MANAGING HEALTH CARE (PATIENTS) OPERATIONS.

By Reason Chivaka

Introduction

Management of operations is at the heart of every organisation. According to

Hammer (2004) organisations whether they are public, private or non profit making

exist to create value and operations management involves the tasks to create value.

Operations management is about creation of value through effective and efficient

management processes (Klassen and Menor: 2006).

This focus of this paper is on operations management in the health sector, particularly

hospitals. The first part will explain the nature of operations management and how

operations inter-link with and support strategic objectives. The second part will

identify, analyse and evaluate the range of tools and techniques used in managing

healthcare operations. This will be followed by a discussion on the importance and

benefits of quality to organisational strategic objectives. The last part will discuss the

range of legislation that impact upon health care operations management.

The Nature of Operations in the Health Sector

The healthcare sector is undergoing major reforms which are meant to, improve

patient care and safety, reduce waiting times, and eliminate resources wastages. The

major challenges being faced by healthcare providers particularly hospitals is that,

PATIENT CARE OPERATIONS MANAGEMENT. By Reason Chivaka

recipients of the services are now more aware of the types of care they should be

receiving, are less willing to accept long waiting times for treatment, and want to be

involved in planning and implementation of their their care (Vissers and

Beech:2005). These challenges call for changes in operations management if health

care service providers are to meet the needs of the patients.

Review of the literature shows that, there are various definitions and views on what

general operations management and health care operations management is. According

to Water (1991), operations management is responsible for managing the

transformation of various kinds of inputs into useful outputs. Stevenson (1993), said

that, operations management is the management of systems that create goods and

services. Similar views are from Barnett (1996) who said that, operations

management deals with the efficient conversion of organisational resources into

goods or services that an organisation has been set up to provide. Operations

management is at the fore front of services delivery Brown etal (2001. This means

that, health care providers should ensure that, their operations management is

supportive of the core business which is provision of quality patient care. Klassen and

Menor (2006), emphasised this view when they said that, operations management is

integral to the development and delivery of goods and services.

The concept of operations management in the health sector was adopted from the

PATIENT CARE OPERATIONS MANAGEMENT. By Reason Chivaka

manufacturing sector and private sector service delivery organisations. Brown et al

(2001) defined service operations management, as the transformation process in

which there is a high degree of interaction between the recipients and the

organisation. This definitions mirrors the nature of operations management in the

health sector which is defined as, the analysis, design, planning and control of all

steps necessary to provide a service for patients (Vissers and Beech:2005). Similar

views are from Langabeer (2008) who said that, health care operations management

is concerned with the most efficient and optimal methods of supporting patient care

delivery. From these definitions it is clear that, the main focus of health care

operations management should be, the identification of patients needs, designing and

delivering services that meet the needs of the patients in an effective and efficient

manner.

The inter-link between Operations and Strategic Objectives.

Operations management begins with organisational plans and strategies which could

be short, medium or long term (Shim and Siegel: 1991). This is because the

operational plans emanate from the organisation's strategic plans. For example in UK,

the organisational strategies for hospitals are derived from the NHS Plans. These

strategies lead to the development of hospitals strategic plans and operational plans

which are then given to various departments within the hospitals for execution. The

main objectives are usually, reduction of patient waiting times, improving patient

PATIENT CARE OPERATIONS MANAGEMENT. By Reason Chivaka

safety, and prevention of infection control. McLaughlin and Hays (2008), identified,

patient safety, effectiveness, reducing waiting times, efficiency, and being responsive

to patient's needs as being at the core of health care operations management. It is

therefore important that, these issues should be at the centre of every health care

provider's operations management as they form the core of the strategic objectives.

Consequently, the operations should be designed in a way that support the strategic

objectives whose aim is to meet the needs of patient care

Constituents Parts of the Supply Chain

An effective supply chain is crucial to the success of any organisation. DeBree (2001)

argued that, a supply chain is like an oil pipeline, it should not be clogged otherwise

the whole system will come to a halt. Handfield and Nichols (2002) defined a supply

chain as activities associated with the flow and transformation of goods or services

from raw materials to end users as well as the associated information flow. In the

healthcare sector the main focus is on capacity management, resource flexibility,

information flows and service performance (Sengupta et al: 2006). For example in the

UK health sector the main constituents parts of the supply chain are for hospital

surgical departments are, community. General Practitioners, Consultants Clinics,

wards and theatres.

Community

-people who use healthcare services come from the community and at times some

PATIENT CARE OPERATIONS MANAGEMENT. By Reason Chivaka

patients are transferred from other hospitals. In the UK all the people are registered

with General Practitioners (GP.s) who are their first port of call whenever they need

to utilise healthcare services.

General Practitioners (GP)

-their role is to see patients and treat them. In the event of them not being able to deal

with the problems, they will either refer the patient to the hospital's emergency

department or out patient clinic. The nature of the referral is determined by the nature

of the patient's diagnosis.

Consultants Out Patient Clinics

-these clinics are run by our hospital Consultant Doctors. Depending on the nature

of the diagnosis, they can either, discharge the patient with or without treatment or

they will put the patient on the waiting list for surgery.

Emergency Department

-This hospital department deals with emergency admissions. Depending on the

patient's diagnosis, one can either be discharged or admitted to the respective ward

for further investigations, treatment or surgery.

Surgical Admissions Ward.

-admit all patient's with surgical related problems from the emergency department

and clinics. After admission the patients are then moved to the ward that deals with

patient's surgical problems.

PATIENT CARE OPERATIONS MANAGEMENT. By Reason Chivaka

Surgical Specialist Wards.

-the main source of patients are the Consultant's out patient clinic (elective

admissions) and from Surgical admissions ward (emergency admissions)

Theatres

-once in the ward patients are prepared for theatre and will be returned back to the

ward post operatively. They will stay in the ward until they are certified fit to be

discharged.

Discharge Home.

-once certified fit for discharge, patients will be prepared for discharge to their

respective homes.

However, it is important to note that, the chain is like a cycle as after discharge some

of the patients will go back to their GPs and to out patients clinic or emergency

department and they will be back in the supply chain system again.

Problems with the Patient Care Supply Chain

The problem with this patient supply chain, emanates from the various constituents of

the supply chain. In the UK, communication between hospitals and GP Surgeries is

still posing a challenge to efficiency and effectiveness of the supply chain. There are

many gaps between the chain which hinders its effectiveness. DeBree (2001) argued

that, the focus of patient care supply chain should be on the whole system from the

PATIENT CARE OPERATIONS MANAGEMENT. By Reason Chivaka

GP, out patient clinic right up to the day of discharge from the hospitals. Similar

views are from Chandra (2008) who said that, to achieve improved performance,

healthcare supply chain must be efficient, integrated and hospitals could benefit by

reaching out to General Practitioners and invite them to be partners of the supply

chain. Improved coordination, communication, sharing of information, and

integration should be seriously considered if the patient care supply is to be

improved. The ideal situation is for various constituents such as GP surgeries,

emergency department, wards , theatres and medical staff to operate as one chain and

not disjointed. These improvements will not only benefits the patients but will greatly

improve health care operations management.

Tools and Techniques Ideal for Managing Operations in Hospitals

Operations management has evolved and is no longer confined to manufacturing

concerns. Operations management tools and techniques which were used in the

manufacturing industry are now common in the service industry sector, both profit

making and non profit making organisations. According to Davis et al (2002), the

need to deliver high quality services has led to the adoption and utilisation of various

operations management tools and techniques in the public sector. (Jensen et al: 2007),

said that, operations management utilises various tools, techniques and quantitative

methods to aid planners, decision makers and analysts to design, analyse and improve

the operations or performance of a system. 7

PATIENT CARE OPERATIONS MANAGEMENT. By Reason Chivaka

Le an Sy ste m

Whilst various tools and techniques are useful, in healthcare service the main focus

has been on lean thinking. Slack et al (2005) said that, the lean approach is founded

on doing things well, on gradual improvement and on elimination of waste at every

step of the way.

In hospitals, the main focus is on improving the patients journey from the point of

entry into the system right up to the time of discharge by eliminating time wasting

activities, getting everyone involved and continuously improve the services.

According to Slack et al (2005), three things underpin the lean philosophy and these

are, elimination of waste, staff involvement in the operations and continuous

improvement. Lean system is used to improve the services at each and every stage of

patient's care such as services at GP surgery, Consultant clinics, Emergency

department, Surgical Admissions ward, Specialist wards and theatres.

Lean system is ideal for patient care operations because of its emphasis on

continuous improvement. However whilst the lean system is important, it requires

total commitment from everyone in the organisation to realise its benefits. The value

of lean system has been well documented. Hall (2006), said that, lean system helps to

eliminate delays, poor communication and coordination between the various

healthcare organs.

PATIENT CARE OPERATIONS MANAGEMENT. By Reason Chivaka

Conclusion

Managing operations in health care providing organisations is not an easy task. The

demands of the service users are increasing and proving to be very challenging to the

service providers. It is therefore important that, the patient supply chain should be

properly managed and the various parts of the chain should communicate, coordinate

and work as a team. Various tools such as the lean system can be effectively utilised

to improve health care operations. Unless the proper tools are used and all the

stakeholders work together, patient care operation management will continue to pose

serious challenges to service providers.

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