Hospital process orientation from an operations management perspective: development of a measurement tool and practical testing in three ophthalmic practices

Abstract

BackgroundAlthough 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. To view a hospital as a series of processes organized around patients with a similar demand seems to be an attractive proposition, but it is hard to operationalize this idea in a measurement tool that can actually measure the level of PO. This research contributes to HPO from an operations management (OM) perspective by addressing the alignment, integration and coordination of activities within patient care processes. The objective of this study was to develop and practically test a new measurement tool for assessing the degree of PO within hospitals using existing tools.MethodsThrough a literature search we identified a number of constructs to measure PO in hospital settings. These constructs were further operationalized, using an OM perspective. Based on five dimensions of an existing questionnaire a new HPO-measurement tool was developed to measure the degree of PO within hospitals on the basis of respondents’ perception. The HPO-measurement tool was pre-tested in a non-participating hospital and discussed with experts in a focus group. The multicentre exploratory case study was conducted in the ophthalmic practices of three different types of Dutch hospitals. In total 26 employees from three disciplines participated. After filling in the questionnaire an interview was held with each participant to check the validity and the reliability of the measurement tool.ResultsThe 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. The result of refinement of the items of the measurement tool after practical testing is a set of 41 items to assess the degree of PO from an OM perspective within hospitals.ConclusionsThe 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. The study shows that PO is a complex concept and appears still hard to objectify.

‘Act on Oncology’ as a New Comprehensive Approach to Assess Prostate Cancer Centres – Method Description and Results of a Pilot Study

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“…Multidisciplinary management in specialised prostate cancer centres implies new organisational and management challenges [10] , [13] , [14] . Hospitals traditionally have a vertical management structure with individually operated clinics or departments, while a horizontal management approach would be more appropriate to align and integrate the different medical, supportive, and management functions to achieve high medical and operational standards [21] , [22] , [31] .…”

“…In a continuous improvement concept for complex medical organizations, the assessment of both quality and efficiency of medical and non-medical processes as well as the definition of relevant performance indicators are required [20] , [21] , [22] . Recognizing this need, we adapted the ‘capability maturity model integration’ (CMMI) approach to assess complex medical organizations like cancer centers [23] .…”

Transition to hospital process orientation: The case of regional hospitals in Latvia

“…[1][2][3][4] With the rise of information technologies already decades ago various types of organisations started to look for efficiency as well as quality of service in processes instead of functional and hierarchical structures. [5] Possibility of management of processes instead of functions in clinical setting is relatively new and is related to electronic recording of most patient related activities in hospital information systems.…”

“…[7] Therefore the traditional functional structure of hospitals will have to be replaced by a structure which takes a holistic and systematic view on healthcare delivery as a service business process [8] and traditional health delivery processes will have to be restructured into integrated care trajectories for nominated patient groups, which are manageable, measurable, and therefore accountable. [4,9] However, there are no straightforward answers on how the transition to process orientation should be encouraged. [7,10,11] Introduction of HPO elements for adapting to the changing environment pose an unsolved problemthere does not exist a conceptual framework that facilitates the transition of hospitals as open complex socio-technical systems to process oriented management.…”