Health Service Operations Management
Literatuur - Health Service Operations Management
Book chapter 1:
Operations management = the planning and control of the processes that transform inputs
into outputs. Example: doctor consultation, input is request of the patient, output might be
diagnosis, referral, cure. In this example, resources may be time and diagnostic services that
are used.
The role of the HSOM process is to ensure that adequate resources are in place on time to
provide a service and on the tasks involved to produce this service in such a way that
service standards are met, whilst also avoiding wasteful provision of excessive resources.
The central function of the care provider is to provide patient care. Hence, the demand for
care is the key input which influences the planning and control of the resources required to
transform inputs into outputs. Other factors that influence this are: finances, availability of
goods and the nature and actions of other hospitals.
Clinical processes are the primary processes in which the transformations take place. They
are supported by management processes that take care of the planning and control of
resources required for the diagnosis and treatment of patients.
Ancillary processes are needed to support the general functioning of the hospital. The
organization of services for cleaning hospital wards and departments and for maintaining
hospital equipment.
Operation level: individual patients are scheduled for appointments or an admission requiring
outpatient clinic resources or operating theater resources and a bed in a ward.
Tactical level: availability of resources for the coming weeks is checked.
Strategic level: checks are made on the amounts of resources required for the longer term.
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Health status (e.g. mortality rates, levels of morbidity and disability) are important metrics of
the success with which clinical processes are transforming inputs into outputs.
Client experience where the patient or their family is the client (might also be a doctor).
Use of resources is relevant to all three generic processes, they need to be monitored for
efficiency and effectiveness.
There are relationships and possible conflicts between the different outputs.
In its attempts to ensure that there is effective and efficient organization of the delivery of
services, the role of HSOM is to achieve an acceptable balance between different types of
output.
Value-based healthcare relates the value for customers to the costs of delivering service, the
patient process is put in the foreground. The focus of hospital management today is on the
total process of the patient, leading to output and outcomes.
Health Service Operations Management = the analysis, design, planning and control of all
of the steps necessary to provide services for patients in such a way that their needs are
met, that service standards are met and resources are used efficiently.
Context of HSOM: overall healthcare system → main external factor that influences
behavior of individual providers. For example: market, for-profit, national health system and
governmental regulations.
- For-profit setting: emphasis is on profit maximization, maximizing the number of
patients that they can treat at acceptable standards of quality but at minimum costs
per case.
- Market environment: creates incentives for providers to ensure that the processes for
transforming inputs into outputs are functioning in an effective and efficient way.
Providers must continually review and invest in their transforming processes as a
means of maintaining their market share, attracting new patients or reducing costs.
Market determines incentives for investments.
- National health system or government-regulated system: providers are budgeted by
the contracts annually arranged with purchasers (government related bodies or
insurance organizations). The main incentive for providers is to ensure that
budgetary targets are not exceeded. Hence, providers need to invest in mechanisms
for monitoring the use of key resource performance targets, providers in public health
services probably have lower incentives to continually review and update
transforming processes or to ensure that other output measures, such as client
perception are satisfactory.
In Europe, government-regulated systems are dominant, but more market incentives are
being introduced. All systems seem to adopt a value-based healthcare perspective. Value is
defined as health per dollar or benefits for the customer versus costs. However, this
value-based perspective needs to be defined more precisely and the chain from the
perspective of the customer may require collaboration with other providers.
Other contextual issues of HSOM:
- Changing demographic mix in the population → increase in elderly.
- Advances in medical technology are changing and expanding the options that are
available for patient care.
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- Increase of knowledge amongst patients due to the internet and media.
Dual management = clinical professionals share management responsibilities with
administrative staff and business managers.
Healthcare management decision making often takes the form of finding consensus amongst
the different actors that are involved. It is about finding the right trade-off between different
perspectives.
A model is a formal description of a system or a part of a system under study.
A system is a collection of elements that are distinguished from the environment, due to a
common perspective, and that have a mutual relationship.
Abstraction takes place by selecting the relevant subsystems and aspect systems. Then we
make a model of the system under study by simplification. Models can provide expected
performance of the system under study (through comparing with performance in reality or
sensitivity analysis). Lastly, the results need to be interpreted in terms of their meaning for
the real system.
Design cycle:
- Problem definition
- Diagnosis
- Solution design
- Intervention
- Evaluation
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Book chapter 2:
Service management is a multidisciplinary approach to designing, delivering and
evaluating services for customers that add value for the customer. Important characteristics
of services are:
- The customer participates in the process
- Services are simultaneously created and consumed
- Services are perishable and can therefore not be stored
- Services are intangible
- Services can vary greatly from customer to customer because of their heterogeneous
nature
- Services cannot be transferred between patients.
Operations management is an area of management concerned with designing and
controlling the process of production of goods or services.
Considering HSOM, we combine service management and operations management. This
way, we can make use of concepts of both approaches.
Service management concepts:
- Service package
- Service strategy
- Service blueprint
- Service modularisation.
A service package is a bundle of services and goods with information that is provided in a
particular environment and consists of five features:
- Explicit services: the immediate benefits of intrinsic features of the service (absence
of pain after surgery).
- Implicit services: psychological benefits of extrinsic features of the service (security of
the hospital environment).
- Information: from the service provider about the service (health status before and
after surgery).
- Facilitating goods: medical supplies used during the service, leaflets for follow-up
care.
- Supporting facilities: physical resources that need to be in place for a service
(hospital facilities).
Services can be defined as value-adding transactions, in which in principle, no physical
goods are transferred from the provider to the customer. In healthcare, the service is mostly
manual labor and goods are a facilitator.
Operation can be defined as a value-adding transformation of input to output.
A resource is an input for the operation that is used for the transformation of inputs to
outputs.
An operation type is a group of operations using the same resources, though the amounts
of resources used may differ.
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