Work process change in hospital services

Summary

Funded as an ARC Linkage Project and involving industry partners in Australia and Canada, this study examines how process re-engineering methods, such as Lean Management and Six Sigma, are implemented in hospitals in Australia and Canada and how they impact on staff and patient care.

Key researchers

  • Professor Amrik Sohal
  • Professor Greg Bamber
  • Professor P.M. Stanton (RMIT University)
  • Dr R.H. Gough (Victoria University)
  • Professor S.G. Legget (La Trobe University)
  • Professor T.K. Bartram (RMIT University)
  • Dr D. Liew (Industry representative)

Project background and aims

Process re-engineering (PR), also known as process redesign and process improvement, and encompassing Lean Management and Six Sigma, is used increasingly around the world in healthcare, but there is little research about how these methods impact hospital staff. Process re-engineering is defined as the radical redesign of organisational processes in order to produce improvements in performance. In healthcare, this includes both business/organisational and clinical processes.

This project focused on process re-engineering interventions in three hospitals in two jurisdictions namely, the state of Victoria in Australia and the province of Alberta in Canada.

This study aimed to answer the following research questions:

  1. How can PR be implemented effectively to achieve positive outcomes for patients and staff within an environment of cost constraint?
  2. What is the impact on work practices and processes in and between wards and departments, and throughout the hospital?
  3. How do staff respond to changes in work practices and processes and how involved are they in change processes?
  4. Are key human resource measures such as job satisfaction, occupational health and safety, empowerment and organisational commitment utilised?
  5. How are data regarding operations, productivity, and related cost reduction quality of patient care and patient satisfaction incorporated?
  6. What can we learn from the implementation and outcomes across PR interventions in Australia and Canada that can inform strategic guidelines for implementation?

Methodology

Using qualitative methods, the study gathered data through interviews with individuals who had participated in five process re-engineering interventions in three hospitals in two health services. Over the course of the study, 144 formal interviews were conducted with 125 interviewees, 57 in Canada and 87 in Australia. The data were coded using a coding framework that linked to both the research questions and emerging themes from the data.

Findings

Staff participation in the processes varied from project to project, with hospital employees, such as nurses and allied health professionals, reporting participation to a greater extent than the medical staff. This staff engagement was positively influenced by the perception of staff that they were able to exert control over their work practices, the level of trust that they held in their local manager, perceptions of fair and adequate distribution of resources, access to training, and feedback on their achievements.

The impact on work practices and processes also varied between projects. Our methodology did not evaluate the success of the projects, as we were more interested in the organisational responses, but we found that some projects resulted in significant change that was sustained over a period of time, while other projects were unable to sustain the changes. In some cases, the individuals that we interviewed did not even agree whether the project had been a success, and many suggested they did not know the impact on patient outcomes. All of these initiatives were introduced in the context of cost control and resource restraint. Hospital staff were often not able to differentiate between the impact of the interventions and the more general pressures related to increasing demand with seemingly fewer resources.

The measures and data were consistently identified as inadequate, with both sites suggesting that they had not been measuring what they should have been. Obtaining data that was useful to the PR analysis was often difficult, especially in Victoria, and was primarily focused on efficiency measures. Specifically, participants suggested the need to have better data related to patient outcomes. Interestingly, while there was little focus on human resource measures such as job satisfaction, occupational health and safety, empowerment and organisational commitment in the PR processes, our interview participants did not raise the lack of focus in these areas as an issue. Although we had a larger number of manager interviewees than front-line staff, generally all of the participants felt that the collective bargaining outcomes that were in place were sufficient to protect their interests in these change processes.

Output

Funding information

This was a three-year project funded by the Australian Research Council (Linkage Projects Scheme) involving two industry partners (one in Australia and the other in Canada) who also provided cash and in-kind support.