ORGANIZING AND MANAGING PATIENT FLOWS
WEEK 1
Used literature:
LEARNING GOALS
Ecosystems can be understood as dynamic and co-evolving communities. So a
system is..
Purposeful
Collection of entities
Relationships between entities (structure)
Behaviour: dynamic interactions (system as a negotiated order)
External environment (open systems) (boundaries allow exchange +
relationships)
Input-transformation-output-feedback
Process, flow
Transformed in terms of healthcare an ecosystem is a dynamic and co-
evolving community
- 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 populations;
- 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
, An eco-system is the network of organizations—incl. suppliers, distributors,
customers (patients), competitors, government agencies, and so on—involved
in the delivery of a product or service through both competition and
cooperation.
Ecosystems differ from networks because of the following reasons,
In general, there are two types of systems. The first one are natural systems,
e.g. fauna and planets. The second ones are the systems that are created by
humans.
There are two forms of systems. With an integral system, you already know
the starting point and how you are going to connect parts. Starting with already
the whole thing in mind. With an integrated system, you bring the parts
together.
Types of systems
1. Sub system: a number of parts with all the relations, e.g. a department
2. Aspect system: a specific set of relations of a system, e.g. arrows from a
quality perspective or a finance perspective
An organization = system, and departments are subsystems
However, increasingly we see interorganizational systems, i.e. systems of
organizational systems:
- In which organizations are sub-systems of interorganizational systems.
So, whether an entity is a system or subsystem depends on where you draw the
system boundary. Because if you choose the hospital as a system, the
departments within the hospital can be considered as subsystems. Subsystems
for example are: reception hall, emergency department, short stay and drugs
storage system.
,Logistics are related to managing the flow of goods. The purpose of logistics
is flow, but logistics is more than only flow. Remember that it can also be a flow
of patients in a hospital or nursing service.
A systematic approach to organize and manage the production process and flow
of products/services of a social system (= (intra-)organization.
NOTE: flow needs a production process (transformation), but when within such a
process there is not automatically flow.
Flow = A steady, continuous stream or supply of something. The activity of
organizing and managing the movement, equipment, and accommodation of
troops.
Note: having a process does not automatically lead to flow. Flow implies
unhampered moves through the process.
Operation = focused on what you are producing.
Organizing = designing a flow architecture; it results in a designed structure of
parts
(= activities, jobs) and connections btw parts (= relationships, interactions) in the
flow. (‘Creating architectural conditions for flow’)
Managing = controlling (incl. coordinating & steering) parts & connections to get
an intended outcome – given a flow architecture (!) (‘Controlling the flow for
outcome’.)
Currently, there are lot of challenges in healthcare where logistics can help!
More and more companies are becoming aware of the benefits of logistics.
Back in the days, thinking in terms of efficiency (keeping costs down) was
enough for good management. But large series led to long delivery time, which
was one of the motivation forces behind the demand for better logistics.
In a system, there are all kind of flow of goods. The next step is to break the
system down into its separate units or subsystems. Subsystems are parts of a
system that can be considered separate in themselves without losing sight of the
whole.
In logistics management (also known as business logistics), the flow of goods
between manufactures and customers is usually divided in to types of systems.
Business logistics can be seen as the generic term for all activities performed to
control the incoming and outgoing flow of goods.
1. Material management: all activities undertaken to feed the efficient flow of
raw materials and semi-finished products, and the accompanying flow of data, to
and through the production process, as well as those activities performed to
achieve the most efficient possible use of production equipment.
2. Physical contribution: concerned with the flow of goods and accompanying
flow of data that starts at the end of the production process and finished with the
consumer.
Production can be divided in convergent and divergent production.
Convergent production is when the final product is made up of various
, contributing parts, e.g. buildings. In contrast, divergent production is when the
process of creating a product from only one source of raw material, e.g. milk.
In healthcare, the core of the production is providing services.
When a company is not satisfied with their current internal and/or external
logistics performance, they can develop a logistic concept. In these
circumstances, developing a logistic concept has three main functions: 1) to fully
understand the management of the flow of goods, 2) to provide framework for a
coordinated action plan, and 3) to stimulate full awareness of logistics throughout
the company.
One of the core tasks of logistic management is finding the balance between the
realization of extern and internal objectives. There are four point requiring
specific attention: physical structure, control, informed provision and the
organization of personnel.
Based on this concept, management can make informed decisions on the
deployment of the personnel and the allocation of resources to improve logistics
performance of the organization.
Three opportunities for improving customer service are: 1) reducing the
lead time, 2) the reliability of delivery, and 3) increasing flexibility. These three
opportunities will eventually reduce integral costs.
Paradigm shift from digitization to transformation
There are three digital evolutionary phases. The first phase is the
digitization; conversion from paper to databases. The second phase is
digitalization; the adaption of digital technology in business processes. The
third phase is transformation; the creation of new business models based on
the possibilities of digital technology and platforms to integrate business
processes. This transformation fundamentally changes the way in which
organization operate and realize value for customers.
Digital transformation impacts the division of labour and the vision between
man and machine. Digital technology will take over work of humans in both
execution and control. Both phases are focused on supporting humans at the
workplace.
