Value Creation in Healthcare through Secondary Activities : A Case study investigating food processes

Abstract: The world is facing the challenge of an increasingly growing and aging population which leads to increasing requirements on the healthcare system. This has led to higher financial pressure on operational managers to do more with less resources. Hospitals are characterised by rigid routines, strict hierarchical structures and lack of consistent definitions of value which creates challenges for improvement projects and implementation. To explore an alternative perspective of how to increase value in healthcare, the concept of secondary activities is introduced. Secondary activities are defined as activities that are indirectly related to healthcare and medical processes in hospitals. Presently, secondary activities are not prioritised in healthcare since the distinction has not been made before and therefore is the value-gain interesting to investigate. The purpose of this report is to investigate how to increase value in healthcare through improved secondary activities and the following research questions are used to fulfill the purpose: What are the challenges of defining value in healthcare? 2. What process improvement strategy is suitable for improving secondary activities? 3. What implementation strategy is suitable when improving secondary activities? The method used to conduct this study consisted of a literature study covering the fields of value creation, Lean in healthcare and change management in hospital management, followed by a case study at Norrtälje Sjukhus where the food process was investigated. Results of the study showed that the challenges of defining value in healthcare are the different mindsets between professions operating in hospitals and the required balance between ethical and financial aspects. II At Norrtälje Sjukhus, the assistant nurses valued time spent with patients. In order to free more time for them, secondary activities have great potential of increasing value through improvement projects. The combination of Lean and Biodesign based on comprehensive observations proved to be a suitable process improvement strategy for improving secondary activities. Moreover, secondary activities lag well behind primary activities regarding digitalisation which can increase the value of secondary activities through improved workflows. When value is defined as time spent with patients this process improvement strategy proved to be successful. Results of improving the food process in the case study showed that the total annual savings for the hospital were 3212 work hours which corresponds to 761 244 kr. Prerequisites for a successful implementation strategy are awareness of problems, needs and to have an improvement strategy that fits the situation. Introduction of changes should made together with the personnel and be incremental to minimise disturbances to other healthcare activities. A remaining challenge is the lack of responsibility and managerial competence in the regular hospital organisation that is needed for future, continuous and sustainable improvements for secondary activities.