Towards an organisation-wide process-oriented organisation of care: A literature review

Vos, Leti; Chalmers, Sarah E; Dückers, Michel; Groenewegen, Peter; Wagner, Cordula; Merode, G.G. van

doi:10.1186/1748-5908-6-8

Cited by 51 publications

(64 citation statements)

References 39 publications

(99 reference statements)

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“…31 37 This relates to the organisation's cultural capability and the influence of the underlying beliefs, values, norms and behaviours. Motivation influences the willingness to participate 13…”

Section: Discussionmentioning

confidence: 99%

“…An enterprise-wide lean programme for improvement was launched. The programme aimed to accomplish quality improvement in parallel with the organisational change to counteract the transitional setbacks in quality that large-scale change may entail 31. A research programme was established to evaluate the effects.…”

Section: Introductionmentioning

confidence: 99%

“…17 22 26 31 35 36 38 44 as sufficient and available resources, financial as well as staff time, affect the strategic dimension.10 17 22 23 31 35 36 …”

mentioning

confidence: 99%

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Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews

2014

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ObjectiveLean interventions aim to improve quality of healthcare by reducing waste and facilitate flow in work processes. There is conflicting evidence on the outcomes of lean thinking, with quantitative and qualitative studies often contradicting each other. We suggest that reviewing the literature within the approach of a new contextual framework can deepen our understanding of lean as a quality-improvement method. This article theorises the concept of context by establishing a two-dimensional conceptual framework acknowledging lean as complex social interventions, deployed in different organisational dimensions and domains. The specific aim of the study was to identify factors facilitating intended outcomes from lean interventions, and to understand when and how different facilitators contribute.DesignA two-dimensional conceptual framework was developed by combining Shortell's Dimensions of capability with Walshes’ Domains of an intervention. We then conducted a systematic review of lean review articles concerning hospitals, published in the period 2000–2012. The identified lean facilitators were categorised according to the intervention domains and dimensions of capability provided by the framework.ResultsWe provide a framework emphasising context by relating facilitators to domains and dimensions of capability. 23 factors enabling a successful lean intervention in hospitals were identified in the systematic review, where management and a supportive culture, training, accurate data, physicians and team involvement were most frequent.ConclusionsIn the absence of evidence, the two-dimensional framework, incorporating the context, may prove useful for future research on variation in outcomes from lean interventions. Findings from the review suggest that characteristics and local application of lean, in addition to strategic and cultural capability, should be given further attention in healthcare quality improvement.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews

2014

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“…Internationally, there is an increasing shift from secondary to primary care in order to reduce healthcare costs simultaneously with sustained quality and safety of care [1,2]. This restructures care by creating healthcare chains that connect current organisations along similar patient groups, in which the general practitioner (GP) has a coordinating role [3,4].…”

Section: Introductionmentioning

confidence: 99%

Improving transitional patient safety: research protocol of the Transitional Incident Prevention Programme

Melle

Zwart

Bont³

et al. 2015

Saf Health

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Introduction: Patient transitions between primary and hospital care include referral, discharge, and simultaneous care by the outpatient clinic and the general practitioner (GP). Research on referrals and discharge shows that safety incidents in these transitions are common. We developed the multifaceted Transitional Incident Prevention Programme (TIPP), which aims to improve transitional patient safety preventing future incidents. With this study, we aim to evaluate the effectiveness of the TIPP programme on transitional patient safety, and to evaluate its implementation and the acceptance in GP-practices and hospitals. Methods: The TIPP intervention study is a controlled before and after study combined with qualitative methods. The study will be conducted in both rural and urban settings including three hospitals, together with referring primary care practices. The TIPP intervention is aimed at three aspects of transitional safety: 1) Healthcare process, 2) Transitional patient safety culture, and 3) Patient participation. Together with the participating hospital departments, GPs and patients, we will develop a tailored improvement programme, taking into account the different context of each setting.

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“…[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.…”

Section: Introductionmentioning

confidence: 99%

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

Barzdins

Konstante²,

Mitenbergs

et al. 2015

JHA

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Management of processes instead of functions has growing importance into the health care. Transition to hospital process orientation (HPO) changes the way physicians and other health professionals have used to practice before. Study was performed to explore factors affecting introduction of HPO in Latvian hospitals responding to significant external pressures during the years of economic crisis to detect the best practices used for process management implementation in clinical setting. To reach the research goal dissimilarities between current performance and management of hospitals were explored. As changes in hospital reimbursement system demand improved efficiency, hospital's performance was measured by decrease in avoidable hospitalisations, and increase in usage of more cost effective alternatives to a full hospitalisation. A regression analysis was performed to evaluate correlations of hospitalisation rates in Latvian hospitals to various outpatient health services utilisation indicators. This was done to exclude influence of external factors on hospital performance and to prove the positive impact of HPO initiatives on hospitalisation rate. Afterward the performance of all regional hospitals was compared and the two most distinct hospitals were selected for further in depth analysis. Operational data of the selected hospitals and a set of structured interviews outlined the differences between both hospital's managerial practices and factors affecting the introduction of process oriented initiatives. The theoretical research together with comparative analysis of approaches used in both hospitals served as a basis for elaboration of recommendations towards development of HPO and facilitation of the development of self-management competence of health professionals.

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Towards an organisation-wide process-oriented organisation of care: A literature review

Cited by 51 publications

References 39 publications

Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews

Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews

Improving transitional patient safety: research protocol of the Transitional Incident Prevention Programme

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

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