Jenei István

István Jenei: Lean transformation of hospital processes – Structuring foreign and Hungarian experiences,
PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration
health care has been a topical issue in recent years in Hungary, and because this is an
important issue internationally as well.
The background of the research is provided by the area, information base and
notions of operations management (OM). Within that, the two major issues concerned
are the management of the health care service processes (i.e. health operations
management), and the concept of lean management. To ensure the correct interpretation
of the statements of the dissertation, it is imperative to define its basic concepts, i.e.
hospital processes, quality, efficiency and lean management. This is what I shall do
first.
Donabedian suggests that, in general terms, the process of health care provision
“…is the highly complex system of interactions and activities created between the
doctor and the patient, and any other activity within the limits of the operation of the
health care organisation” (Gődény, 2007, p.200.). Since the dissertation treats hospital
processes, by “health care organisation” as defined by Donabedian I mean the hospitals.
This definition is interpreted and specified by Ebner – Köck (1999) who, on the basis of
the distinction present also in the definition, speak of main- and supportive processes.
The first contribute directly to value creation, that is, the patients take part in them
directly, while supportive processes enable the operation of the main processes, such as
laboratory tests, laundry service, pharmacy service, sterilisation, maintenance, cleaning
etc. (Figure 1).
Quality is another key concept of the dissertation. Despite several attempts to
define it, it has had no commonly accepted definition to this day. The dissertation starts
out from the definition of quality by one of the most renowned professionals of the
field. According to Feigenbaum (1983); quality “Is the totality of the market, design,
manufacturing and maintenance characteristics of the product and the service, through
which the latter meet the expectations of the consumer” (quoted in Gődény, 2007,
p.130.). The common interpretation of quality in the health care management literature
is more complex, however basically matches this definition. Donabedian identifies three
components of quality within health care service. (1) The outcome (e.g. state-of-health,
attained quality, mortality etc.), the (infra)structure (buildings, equipment, personnel,
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