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
the health care organisations, the staff usually work in functional silos: the wards
operate individually, the process-centred approach is absent. Often, the only person who
has a clear notion of the patient’s journey through the service is the patient himself. The
information processes associated with service provision are even more complicated:
they may amount to five or six times the patient journey. Unclear and over-complicated
processes generate many errors, duplications and delays, and they frustrate staff
members in direct contact with the patients, who cannot provide service of satisfactory
quality despite their best intentions (Fillingham, 2007, Parnaby – Towill, 2008).
Let us note again that a major part of the problem is attributable not to the
inadequate professional skills, attitude or efforts of the staff, but to the system in,
and the processes amidst which they must work (Spear, 2005). The primary cause is
the historical heritage. Traditionally, hospitals relied on their highly skilled and devoted
professional staff members to ward off occasional operational errors. That is, quality
service used to be guaranteed by the excellent medical and nursing staff, not by
excellent systems. This approach, however, is about to change now, due exactly to the
relevant, growing, social pressure.
For, an increasing number of initiatives target the systematic identification and
elimination of errors (Tucker and Edmondson, 2003). The Hungarian programme called
NEVES, for example, was designed to explore the generic root causes (systematic
errors in care provision), and to improve communication, information supply,
education, process organisation and management, to fine-tune staff planning and
organisation, and to upgrade the allocation, use and operation of equipment and
instruments (Belicza, 2008).
The initiatives concerned, however, have seldom resulted in a quantum leap. This
is how Brent James, Director of the Intermountain Healthcare (Salt Lake City, USA)
Institute for Health Care Delivery Research put it, “Quality development methods made
their first appearance in clinical practice 15 years ago. Despite some successful
projects, most organisations have difficulties in the comprehensive application of the
system to this day. Although they can already achieve results on a small scale, the
extension of individual projects to organisation-level sustainable developments has
remained a problem.” (internationalforum.bmj.com, 2008).
- 37 -