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Summary and case notes of HPI4010 Organizing and Managing Patient Flows (and project Lean), mater HPIM
Summary and case notes of HPI4010 Organizing and Managing Patient Flows (and notes on the literature for project Lean)
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SummaryManaging and Organizing Patient Flows
HPI4010
Inhoud
Socio-Technical Thinking (organizational design approach) ................................................................... 2
The genealogy of STS thinking ......................................................................................................... 2
Principles of STS thinking................................................................................................................. 2
Organizational Complexity and Division of Labour (DoL) ................................................................ 4
Organizational Stress Loop .............................................................................................................. 4
Organization Sustainability Loop (De Sitter) ................................................................................... 6
Dutch STS Design Sequence ............................................................................................................ 7
Criticism on Socio-Technical Thinking ............................................................................................. 8
Lecture day ...................................................................................................................................... 8
Lean Thinking (managerial approach) ................................................................................................. 9
Other approaches (of process management and improvement) besides lean............................... 9
Five principles (of lean) according to Womack and Jones ............................................................ 11
Eight types of waste (by Liker) ...................................................................................................... 13
Lean methods: the 14 principles (by Liker) ................................................................................... 14
Lean tools to deal with waste........................................................................................................ 15
The Toyota Production System (TPS) ............................................................................................ 16
Lean in Healthcare ......................................................................................................................... 16
Critical assessment of Lean ........................................................................................................... 17
Project literature ........................................................................................................................... 18
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,Socio-Technical Thinking (organizational design approach)
The genealogy of STS thinking
STS-thinking is:
- An open system: looks at the relation with the environment (interrelation)
- An integral approach: looks at the interrelation between social (= ‘human part’, cultures,
routines etc.) and the technical (= technology, procedures (work)systems etc.) aspects of
organizational design = joint optimization
- A theory as in societal, economic and human terms, it is:
o Explanatory – giving reasons why an organization is preforming good or bad
o Predictive – in what alternative design would perform better
- A design theory – STS-D – ‘designing the organization’ – giving insights and a tool-kit, aiming
at creating adaptive, humane, innovative and healthy workspaces and organizations. This is
done in a participative manner: in co-creation with stakeholders, the people who will work
within the new approach.
The history of STS-thinking:
- Pioneer phase (40s-50s) – by the Tavistock Institute due to the Durham case seen that only
new technology does not improve efficiency → joint optimization
- Classical phase (60s-70s) – by Tavistock Institute, see core (classical) principles below
- Modern phase (80s-00s) – STS schools on a global level, e.g.:
o The Netherlands / Lowlands - Integral Organizational Design (Ulbo de Sitter Institute,
USI)
o Australia & N-America - Participative Design & Large-Scale Interventions
➔ These schools are working together since 2013: ‘Co-creating humane and innovative
organizations’ to deal with the current challenges – GLO-WIN initiative (plus, see
their 10 principles below)
➔ The current challenges: time and place independent work, IT, digital transformation,
sustainability, ecosystem and network design and development → What does this
mean for STS thinking and designing? Is there a need to embrace new / other
insights?
Difference between the Classical point of view and the Dutch
/ lowland view, as the latter assumes it is difficult to influence
the social and technical system and therefore includes DoL to
influence the systems. This core issue is different form the
other schools.
Principles of STS thinking
The core (classical) STS principles (Tavistock Episode):
- Joint Optimization of the Social and Technical system – need to be designed in combination.
A central goal is improving everyone’s quality of working life (and thereby the outcome)
(note: often the technical aspect dominates → less efficient)
- Organizational Choice: different deployment of technology in every organization leads to
different outcomes, thus co-creation of social and technical system is important.
o This leads to there being no such thins as ‘best practices’ only inspiration
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, - Minimal Critical Specification: specify what (the purpose / outcome) not how. Rely on
craftmanship and trust, invest in learning and flexibility
- Redundancy of Functions: within a team, members should be capable of carrying out
different tasks, leading to enhanced usability of human potential and provides flexibility.
o Teams are the smallest organizational component (consisting of a number of
individuals)
o Flexibility – being less sensitive to disturbances, more can be absorbed at the place of
occurrence, no need for passing on vertically or horizontally
- Incomplete designs: all designs can be improved and are incomplete (supports statement
about there not being ‘best practices’)
The 10 principles of the Global STS Network
The purpose: “Organization designing that enables WHOLE ecosystem effectiveness that is mutually
beneficial to all stakeholders who collaborate in work that delivers shared value – healthy work,
innovative products and services, business productivity, sustainability for the planet -and prosperity
for all.”
1. Responsible autonomy: to internal supervision and leadership (self-regulation) at the level of
the individual, team or group - people take the initiative to decide on goals and how to
achieve them – on effective functioning and relating the team to the wider system. Especially
effective in dynamic contexts where risks are high and communication difficult.
2. Self-organization: the ability of a system to spontaneously arrange its components or
elements in a purposeful, non-random manner without the help of an external agency.
Central is the concept: emergence.
3. Human scale / technology for and with people: designing things to be useful, comfortable
and safe for people – matching the physical and cognitive characteristics of humans:
a. digital technology can drive greater self-awareness and self-assessment about how
individuals create and contribute to enterprise value
b. technologies are inherently incomplete and consequences are catastrophic as today’s
technology is complex: Therefore, technology is best seen to depend upon and co-exist with
people, in terms of the human roles and capabilities that must be developed to monitor,
control, and maintain technical systems
➔ Think of problems in integrating this principle
4. Mutual trust: mutual trust (and respect) are prerequisites for open communication and
honest dialogue about values, goals and expectations. Mutual trust emerges from common
interests, giving each other the chance to express questions, doubts and disagreements and
have faith that these add value. Everyone needs to be congruent and transparent.
5. Shared purpose: the ‘why’ of the value provided (to the external world) should be clear and
shared by the members of the system. The purpose is connected to ‘meaningful work’ this is
a good way to unify diverse stakeholders.
6. Diversity: respect equality amongst people, but at the same time celebrate the diversity that
exists and that enriches and empowers teams. Only guaranteeing equality may lead to
bureaucratization.
7. Customer centricity: the eventual goal is to help the clients, therefore incorporate client
centricity as the starting point of each design. A truly client-centered organization is an
organization which can organize itself around groups of customer orders in a dynamic way.
8. Core transformation process: in a client-centered organization the value adding process is
the measure or all thing, in this the efficiency and effectiveness are important → the starting
point of the design, other processes need to be organized around this.
3
, 9. Simplicity: create inherent simple organizations (that can deal with complex situations) in
order to deal with the complex VUCA (volatile, uncertain, complex and ambiguous)
environment. (Autonomy of employees and teams and transparency are important).
10. Learning: the ability to learn and the “learning potential” is a core quality of an organization;
it requires shaping organizational context that impacts the opportunities or barriers to learn.
Giving the opportunity to quick adaptation to the environment, having active jobs.
Criticism: wouldn’t it be better to start from the current challenges and list new principles based on
those?
Q1. Do you see the development in thinking of STS from its Tavistock Episode to its current Global
STS Network attempt?
Q2. Would you like to add/eliminate principles? (what are you missing, what is your criticism?)
Organizational Complexity and Division of Labour (DoL)
The basics of work, an organization is a total of:
- Organizing: creating a whole and the parts within this - division of labour
- Managing: controlling and coordinating of what is created (organized) to accomplish the
activity
Organizational complexity:
- A function of the number of parts and relations (interactions)
- Related to the stability and specificity of the parts and relations
The number of parts is a choice in DoL. DoL cosists of two dimensions:
- Separating: the doing and thinking (the upper-part of the organization
is thinking and the bottom-part is thinking) → vertical differentiation
- Splitting: splitting up the doing and thinking → horizontal
differentiation
Maximum DoL is a total of vertical and horizontal differentiation, this leads to
bureaucratization.
Minimum DoL is connected to STS thinking
Q1: Which major types of Division of Labour can be distinguished? (Note: do not confuse types with
dimensions.)
Q2: And, what is the impact of this types on organizational Healthy organization
complexity?
Q3: And, what is the impact of this types on the
performance of organizations and people? (note,
organizations are developed for the client (environment,
e.g. the patient)
Structure of organizations →
Organizational Stress Loop
In maximum DoL the ‘white spaces’ undergo tension when things do not go according to plan, this
leads to a stressed organization as the control is at a higher level, creating a big distance between
doing and thinking (control). Therefore, the controllers have the tendency to standardize in a way
which is often not appropriate for the problem. The organizations with maximum DoL are also called:
functional differentiated organizations (bureaucracy).
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