Implementering av processlösningar i sjukvården

Doktorsavhandling, 2010

Many healthcare organizations are increasingly confronting long waiting times and queues of patients. It is no longer feasible to add resources, due to increasing economic constraints. Implementing process flow solutions, derived from the operations management field, is a promising way of trying to meet these challenges. This dissertation investigates factors influencing the implementation of process flow solutions in healthcare. Findings are based on five empirical case studies, i.e. four emergency departments and one out-patient clinic. The term ‘process flow solutions’ is used as an umbrella term for all kinds of solutions that strive to establish a swift and even flow of patients before and after their meeting with physician or nurse. These process flow solutions can come from a number of different techniques and approaches such as Lean Production, Toyota Production System or Focused Operations. Although there has been theoretical work published regarding the benefits of using process flow solutions in healthcare, in reality the impact has often been limited. One explanation lies in the implementation difficulties of these solutions in an ambiguous healthcare context. There is a need of more research to draw conclusions regarding factors that influence the implementation. A qualitative research method was used, and data collection was based on interviews, conversations and participant observations. Several factors were identified which play a significant role when attempting to implement process flow solutions in the production of care. This dissertation shows that all key factors that hinder the implementation can be categorized into three main areas: Management on strategic and operational level, Professional hierarchies and traditions, and Existing knowledge paradigm. These areas are connected, implicitly or explicitly, to an experienced multifaceted customer conception which leads to insufficient patient focus in the implementation. This dissertation suggests that this patient focus, initiated in the production of care, can further help healthcare organizations to increase the required integrations of the present separate worlds of professions and functions.