Engineering cellular organisation and operation for effective healthcare delivery supply chains

• Published in: The international journal of logistics management 2009-05, Vol.20 (1), p.5-29
• Main Authors: Parnaby, J., Towill, D.R.
• Format: Article
• Language: English
• Subjects: Case studies; Corporate culture; Design; Engineering; Health care delivery; Health services; Hospitals; Logistics; Organization theory; Studies; Supply chain management; Supply chains; Systems development; Systems engineering; Task forces; United Kingdom; Value chain
• ISSN: 0957-4093; 1758-6550
• DOI: 10.1108/09574090910954828

Purpose - The purpose of this paper is to provide a comprehensive description, justification and modus operandi for implementation of cellular operations within healthcare delivery supply chains. The methodology outlined has a sound theoretical basis, has been proven in a wide range of market sectors (including hospitals) and hence qualifies for consideration as a contribution to "new management theory".Design methodology approach - Approach is based on the well established management-by-projects (MBP) methodology for analysis, design and effective implementation of change. There is detailed coverage of the five-step MBP programme with specific applications in healthcare. The importance of "people involvement" as a core requirement is demonstrated via the set-up of task forces to design and operate such cells. These groups integrate cognate activities so as to provide seamless patient flow within the healthcare delivery process. MBP is derived from a systems perspective. This in turn is concerned with maintaining quality, reducing uncertainty, smooth transference, synchronisation, schedule adherence, and minimisation of throughput times.Findings - The outputs from case studies executed in a large UK teaching hospital confirm the substantial benefits accruing from cellular operation. In both materials supplies and urology admission processes significant improvements result form adoption of the MBP change methodology. This includes substantive 50 per cent reduction in patient throughput times, plus 25 per cent increase in bed utilisation. Measurable cost benefits are achieved in materials supply, especially via simplification of ordering systems.Research limitations implications - The healthcare applications demonstrate the applicability of MBP within this specialised scenario. However, the solutions depend on the innovatory capability of the relevant task forces who execute the projects. Since these necessarily include participation by coal-face "players", i.e. doctors, nurses, support staff, etc. advised by internal "change experts" the solutions adopted are shaped to be the best and most appropriate "local" schema.Practical implications - It is essential that task forces be properly constituted, well trained, well advised, and actively practice the plan-do-check-act cyclic route of well-tested improvement. "Train-Do" is the key. However, in healthcare especially, the "Elephant Must Be Eaten in Bite Sized Chunks". In other words the organisation needs visi