Transcript Slide 1

Reengineering
Reengineering is necessary when:
1. Organizational performance lags substantially
behind your competitors, or you fear a business
crisis (losing market share). Need improvements
of 50% or more to catch up.
2. New developments, often technological
advancements, change your marketplace and
demand action.
3. Your competitors undertake proven innovation and
you must respond.
4. You wish to establish or maintain competitive
advantage.
Common Focus for Hospital
Reengineering
1. Patient aggregation
2. Clinical Resource Management (CRM)
3. Management Structure
4. Service decentralization
5. Downsizing layoffs
6. Skill mix changes
7. Non-core cost savings.
Reengineering (work redesign)
is defined as:
“The fundamental rethinking and radical redesign of
business processes to cause dramatic improvements
in performance.”
Business processes are:
The activities within an organization that add value
from the perspective of the customer and resolve a
discontinuous, dramatic alteration of current business
practices.
Reengineering Projects
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Planned layoffs
Forced retirements
Executive mandated changes
Major facilitation (managed care)
Partnerships
Product line development
Contracted services
Computer-assisted decision making
Standardized clinical protocols (clinical paths with
outcome measures)
10. Decentralized decision-making.
Reengineering (Work Design)
Several elements of reengineering differentiate it from the
current quality methodologies:
1. Reengineering requires actual renovation of at least one
of an organization’s major processes as opposed to the
refinement of existing processes.
2. Reengineering aims for quantum leaps of improvement
as opposed to incremental, step-by-step improvements.
3. Reengineering is driven from the top of the organization
and demands senior management’s continuing
participation.
4. Reengineering always includes the innovative use of
informative technology.
Reengineering conflicts with CQI.
Common Operating Principles in
Reengineered Organizations
• Line up organizational responsibility with core
business processes.
• Give organizational units responsibility for a process
from beginning to end.
• Greatly reduce management layers since the need for
synchronization between narrowly defined functional
departments and jobs is reduced.
• Define individual jobs more broadly to include
multiple skills and functions.
• Use full-time, permanent teams (multiple people with
the same responsibility) as common organizational
units.
Common Operating Principles in
Reengineered Organizations, cont.
• Push towards self-management (individual employees
and/or teams) as the norm.
• Use technology to make information available on an
‘anytime, anywhere’ basis.
• Establish spans of control 2 to 10 times greater than
in traditional organizations.
• Reconfigure information to match process-related
measures rather than functional/departmental
indicators.
• Extend the design, operation and management of
business processes into supplier and customer
organizations.
• Focus on time-related measures as important
operating indicators.
PITFALLS
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Try to fix a process instead of changing it.
Don’t focus on business processes.
Ignore everything except process redesign.
Neglect people’s values and beliefs.
Be willing to settle for minor results.
Place prior constraints on the definition of the problem
and the scope of the change effort.
Quit too early.
Allow existing cultures and attitudes to prevent the effort
from getting started.
Try to make the change happen from the bottom up.
Assign someone as “change czar” who doesn’t
understand reengineering.
Pitfalls, cont.
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Skimp on the resources devoted to reengineering.
Bury the effort in the middle or the corporate agenda.
Dissipate energy across a great many change efforts.
Attempt to change when the CEO is two years from
retirement.
Fail to distinguish reengineering from other business
improvement programs.
Concentrate exclusively on design.
Try to make reengineering happen without making
anybody unhappy.
Pull back when people resist the changes.
Drag the effort out.
New Rules to Redesign
and Improve Care
Private and public health purchasers, health care organizations,
clinicians and patients should work together to redesign health
care processes in accordance with the following rules:
1.
Care based on continuing healing relationships. Patients
should receive care whenever they need it and in many
forms, not just face to face visits. This rule implies that the
health care system should be responsive at all times (24 hours a
day, every day) and that access to care should be provided over
the internet, by telephone, and by other means in addition to face
to face visits.
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Customization based on patient needs and values. The
system of care should be designed to meet the most common
types of needs, but have the capability to respond to individual
patient choices and preferences.
New Rules to Redesign
and Improve Care, cont.
3.
The patient as a source of control. Patients should be given
the necessary information and the opportunity to exercise the
degree of control they choose over the health care decisions that
affect them. The health system should be able to accommodate
differences in patient preferences and encourage shared decision
making.
4.
Shared knowledge and the free flow of information. Patients
should have unfettered access to their own medical information
and to clinical knowledge. Clinicians and patients should
communicate effectively and share information.
5.
Evidence based decision making. Patients should receive care
based on the best available scientific knowledge. Care should not
vary illogically from clinician to clinician or from place to place.