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Summary HSOM exam 2021

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Erasmus Universiteit Rotterdam (EUR)

This summary/ overview contains all the lectures of the course HSOM given in 2021. Furthermore, it gives a brief summary of the literature of weeks 3, 4, and 5. And there are also some notes of workgroups included. Note: there can be a few dutch words in the document.

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six sigma
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health service operation management
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Health Service Operations Management – summary
This summary/ overview contains all the lectures of the course HSOM given in 2021. Furthermore it
gives a brief summary of the literature of week 3, 4 and 5. And there are also some notes of
workgroups included.

Week 1 – introduction and fundamentals of HSOM
The analysis, design, planning and control of all the steps necessary to deliver
services to clients in healthcare
Content of the course:

Operation management:
Operation: set of activities that transforms input into
regulations

output
input: use one time (e.g. specific piece of wood, nail)
resources: use multiple times (e.g. tools)
input operation output
resources

Types of operations:
 Alteration
 Transportation
 Inspection
 Storage (In services: storage as an operation or as a delay in operations?)
Unit: a department in a health organization that performs operations of the same
operation type.
Process/chain: series of operations that need to be performed to produce a
particular service.
Network: combination of units and chains performing operations for services for
several groups of clients.

Perspective Unit OM Process OM Network
item approach approach logistics

, approach

Focus points Resource Service level Trade off
utilization; between service
workload control level and
resource
utilization

Strong points Capacity Process Combination
management management

Weak points Not process Not related to the More effort
oriented use of resources

Service: A service is an activity or series of activities of more or less intangible
nature that normally, but not necessarily takes place in interactions between the
customer and service employees and/or physical resources or goods and/or
systems of the service provider, which are provided as solutions to customer
problems. (Gronroos, 1990)
Characteristics of a service:
 Customer participation
 Simultaneous creation and use (interaction)
 Heterogeneity (different per “patient/ customer”)
 Perishable (you can’t keep it, service can’t be stored)
 Intangible (=ongrijpbaar)
 Non-transferrable ownership (you cannot pass through received service)
The service package (Fitzsimmons et al., 2014):

Classic value chain of Porter:

,Health service value:
Value = Perceived value/ Sacrifices
 Perceived value: clinical outcomes, functional outcomes, experience
 Sacrifices: cost, effort
(health) service quality:
The 5 dimensions of general The 5 dimensions of health
service quality (servqual) service quality (revised servqual)
• Reliability • Reliability
• Responsiveness • Responsiveness
• Empathy • Empathy
• Assurance • Communication
• Tangibles • Caring
(Parasuraman et al. 1988) Bowers et al. 1994)

,Issues:
 How can the fragmented, siloed health system be redesigned?
 The way we pay for healthcare incentivizes volume instead of value
(Porter, 2010)
 We measure quality mainly with process indicators instead of outcome
indicators (Porter et al., 2016)
 There is a call for balance between measuring for accountability and
measuring for improvement (Meyer et al., 2012; Elg et al., 2013)
 We need ‘orchestrated teams’ that take responsibility for the ‘full cycle of
care’ (Bohmer, 2016, p.710; Porter, 2010, p. 2478)
Value:
 ‘Value is health outcomes achieved per dollar spent’ (Porter, 2010, p.
2477)
 ‘Value is in the eye of the beholder’ (Prada, 2016, p. 162)
 ‘Focus: What matters to you?’ (Bisognano, 2012)

, Porters Tier model ICHOM (international consortium for
health outcome measurements)

PROMs
• Any report of the status of a patient’s health condition that comes directly
from the patient, without interpretation of the patient’s response by a
clinician or anyone else (Rothrock, Kaiser & Cella, 2011).
• Generic: EQ-5D Index/VAS; Domain specific: NRS pain, PROMIS anxiety;
Disease specific: Oxford Hip Score, Oxford Knee Score, before and after
measurement.
• For example: Have you had any trouble with washing and drying yourself
(all over) because of your hip?
PREMs, Patient satisfaction, CQ index, e.g. factor Communication with doctors:
• Doctors treat me with respect, take me seriously, listened carefully,
explained things clearly, spent enough time, kept their appointments
(Stubbe, Gelsema, Delnoij, 2007).
NPS: What is the likelihood that you would recommend this hospital to a friend or
colleague
• NPS= % prospectors- % detractors

,The value agenda porter and lee:

Integrated practice units (IPU) in porters paper:
A dedicated team made up of clinical and non-clinical personnel
• Organized around the patient’s medical condition;
• Organized or experienced as an organizational unit;
• Taking responsibility for outcomes and costs full cycle of care;
• Taking responsibility for engaging patients and their families in care;
• Co-located in dedicated facilities;
• Measuring outcomes and costs using a common measurement platform;
• Meeting formally and informally on a regular basis to discuss patients,
processes and outcomes.
Integrated care: ‘A coherent and coordinated set of services which are planned,
managed and delivered to individual service users across a range of

,organizations and by a range of co-operating professionals and informal carers’
(Minkman, 2012, p. 8, Raak et al., 2003)

Creating a quality dashboard for the IPU
• Use a bottom-up approach
• Engage both care professionals and patients
• Start with improvement indicators and complement these with
accountability indicators

, • Use existing data structures
• Distinguish indicators (signals) and their key determinants (managing
performance)
• Formulate ambitious ‘stretch’ goals

Week 1 – literature
 Vissers & Beech, Chapter 1 Introduction
 Vissers & Beech, Chapter 3 Basic Concepts and Approaches.
 Fitzsimmons & Fitzsimmons, Chapter 1 The Service Economy, pages 13-24
(Version 9: pages 11-22)
 Fitzsimmons & Fitzsimmons, Chapter 3 New Service Development. pages
69-71: Service design elements. (Version 9: page 72-73, a small part is
missing, I uploaded this part as pdf-file in Literature)
 Fitzsimmons & Fitzsimmons, Chapter 6, Service Quality, pages 143-157 (In
version 9, pages 149-163)
 Bowers MR, Swan JE, Koehler WF. (1994). What attributes determine
quality and satisfaction with health care delivery? Health Care
Management Review 19(4):49-55.
 Ahaus, C.T.B. (2018). Perceptions of practitioners and experts on value-
based healthcare: a mixed-methods study. EurOMA proceedings

Week 2
Unit operation management- demand
Demand = expressed needs from clients (patients)
Good to define and measure demand (e.g. look at patterns)
• Characteristics patient groups
o Eg. Arrival patterns
o Plannability
o Heterogeneous

Unit operation management – capacity
Capacity = Access to recourses that are required for the operations of the unit
Resource types:
• Accommodations
• Equipment
• Personal/staff
• Specialist time (=specific type of personal)
When talking about resources it is about characteristics and availability
Characteristics:
• Dedicated and shared resources (e.g. operation room)
• Specialist-time as a shared resource (e.g. shared by different units “poli en
SEH”)
• Leading and following resources

, o Leading: able to make own schedule and plan
o Following: dependent on earlier resources in process (e.g. X-ray,
ICU)
• Bottleneck resources (determines the capacity in the flow e.g. Ok
beschikbaarheid/wachtlijst)
• Continuous or intermittently available resources
o Continuous: ICU, SEH (24/7 Care)
o Intermittently: x-ray (mainly office hours)

Availability:
Examples CT scan
Potential capacity: alles
Available capacity: only on working days/
working hours
Usable capacity: available – maintenance/
education
Utilized capacity: daadwerkelijk gebruikt
door patiënt

Unit operation management – performance measurements (utilization)
Performance indicators:
• Patient related
The 5 dimensions of health service quality:
o Reliability
o Responsiveness
o Empathy
o Communication
o Caring
• Organization related
 Utilization

, Utilization= utilized capacity / usable capacity
Turnover time: the time interval between two
succeeding cases; the time between one patient
leaving the OR and the next patient entering that
OR, also known as cleaning time.
First-case tardiness: (a “late start” of merely the
first surgical case of the day), the difference in
minutes between the scheduled starting time
(generally 8:00 AM) and the actual room entry
time of the first patient on that day (per OR).
Over-time: when the end point of the day is not within the block time

Notes workgroup:

Not strongly recommended to set targets on net and gros utilization. Because
they include overtime Targets can lead to more overtime and push in the
wrong direction.
Do recommend to use targets during block time! (then you could say, see figure
above, decrease turnover time or first case tardiness).
Unit operation management – Planning and scheduling
Levels of planning:

- Strategic level: availability of the right resources in sufficient quantity
- Tactical level: resource allocation, allocation of resources to departments
and specialties
- Operational level: resource scheduling, scheduling of patients

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