Bert Meijboom

Using quality indicators to improve hospital care: a review of the literature

PURPOSE To review the literature concerning strategies for implementing quality indicators in hospital care, and their effectiveness in improving the quality of care. DATA SOURCES A systematic literature study was carried out using MEDLINE and the Cochrane Library (January 1994 to January 2008). STUDY SELECTION Hospital-based trials studying the effects of using quality indicators as a tool to improve quality of care. DATA EXTRACTION Two reviewers independently assessed studies for inclusion, and extracted information from the studies included regarding the health care setting, type of implementation strategy and their effectiveness as a tool to improve quality of hospital care. RESULTS A total of 21 studies were included. The most frequently used implementation strategies were audit and feedback. The majority of these studies focused on care processes rather than patient outcomes. Six studies evaluated the effects of the implementation of quality indicators on patient outcomes. In four studies, quality indicator implementation was found to be ineffective, in one partially effective and in one it was found to be effective. Twenty studies focused on care processes, and most reported significant improvement with respect to part of the measured process indicators. The implementation of quality indicators in hospitals is most effective if feedback reports are given in combination with an educational implementation strategy and/or the development of a quality improvement plan. CONCLUSION Effective strategies to implement quality indicators in daily practice in order to improve hospital care do exist, but there is considerable variation in the methods used and the level of change achieved. Feedback reports combined with another implementation strategy seem to be most effective.

International manufacturing and location decisions: balancing configuration and co‐ordination aspects

Questions on configuration and co‐ordination are seldom integrated in research on international manufacturing and location decisions. Suggests a way in which these two aspects can be linked by combining concepts from international business and manufacturing strategy. Elaborates the practical relevance of this integration in the experiences of Dutch investors locating plants in Thailand. Simultaneous attention to configuration and co‐ordination enhances the understanding of the functioning of foreign plants in international networks and yields some important implications for managers responsible for international location issues.

Modularity in supply chains: a multiple case study in the construction industry

– The objective of this study is to assess the applicability of Fines three‐dimensional modularity concept as a tool to describe and to analyze the alignment of product, process, and supply chain architectures. Fine claims that the degree of modularity in the final output product has a one‐to‐one correspondence with the degree of modularity in transformation processes and supply chains., – An exploratory three‐company case study is used to investigate Fines three‐dimensional modularity concept., – Empirical research shows that Fines three‐dimensional modularity concept works well for descriptive purposes. However, the concept needs refinement when it is used for analytical purposes. For process modularity, the spatial aspect can be related to the concept of the territorial economy of firms, while the time aspect can be elaborated using a product life‐cycle perspective and the concept of interface reversibility. With respect to supply chain modularity, the concept of modular production networks, which specifies combinations of different degrees of geographic, organizational, cultural, and electronic proximity, is appropriate. In the specific setting of the building industry, a methodology for developing product platform architectures would refine the dimension of product modularity., – Starting from the above‐mentioned concepts, several strands of research are outlined for a further elaboration of product (developing a methodology for developing product platform architectures), process (taking a life‐cycle perspective on module development), and supply chain modularity (analyzing conditions for the application of modular networks)., – The application of systematic engineering design methods, interface reversibility, and interorganizational ICT allows firms to align product, process, and supply chain modularity.

Modular care and service packages for independently living elderly

Purpose – The purpose of this paper is to show how modularity manifests in a service context, more specifically in the provision of care and services to independently living elderly.Design/methodology/approach – Four case studies provide insight into the specification of relevant components and their subsequent assembly into a customized package of care and services.Findings – In all cases, component specification and package construction take place in two phases: partly before and partly during care delivery. Early client involvement allows for a combination of standard components that have a lower level of customization, whereas late client involvement allows for adaptation of these components resulting in a higher level of customization. The paper proposes that modularity theory should distinguish between the creation of modular offerings in care provision versus their creation in goods production, since the findings are the exact reverse of the state‐of‐the art knowledge in manufacturing modularity.Re...

Supply chain management practices for improving patient-oriented care.

Purpose – The purpose of the present paper is to discuss organisational problems that occur in situations that are complex because the treatment of patients requires input from multiple health care providers, and to argue conceptually how to resolve these problems by using SCM practices.Design/methodology/approach – First SCM, being related to settings where several companies contribute to the production of one particular product, will be discussed in general. Since patient care is about service provision, the next to be examined will be service supply chains. Subsequently, major challenges in patient‐oriented care provision follow in settings where several health care providers are involved, based on which opportunities for applying SCM in patient care will be presented.Findings – Based on literature addressing country comparisons of patient experiences, four major problem categories are distinguished: communication, patient safety, waiting times, and integration. Although problems also occur within orga...

International operations and location decisions: a firm level approach

The purpose of this study is to acquire a better understanding of why certain production and distribution facilities remain in Western Europe, in spite of economic globalisation. This paper focuses on companies located in the Netherlands but acting on an international scale. The issue is not addressed at a sectoral, regional, or even more aggregate level-of-analysis. Instead, the firm is the unit-of-analysis, which is why exploratory cases were conducted. The notion of strategic role (Ferdows 1989, 1997) is applied to assess internal motives for staying. The effect of external factors on individual facilities that differ with respect to these internal motives are also looked at. The findings suggest that facilities of high strategic importance within the multinational enterprise to which they belong have high expectations of the political/legal and macroeconomic environment. Furthermore, facilities preceding the major decoupling point in a supply chain seem to be more locationally stable than activities subsequent to this point.

Demand-based provision of housing, welfare and care services to elderly clients: from policy to daily practice through operations management

Practical implementation of notions such as patient-orientation, client-centredness, and demand-driven care is far from straightforward in care and service supply to elderly clients living independently. This paper aims to provide preliminary insights into how it is possible to bridge the gap between policy intent, which reflects an increasing client orientation, and actual practice of care and service provision. Differences in personal objectives and characteristics generate different sets of needs among elderly clients that must have an appropriate response in the daily routines of care and service providers. From a study of the available literature and by conceptual reasoning, we identify several important operational implications of client-oriented care and service provision. To deal with these implications the authors turn to the field of operations management. This field has deepened the understanding of translating an organisation’s policy into daily activities and working methods. More specifically, we elaborate on the concept of modularity, which stems from the field of operations management. With respect to elderly people who live independently, this concept, among others, seems to be particularly useful in providing options and variation in individual care and service packages. Based on our line of reasoning, we propose that modularity provides possibilities to enhance the provision of demand-based care and services. Furthermore, our findings offer direction on how organisations in housing, welfare and care can be guided in translating demand-based care to their operational processes.

The effect of industry clockspeed on supply chain co‐ordination: Classical theory to sharpen an emerging concept

Purpose – The relevance of “industry clockspeed” to supply chain co-ordination (SCC) has recently been stressed but hardly been researched. Taking an information-processing perspective, the purpose of this paper is to examine the development of SCC theory under varying clockspeed circumstances. Design/methodology/approach – This exploratory research project investigated four Dutch multinational firms operating in industries with different “clockspeeds”. Findings – The main findings of this exploratory research suggest that, with increasing clockspeed, the use of inventory as a means of providing slack against uncertainty decreases, whereas the use of lateral relations increases. Remarkably, the role of outsourcing is substantial in both low- and high-clockspeed settings, but limited in the intermediate group. Opposite to this, the role of vertical information systems is limited in low- and in high-clockspeed industries, but substantial in medium-clockspeed firms. These findings are consistent with the basic theory of organisational life-cycle patterns. Research limitations/implications – More data should be collected and analysed in subsequent research, e.g. data relating to more companies, investigated over longer periods of time, paying attention to multiple dimensions such as company age and size. Organisational solutions that may deal with accelerating industry clockspeeds are platform-based product development, time and form postponement, and modular production networks. Practical implications – Supply chain managers should be wary of one-size-fits-all solutions irrespective of current industry settings or company maturity stage. Originality/value – Previous research argues that the shorter the life cycles of the products that firms sell, the more rapidly they have to invent not just new products, but new ways of organising as well. This study is a follow-up to this work with a focus on the co-ordination within a supply chain in response to varying levels of industry clockspeed, an issue hardly considered in earlier work

Production-to-order and international operations; A case study in the clothing industry

Principles of supply chain management are discussed in relation to the modifications, extensions, and challenges currently prevalent in internationally operating companies. The central issue is: How do international operations affect common SCM principles? First, insights from the literature are reviewed. Then, a case study is presented based on a company with activities that are spread all over the world and that belong to distinct stages in the supply chain. Subsequently, an evaluation is provided along the lines of the conceptual view on international supply chain management presented earlier. The paper concludes with implications for managers in international operations, as well as directions for further research.

Improving long-term care provision: towards demand-based care by means of modularity

BackgroundAs in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes.MethodsStarting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software.ResultsOur data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services.ConclusionThe adequate setup of an organizations supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to elaborate on how to further enable demand-based provision of long-term care by means of modularity.