HPI4010 – Organizing and Managing Patient Flows
Content:
- Preparation for day 1
- Learning goals for day 2
- Learning goals for day 3
- Days 1-3 (self-study) digital information
HPI4010 – preparation for day 1 (system thinking, flow and process)
See lectures day 1 (29-10-19)
Literature:
- Preparation for the course
▪ Ribera et al. (2016). Hospital of the Future. Accenture.
- Week 1 – intro and system thinking
o Preparation for week 1 (mandatory)
▪ Dessers & Mohr (2019). Integrated Care Ecosystems (chapter 3).
o Process and flow (mandatory)
▪ Visser & Goor (2006). Logistics: principles and practice (chapter 1, chapter
2.1).
Notes from literature:
Dessers & Mohr (2019) Integrated Care Ecosystems
Chapter 3: ecosystem definition
Taken together, we conclude that ecosystems can be understood as dynamic and co-evolving
communities
- Of diverse actors;
- Defined by a framed purpose;
- Who develop purpose driven activities at various interacting levels of the ecosystem;
- In order to create and capture new value;
- Through both collaboration and competition;
- Within unique social, physical and systemic conditions.
Care ecosystems can then de defined as dynamic and co-evolving communities
- Of sovereign and unique organizations, independent care providers, informal care givers,
care networks, patients, funders, regulatory agencies, and others;
- Which co-produce care or develop care innovations;
- Related to a specific or to multiple patient population(s);
- Through various levels of collaboration, competition, dependence and independence;
- Within unique social, physical and systemic conditions;
- Which typically have various levels of success in achieving the quadruple aim.
And we see integrated care ecosystems as dynamic and co-evolving communities
- Of sovereign and unique organizations, independent care providers, informal care givers,
care networks, patients and others;
- Which co-produce care or develop care innovations;
- Related to a specific or to multiple patient population(s);
- With requisite levels of care process integration and coordination;
- Within unique social, physical and systemic conditions;
- Which are highly effective at achieving the quadruple aim.
,The ‘unique social, physical and systemic conditions’ include leadership, educated workforce and
finance, and elements of the societal social system that structure and influence the ecosystem,
including law and regulations. The presence or absence of these conditions is either enabling or
constraining of ecosystem development. Certain ecosystems actors, such as funders and regulatory
agencies, may have a high impact on certain conditions.
HPI4010 – preparation for day 2 (socio-technical thinking (organizational design and approach))
Learning goals and answers:
a) What is the genealogy (stamboom) of STS thinking? (Tavistock School (classical approach),
Dutch/Lowlands School (design approach), …)
Web lecture 1 and references Van Eijnatten (1998) / Mohr & Van Amelsvoort (2016)
Web lecture 1 (genealogy of STS thinking: history and schools)
Socio-Technical Systems (STS) – definition
STS thinking recognizes the internal functioning of an organizational design (socio-technical system)
in relation to its environmental context. STS as an open system.
Socio-technical refers to the interrelatedness of social (= ‘human part’, cultures, routines, etc.) and
technical (= technology, procedures, systems, etc.) aspects of an organizational design. The term
integral is also used for this.
It is a theory due to its explanatory and predictive powers:
- Explanatory: why is an organization performing in societal (f.i., sustainability), economics (f.i.,
productivity) and human (f.i., well-being) terms good or bad;
- Predictive: what alternative design will perform better.
As a design approach (= STS-D), it aims at creating adaptive, innovative and healthy workplaces and
organizations – which is done in a participative manner, in co-design with stakeholders.
Genealogy of STS thinking history, schools and future (purpose is to understand that STS has a firm
base)
Starting point: mining studies (problem of the long-wall technology)
(grounding work by Emery, Trist and Bamford 1940s-50s – Tavistock Institute, London)
Durham Case: discovery of joint optimization
Joint optimization of social and technical system: both systems need to be seen (designed) in
combination, and not to the maximum of one’s technical or social aspect (note: often the technical
aspects dominates)
,Start and 1st spread out (Van Eijnatten, 1998)
Forming of STS schools on a global scale in 80-00s (Van Eijnatten, 1998)
Currently, re-emerge into a global STS network
Lowlands: Ulbo de Sitter Institute (USI)
North America: STS Roundtable
Since 2013, both communities (schools) have organized annual conferences to learn from each other
again. And, published a book together (Co-Creating Humane and Innovative Organizations)
Currently, GLO-WIN initiative: STS 21st century (global organization & workplace innovation)
21st century challenges:
- Time and place independent work, virtual teams
- IT (robotica, Al, virtual reality) and work systems
- Digital transformation
- Sustainability (green challenge)
- Ecosystems and network design and development
, Literature
Van Eijnatten (1998) Developments in Socio-Technical Systems Design (STSD)
The four turning-points from sequential steps in a democratization of the workplace.
Grounded in a bibliometrical analysis of the literature, we have sought to split the historical line of
STSD into phases. We distinguish three development trajectories:
1. Phase I (1949-1959+): the period of the Socio-Technical Pioneering Work.
2. Phase II (1959-1971+): the period of Classical STSD.
3. Phase III (1971-): the period of Modern STSD.
The latter phase can be subdivided further into the following:
- Type A (1971-): Participative Design.
- Type B (1973-): Integral Organizational Renewal.
- Type C (1979-): Democratic Dialogue.
- Type D (1971-): North American Consultancy.
To typify the development of STSD, each phase will be described by means of anecdotes. We will
discuss the discovery of the Semi-Autonomous Work Group (Phase I), the Industrial Democratization
Project (Phase II) and Participative Design, and Democratic Dialogue and Integral Organizational
Renewal (Phase III), respectively.
The Tavistock episode
STSD’s beginnings are found in post-war British coal mines. The early 1950s brought about a new
form of work organization that we now look upon as ‘self-managing groups’. The British coal
industry, which has always had its ups and downs, suffered frequent labour conflicts. It was
nationalized and further mechanized after the Second World War. As a field of work, it was not that
easy for social scientists to penetrate. However, Ken Bamforth, a new researcher from the Tavistock
Institute of Human Relations in London, managed to get into the field in a way many others did not.
In their article, now widely renowned, which was carefully included in an elaborate description of the
mechanized coal-mining process unravelled in small subtasks, Trist and Bamforth (1951) present, in
guarded terms, a unique underground alternative work organization built up of so-called ‘composite
work groups’. These were small, relatively autonomous work groups consisting of eight miners, who
were responsible as a group for a full cycle in the coal-mining process.
It was a great success and led to the introduction of a new scientific paradigm: Socio-Technical
Systems Design. As Trist later recalled in his correspondence with Emery, the beginnings of the socio-
technical paradigm were not exactly plain sailing. In fact, the pioneering phase came about
erratically.
Classical STSD in Europe
The further development of STSD was foreshadowed by Fred Emery’s arrival at the Travistock in
1958, while director Wilson left. Trist eventually managed to find financial support for Socio-
Technical Concept Development, so that Emery, aided by Herbst and Miller, could start on the
difficult task of typing up the many loose ends from the pioneering phase. The transition from the
pioneering phase to that of classical STSD is demarcated by three documents.
Following Emery (1959), the start of the idea of open systems in the production organization results
in the evolution of a ‘socio-technical system’. Both social and technical components are part of a
socio-technical stem, i.e. people and machines. The technical component is taken to be the ‘internal
environment’ of the organization. In his review, Trist (1981) says that the technical and social
systems are independent of one another; the former follows the laws of natural sciences, and the
latter those of social sciences. However, the two do not operate independently of each other. They
rely on each other to fulfil the production function.
