1. Describing and analysing process interfaces in healthcare:
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Describing and analysing process interfaces in healthcare:
An Operations Management perspective
Department of Operations / Piet Penninga

2. Introduction Handover of care Notion Process orientation of healthcare
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Introduction
Handover of care
Notion
Process orientation of healthcare
Research Framework
Methodology
Results
Conclusions

3. Handover of care Continuity of care Complex interface function:
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Handover of care
patient
information
Continuity of care
Complex interface function:
Patient, Information, Responsibility is transferred from professional to professional
40% handover failures (Schoen, et al. 2005, 2007; Hesselink 2014)
Importance of handover is increasing
Vulnerable elderly
Multi morbidity
Medical (hyper)specialisation
responsibility

4. Process orientation of healthcare
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Process orientation of healthcare
Healthcare process:
Medical Supply-Chain:
Process steps at different organisational levels (Lillrank, et al. 2011)
Interaction and performance of process steps
Operations Management performance (Croom, et al. 2000)
Information exchange
Communication
Responsibility
Organizational context

5. 11/21/2018
Note:
This study was started from the notion that describing and analyzing process interfaces in a healthcare setting might benefit from an Operations Management perspective.

6. Understanding handover of care
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Understanding handover of care
Complex interface function
Multidisciplinary approach: framework
Performance on:
Information
Communication
Responsibility
Determines performance on handover
Organizational context

7. Framework Organizational context Information Handover Communication
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Framework
Handover
performance
Information
Communication
Responsibility
Organizational
context

8. Understanding handover of care
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Understanding handover of care
Interface function
Multidisciplinary approach: framework
Production processes versus medical processes?
Assessing our framework
Literature survey (LS)
Exploratory case study (Ex CS)

9. Methodology OM LS Ex CS O & SC: LS: Ex CS: 5 papers (overview)
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Methodology OM LS
Ex CS
O & SC:
5 papers (overview)
LS:
17 papers Handover
Responsibility
Ex CS:
3 hospitals
6 cases
14 interviews

10. Results literature survey (example)
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Results literature survey (example)
OM:
Integration and coordination of primary and planning processes
(Vries en Huijsman, 2011)
LS:
Positive effect:
Well coordinated care
Well implemented handover mnemonics and discharge templates
Negative effect:
Fragmented handover organisation
Non standardised processes

11. Results literature survey
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Results literature survey
Selection of important results
A lot of research on information quality
Use of IT no guarantee for success
20% of the patients experienced bad information and coordination
If any standardisation: bad implementation
Organisational fragmentation
Responsibility not (properly) addressed

12. Results exploratory Case study (example)
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Results exploratory Case study (example)
OM: Integration and coordination of primary and planning processes
LS:
Positive effect:
Well coordinated care
Well implemented handover and discharge templates
Negative effect:
Fragmented handover organization
Non standardised processes
Ex. CS: ?
Ex. CS:

13. Results exploratory case study
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Results exploratory case study
Case
Information
Communication
Responsibility
Organizational context #1
Weak: Medical information differs and may last up till 2 weeks after discharge;
Medication systems imperfect.
Weak: Patient not involved in medical transfer.
Weak: Hospital centric.
Strong: Transfer nurse (social care).
Weak: Differs for each Physician for medical transfer.
Strong: Hospital in the lead (accepted?).
Weak: Different for each department. #2
Weak: Medical information differs and may last up till 2 weeks after discharge; Medication systems imperfect; Low quality IT systems.
Strong: Case manager in complex situations.
Weak: Depends upon nurse and situation.
Strong: Hospital in the lead (accepted!); Handover process starts already during intake. #3
Weak: Medical information differs and may last up till 2 weeks after discharge; Medication systems imperfect;
IT system insufficient.
Weak: Different for each department;
Lack of procedures. #4
Weak: Medical information may last up till 2 weeks after discharge;
Social information unclear; Medication systems imperfect.
Strong: Starting a network (results unknown);
Weak: Differs for each Physician for medical transfer;
Not addressed for social care or paramedical care.
Weak: Different for each department; Fragmented between organizations;
Problems increases upon complexity (no procedures in those situations). #5
Social information separate letter;
Medication systems imperfect;
No knowledge of social situation.
Strong: Case manager in complex situations;
Network of organizations;
Information checked upon understanding.
Weak: Sometimes no contact or communication with social care physician.
Not addressed for social care of paramedical care.
Strong: Hospital in the lead (accepted!); Handover process starts already during intake;
Certain amount of standardization.
Weak: Different for each department; Problems increase upon complexity. #6
Social information
Separate;
Medication systems imperfect; IT system insufficient.
Weak: differs for each Physician for medical transfer;
Uncertain or no procedures upon raising complexity.

14. Results exploratory case study
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Results exploratory case study
In line with Literature Survey, and additional:
Fragmented organisation:
Complex care: integration of medical & social care
Different parallel handover situations
Different information & communication systems
Gap between professionals:
Responsibility
Competing interests
No organizational knowledge on handover performance
Low ability to learn

15. determine handover quality
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Conclusions
Information & communication are determinants of handover quality
Organizational setting
Responsibility
Determinants at two different levels:
Medical oriented
Process oriented
Overall Goal setting along the medical supply chain is missing
Low ability to learn
determine handover quality

16. Note Understanding healthcare interfaces and it’s performance
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Note
Understanding healthcare interfaces and it’s performance
does benefit from an Operations Management perspective!
But how does this medical environment differ from a production environment?
Which determinants are important and how do they interact?

17. To be continued Focus should be on:
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To be continued
Focus should be on:
Definition of handover performance:
With respect to: information, communication, responsibility, and patients’ perception
Responsibility
Organisational determinants ?
Interaction effects
Effects on information & communication
Organisational learning

18. Thank you for your attention
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Thank you for your attention