Lebanese University Operations Management PDF

Lebanese University Faculty of Medical Sciences Masters of Science – Health Administration (MHA) Operations Management Operations HCSY – M2100...

Lebanese University Faculty of Medical Sciences Masters of Science – Health Administration (MHA) Operations Management Operations HCSY – M2100 Management Module 2. Healthcare Systems Improvement Instructor: Dr. Katia Saliba Course Understanding the role of operations in any organization Designing new or improved operating procedures and systems for competitive Content advantage Making short-run and long-run decisions that affect operations and managing the work force Evaluating the performance of operating units Managing existing resources in healthcare setting Dr. Katia Saliba - Faculty of Medical Sciences - LU 2 The Process Knowledge Areas 1 3 Chapter 1: The Process Knowledge Areas INTRODUCTION INTRODUCTION Operations management The direction and control of the processes that In all walks of life, you will find operations managers. They transform inputs into outputs for customers— don’t fit into any one category, and they do not have all finished goods or services. the same responsibilities, but one thing is the same—they It entails the design and control of systems make everything happen. responsible for the productive use of raw Operations management is both an art and a science. It materials, human resources, equipment, and involves working with things and with people, with facilities in developing goods and/or services. certainties and with possibilities and probabilities. Operations management encompasses The science includes understanding the processes, tools, ✓ planning, ✓ sourcing and purchasing, and techniques. ✓ inventory management, The art is in applying them effectively within the context of ✓ production management, the people who provide the inputs, the people who ✓ marketing, process the inputs into outputs, the people who deliver the ✓ sales, ✓ distribution, outputs, and the people who buy those outputs ✓ supply chain management, What are these processes? How they are defined? ✓ quality management, ✓ management information systems, and more. Dr. Katia Saliba - Faculty of Medical Sciences - LU 4 Chapter 1: The Process Knowledge Areas WHAT IS A PROCESS ? WHAT IS A PROCESS ? A simple example that will help illustrate a process in action is to look at the process of ordering a meal at There are many definitions that exist to describe what a a restaurant. process is, but most commonly it is described as a sequence of linked tasks or activities that, at every stage, The process activities are as follows: consume one or more resources (employee energy, time, 1. The process starts when a customer places an infrastructure, machines, and money) to convert inputs order. (data, material, and parts) into outputs (products, 2. A waiter then takes the order. services, or information). 3. The waiter places the order with the kitchen. Furthermore, processes outline a specific ordering of work 4. The chef prepares the order. activities across time, with a beginning, an end, and 5. The process ends with the delivery of the meal to clearly defined inputs and outputs, and serve as the the customer. fundamental building blocks of all organizations. Everything we do is a process, and in each area or function of an organization there are many processes being executed. These processes interact with other processes, and organizations large and small can be seen as complex networks of interconnecting processes. An organization’s success hinges in large part on how well it carries out its processes, and an effective process is one that produces intended results consistently and efficiently. Dr. Katia Saliba - Faculty of Medical Sciences - LU 5 Chapter 1: The Process Knowledge Areas WHAT IS A PROCESS ? A process is: a sequence of linked tasks or activities which, at every stage, consume one or more resources (employee energy, time, infrastructure, machines, money) to convert inputs (data, material, parts) into outputs (products, services or information). Dr. Katia Saliba - Faculty of Medical Sciences - LU 6 Chapter 1: The Process Knowledge Areas WHAT ARE THE CHARACTERISTICS OF A PROCESS? WHAT ARE THE There are several core elements to a process. A well- defined process contains five core components: CHARACTERISTICS OF A PROCESS? 1. Resources 2. Inputs Every organization wants to develop its business and 3. Activities improve the performance of its daily operational work 4. Outputs and the quality of its service delivery. 5. Controls Business processes are the operational activities that provide, produce, and deliver its products and services, and every organization consists of employees who perform activities, using a variety of different resources and with varying levels of control. Therefore, it is important to understand the characteristics of a business process before trying to improve one. /SERVICE Dr. Katia Saliba - Faculty of Medical Sciences - LU 7 Chapter 1: The Process Knowledge Areas WHAT ARE THE CHARACTERISTICS OF A PROCESS? 1. Resources 4. Outputs Process resources are all of the things that a process must The outputs of a process can be products, services, or routinely have to be able to convert inputs into outputs. information and should conform to the specifications agreed Resources may be tangible or intangible, and examples of in advance with the customer of the process, whether they resources might include are internal or external. Outputs examples include Tangible: People, a computer, and software Tangible: Products Intangible: Skills and experience Intangible: Advice 2. Inputs 5. Controls The Inputs of a process are the things that are transformed Process controls are activities involved in ensuring a by the process into an end product or service required by process is predictable, stable, and consistently operating the customer of the process. at the target level of performance with only normal Inputs may be tangible or intangible, and examples of inputs: variation. Process controls may be imposed either Tangible: Written data, parts, and forms externally or internally. For example, customer Intangible: Verbal requests specifications, legislative requirements, and copyright laws are all externally imposed, whereas internal quality checks 3. Activities and organizational approvals are derived from within the organization. Activities in a process can be thought of as the actions that move the inputs through the process to become outputs. Process controls are activities involved in Examples of activities in a process include: ensuring a process is predictable, stable, and Tangible: Measuring, sawing, painting, and writing consistently operating at the target level of performance with only normal variation. Intangible: Reading, approving, or submitting Dr. Katia Saliba - Faculty of Medical Sciences - LU 8 Chapter 1: The Process Knowledge Areas WHAT ARE THE CHARACTERISTICS OF A PROCESS? Processes outline all of the activities an organization Every business process has a goal, has engages in, using people, technology, and information to specific inputs and outputs, uses resources, carry out its goals. has a number of activities that are performed in some order, creates value of some kind for All processes are made up of some combination of the customer (either internal or external), and inputs, outputs, and activities, but the level to which may effect more than one organizational unit. people, systems, data, and rules play a role depends on the type of process. Organizations combine these things in pursuit of a business goal, in our perspective healthcare goal, and to add value to the customer. In our case patient and other stakeholders. There are many ways to accomplish the same goal and many ways that customers perceive value, so there is almost an infinite number of ways to combine inputs, activities, controls, and resources in a business process that achieves a desired output. The trick is to combine the available inputs, resources, and controls in the most efficient and effective manner to satisfy the customer. Dr. Katia Saliba - Faculty of Medical Sciences - LU 9 Chapter 1: The Process Knowledge Areas What are the Different Types of Processes? WHAT ARE THE DIFFERENT TYPES You’ve likely come across the outcomes of inefficient OF PROCESSES? processes as well. Unhappy customers, stressed colleagues, missed Everyone in and related to your organization carries out deadlines, and increased costs are just some of the dozens of processes every day. For example, you may problems that dysfunctional processes can create. go through the same steps each time you generate a report, resolve a customer complaint, complete a Every organization has various types of processes that contract, or build a new product. run its business, but each can usually be categorized into one of three process types: Processes can be formal or informal, whereby formal processes are documented and have well-established Management: These are business processes that steps. For example, you might have process maps for govern the operations of an enterprise or receiving and submitting invoices, or for creating new organization. Typical management processes customer accounts. include strategic planning and corporate governance. Formal processes are particularly important when there Operational: Also known as primary or core are legal, safety, regulatory, or financial reasons for processes, these are business processes that form following particular steps. the primary objective of the enterprise and subsequently create the primary value stream. Informal processes are more likely to be ones that you have created yourself and that possess a fairly narrow Typical operational processes include Engineering, focus. For example, you might have your own set of Purchasing, Manufacturing, Marketing, and Sales. steps for taking meeting minutes, carrying out market An example of a core process for a manufacturer research, or keeping track of tasks. might be to assemble parts. Dr. Katia Saliba - Faculty of Medical Sciences - LU 10 Chapter 1: The Process Knowledge Areas WHAT ARE THE DIFFERENT TYPES OF PROCESSES? Supporting: These are business processes that Disjointed processes that are not coordinated, support the core operational processes of an managed, or continuously improved can lead to organization. Typical supporting processes include numerous problems, such as: Finance, Information Technology, and Service Customers complaining about poor product quality or Delivery departments such as Project Management bad service and Process Improvement, as well as Organizational Colleagues getting frustrated Development and Customer/Technical Support. In the manufacturing example, a supporting process might Work being duplicated or not done at all be to recruit production staff. Cost increases Wasted resources and cycles While these three categories play meaningfully different Bottlenecks causing operators to miss deadlines or roles, they need to be aligned and integrated in order to critical service level agreements enable effective performance of the entire company. Effective and sustained process improvement must consider the management and support processes as well as the core business processes, whether they are formally or informally regarded or used. When everyone follows a well-tested set of steps, there is less duplicated effort, there are fewer errors and delays, and staff and customers feel more satisfied. Dr. Katia Saliba - Faculty of Medical Sciences - LU 11 Chapter 1: The Process Knowledge Areas Process Owner PROCESS OWNER A Process Owner should : Be a subject matter expert of the process or the Process Owners are a critical component of Process domain in which the process is classified Improvement efforts. They are the named individuals Demonstrate process-oriented thinking responsible for the performance of a process in realizing its objectives. Understand the outcomes and experience needed to achieve customer satisfaction Process Owners are responsible for the comprehensive Have insight into performance issues or disconnects management of processes within the organization, within the process including approving documents (Process Maps, Procedures, and Work Instructions), determining key Be a well-respected professional who can positively performance indicators, as well as monitoring process influence process operators performance and recommending improvements. A Process Owner is the only person with the authority to make changes to a process and is the contact person for all information related to its performance. In most cases, Process Owners are leaders within an organization but can also be individuals in non- leadership positions. Process Owners are supported by Process Improvement Organizations and ultimately inherit the solutions created by a Process Improvement project team. Dr. Katia Saliba - Faculty of Medical Sciences - LU 12 Chapter 1: The Process Knowledge Areas Relationships among Policies, Processes, and Procedures RELATIONSHIPS AMONG Policies, Although it is very easy to lump these terms together as if they were a single entity, knowledge of the difference Processes, Procedures, and Work will enable participants to understand the documentation Instructions that will be produced, as well as deliver higher-quality artifacts throughout Process Improvement projects. Process Improvement requires that participants understand the distinction between a Policy, a Process, Policies a Procedure and work instructions. Policies are guiding principles that are intended to All four terms address related subject matter but do so influence decisions and actions across an organization with different types of content and at different levels of and govern the implementation of its processes. detail. They include laws, guidelines, strategic goals, and Each term has a unique purpose that drives the content business rules under which an enterprise operates and contained within each document. governs itself (why an organization does something). Although these terms are often used interchangeably, They contain the formal guidance needed to coordinate Policies, Processes, and Procedures are in fact distinct and execute activity throughout an organization. items. When effectively deployed, policies help ensure process Consequently, it is important to have a formal definition designs meet organizational standards. of each term prior to embarking on improvement There is not a one-to-one relationship between a Policy initiatives. With this understanding, participants and and a Process as corporate policies may affect multiple stakeholders know what work will be performed over the processes. course of a Process Improvement project. Dr. Katia Saliba - Faculty of Medical Sciences - LU 13 Chapter 1: The Process Knowledge Areas Relationships among Policies, Processes, and Procedures However, processes must reflect the business rules contained in any related Policies. Policies outline a particular principle and its classification, describe who is responsible for its enforcement, and outline why the Policy is required. A simple Policy Document is the most common tool used to describe a Policy (Figure 2-1). It is important to note that a Business Rule is a declarative statement of control or constraint that the business places upon itself or has placed upon it. Policies, on the other hand, are general or informal statements of direction for an enterprise. Although both are considered elements of guidance, policies are usually translated and refined into business rules. A Policy may be the basis for one or more business rule statements, just as a business rule statement may be based on one or more policies. An example of a Policy– Business Rule relationship for a car dealership would be the following: Business Policy: We only sell vehicles in legal, roadworthy condition to our customers. Business Rule: Vehicles must be safety checked upon return from each customer test drive. Dr. Katia Saliba - Faculty of Medical Sciences - LU 14 Chapter 1: The Process Knowledge Areas Relationships among Policies, Processes, and Procedures Processes Common tools used to display processes include Flowcharts, Cross-Functional Process Maps, and Processes are related activities or actions that are taken to Integrated Definition for Functional Modeling (IDEF) produce a specific service, product, or desired result. Diagrams. Processes can be formal or informal, large or small, An example that illustrates this concept is the process of specific to a set of cross-functional departments, or span repairing a vehicle at a car dealership. The process is across an entire organization. triggered by a customer’s request for an appointment and Processes are publicly known, documented, supported, concludes when the vehicle is returned to the customer for and widely used by an organization. use. Figure 2-2 illustrates this in a simple Process Map. They contain resources, steps, inputs, and outputs used to indicate where there is separation of responsibility and control within a series of related and connected activities (what an organization does or should be doing). Unlike the relationship of Policy to Procedure, there is a direct relationship between Processes and Procedures as Procedures describe in detail how each activity within a process is carried out. Processes address who is responsible for performing activities (departments or divisions), what major activities are performed, and when the process is triggered and subsequently halted. Dr. Katia Saliba - Faculty of Medical Sciences - LU 15 Chapter 1: The Process Knowledge Areas Relationships among Policies, Processes, and Procedures Procedures A Procedure is a set of written instructions that define the specific steps necessary to perform the activities in a Process (Figure 2-3). They document the way activities are to be performed to facilitate consistent conformance with organizational requirements and to support quality and consistency. They define how the work is performed and are typically documented in step-by-step fashion, describing in detail each activity within a process. Procedures detail specifically who performs the activity (the role within a department), what steps are performed, when the steps are performed, and how the steps are performed, including any standards that must be met. The development and use of Procedures is an integral part of successful process-focused organizations. Procedures provide individuals with the information needed to perform their jobs properly and they detail the regularly recurring work processes that are to be conducted or followed. Dr. Katia Saliba - Faculty of Medical Sciences - LU 16 Chapter 1: The Process Knowledge Areas Relationships among Policies, Processes, and Procedures Many businesses use Procedures to reduce errors, assist Organizations may choose the most optimal and user- with training employees, or as a point of reference to friendly route for their users. ensure consistency of work. In doing so, use of Procedures can minimize variation and help ensure quality through consistent implementation of activities within an organization. Work Instructions Work Instructions are a form of Procedure and are generally recognized as a subset of Procedures. However, they are typically written to describe how to do something for a single role or activity within a process, whereas full-fledged Procedures describe the detail of every activity within an end-to-end cross-functional process. Well-written Procedures can often eliminate the need for documenting Work Instructions. However, most process mapping and modeling tools available today enable and encourage Work Instructions over formal Procedures due to the click-through and component-oriented nature of the applications. Dr. Katia Saliba - Faculty of Medical Sciences - LU 17 Chapter 1: The Process Knowledge Areas Relationships among Policies, Processes, and Procedures Policies Why? Dr. Katia Saliba - Faculty of Medical Sciences - LU 18 Chapter 1: The Process Knowledge Areas Relationships among Policies, Processes, and Procedures / Service Dr. Katia Saliba - Faculty of Medical Sciences - LU 19 Chapter 1: The Process Knowledge Areas USING Policies, Processes, and Procedures USING Policies, Processes, and Procedures The most common solution to this problem is to pair process diagrams and procedural detail together, clearly The easiest way to think about Policies, Processes, and detailing the steps in a process that a procedure refers to. Procedures is in the level of detail contained within each item By doing this, employees can see the greater context and (Figure 1-4). implications of the cross-functional process while also Processes can be described as being at a high level and having the level of detail required to successfully complete operating across an organization’s various functions, whereas their duties. procedures are at a lower level and contain more detailed When proper policies exist, everyone within an information, breaking down the various activities within a organization who is using different processes and process. procedures will be able to see the connection of what they In simple terms, the primary difference between a process are doing to why they are required to do so in a certain and a procedure is that a process is what you do and a manner. procedure is how you do it. The most important element is that there is a cascading Policies are at the macro level of detail and contain guiding effect of improvements made at a higher level on those at principles or rules intended to influence decisions and actions a lower level. carried out in Processes and Procedures. If a recommendation to replace a given Policy with a better All are innately linked and, depending on the organization’s one is made and accepted by business Process Owners, needs, may or may not be required in order to execute day- then corresponding changes in the subsequent Processes to-day activities or Process Improvement efforts. and Procedures must follow in order to ensure compliance. Processes are an excellent means of displaying a series of Policies, Processes, and Procedures are all part of an related activities in an easy to understand format; however in organization’s Process Ecosystem and usually work best many cases they are deemed too high level for employees to when all are managed together Figure 1-5. use to perform their day-to-day tasks. Dr. Katia Saliba - Faculty of Medical Sciences - LU 20 Chapter 1: The Process Knowledge Areas USING Policies, Processes, and Procedures The laws or regulations that govern or constrain operation Describe what happens with- in the organization to build products that conform to the standards in accordance with the policies of the organization They implemented by step-by-step instructions that implement the process 1 Dr. Katia Saliba - Faculty of Medical Sciences - LU 21  FIGURE 1-5 Distinguishing Characteristics of Chapter 1: The Process Knowledge Areas a Policy, a Process, and a Procedure Policies Processes Procedures Policies are driven by environmental Processes are driven by achievement of Procedures are driven by a completion factors desired outcome of a task Policies are adhered to Processes are operated Procedures are executed Policies statements serve to guide Process activities are completed by Procedures steps are completed by process design and operation different people with the same objectives, different people in different departments department barriers are non-existent with different objectives Policies are expressed in broad terms Processes are less detailed and describe Procedures are highly detailed and and guide activities what activities should occur describe how activities are executed Policies focus on satisfying controls Processes focus on satisfying customers Procedures focus on satisfying rules and standards Policies define organizational Processes transform inputs into outputs Procedures define the sequence of constraints through use of resources steps to execute a task Policies are evolutionary Processes are dynamic Procedures are static Policies guide people, actions, and Processes cause things or events to Procedures cause people to take events happen actions and decisions Policies change less frequently Processes change gradually Procedures are prone to change Policies have widespread application Processes are moderately spread Procedures have narrow application Dr. Katia Saliba - Faculty of Medical Sciences - LU 22 Chapter 1: The Process Knowledge Areas EXAMPLES IN THE HEALTHCARE SETTINGS EXAMPLES IN THE HEALTHCARE SETTINGS In healthcare, policies, processes, and procedures are critical components that ensure safe, efficient, and effective delivery of services. Here are detailed examples of each: Personal Protective Equipment (PPE): Requires the use 1. Policies in Healthcare of gloves, gowns, masks, and eye protection as appropriate for the procedure and patient condition. Policies are overarching principles that guide decision- Vaccinations: Ensures that all healthcare workers are making and behavior within an organization. They provide up-to-date with necessary vaccinations (e.g., flu, a framework for consistent action and compliance with Hepatitis B). regulatory requirements. Isolation Protocols: Defines procedures for isolating Example: Infection Control Policy patients with contagious diseases to prevent cross- Objective: To minimize the risk of infection transmission contamination. within the healthcare facility. Environmental Cleaning: Specifies cleaning and Key Elements: disinfection procedures for surfaces and equipment. Hand Hygiene: Mandates regular handwashing with soap and water or using an alcohol-based hand sanitizer Implementation: Training for all staff on infection control before and after patient contact. practices, regular audits, and compliance monitoring. Dr. Katia Saliba - Faculty of Medical Sciences - LU 23 Chapter 1: The Process Knowledge Areas EXAMPLES IN THE HEALTHCARE SETTINGS 2. Processes in Healthcare Processes refer to the series of steps taken to achieve a particular end. In healthcare, processes ensure that care delivery is systematic and efficient. Example: Patient Admission Process Objective: To ensure a smooth and thorough admission of 4. Room Assignment: patients into the healthcare facility. Allocate appropriate room based on patient needs and Key Steps: availability. 1. Pre-Admission Preparation: 5. Introduction to Care Team: Verification of patient identity and insurance details. Introduce patient to primary healthcare providers and Pre-admission testing and documentation collection. support staff. 2. Initial Assessment: 6. Patient Education: Nursing staff conduct initial health assessments, Provide information on facility rules, visitation policies, including vital signs and medical history. and patient rights. 3. Documentation: Complete admission forms and consent documents. Monitoring: Regular review of admission procedures and Enter patient data into the electronic health record feedback from patients and staff to identify areas for improvement. (EHR) system. Dr. Katia Saliba - Faculty of Medical Sciences - LU 24 Chapter 1: The Process Knowledge Areas EXAMPLES IN THE HEALTHCARE SETTINGS 3. Procedures in Healthcare 3. Site Preparation: Procedures are specific, detailed instructions on how to Select an appropriate vein for IV insertion. perform a task or activity. They ensure consistency and Clean the insertion site with antiseptic solution. safety in the execution of processes. 4. Insertion: Example: Administering Intravenous (IV) Medication Insert the IV catheter using aseptic technique. Objective: To safely and effectively administer IV medication to patients. Secure the catheter and connect it to the IV line. 5. Administration: Steps: 1. Preparation: Administer the medication as per the prescribed rate and dosage. Verify the physician’s order for the IV medication. Monitor the patient for any adverse reactions during and Check the medication for correct drug, dose, and after administration. expiration date. 6. Documentation: Wash hands and don gloves. Record the medication administration in the patient’s 2. Patient Identification: medical chart. Verify patient identity using two identifiers (e.g., name Note any observations or patient reactions. and date of birth). Explain the procedure to the patient and address any Evaluation: Regular competency assessments for staff concerns. and audits of procedure adherence. Dr. Katia Saliba - Faculty of Medical Sciences - LU 25 Chapter 1: The Process Knowledge Areas EXAMPLES IN THE HEALTHCARE SETTINGS Integrating Policies, Processes, and Procedures To ensure cohesive and effective healthcare delivery, it is essential to integrate policies, processes, and procedures seamlessly. For example, an Infection Control Policy (policy) will outline the Patient Admission Process (process) steps to identify and manage infectious patients, which includes the Procedure for Administering IV Medication (procedure) under strict aseptic conditions. This integration ensures that all aspects of patient care are managed consistently and safely. Dr. Katia Saliba - Faculty of Medical Sciences - LU 26 Chapter 1: The Process Knowledge Areas BEST PRACTICES FOR DEVELOPING BEST PRACTICES FOR DEVELOPING Ensure subject matter experts are identified and readily available to resolve issues Policies, Processes, and Procedures Develop each artifact with the customer and/or user in The following list describes best practices for developing mind (internal or external) and implementing Business Processes, Policies, and Ensure each document does not include any Procedures for use across an organization: unnecessary information Establish format, content, and writing standards for all three items Benefits of Developing Policies, Identify who will write, review, and maintain the Processes, and Procedures documents Development of Policies, Processes, and Procedures helps Write Policies, Processes, and Procedures in separate organizations documents Provide visibility into areas of quality, productivity, cost, Ensure each document is written with clear, concise, and schedule simple language Improve communication and understanding Ensure documentation is easy to access, use, and Plan and execute activities in a disciplined fashion update Capture lessons learned Setup common vocabulary to reduce confusion and Facilitate the execution of organization-wide processes ensure consistency of terms Analyze and continuously improve operations Use version controls to ensure proper document management Reach new maturity levels Provide a basis for training and skills assessment Dr. Katia Saliba - Faculty of Medical Sciences - LU 27