Summary
Healthcare quality improvement by redesign.
Aspects of redesigning healthcare processes and the effect on quality of care.
Janneke van Leijen-Zeelenberg
BACKGROUND: The overall aim of the research presented in this dissertation was to explore if, why and how redesign initiatives were successful. These questions were posed both within an acute and an elective care setting. Besides understanding the effects of the redesign initiatives on several dimensions of quality of care, attention was paid to factors contributing to the success or failure of the redesign initiative and to understand the influence of the redesign initiative on other aspects than quality of care.
SETTING: The work was conducted in two projects carried out between October 2009 and April 2013. The first project concerns the redesign of information transfer and feedback in acute care chains in the Maastricht region. The second project concerns the redesign of the care process of the otorhinolaryngology (ORL) outpatient clinic in the Maastricht UMC+ by means of Lean Thinking.
METHODS: In both projects, participatory action research (PAR) is used as main research method. PAR often involves using mixed methods for data collection, as is done in this dissertation. Semistructured interviews, focus groups, questionnaires, collection of physical artifacts and archival records are the main sources of data. RESULTS: Process redesign initiatives have the potential to improve quality of care, mostly reported as improvements of effectiveness, efficiency and patient safety. Evidence supporting process redesign in health care is however limited and inconsistent. Exploring patients’ experiences and preferences in an otorhinolaryngology outpatient clinic by means of a qualitative study leads to beneficial insights. Patients are able to provide opinions on the care provided to them and are able to differentiate among several dimensions of patient centered care. Applying Lean to an ORL outpatient clinic shows promising results, with reduction of transportation, motion and waiting being visible to the employees of the outpatient clinic. More-over, the findings suggest that Lean implementation influences providers’ perceptions of their organizational environment, such as the willingness to change and the openness among employees at the ORL outpatient clinic.
The incongruence between the need to closely cooperate with other health professions on the one hand, and organizational routines being monoprofessional on the other hand are potentially harmful for effective and efficient cooperation in acute care chains. In addition, successively implementing a redesign requires organizational unlearning of the ‘old’ routines next to organizational learning of the ‘new’ routines.
CONCLUSION: The general message from this dissertation is that better evidence needs to be produced on if redesign initiatives improve quality of care, why redesign initiatives work or not and how redesign initiatives affect the organization or system.
Keywords: Process redesign, quality of care, lean thinking, organizational routines, communication, implementation, acute care chain, otorhinolaryngology, patientcentered care
