Editor’s Choice


A patient-focused business model: contradiction in terms?

Worldwide, healthcare organizations are being challenged to deliver patient services with fewer nurses and increasingly scarce resources. Simultaneously, service users are becomingly increasing knowledgeable and confident in articulating their views and needs, and funding bodies now expect services to meet quality indicators. This situation is not new, although the recent financial environment has sharpened the focus. It is an increasing imperative that healthcare providers adopt and demonstrate rational frameworks for service review and redesign.

In this issue of JAN, Broekhuis et al. (2009) describe one such process, conducted by a community home care organization in the Netherlands. This newly merged organization ran as a single unit comprised of separate divisions. Recognizing that current operational systems were not meeting consumers’ needs in a ‘right first time’ fashion, management initiated a review process to consider options for reconfiguration. An external group acted as expert informants, and to summarize and provide feedback during the review process. First steps entailed detailing current organizational procedures. Unsurprisingly – to anyone who has ever undertaken an organizational review of inter-departmental systems – this revealed idiosyncratic working practices with a high level of duplication, unnecessarily effortful processes and missed opportunities. Broekhuis et al. then go on to describe the structured process used to unpack what was required of this organization, and to consider alternative strategies for how this might be delivered.

The interesting feature of this study is the overt use of business models to redesign services to achieve both increased efficiency and enhanced individual patient focus. Many, particularly those working within healthcare systems that are at least part-funded on a not-for-profit basis, have experience of the tensions attendant on simultaneous application of a service ethos (e.g. the UK National Health Service, ‘free at the point of need’) and increasingly stringent financial targets. We have first-hand experience of the juggling act required when trying to meet budgets and targets whilst accommodating exponential growth of medical technologies and consumer demand, both quantitatively and qualitatively in terms of ageing populations, creeping medicalization of life events (Moynihan & Henry 2006), and hence increasing ‘need’. Every day in acute services clinicians deal with individuals and their problems, and waiting time targets and ‘access block’ statistics; and long-stay facilities struggle to meet social and emotional needs as well as physical care requirements, all within budget. Disconnection and miscommunication between the operation of curing/caring models and business management are not uncommon, and can be very costly in human as well as financial terms. Broekhuis et al.'s paper describes a process that aimed to cut through this difficulty using a rational and transparent framework for working practice redesign.

The paper does not tell us whether this redesign project was successful: there are no reports of significant findings, quantitative or qualitative. There is no indication whether the process improved employee or consumer satisfaction or staff retention rates, or reduced organizational overhead costs. We are told that the review process revealed how intelligent use of consumer contact time with experienced healthcare professionals (‘front office’ activity) could be both financially advantageous for the organization and provide positive client experiences. This will be welcome to readers, although hardly news, given that most nurses are well aware that sensible and sensitive deployment of the skilled workforce benefits patients and the organization as well.

The appeal of this paper is not so much one of novelty, but of pleasure at reading of an organization undertaking a structured approach to service redesign that aimed to engage both sides of the healthcare coin, and put patients at the centre of ‘the business’.