SERVICE MANAGEMENT IN HEALTHCARE ORGANISATIONS
1 Introduction: The 5 P&I Model
Healthcare is a service sector. We saw the last couple of years that a lot of services are
interesting to look at in healthcare. That’s why we look at the 5 P&I model
The course is built around the 5P&I’s:
• Performance:
o Wat we willen doen vertalen we naar onze
performance, aan de hand van een meetsysteem
o quality, speed, flexibility, dependability and
productivity
• Positioning
o A clear concept: what do we want to achieve as
an organization: strategic
• People
o People are very important. People are central: clients, residents, patients,
employees,…
o But it is important to see this in a bigger context. This is not a HRM course.
• Process
o Managing capacity, lean management, patient flows and material flows
o Processen op de werkvloer zodanig afstemmen dat we excellente service
kunnen bieden
• Place
o Environment in which we do something f.e. it is not nice there are no
windows in the classroom
• Innovation
o Innovatief zijn
The emphasis of this course is more on the processes. It fits in what we call operation
management. That will be the main focus of this course.
Even if we focus on operational problems (staffing issues, planning issues, waiting lines,…),
we will try to focus on the process and improve that. We need the bigger picture (clear
understanding: how do we need to position ourself). Do we need to know where we go to as
an organization.
Service management = How do we want to position ourself as an organization in terms of
service à if we know this, we translate it in the performance management system
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, 2 Positioning & Performance: care, service and experience
2.1The The progression
progression of economic
of Economic value
Value
Differentiated Relevant to
Competitive Customer
positioning Create needs
Deliver experiences
services
Produce
goods
Extract
commodities
Undifferentiated Irrelevant to
Market Premium
Pricing
We zien een evolutie van verkoop van eenPineproduct, naar verlenen van service, naar verkopen
and Gilmore, The Experience economy, 1999
van experience.
• Voorbeeld koffie: Many of us go to a coffee shop to drink coffee, not only to drink
coffee, but to sit there or study there. Drinking coffee is like having an experience:
you can remember the barista making the coffee, like it was made with love.
Sometimes you see that a coffeeshop is integrated in a bookshop.
à We see that is is not only about the service of serving coffee, or selling the coffee
there is a evolution to an experience economy.
• Voorbeeld autohandelaar: Look at the car dealer ships. If you enter the garage, you
don’t come in a garage, but you enter a nice environment. You can sit there; drink a
cup of coffee and you can wait there and look how they work at your car (through
the window). This is not only a product or a service (repair) business. But they are
more in the experience business. Buying a car is more than buying a product.
• Voorbeeld vliegtuigmaatschappij: Airline company: to take an airplane, you need
engines (=motoren). Engines are the most important part of an airplane (vb. Merk
engine: Rolls Royce). When you are the CEO of an airline company, you need to make
a choice in the type of engines that you want. Today Rolls Royce don’t sell engines
anymore, they sell a service pack (not just a product), called ‘powered by the hour’.
You can fly 24/24. If you talk about the engine part, the most important thing for the
client is that you can fly in a safe environment.
à ‘we are not an airline company, we sell traveling experience’
à Flying is not just flying, it is creating a good experience during the flight. It also
includes the airport
• Voorbeeld Ryanair: Some companys do not move up to service and experience, f.e.
Ryanair. They will never say we deliver a good travel experience. That is not what
they stand for. For them is it transporting people in an efficient, low costing way.
That is another business model, another positioning choice.
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,Business, is that relevant for healthcare? What is the meaning of the ‘progression of
economic value for healthcare’?
• Knowledge and care is not enough anymore. Also the experience of patients and
employees is important
• What is Disney whas the CEO of a hospital (boek Fred Lee): healthcare organisations
as experience company
• There are a lot of terms coming up: customer engagement, customer satisfaction,
customer focus, customer experience, service quality, curstomer journey,…
In fact, if we look at the evolution, the core business is the knowledge in care and cure that
we have. That is the most important. But nevertheless, in the last couple of years we see
that in the hospitals and nursing homes that we do a lot to the quality and service that they
offer. A lot of hospitals are telling us: ‘patient is central’, ‘we want to deliver good service’,
quality of care and cure, but also quality of the service. They also want to give a good
experience.
Voorbeeld UZ Gent: Big numbers of cars in UZ Gent on Tuesday and Thursday: Tuesday
around noon, there are more than 500 cars moving around: many of the cars are looking for
a parking spot: that is one of the big problems. You can say: It is not an important part of the
care process. But if you are a patient and you risk to be too late, they have stress, and are
not so happy about it. Ill patients cannot always take public transport.
At a hospital you deliver the service of parking places: but in practice you see it is difficult to
do this in a good way, and when you see that they get some stress, it will affect their
emotions. When you move to the emotional part à you move to experience.
!! This is really a challenge in healthcare.
à Care organizations as experience firms? Can we dream? We have to be careful in
healthcare setting that we want to be an experience company. It is a very complex construct
with a lot of things going on.
2.2 Service & experience is not the same.
Service Experience
Een dienst leveren Een beleving creëeren
Klant Gast
Dienstverlener Rolmodel
Percepties vs. verwachtingen Emoties en beleving
Offering parking space to our costomers is a service. A lot what we do in our care
organisations are services. In terms of quality of the service, most is based on perception =
subjectional. This is sometimes frustrational. Patients do have perceptions, what is not
always in line with objective quality (but what it is? Not always easy).
When you say the patient is central, that creates a lot of expectations!
Experience is another thing. It’s about emotions. A lot of emotions are going around in
healthcare (being sick, having a disease is an emotional event). The way we deal with our
patients and their family can affect their experience.
In the experience we speak about guests, not about patients and about role players instead
of employees.
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, 2.3 Service (quality)
Service = The application of specialized competences, knowledge and skills through deeds,
processes and performances for the benefit of a customer
Service has a couple of characteristics, which had an impact on how things go in healthcare:
• Intangibility (ontastbaar): a book is tangible; a bottle of water is tangible. But what
we do in treating patients is intangibility and has a lot of impact
o Evaluation: how do we evaluate services? It’s very difficult to evaluate service
because it is based on a subjective evaluation: about what we perceive.
§ How do organizations measure what we do (quality) in the
organization?
• Surveys
• if you want better insight of how people evaluate à inspection
o typical characteristics: (more objective) you have to
document a lot of what you doing. They come to look
and see if you have done what you said you would do
• Focus groups with patients & family members
• …
• Simultaneity: co-production: our clients co-produce (cliënten betrekken): they take
part in the process. If we talk about the performance of the process. Part of the
performance is also linked to the performance of our patients //co-creation: clients
can help to improve our processes
• Interactivity: interaction between the client and the care giver
• Heterogeneity (Customization): At the end of the day, every patient is different in
what they need, what they want. We cannot read every patient with their own need.
o Customization. We recognize that there are different segments of patients
that don’t go to the same hospitals. Hospitals organize themselves in terms of
heterogeneity patients vb. Cardiologische hospitals
o Heterogeniteit in diensten o.w.v. verschillende behoeften van bepaalde
groepen
o >< Personalisatie (gaat meer over één klant)
• Perishability: integration (gelijktijdigheid van productie en consumptie): what we do,
most is based on time of people. Most sources are limited. That time and capacity is
perishable. If you come to the teaching room and the teacher is not there, your time
is wasted.
o Voorbeeld ER: In the emergency room, you have a capacity, but half of the
time, the capacity is not completely filled up. Capacity that is not used, is lost.
o Perishability of time is a lot of fluctuating demand: you try to control the
fluctuating demand, and that is the problem in the ER. They can’t control it by
an appointing system.
o When you have 10 positions in the ER, what is the average utilization: 50%.
That is low. The demand is the reason. It is very difficult to say when the
patients are coming in. you have peeks and fluctuation of the demand. If you
want to do a good job as an emergency room, you need the capacity
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