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Towards the Design of a Process Management Approach for the Delivery of Unscheduled Urgent and Emergency Healthcare

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Towards the Design of a Process Management Approach for the Delivery of Unscheduled Urgent and Emergency Healthcare UNIVERSITY OF SOUTHAMPTON FACULTY OF BUSINESS, LAW AND ARTS Southampton Business School Towards the Design of a Process Management Approach for the Delivery of Unscheduled Urgent and Emergency Healthcare by Ganye Kwah Driscole Thesis for the degree of Doctor of Philosophy December 2017 UNIVERSITY OF SOUTHAMPTON ABSTRACT FACULTY OF BUSINESS, LAW AND ARTS Management Science Thesis for the degree of Doctor of Philosophy TOWARDS THE DESIGN OF A PROCESS MANAGEMENT APPROACH FOR THE DELIVERY OF UNSCHEDULED URGENT AND EMERGENCY HEALTHCARE Ganye Kwah Driscole Delivering effective urgent and emergency healthcare continues to challenge developed economies despite recent increased spending. The literature suggests that the current design of accident and emergency departments (A&E) does not reflect the process nature of the delivery of unscheduled urgent and emergency care. The research described in this thesis supports the development of a process model to strengthen unscheduled urgent and emergency healthcare delivery and improve A&E operations. A comprehensive literature review is undertaken to investigate the extent and efficacy of process management in healthcare delivery. It shows that process management methods such as Business Process Re-engineering and Lean tend to be applied to individual departments. End-to-end process orientated approaches are scarcely applied. Assessing access to urgent and emergency healthcare in England, a lack of process design and management is found which results in confusion for patients. Based on principles of process orientation, a new proposal is developed that features local urgent healthcare hubs. To investigate the current process, an analysis of A&E providers by catchment area was carried out for London to understand how features of an area such as number of general practitioners affects demand in A&E. Combining catchment area analysis with regression, a novel methodology is demonstrated that indicates how demand for A&E is affected by local characteristics. i Using simulation analysis informed by Geographic Information System (GIS) location analysis, a new methodology is created to demonstrate the potential for a process orientated approach to management of urgent and emergency healthcare. Using a case study in the London Borough of Hounslow, an analysis was carried out, firstly, of the current situation; secondly, of a National Health Service (NHS) proposal and, thirdly, the proposal put forward for urgent healthcare hubs. Several scenarios are analysed in which patients are diverted to other services, to demonstrate the effects of changes of provision on patient access and queueing efficiency. ii Table of Contents DECLARATION OF AUTHORSHIP ...................................................................... xi Acknowledgements ....................................................................................................xii Abbreviations xiii Chapter 1 Introduction .............................................................................................. 14 1.1 RESEARCH BACKGROUND ............................................................................................. 14 1.2 RESEARCH CONTEXT ................................................................................................... 15 1.2.1 PREPARING THE HEALTHCARE SYSTEM FOR OPERATIONS AND MANAGEMENT EVOLUTION ............. 15 1.2.2 STRUCTURE OF HEALTHCARE SYSTEM AND CHALLENGE TO CURRENT PROCESS OUTLOOK ............... 17 1.3 BACKGROUND TO HEALTHCARE OPERATIONS MANAGEMENT (OM) ........................................ 18 1.4 THE NOTION OF HEALTHCARE DELIVERY ........................................................................... 19 1.4.1 EFFICACY OF PROCESS MANAGEMENT IN HEALTHCARE OPERATIONS .......................................... 19 1.5 RESEARCH MOTIVATION .............................................................................................. 20 1.6 RESEARCH PROBLEMS ................................................................................................. 22 1.7 RESEARCH OBJECTIVES ................................................................................................ 26 1.8 RESEARCH QUESTIONS................................................................................................. 26 1.9 ORGANISATION OF THE THESIS AND RESEARCH OUTLINE....................................................... 26 Chapter 2 Research Methodology ............................................................................ 28 2.1 INTRODUCTION ......................................................................................................... 28 2.2 RESEARCH METHODOLOGY AND EPISTEMOLOGICAL CONCEPTION ........................................... 29 2.2.1 EPISTEMOLOGICAL DEVELOPMENT ...................................................................................... 29 2.2.2 CASE STUDIES .................................................................................................................. 32 2.3 RESEARCH METHOD AND RESEARCH DESIGN...................................................................... 34 2.3.1 LITERATURE SELECTION METHOD ........................................................................................ 34 2.4 STUDY SETTING, DATA COLLECTION AND STRATEGY ............................................................. 35 2.4.1 DATA COLLECTION ............................................................................................................ 36 2.4.2 DATA QUALITY ................................................................................................................. 38 2.4.3 THE OUTPUT AREAS (OAS) ............................................................................................... 39 LSOA and MSOA ...................................................................................................................... 39 2.4.4 REGISTERED AND RESIDENT POPULATION ............................................................................. 40 2.4.5 ETHICAL CONSIDERATION .................................................................................................. 40 2.5 DATA ANALYSIS ......................................................................................................... 41 2.5.1 SPATIAL DATA ANALYSIS AND ARCGIS APPLICATION ............................................................... 41 2.5.2 DESCRIPTIVE STATISTICAL ANALYSIS ..................................................................................... 42 2.5.3 REGRESSION ANALYSIS ...................................................................................................... 43 2.5.4 SIMULATION ANALYSIS ...................................................................................................... 43 2.6 COMBINING GIS AND SIMULATION................................................................................. 44 2.7 EXPERIMENTAL CASE STUDIES ....................................................................................... 44 2.8 SUMMARY AND CONCLUSION........................................................................................ 44 Chapter 3 A review of process management methods, their design and implementation in healthcare delivery ..................................................................... 46 3.1 BACKGROUND ........................................................................................................... 46 iii Table of Contents 3.1.1 DEFINITION OF “PROCESS.” ............................................................................................... 47 3.1.2 PROCESS MANAGEMENT AND ITS ORIGIN .............................................................................. 47 3.1.3 THE MAIN APPROACHES TO PROCESS MANAGEMENT ............................................................. 50 3.1.4 WHY ADOPT PROCESS MANAGEMENT IN HEALTHCARE ............................................................ 50 3.1.5 PROCESS ORIENTATION (PO) ............................................................................................. 51 3.1.6 PROCESS ORIENTATION IN HEALTHCARE DELIVERY MANAGEMENT ............................................. 53 3.2 PROCESS METHODS .................................................................................................... 55 3.3 THE CARE DELIVERY VALUE CHAIN ................................................................................. 55 3.4 BUSINESS PROCESS RE-ENGINEERING (BPR) ..................................................................... 58 3.4.1 DEFINITION OF BPR ......................................................................................................... 58 3.4.2 BUSINESS PROCESS RE-ENGINEERING IN THE HEALTHCARE SECTOR ............................................ 59 3.4.3 PATIENT PROCESS RE-ENGINEERING (PPR) .......................................................................... 64 3.4.4 CHALLENGES OF BPR IN HEALTHCARE AND ASSESSMENT OF EFFICACY ....................................... 66 3.5 BUSINESS PROCESS MANAGEMENT (BPM) ...................................................................... 68 3.5.1 DEFINITION OF BPM ........................................................................................................ 68 3.5.2 HOW AND WHY ORGANISATIONS APPLY BPM ....................................................................... 69 3.5.3 APPLICATION OF BPM TO HEALTHCARE ............................................................................... 70 3.5.4 CHALLENGES OF BPM IN HEALTHCARE ................................................................................
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