1: Introduction
Operations management: planning and control of the processes that transform inputs into outputs.
EXAMPLE: individual doctor/patient consultation
- Input: patient with a request for healthcare
- Resources: care provided by doctor, e.g. their time, diagnostic/therapeutic services
- Output: patient is diagnosed, referred to a further service or cured
The role of health OM is to ensure that adequate resources were in place to provide an acceptable
service for the patient.
Inputs: patient demand,
the overall level of finance
available to provide care,
the availability of goods
from suppliers and the
nature and actions of other
hospitals.
The resources to be
planned and controlled
within these processes
include staff, materials and
equipment.
Clinical processes: planning and control of resources used for diagnosis and treatment of patients.
Management processes: organising the payment of staff and purchasing goods from suppliers.
Ancillary processes: organisation of services for cleaning hospital wards and departments and for
maintaining hospital equipment (general functioning of the hospital).
Outputs:
- Health status markers relevant to success of the transforming processes
o E.g. mortality rates, level of morbidity
- Client perceptions patient satisfaction but also perceptions of managers or doctors
- Use of resources monitor efficiency and effectiveness
There are relationships and potential conflicts between the different types of output. It is the role of
health OM to achieve an acceptable balance between different types of output.
Health operations management: analysis, design, planning and control of all the steps necessary to
provide a service for a client.
There are a few key external factors and additional internal factors that influence health OM decision
making. The main external factor that affects the behaviour of individual providers is the overall
healthcare system setting in which they function: market/for profit vs. national health
system/government regulated. In a market setting, the emphasis for providers is on profit
maximisation (max. patients at min. cost). The transforming processes are functioning in an effective
,and efficient way and must be reviewed continually. The goals are maintaining market share,
attracting new patients and reducing costs. In a government regulated setting, providers are
budgeted by the contract annually arranged with purchasers (insurance organisations). The providers
need to ensure that budgetary targets are not exceeded. They need mechanisms for monitoring the
use of key resource areas. Other external factors are for instance demographic change (e.g. more
older people in the population), advances in medical technology and increasing patient knowledge.
Some internal factors are unclear roles and responsibilities for those involved in the decision-making
and finding consensus among the different actors involved.
Health OM is related to quality management, performance management, information management
and operational research.
Strategic planning decisions create the
long term vision of the hospital, which
needs to be implemented and
sustained.
This is the start of the process of
deciding how best to transform inputs
into outputs. Here is the initial check
that the hospital has the right
transforming processes in place to meet
the needs of the patient.
Assessment of the types of
units/departments, the types of
resources and the types of
operations/activities. Units undertake
similar types of operations for different
types of patients.
Chains: the total range of resources
required to produce a product or to
treat a patient, similar to patient
pathway. Chain logistics: coordinating
the appropriate and efficient allocation
of resources along patient pathways.
, Health Operations Management – Vissers & Beech (2005) – Chapter 3: Basic concepts and
approaches
The clients of health OM processes are health and/or social care professionals.
Operation: an activity that transforms inputs into outputs and thereby adding value. Each operation
generates an individual product. The cumulative effect of these individual products is a provided
service. An operation can also imply a group of activities that constitute together the operation. An
activity in itself involves different tasks. There is little or no freedom in the relative timing of tasks
and activities, as they all contribute to the operation.
Operation type: a group of operations using the same resources, though the amount of resources
used may differ.
Resource: an input for an operation that is used for the transformation into outputs, but can be used
again for another operation (as opposed to material inputs that become part of the output).
E.g. operating theatre, personnel & equipment resources. Prosthesis material input.
Unit: a department in a health system that performs operations of the same operation type. A unit
has access to the key resources (staff, capital equipment, materials).
Operations:
- Alteration (e.g. surgical procedure)
- Transportation (e.g. transport of patient from the ward)
- Storage (e.g. waiting for operations)
o Productive waits waiting for a drug to become effective, recovery
o Non-productive waits are indicators for malfunctioning of the system and exposes
areas where performance might be improved
- Inspection (e.g. inspection of the wound)
Operations can be characterised by:
- Duration: time to undertake the operation
- Workload placed on the required resources: number and types of staff required
These characteristics of operations determine the way operations and processes can be planned and
controlled.
Process/chain: the chain of operations that need to be performed to produce a particular service.
After identifying the key operations and the resources necessary, you need to identify the ways in
which they should be linked to produce a particular service. The chain may include productive
activities and productive waits. Often process is used when only one provider delivers a service and
(supply) chain is used when the service is produced in collaboration with different providers. Each
process had a customer. Internal customer that focuses on part of the chain e.g. specialist who
orders a test. Ultimate customer a patient. Each process should also have a process owner, who is
responsible for managing the process.
An OM approach also requires reflection on other key characteristics of processes, so that the
manager can establish appropriate control systems and informs decisions about the allocation of
resources.
Important characteristics when designing and planning a process:
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