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Trends in contextual variables of the use of business improvement approaches in Dutch hospitals.

Sanders, E.M. (2010) Trends in contextual variables of the use of business improvement approaches in Dutch hospitals.

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Abstract:Introduction Over the past century, the health care sector is being reformed in many countries. Costs are exploding, attributed to technological advances and an aging society, and waste is identified as an important contributor to the increase in health care expenditures (Institute of Medicine, 2001). In an effort to strengthen their operating performance, leading health care organizations use interventions originating from operations management, however Rundle (2000) has suggested that the health care industry is falling behind in issues of management. Sousa and Voss (2008) suggested that contingency factors might contribute to the success of the use of business improvement approaches. The contingency theory claims that there is no best way to organize a corporation; instead the optimal course of action is dependent upon the internal and external situation (Woodward, 1985). Contingency research on the quality improvements in healthcare has rarely been performed (Dean, Suchyta, Bateman, Aronsky, & Hadlock, 2000; Hackman & Wageman, 1995). This thesis will conduct a research about the approaches used in Dutch hospitals in order to improve their business, in this report called business improvement approaches, and the success and evaluation of those approaches. The research describes the different trends in the contextual variables relating to the use and the success of the approaches and will elaborate on the different contingency variables. Research Approach The main research question of this research is: What are the trends and possible influences in the selected contextual variables of business improvement approaches relating to the response and performance variables in Dutch hospitals? This research is a first step exploring the relatively new field of the use of business improvement approaches in Dutch hospitals. The objectives of this research are to develop an overview of variables that influence the use of the most common business improvement approaches and to develop several inventories of the trends of the contextual variables and the use of business improvement approaches. Methodology This research is the second part of a larger research study. The first research has been started with an inventory on what common business improvement approaches exist in the literature and a selection of approaches was been made based and the approaches have been characterized and distinguished. Thereafter based on the literature, the variables influencing the response and performance variables of business improvement approaches have been described for this part of the research and four of those variables have been selected for further examination for this research. Thereafter an expert meeting was been set up, to validate the selection, definitions and characteristics of the different business improvement approaches. After validating the characterizations a survey was been held for both the researches. Thereafter a pre-test of the surveys was been performed in four different hospitals and the survey has been adapted, based on the comments of the different managers, before it was ready to go online. The outcomes of the survey were analyzed for the first part of the research and different inventories of the improvement approaches used in the hospitals and of the evaluation of the used approaches were provided. For this research those results were needed in order so analyze the possible trends between the four selected contextual variables and the response and performance variables of the business improvement approaches. Results An inventory of the contextual variables influencing the use of business improvement approaches has been made and four of those variables have been included in this research en have been explored in more detail. Eleven business improvement approaches have been included in this research. The results show that general hospitals have been using a wider range of approaches, compared to the other types of hospitals The university hospitals never evaluate the results above objectives , while general hospitals most of the times achieve the quality aspects objectives. The results confirm the fact that the use of business improvement approaches in hospitals is a relatively new field, with little experience of the hospitals. However the results contradict each other in the trends in experience and the success of business improvement approaches. The priorities of the approaches are divided, overall timely is most often high prioritized, corresponding with the use of care pathways, while financial is mostly no priority. The results show that most hospitals do have different kind of datasets available and make use of external parties in the use of approaches. Most of the hospitals do have an education program, however professionals are rarely included. Conclusions It seems that in general the approaches that are harder to use, because they require more knowledge or are harder to implement, are more often used or only used in general hospitals, compared to UMC’s and top clinical hospitals. It could be possible that general hospital use a wider range of business improvement approaches, because they are more influenced by the changes in the Dutch health care and the more competitive environment, this could also explain the better performance of general hospitals. The results show that there is little expierence with the approaches in the hospitals and that there is a possible lost of knowledge, when employees rapidly change jobs and external parties have been extracted. The results show that there is a possible lack of dissemination of knowledge and experience in the hospitals. Both facts could cause problems in the future. The fact that financial is most often the lowest priority of the use of business improvement approaches is remarkable based on the changes in the Dutch Health care and the pressure to cut costs. Limitations The most important limitation of this research remains the use of the different business improvement approaches, corresponding with the limitations of the first research. This could influence the possible trends that have been explored in this research. Another limitation is the number of respondents per hospital and the total number of included hospitals. This research is a first exploration of the field and therefore the perception of the manager is important and the answers of managers of different hospitals are more interesting than the answers of different managers at one hospital.It could be interesting for further research to examine the answers of the managers of one hospital in order to compare the answers and to provide a more representative view of the hospitals. Thereby is the total number of respondents is too small in order to examinine different influences and relations between the variables. However the design of the study has ben chosen consciously in order to collect as much interesting data as possible, being a first exploration of the field. The results provide many opportunities for next research. Another field for further research could be the success of the business improvements. The results of this research show that most of the quality aspects are evaluated below the objectives of the hospitals. It would be interesting to examine why they are evaluated below objectives. Did the hospitals apply the business improvement approaches in the wrong way or were the demands too high? Implications Because this is a first step in exploring the field of the use of business improvement approaches in Dutch hospitals, it is difficult to provide practical recommendations for Dutch hospitals based on this research. Though the results show some interesting insights that have implications for hospitals. In order to improve the use of business improvement approaches two importants steps should be taken. A first step should be to make use of the resources that are already in the organization; to recognize knowledge and experience, to involve the employees and to train the different stakeholders and to make the information about the processes more standard and easy accessible. A next step should be to collaborate together with other organizations to work together, as well external parties as research centres as other hospitals in order to share knowledge and experience and together improve the processes.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:05 communication studies
Programme:Communication Studies MSc (60713)
Link to this item:http://purl.utwente.nl/essays/60580
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