Redefining Service Delivery

A Harvard Busines Review article has an interesting take on service redesign. It notes that service delivery is rarely subject to the same radical redesign or disruptive innovation that happens in product manufacturing. Changing long established norms of the 'way we do things around here' is challenging and they suggest a structured series of questions to help.

This article in the Harvard Business Review caught my eye (Ways to Reinvent Service Delivery by Kamalini Ramdas, Elizabeth Teisberg and Amy L Tucker in HBR Dec 2012 pp 99-106). It’s about service redesign in health care and financial sectors. An interesting juxtaposition that I’ll pick up in another post but for now I want to share the redesign ideas.

The authors quote health care examples from places as diverse as USA, Germany, France, India and Rwanda. Using these examples, they have come up with four dimensions on which to focus when reconsidering ‘how we do things around here’. In the process of adding value for clients’ (for which read patients or people who use services) it also adds value for you.

They suggest a series of questions related to the dimensions. I’ve précised them below but cannot do justice to the full article and urge you to read it.

 Structure of the provider-client interaction

The first question is Does shared experience or shared information among clients add value for them? If yes then consider group consultations or other forms of peer support. The next question is Do your clients need tight communication among multiple providers? in which case one stop shops at the point of diagnosis and other forms of co-location or co-delivery may help.

The service boundary

Here the questions are Does a segment of your clients use a very similar set of complementary services? and Do problems with complementary services affect customer’s outcomes? Both these lead to thinking about those with different long term conditions having similar needs and considering non-traditional and non-medical services such as lifestyle changes, help getting back into work. There is increasing interest here in social prescribing and well established care co-ordinators and navigators.

The allocation of tasks

As they say in introducing this section, you can unlock a tremendous amount of value by revisiting who actually delivers the service. If you ask Does the employees’ expertise match the task? you quickly realise that we use very expensive resources for general tasks. Most physicians they asked spend more than half their time on things that don’t require medical expertise. The second question in this section is What tacit social assumptions influence task assignments? and they repeat the challenge about moving beyond only one-to-one consultations.

The delivery location

The questions here fit with our current focus on delivering care closer to or in the home. Does the location limit clients’ access or success? and Have communication and information needs changed? Both point towards thinking about how the patient can access expertise without having to go to the hospital or surgery. It is also about staff who would traditionally be office or hospital based. With mobile technology they can access records and be as connected with their team even if not on site.

 

Overall, I liked the simplicity of the dimensions and questions. I can see how they could be used in meetings and workshops to provide a structure for discussions. They are, of course, not independent of each other in that a change in one dimension may enable or block a change in another.

Isn’t it always striking that any example of an innovation to improve patient experience, outcomes or service efficiency is being implemented somewhere by someone? Why can’t we put all the scattered examples of great practice into one local area and make it the best in the world?

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