Business Process Redesign (BPR). • Radical restructuring of a business process.
• with wide-scale application of information technology (Hammer, 1993). AS-IS.
BPR Best Practices for the Healthcare Domain Mariska Netjes, Ronny S. Mans, Hajo A. Reijers, and Wil M.P. van der Aalst
Outline • Introduction • Background • Methodology • Suitability of Best Practices • Effectiveness of Best Practices • Derivation of Best Practices • Conclusion
Business Process Redesign (BPR) • Radical restructuring of a business process • with wide-scale application of information technology (Hammer, 1993)
AS-IS
TO-BE
BPR best practices • historical solution that seems worthwhile to replicate in another situation or setting • set of best practices is inspiration for practitioners to generate local updates to existing process • focus on organization and structure of processes and NOT on improving the medical practice itself
Research Questions • To what extent are the BPR best practices suitable for redesigning healthcare processes? • Is the use of best practices effective in the healthcare domain? • Is it possible to extend the set of best practices with the lessons learned from redesigning healthcare processes?
Outline • Introduction • Background • Methodology • Suitability of Best Practices • Effectiveness of Best Practices • Derivation of Best Practices • Conclusion
BPR Framework EXTERNAL ENVIRONMENT Customers
Products
Business process Operation view
Organisation - Structure - Population
Behavioural view
Information
Technology
BPR best practices • Best practices are identified related to the topics in the framework • Collection of 29 best practices for business process improvement * • For each best practice: • a qualitative description, • the potential effects, and • possible drawbacks
is given * H.A. Reijers, S. Limam Mansar. Best Practices in Business Process Redesign: An Overview and Qualitative Evaluation of Successful Redesign Heuristics, Omega: Int. Journal of Management Science 33(4), 2005
BPR Framework and BPR Best Practices
task elimination
EXTERNAL ENVIRONMENT Customers
parallelism
Products
Business process Operation view
Organisation - Structure - Population
case manager
Behavioural view
Information
Technology
specialist-generalist
Phases in BPR initiative process model simulation
validation
list with applicable best practices
list with process parts to-be scenarios
new process models simulation
validation
decision M.H. Jansen-Vullers, H.A. Reijers. Business Process Redesign in Healthcare: Towards a Structured Approach, INFOR 43(4), 2005
Outline • Introduction • Background • Methodology • Suitability of Best Practices • Effectiveness of Best Practices • Derivation of Best Practices • Conclusion
Methodology • The research questions are addressed on the basis of 14 case studies: z INSPEC
ABI/ Inform
x
y
process(es)
health
design
pathway(s)
care
redesign
flow(s)
healthcare
reengineering
chain(s)
hospital(s)
management
operation(s) operational
10 cases
• 2 case studies we conducted ourselves • 2 case studies Dutch Academic Medical Center
Outline • Introduction • Background • Methodology • Suitability of Best Practices • Effectiveness of Best Practices • Derivation of Best Practices • Conclusion
Question I •
Best practices have been tested earlier in a single case study => redesign approach
•
"To what extent are the best practices suitable for redesigning healthcare processes?" 1. Explicit Use of Best Practices 2. Implicit Use of Best Practices
Explicit Use of Best Practices
• •
Example 1: ask the referring doctor for medical file at referral: REDUC, EXCEP, RESEQ Example 2: give intakers full responsibility for determination of treatment plan: EMP
Implicit Use of Best Practices • •
'Implicitly used': part of the intervention is highly similar to the description of a best practice Example: changing the degree of specialization of the involved resource Ù "consider making resources more specialized or generalized" (SPEC)
Suitability of Best Practices
17
21 18
Outline • Introduction • Background • Methodology • Suitability of Best Practices • Effectiveness of Best Practices • Derivation of Best Practices • Conclusion
Question II • Best practices are applicable to the healthcare domain, but: "Is the use of best practices effective?" • Best practices are effective if the resulting to-be process shows an improved performance on the chosen performance indicators • Evaluation with: 1. Simulation 2. Post-intervention Measurement
Simulation-Based To-be Evaluation • Evaluation cf. phase 4 of the redesign approach: 1. The process owner decides which to-be scenarios and performance goals are most important 2. The key performance indicators are determined for each scenario with simulation • Examples for case 1: • Medical file is asked at referral => 13% reduction in throughput time • Intakers are empowered to determine the treatment plan => 20% reduction in throughput time (decrease from 10 to 8 days)
To-be Evaluation by Post-intervention Measurement • Case studies 4, 5 and 8 use a before-after design and report on the effects of the intervention • All show a.o. a significant reduction of the total throughput time • Example (case 8): average MRI examination time shortened by 5 minutes per patient to maximize MRI capacity and increase patient throughput time with 18%
Outline • Introduction • Background • Methodology • Suitability of Best Practices • Effectiveness of Best Practices • Derivation of Best Practices • Conclusion
Question III • "Is it possible to extend the set of best practices with the lessons learned from redesigning healthcare processes?" • Not all changes that are described in the case studies are covered by the current set of best practices => find lessons learned • Found potential best practices are connected to one of the aspects identified in the redesign framework
Customer Involvement
Obtain insight in the demands of customers and the added value and bottlenecks as perceived by customers • Customer aspect of redesign framework • Application improves the quality of to-be scenarios
Scheduling
Schedule the least variant patient categories at the beginning of the clinical sessions • Behavioral view aspect of redesign framework • Application leads to a reduction of internal queuing times
Resource Joining
Place resources responsible for adjacent tasks (geographically) close together • Organization-structure aspect of redesign framework • Application reduces the throughput time of the process
Outline • Introduction • Background • Methodology • Suitability of Best Practices • Effectiveness of Best Practices • Derivation of Best Practices • Conclusion
Conclusion • BPR best practices seem highly suitable for the healthcare domain • They appear to be an effective means to improve process performance • Three additional, potential best practices seem worthwhile to be considered in future BPR initiatives • The healthcare domain can heavily benefit from relying on previous experiences • BPR best practices are one example of how to re-use design knowledge
