Lillrank | The Logics of Healthcare | Buch |

Lillrank The Logics of Healthcare

The Professional’s Guide to Health Systems Science

1. Auflage 2018, 288 Seiten, Gebunden, Format (B × H): 178 mm x 254 mm, Gewicht: 567 g
ISBN: 978-0-8153-7932-4
Verlag: Taylor & Francis Inc

Lillrank The Logics of Healthcare

Most of the current literature on healthcare operations management is focused on importing principles and methods from manufacturing. The evidence of success is scattered and nowhere near what has been achieved in other industries. This book develops the idea that the logic of production, and production systems in healthcare is significantly different. A line of thing that acknowledges the ingenious characteristics of health service production is developed.

This book builds on a managerial segmentation of healthcare based on fundamental demand-supply constellations. Demand can be classified with the variables urgency, severity, and randomness. Supply is constrained by medical technology (accuracy of diagnostics, efficacy of therapies), patient health behavior (co-creation of health), and resource availability. Out of this emerge seven demand-supply-based operational types (DSO): prevention, emergencies, one-visit, electives, cure, care, and projects. Each of these have distinct managerial characteristics, such as time-perspective, level of co-creation, value proposition, revenue structure, productivity and other key performance indicators (KPI).

The DSOs can be envisioned as platforms upon which clinical modules are attached. For example, any Emergency Department (ED) must be managed to deal with prioritization, time-windows, agitated patients, the necessity to save and stabilize, and variability in demand. Specific clinical assets and skill-sets are required for, say, massive trauma, strokes, cardiac events, or poisoning. While representing different specialties of clinical medicine they, when applied in the emergency – context, must conform to the demand-supply-based operating logic.

A basic assumption in this book is that the perceived complexity of healthcare arises from the conflicting demands of the DSO and the clinical realms. The seven DSOs can neatly be juxtaposed on the much-used Business Model Canvas (BMC), which postulates the business model elements as value proposition; customer segments, channels and relations; key activities, resources and partners; the cost structure; and the revenue model.

Weitere Infos & Material

Chapter 1 Introduction

The healthcare crisis

Technology as a driver of disruption

Misalignment of demand and supply: non-communicable lifestyle-related problems meet reactive medicine

The unstable triangle: patient-provider-payer

Why Operational effectiveness (Lean) is only a partial solution

Unsorted complexity

Segmentation reduces complexity

End of import dominance: healthcare needs management methods that build on its own logic of production

Chapter 2 Healthcare as a service industry

Industry or cluster?

The definition of services

Service-dominant logic and co-creation of value

The Resource Integration model

The logic of production: risks and uncertainties between output and outcome

The Power Gap between doctors and patients

Professional organizations and bureaucratic logic

Markets don’t work – for now

Integration (service design) and coordination (service production)

Open and closed systems

Service machines

Chapter 3 Methodology

Concepts and constructs

Clinical medicine as a technology

The context, intervention, mechanism, outcome – model (CIMO)

Physical and behavioral technologies

Ontology, epistemology, dynamics, and technology

Known unknowns and unknown knowns

Designing service machines

Chapter 4 Demand-Supply-based Operating Platforms (DSO)

The defining demand variables: urgency, severity, arrival

The defining supply variables: technology (what can be done), patient behavior, economic constraints

The seven DSOs

Prevention: something that could have happened does not happen

Emergency: save and stabilize

One-visit: not urgent, not severe, convenient care

Elective: scheduled precision procedure

Cure: iterative process towards a preferable end

Care: chronic or terminal

Project: very complex and costly

Time – perspective as a distinguishing variable

Operating modes and production systems

Single-function, integrated multi-function, modular, mode

DSO as a managerial platform with clinical apps (modules)

Industry comparisons

Prevention: finance and insurance

Emergency: news media, military

One-visit: fast food

Elective: auto assembly

Cure: R&D, marketing

Care: industrial maintenance, facilities management

Project: construction, shipbuilding, software development

Chapter 5 The Business Model Canvas (BMC)

Value proposition

Output, outcome, benefit, value

Quality in healthcare

Customer segments

Clinical and demographic segments

The focused hospital

Customer channels

Facility- and field-based services

Regional service networks

The service distribution trilemma: time/location access, specialization, variety

Customer relations

Patient choice

Patient empowerment

Key activities

Tasks, workflows, processes

Process types: standard, routine, non-routine

Flow efficiency

Key resources

Capacity utilization and resource efficiency

Economies of scale in healthcare

The healing environment


Networks and ecosystems

Supply chains

Cost structure

Personnel, facilities, equipment, supplies

Revenue model

Global budget, capitation, fee-for-service, bundled payment

Incentive dilemmas

Chapter 6 The DSOs as distinct business models

Each DSO has a basic BMC

DSO – specific general BMCs (table)

Chapter 7 DSO ion practice

DSO and the patient journey: single- and multi-DSO journeys

Handovers between DSOs

Single- and multi-DSO – organizations

How clinical modules switch mode

Single-DSO innovations (cases)

The DSO-model in other industries: telecom, facilities management

Chapter 8 Summary, conclusion and discussion

A clever model, but so what?

The healthcare crisis in a DSO-perspective

DSO and hospital design: the disintegration of the General Hospital

DSO and health policy

Known unknowns and future research

Lillrank, Paul (Aalto University School of Science)
Paul Lillrank has been Professor of Quality and Service Management at Aalto University since 1994. He has served as the Head of the Department of Industrial Engineering and management for eight years and been Academic Dean of the school’s MBA program. Aalto University was formed in 2010 through the merger of Helsinki University of Technology, Helsinki School of Economics, and Helsinki School of Art and Design.

Paul Lillrank received a PhD in Social and Political Sciences at Helsinki University in 1988 after spending six years as a post-graduate student in Japan where he researched quality management in Japanese industry. After graduating he joined The Boston Consulting Group in Tokyo and later in Stockholm, returning to academia in 1992 as Affiliated Professor at the European Institute of Japanese Studies at the Stockholm School of Economics. He has been visiting professor at the University of Toyko, served as program director at College des Ingenieurs in Paris, and teaches regularly at the Indian Institute of Technology, Kharagpur.

Professor Lillrank has conducted research in several service industries, such as software, telecom, airlines and retailing. During the recent past his focus has been in healthcare. He has been a pioneer in introducing industrial management methods to the study of healthcare service production. He has co-founded The Institute of Healthcare Engineering, Management and Architecture (HEMA), and the Nordic Healthcare Group (NHG), a consultancy. He has been a frequent speaker and advisor to several healthcare producers and government agencies. His research interests are in Healthcare Operations Management, particularly operating modes, process coordination, knowledge integration through mobile solutions, and regionally supply systems. A current topic is innovations in healthcare management, particularly frugal innovations in the Indian context.

Ihre Fragen, Wünsche oder Anmerkungen

Ihre Nachricht*
Wie möchten Sie kontaktiert werden?
Ihre E-Mail-Adresse*
Lediglich mit * gekennzeichnete Felder sind Pflichtfelder.
Wenn Sie die im Kontaktformular eingegebenen Daten durch Klick auf den nachfolgenden Button übersenden, erklären Sie sich damit einverstanden, dass wir Ihr Angaben für die Beantwortung Ihrer Anfrage verwenden. Selbstverständlich werden Ihre Daten vertraulich behandelt und nicht an Dritte weitergegeben. Sie können der Verwendung Ihrer Daten jederzeit widersprechen. Das Datenhandling bei Sack Fachmedien erklären wir Ihnen in unserer Datenschutzerklärung.