There is limited opportunity for healthcare professionals to redesign services from a whole system perspective. Many services operate on a 24/7 basis; therefore healthcare does not have the luxury of being able to “stop the line” as in manufacturing. Hence, this has led to point of care and/or project-based improvements being implemented (Burgess and Radnor 2013; Dixon-Woods and Martin 2016). This often results in optimising one part of the process but sub-optimising other parts or in fact the whole system. Taking a systems view early on in the pathway design would be beneficial. Once operationalised, the pathway can then be continually monitored and revised using improvement models and cycles (e.g. PDSA).
The ability to recognise where lean and/or agility can be employed within the design of pathways is a skill that has not been well developed in healthcare. Supply chain managers, system designers or their equivalent in healthcare do not seem to exist. Redesign tends to be localised and not well connected to other parts of the system. Therefore, it is difficult to see who takes responsibility for ensuring pathways are designed to deliver the desired outcomes. There is a need for an organisation to take a lead role to ensure that all care providers involved are aware oftheir role in the pathway both in terms of delivery of care and improving the service. Performance measurements need to be coordinated, congruent and transparent across the entire care pathway. To develop a sustainable and integrated healthcare system we suggest the following are required:
- • Collaborative and long-term relationships between key providers which include at the very least health and social care
- • Visibility and alignment of performance measures across the healthcare system
- • Sophisticated demand management to support redesign of pathways (and sub-processes), categorisation of patients and allocation of resources
- • Development of systems thinking and supply chain management skills to take a holistic view of the pathways which stretch across functional and organisational boundaries
- • Well-integrated information systems to support those receiving and giving care
- • Inclusion of resource and emotion flows in the improvement of activities to provide a wider view of the complexities associated with delivering care for those with chronic long-term conditions and co-morbidities.