Nicola Burgess

SimLean: utilising simulation in the implementation of lean in healthcare

Discrete-event simulation (DES) and lean are approaches that have a similar motivation: improvement of processes and service delivery. Both are being used to help improve the delivery of healthcare, but rarely are they used together. This paper explores from a theoretical and an empirical perspective the potential complementary roles of DES and lean in healthcare. The aim is to increase the impact of both approaches in the improvement of healthcare systems. Out of this exploration, the ‘SimLean’ approach is developed in which three roles for DES with lean are identified: education, facilitation and evaluation. These roles are demonstrated through three examples of DES in action with lean. The work demonstrates how the fusion of DES with lean can improve both stakeholder engagement with DES and the impact of lean.

The Knowledge Brokering Role of the Hybrid Middle Level Manager: The Case of Healthcare

In the literature it is argued that middle level managers (MLMs) enact a strategic role in public sector organizations, at the same time as there exist calls for their delayering so that frontline services can be protected. Such calls do not recognize the strategic importance of the hybrid MLM, who crosses professional frontline and managerial domains. Drawing upon the example of their managerial role in healthcare, we highlight that the hybrid MLM enacts a strategic knowledge brokering role and outline contingent factors framing this more strategic role.

Facilitated modelling with discrete-event simulation: Reality or myth?

Is it possible for discrete-event simulation to be used in a facilitated workshop environment? Over the last decade there have been various attempts to use simulation in this way, but we argue here that none have been successful in achieving a fully facilitated mode where the model is both developed and used in the workshop. We attempt to use a discrete-event simulation in a facilitated mode as part of a lean improvement workshop in a hospital setting. The model was successfully developed and used within the 3day period of the workshop. Although the intervention was successful, we still had to build the model in the ‘back-office’, meaning that a fully facilitated mode was not achieved. The paper concludes by discussing how fully facilitated modelling with discrete-event simulation might be made possible; the answer is more about changing mind-sets than about technological challenge.

Service improvement in the English National health service : complexities and tensions

The English National Health Service (NHS) is a public sector organisation with a longstanding objective to deliver high quality healthcare that is free at the point of use. In order to achieve this, the NHS has endured an evocative and controversial theme of reform across many decades. Despite such high levels of reform, the recent Operating Efficiency Framework declared that the NHS is about to enter its toughest ever financial climate. This paper will illustrate the complexities and tensions of implementing service improvement in the NHS in a climate of persistent policy reform, reduced budgets and tough regulation. The paper reports findings of three case studies of hospital trusts in the UK in relation to the implementation of Lean improvement methodologies, highlighting key complexities of a hospital context and the corresponding tension with service improvement activity.

The building blocks of an operations strategy for e-business

This paper sets out to explain the vital role of an operations strategy in e-business. Suggests, through various research findings, that a firm can employ a number of operations strategies, and that they each possess certain core building blocks. Further, when properly combined, these strategies can be customised to a particular situation and offer substantial benefits for an organisation in driving e-business best practices. The paper gives definitions and descriptions of operations management, e-business, e-operations and an operations strategy for e-business. The work is also supported by empirical research data in the form of a small case study.

The applicability of the Viable Systems Model as a diagnostic for small to medium sized enterprises

Purpose – This paper presents research into the use of the Viable Systems Model (VSM) in small to medium sized enterprises (SMEs). Research on the VSM has been focussed on large organisations. The purpose of this paper is to explore the usefulness of the VSM in diagnosing issues of viability in SMEs.Design/methodology/approach – Case study research was undertaken in which semi structured diagnostic interviews took place with SMEs using the VSM as a diagnostic tool. The aim was to investigate whether the VSM would assist in diagnosing problems with viability and whether it could then prescribe and facilitate improvements in operations. Qualitative case study evidence is presented that shows the results of these interventions.Findings – The paper reports some examples of operational problems that were exposed through the intervention process and shows some general conclusions to support the use of VSM for analysing operations and supporting small business viability. A number of “threats to viability” themes...

Rapid Modelling of Patient Flow in a Health Care Setting: Integrating Simulation with Lean

This paper provides an evaluation of an experiment in using discrete event simulation modelling at a Rapid Improvement Event in a large hospital trust. It presents empirical findings about the challenges of building a model rapidly within a time constrained event. The aim was also to help introduce Lean principles so the learning and understanding acquired by participants, their interaction with the model, and the experimentation promoted and facilitated by the model are all considered. Our learning from this action research about rapid modelling and the modifications made to our approach as a result of the experiment are described.