MIS6 (BPR/SPRINT) continued…..

Erewhon General Hospital, circa 1985

The Outpatients Administration (OA) section at EGH is proposing to computerize its appointment process. The main job of the OA is to arrange appointments for patients referred by their family doctor (GP) to see a medical specialist (e.g. a cardiologist) in the outpatient facility. Each speciality holds weekly “clinics”, wherein a small team of senior doctors examines around 60 patients. A short report is dictated after each examination; these are subsequently typed by the OA clerks, and despatched by post to the patient’s GP.

The current paper-based system revolves around an appointment ledger. Appointments are at nominal 10 minute intervals. The job of the clerk is to open the GP’s referral letter, assess the urgency of the case and make an appointment at the first suitable opportunity. A letter is then sent to the patient. If the patient is unable to attend, they are asked to contact the OA department; the appointment is then cancelled and a new letter sent out. A major problem is the high rate of failed appointments, as many as 30% of patients simply do not attend (DNA). Another problem is the long delay between the clinic itself, and the despatch of the examination reports. The backlog of reports means this can often be up to 3 weeks.

It is hoped a computerised appointment system will improve efficiency, reducing both the DNA rate and the delay in sending out reports. The main change is to make the appointments diary “electronic”. This should help finding appointments and by printing letters as soon as an appointment is made it should also speed up the despatch of appointment letters, which hopefully will reduce the DNA rate.

Urgent?

Patient visits family doctor (GP)

GP examines patient

Hospital referral?

Referral letter sent

OP clerk reads letter

Finds earliest appointment

Sends appointment letter

Finds appt. in several weeks

Checks appointment

Appt. ok?

Attends hospital

Contacts hospital

Make new appointment

Y Y N

Y

N

PATIENT FAMILY DOCTOR OUTPATIENTS (OP) CLERK

SWIM LANE PROCESS MAP

25 years later, 2010Choose and Book was part a major IT project to computerize the National Heal Service, begun in 2002

Those Who Forget the Lessons of History Are Doomed To Repeat it, George Santayana

History does not repeat itself but it sometimes rhymes, Mark Twain

A workbench for the designer-manager

Key principles:– Radicalism & innovation: don’t pave the cow-paths!!– Breadth of vision (multiple perspectives)– Depth of understanding (ethnography, process modelling)– Evidence based, informed by research– User-centred design (empower not automate)

Yes, we were lucky in having some good people, but we needed the discipline of SPRINT. SPRINT gave us a structure for doing service design. The methodology helps us do the job. It gives you the confidence to do it again. We’re going to re-BPR “Tax and Benefits”, but it’s part of the day job now. We’ll be doing it ourselves, we don’t need BPR analysts

We’ve had lots of health promotion successes – flu jabs is the best example. The take-up was 30%. Now we know all the over 65s, so when the caller rings up about, say rent arrears, a box pops saying “Mr Vickers is over 65”. The take-up is now 70%. And because we have direct access to the appointment books of the health centres, an appointment can be made, there and then.

MIS7: Managing as designing …. And EBM

Quotes

A decision attitude is dominant in management practice & education today. It is concerned with the various techniques and methods managers use in making choices, starting from the assumption that a good set of options is already available (Boland and Collopy)

A design attitude views each project as an opportunity to question basic assumptions, a resolve to leave the world a better place. Designers relish the lack of predetermined outcomes, the opportunity to go back to those assumptions that have become invisible and unnoticed, looking for the real thing we are trying to accomplish, unvarnished by years of organizational habit. A design attitude fosters a problem-solving process that remains liquid and open, celebrating path-creating ideas about new ways to use technology and new work processes

Systems design needs to be (re)instated as the primary task of the manager…. I assert this to be the manager’s primary task, i.e. to configure the work-system under their jurisdiction as efficiently and effectively as possible. What else could management possibly mean?

Business schools are under intense criticism and have reached a point of crisis. Both academics and management practitioners criticise MBA programmes for their lack of relevance to practitioners… We are on the cusp of a design revolution in business… today’s business people don’t need to understand designers better, they need to become designers Roger Martin, Dean Rotman School of Business

http://www.rotmandesignworks.ca/business_design.html

Evidence-based management (EBM)

• EBM means managerial decisions and organizational practices informed by the best available scientific evidence… using evidence makes it possible for well-informed managers to develop substantive expertise throughout their careers as opposed to faddish and unsystematic beliefs (Rousseau and McCarthy, 2007).– Inspired by “Evidence-based medicine”

• Primary sources of evidence:– Academic research– Benchmarking– Local information systems (e.g. MIS, CRM)– Bespoke research (e.g. phase 1 of SPRINT)

• Example: Forced Ranking (Pfeffer & Sutton, 2006)

BUT – managers, like other professionals, resist!!

Too much evidence, scientific papers are obscure, hard to read (arcane terms,too much methodology, too many caveats); “stories are more persuasiveanyway” (Pfeffer and Sutton)

Teaching EBM (Rousseau & McCarthy)

• KEY PRINCIPLES INCLUDE:– Focus on well-established body of knowledge: e.g.

strategic alignment– Emphasize the application of theory in learning and

practice (e.g. case studies)– Encourage openness to new evidence (“lifelong

learning”)• CHALLENGES INCLUDE:

– Access to research knowledge: need readily accessible, updated repositories containing well-synthesised research summaries

– Traditional business curriculum is fragmented, overly theoretical, remote from practice, teaching-centred, idiosyncratic and out-of-date

EBM: the very idea (Learmonth & Harding)

• Complex argument, main anxieties (put crudely):– EBM is an instrument of managerialism – managers know best,

employees are docile bodies– Exaggerates the certainties of knowledge, and the level of

agreement regarding what counts as evidence and valid research practice

– Privileges the abstract “perceived” knowledge of the researcher over the “lived space” of the practitioner

• Calls for “radical heterogeneity” in terms of research questions and methods:– Need to address organisational power relations (critical

management research)– Methodological pluralism– Embrace messiness of research findings, “it depends”