Year: 2013
Type: dissertation
Abstract: The issues of quality and variation are indissociable as the knowledge of variation is one of the foundations in improving quality.Numerous studies report the existence of a great deal of unwanted variation in healthcare processes and its concomitant detrimental effects on the quality of care.Furthermore, traditional methods employed in eliminating unwanted variation, such as Statistical Process Control and Design of Experiments, remain infrequently used in the context of healthcare.The challenges in understanding and managing variation intensify as healthcare processes become increasingly complex and the uniqueness of patients becomes increasingly evident and relevant.Although variation is of utmost importance and extensively pervades healthcare process, there seems to be a gap in understanding and managing variation in ways that enable delivering care of high quality consistently over time and across patients.Thus, the overall purpose of the research substantiated in this thesis has been to increase the understanding of variation in the quality of healthcare processes.Overall, the research discussed in this thesis followed a case study design, as it explored different aspects of understanding and managing variation in the real-life context of healthcare processes.Both quantitative and qualitative research methods were used in the investigation of five healthcare processes, each of which is accounted for in a separate appended paper.First, the study on physician scheduling at hospital departments (Paper I) suggests that available provider capacity is often in dissonance with patient demand for services and that variation in the capacity may exceed that of the demand.The study also suggests that healthcare providers exert an excessive influence over the timeliness of healthcare processes.In the paper, it is argued that increasing the knowledge of scheduling resources, centralizing resource scheduling into fewer scheduling teams and using a decision system that supports resource scheduling may mitigate the iii The results illustrate the challenges in understanding and managing variation in healthcare processes, in which intervene different interested parties with potentially divergent interests who are nevertheless necessary for providing high-quality care.The results above give several indications of the existence of unwanted variation, either in the form of excessive provider influence on scheduling, deviations from recommended care for reasons other than patient unsuitability or inequalities in the treatment of patients which cannot be explained by differences in patient baseline characteristics.Such unwanted variations ought to be eliminated if variation in healthcare quality is to be reduced.The results emphasize the importance of supporting healthcare providers with tools that enable them to decide in their daily practice whether to comply with standard care or purposefully deviate from such care to accommodate the uniqueness of patients.Thus, unwanted variation ought to be eliminated at the same time as the possibility of treating patients differently based on their specific needs and wants must be safeguarded.
Author: Marco A F R N Santos
Language: English
Field: Decision Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W2122369751