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Healthcare Knowledge Management Primer (Routledge Series In Information Systems)
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Research will have to be conducted to search for metrics to identify and measure each dimension objectively. The use of supplementary metrics in combination with the HPO measurement tool will increase the reliability of the output of the internal PO assessment. This is only possible by examining and assessing the variability and internal consistency of the measures with a much larger sample size.
Chen et al. We would like to emphasise that a degree of PO is merely an indication for how the structure design and work within an organization is organized.
Healthcare Knowledge Management Primer (Routledge Series In Information Systems)
High scores on each dimension of the measurement tool may be expected to have positive effects on the design, planning, and control of the processes within the organization, and organizations will not necessarily have the best performances, like the shortest throughput time as possible. Thus, a high score on the degree of PO will not guarantee the best hospital performance. Research will have to be conducted to link the PO dimensions or defined PO constructs e. Another issue for future research is the complexity of measuring hospital performance, since hospital success and continuity is not only dependent of clinical interventions and financial and production objectives, but also on how well the organization adapts to their external environment or the service level it offers to its clients.
For an extended debate on how to measure and manage healthcare performance, the articles of Dey et al. To a different degree and for distinctive reasons all three hospitals had some difficulties with the PV and PMM dimension. These two dimensions are at the core of process orientation of an organization. To acquire a process-oriented management style, consensus for each care process has to be reached among a variety of healthcare professionals, managers, staff functionaries, and patients in a particular healthcare setting. Subsequently, the hospital will have to adapt existing medical guidelines to local circumstances and preferences in order to define a care process description, which is evidence-based and adjusted to the local care setting.
Achieving consensus in a local care setting is one of the biggest obstacles to acquire an adequate process view in hospitals. Our recommendation would be to start with the standard processes and the routine processes first. Once consensus is reached, organizations will have to take the next step and compose indicators to measure the performance and outcomes of begin-to-end care processes. Finally, our results already indicated an unusual effect of university hospitals on the PO score. Therefore, the historic debate on methodological issues concerning comparative studies of hospital-organizations [ 72 , 73 ], is also valid for the generalizability of our findings, measurement tool, and future research.
The modern roles and functions of hospitals nowadays have made it even more difficult to make use of simple classifications when studying hospital-organizations [ 74 ]. Our results show that discipline may have an effect on the PO score. The perception of management was consistently higher in our study.
Their score had a large positive influence on the average PO score the further away from the care process, the higher the PO score. Another variable is the rather mono-disciplinary nature of ophthalmology as a specialty. Ophthalmology, and other specialties such as dermatology, orthopaedics, and ENT ear, nose, and throat have more routine care processes and these specialties do not work intensively with other specialties [ 71 , 75 , 76 ].
The delimited area of medicine may reduce the complexity of the ophthalmology departments which could have a positive effect on the level of PO within the departments and lead to a higher PO score. An approach to deal with this is to distinguish the specialties with standard and routine processes and less interaction with other specialties from specialties with non-routine processes and more interactions and collaboration with other specialties such as oncology, cardiology, neurology, and gastroenterology.
All these variables should be considered when applying this measurement tool in hospital departments and hospitals in general, since they may have an effect on the average PO score. The purpose of this study is to investigate PO in hospitals from an OM perspective in order to develop and practically test a measurement tool to measure HPO in operations management terms.
The intention to develop such a measurement tool is to measure the design, planning, and control of aligned, integrated, and coordinated cross-functional processes in hospitals. Many hospitals are in the process of restructuring and introducing new coordination and skill mix mechanisms in order to integrate units clinical integration , introduce multidisciplinary teams, and resource pooling, which are the basis of process orientation [ 31 , 66 ]. By applying this measurement tool hospitals can classify the perception of process orientation within their organization on the basis of mean values.
Consequently, hospitals will be able to identify strong areas of PO within their organizations and areas for improvement. In this manner, the application of this measurement tool enables hospitals to measure the effects of the change processes they applied to become more process-oriented and evaluate how they are evolving towards process-oriented care delivery. The results from the practical testing of the measurement tool show that the developed tool was able to measure the differences between hospitals from the proposed OM perspective to a certain degree.
The study suggests that by measuring the 41 items, a hospital can assess the degree of PO of the organization from an OM perspective. The total of 41 items reflects the magnitude and complications to become a process-oriented hospital. Nevertheless, hospitals will have to use the whole range of items and include distinct disciplines in order to get a complete assessment. In addition, metrics should be used to objectify the perception of the participants. In this research no human subjects including human material or human data were involved. Therefore, neither approval by an appropriate ethics committee nor informed consent from participants to participate in the study was obtained.
This manuscript is based on the master thesis of PDG. All authors contributed to the conception and design of the study. Literature search was done by PDG. All authors read all relevant articles and contributed equally to the development of the measurement tool. PDG was responsible for the practical testing. All authors were responsible for analyzing the data. All authors read and approved the final manuscript. The authors would like to thank the participants of all hospitals involved, the OM-experts, the reviewers of the master thesis, and the referees for their constructive comments on the manuscript.
National Center for Biotechnology Information , U. Published online Nov Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Jan 25; Accepted Nov 1. This article has been cited by other articles in PMC.
Associated Data Supplementary Materials Additional file 1 Indicators for hospital production, service, and available resources. Additional file 2 The HPO-measurement tool after testing. Abstract Background Although research interest in hospital process orientation HPO is growing, the development of a measurement tool to assess process orientation PO has not been very successful yet.
Methods Through a literature search we identified a number of constructs to measure PO in hospital settings. Results The application of the HPO-measurement tool, analysis of the scores and interviews with the participants resulted in the possibility to identify differences of PO performance and the areas of improvement — from a PO point of view — within each hospital. Conclusions The development and practically testing of a new HPO-measurement tool improves the understanding and application of PO in hospitals and the reliability of the measurement tool.
Keywords: Health services, Process orientation, Process management, Hospital, Measurement tool, Operations management. Background Hospitals face increasing pressure to reduce costs, improve operations and provide evidence of the quality and efficiency of their organizations [ 1 , 2 ]. Process orientation and operations management The objective of this study is to develop and practically test a new measurement tool to assess the degree of process orientation PO in hospitals from an operations management OM perspective.
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Process orientation in hospitals Hospitals and healthcare organizations in general have started to move from relatively functional and hierarchical structures to structures focussing on cross-functional teams and flattened organizational structures [ 24 ]. Existing tools for measuring process orientation Different authors have addressed the question of conceptualizing and measuring PO. Table 1 Existing approaches for measuring process orientation.
Author Objective Perspective Distinguished variables or dimensions Applied to hospital setting McCormack [ 41 ] Assess the degree at which an organization pays attention to its relevant core processes. Information systems theory Care activity; Yes Co-ordination activity; Supply activity. Information systems theory Organizational structure; Focus measurement; No Ownership management; Customer requirements.
Hammer [ 49 ] Plan and execute process based transformation. Open in a separate window. Methods Development of the measurement tool The conventional research approach is to develop a measurement tool first and subsequently provide statistical evidence for the validation. Process view Process View is the first step towards PO. Process jobs According to Hammer [ 49 ] employees must be skilled in team work, problem solving, process improvement, and decision techniques. Process measurement and management Since a business process can only be controlled and managed if it can be measured, organizations need to implement indicators for performance and take preventive and corrective actions when necessary [ 45 ].
Customer-focused process values and beliefs Processes are the central core from which business is conducted, as long as they are supported by the people within the organization [ 55 ]. Results The three case studies Hospital 1 is a large university hospital, which strives to attain balance between their three organizational objectives: patient care, education, and research.
Table 3 Staff per hospital data Table 4 production Characteristics per hospital data Table 5 Participants per hospital and per discipline. Results per hospital Different types of output resulted from the application of the HPO measurement tool. Table 6 Average dimension-scores per hospital with corresponding comprehensibility and reliability percentages. Table 7 Internal consistency per dimension. Discussion This research improves the understanding and application of PO in hospitals. Strengths and limitations In general, there were indications that the measurement tool is vulnerable to over-positive or over-negative responses due to own interests, motivation or expectations of the respondent.
Practical implications and future developments There are a number of areas to improve the HPO measurement tool for future research. Conclusions The purpose of this study is to investigate PO in hospitals from an OM perspective in order to develop and practically test a measurement tool to measure HPO in operations management terms. Ethics statement In this research no human subjects including human material or human data were involved. Competing interests The authors declare that they have no competing interests.
Supplementary Material Additional file 1: Indicators for hospital production, service, and available resources. Click here for file 38K, doc. Additional file 2: The HPO-measurement tool after testing.
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Click here for file 33K, doc. Acknowledgements The authors would like to thank the participants of all hospitals involved, the OM-experts, the reviewers of the master thesis, and the referees for their constructive comments on the manuscript. Hospitals get serious about operations. McKinsey Q. Time-based management of patient process. J Health Organ Manag. Strategic management of health care organizations. Hospital operations and length of stay performance. Int J Oper Prod Manag. Health care delivery performance: service, outcomes, and resource stewardship.
Perm J. Improving hospital restructuring: lessons learned. Health Care Manage Rev. Implementation of lean and six sigma quality initiatives in hospitals: a goal theoretic perspective. Oper Manag Res. J Manuf Technol Manag. Harv Bus Rev. The new industrial engineering: information technology and business process redesign. Sloan Manage Rev. Health Operations Management. Patient Flow Logistics in Health Care. London: Routledge; Beyond world-class: the new manufacturing strategy.
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Artif Intell Med. How process enterprises really work. Knowledge management and process performance. J Knowl Manag. Business process orientation: Gaining the e-business competitive advantage. London: St. Lucie Press; What is the right organization design? Organ Dyn. The effects of process orientation: literature review.
Bus Process Manag J. Are you viewing, mapping or managing your processes? TQM J. How to implement process-oriented care. Accred Qual Assur. Making clinical governance work. Br Med J. Organisational design for health integrated delivery systems: Theory and practice. Health Policy. Does case-mix based reimbursement stimulate the development of process-oriented care delivery?
Process-based organization design and hospital efficiency. Restructuring improves hospital competiveness. Healthc Financ Manage. Coordination in hospitals: organized or emergent process?
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