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Summary HCM Health Service Operations Management (literature)
Summary of the mandatory literature of the course: health service operations management. Master Healthcare Management.
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Literature Health Service Operations Management 2021/2022 | Joyce RommensLecture 1: Introduction and fundamentals of HSOM; process OM (S.
Elkhuizen)
1.1 Vissers & Beech - Chapter 1 Introduction
The term operations management refers to the planning and control of the processes that transform
inputs into outputs. This definition also applies to health OM. Consider the individual doctor/patient
consultation. The input to the consultation process is a patient with a request for health care. The
output of the consultation process might be that the patient is diagnosed, referred to a further
service, or cured. The resources that must be managed to transform inputs into outputs are those
associated with the care provided by the individual doctor: for example, their time and any
diagnostic or therapeutic services that they use.
The central function of the hospital is to provide patient care. Hence, patient demand for care is the
key input that influences the planning and control of the resources required to transform inputs into
outputs. However, as Figure 1.1 illustrates, other ‘inputs’ influence both the types and levels of
patient demand and the ways in which the hospital delivers care. These other ‘inputs’ include the
overall level of finance available to provide care, the availability of goods from suppliers, and the
nature and actions of other hospitals.
Health OM can be defined as the analysis, design, planning, and control of all the steps necessary to
provide a service for a client.
Health OM activities are complemented by and related to other areas of ‘management’ activity that
focus on the core processes of the organisation. These other areas include:
- Quality management, which aims to improve and maintain the quality of services delivered
by processes;
- Performance management, which concentrates on measuring and monitoring the
performance of the organisation in terms of the outcomes of processes;
- Information management, which concentrates on the development of tools for providing and
handling information about processes; and
- Operational research, which offers analytical techniques and approaches that can be used to
investigate and improve processes.
1.2 Vissers & Beech - Chapter 3 Basic Concepts and Approaches.
For many health OM processes the most important client is the patient and the product produced
might be their diagnosis and/or treatment.
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As a minimum, such products are usually defined according to the specialty classification of patients:
for example, orthopaedic patients. However, products might be further subdivided according to the
diagnostic grouping of patients (for example, patients with diabetes), their ages (for example,
services for older people), or according to the type of health care procedure that they require (for
example, patients requiring hernia surgery). Methods of grouping patients have also been based
upon their likely consumption of health care resources (diagnosis related groups and health
resources groups) or their expected benefit from treatment (health benefit groups).
Operations
Operations are at the heart of an organisation. Organisations exist to create value and operations
involve activities to create value. An operation can be defined as an activity that transforms inputs
into outputs, and thereby adding value.
Note that an operation can also imply a group of activities that constitute together the operation. A
surgical procedure, for instance, consists of activities by the surgeon, the anaesthetist, and the
supporting personnel. An activity, again, involves different tasks.
Operations can be grouped into operation types. An operation type is a group of operations using
the same resources, though the number of resources used may differ. A resource is 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.
A unit is a department in a health system that performs operations of the same operation type: for
example, imaging departments undertake X-ray procedures. A unit also has access to the key
resources (staff, capital equipment, and materials) required to undertake operations of the same
type.
Resources
If the identification of key operations represents the first stage in ‘the analysis, design, planning and
control of all of the steps necessary to provide a service for a client’, the second stage is to
understand the ways in which operations use and consume resources. Operations can be
characterised by duration (i.e., time to undertake the operation) and by the workload placed on the
resources that are required for the operation (e.g., number and types of staff required for the
operation). A basic philosophy of OM is that these duration and workload characteristics of
operations (and of processes as the constellation of operations to produce a service) determine the
way operations (and processes) can be planned and controlled.
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Process or chain
As indicated earlier, operations represent the building blocks that, when added together, generate
the overall set of transforming processes required to deliver a product for a client. Having identified
these individual building blocks, and the resources that they use, an operations manager needs to
identify the ways in which they should be linked to produce a particular service. This chain of
operations (or overall delivery process) may include both productive activities and productive periods
of waiting (e.g., waiting for a drug to become effective). A process or chain can therefore be defined
as the chain of operations that need to be performed to produce a particular service.
Often the label ‘process’ is used to identify the delivery of a service that is delivered by a single
provider, and the label ‘chain’ or ‘supply chain’ is used for the process of a service that is produced in
collaboration between different providers. Note that health care does not yet have an established
term to parallel supply chain (care chain, perhaps?). Supply chain refers to the flow of goods while in
health care we would like to refer to the flow of patients. Complex processes in hospitals that include
many departments in the patient journey could also be labelled as a care chain.
An important distinction in health care processes is whether access to resources can be scheduled.
Emergency processes, such as many aspects of care for trauma patients, cannot be scheduled, so the
resources to undertake operations need to be readily available. This reduces flexibility in resource
allocation decisions and potentially means that ‘spare’ capacity might need to be available. For
elective patients, access to resources can be scheduled (and delayed) to maximise efficiency.
The length of a process, in terms of the number of operations that constitute the chain, is another
important characteristic. A short process, for instance a diagnostic consultation following a request
by a general practitioner (GP), offers different challenges when scheduling the allocation of resources
compared with a long process, involving many operations, or a chronic process, which may not have
a clearly defined ending.
Processes might also include decoupling points. This is a point in the process where operations
before and after are decoupled by a ‘waiting list’ or a ‘productive period of waiting’. ‘Waiting list’
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