The Operating Role

An organization’s operations function is concerned with getting things done; producing goods and/or services for customers. Traditionally, operations is looked at only as a department which takes care of day to day, short term issues, and strategic management is looked at as a means to achieving long term goals. This traditional view ignores the importance of operations in providing a strategic direction. In their publication in 1984, authors Hayes and Wheelwright, have actually classified the organizations into four stages of strategic importance of operations.

So, how does a department dealing in day to day short term activity lead to a long term strategy? Here are 5 ways to do that:

1)    Customer feedback:

Patient feedback is the views of the patient on the services provided. As quality gurus put it across, Voice of customer (VoC) is everything that you need to know. More so in healthcare, where the product itself is intangible and knowledge is limited, the only reliable medium of information that the customers have is feedback from others. So, it makes more sense to know what your customers are talking about.

Feedback can come in the form of surveys, audits, complaints and suggestions. Quantitative analysis techniques can help quantifying the numbers on how people think about a particular product/ service. Qualitative techniques like focus group and one-to-one interviews help understand the details on why people feel in a particular way about the service. Mystery shopping is another way of objectively collecting feedback, but its application is only limited in healthcare.

The importance of customer feedback is realized not in collecting it, but in knowing what we can do with it. NHS, England, has actually taken a lead in this regard and commissioned a project called NHS citizen to take into account the opinions of its customers for strategy formulation. Government of India, through its Ministry of Health, has very recently proposed a system of collecting patient feedback to give star rating to government hospitals. This rating shall be linked to incentive amounts to states under the National Health Mission. By doing so, the government hopes to introduce accountability into the public healthcare delivery domain.

2)    Lean Processes:

Lean, as we all know, is all about eliminating wastes from the processes. The biggest challenge to implementing lean is not the implementation per-se, but the motivation to implement. It has to be implemented in the organization as a way of thinking (Lean Thinking), and has to come from top downwards.

It is important to understand what constitutes a waste. In our day to day work, we tend to overlook those wastes, just because of the simple reason “this is how it is done”. Organizations need to re-think their processes. Do a value stream mapping, and use the lean tools to identify the causes and rectify.

When you start a value stream mapping, you would realize that instead of improving departments in silos, you would actually be making improvements around patient flow. An obstetric value stream, for example, would start from patient presenting to the OPD for their first antenatal visit to end of peurperium, and it would include all departments like front office, OPDs, labour room, nursery etc. This would lead to shifting the focus from around the various departments to around the patients’ needs.

3)    Empowering the front line staff:

Invariably each one of us has experienced situations where a front-line employee at a hotel/restaurant/call center or some other place, couldn’t solve our problem because she wasn’t empowered to do so, and a lot of resources were wasted in taking it up with the higher.

Front-line staff with decision making authority can save the management a lot of time, and also increase the patient satisfaction multi-fold. When such employees hesitate in taking decisions, it is usually because they have been reprimanded for doing so, in the past. Be supportive, inculcate a positive work environment and have an effective communication with your staff.

4)    Senior Management on shop floor, more often:

Irrespective of the size of the organization, most often than not the CEOs and the senior management personals are usually occupied with more of “Strategic” work than being on the floors. Almost each one of us is guilty to it. As the responsibilities mount, we start cutting ourselves from being on the floors to handling other responsibilities, and delegating day to day operations to subordinates. As a CEO/Senior management personal, it is our duty to maintain a positive and constructive work culture. This is a responsibility we cannot delegate.

The other important gain you have from working on floor level is of being connected to your employees. It gives you an opportunity to interact with them, understand their difficulties, knowing their views on service excellence, communicating the company’s values to them on a regular basis, motivating them for their work and actually assessing the operational gaps and addressing them.

5)    Clinical Quality

All said and done, the primary goal of patient visit to the hospital is for the clinical outcomes. No two patients are the same and the same holds true for the patient course in hospital. So, with all these variances inherent in the system, it becomes really difficult to standardize the variables. How do you then measure and communicate the value? The only option available to you is to standardize the processes. Irrespective of whether you opt for accreditation or not, standardization of processes is the only thing that can help you gain strategic advantages.

There are various examples of the process standardization to achieve outstanding quality, especially in the Indian scenario where the volumes are so high that it makes it easier to train people to become specialists in whatever small work they do. Numerous case studies published on Aravind Eye care have highlighted the efficiency of the staff when repetitively doing the same thing multiple times on a daily basis. What it actually does is, standardizes the processes and reduces the variations. HBR had published in its article how the clinical protocols developed by CARE Hospitals have actually resulted in outcomes that are 100 fold better than the ones in USA.

(I had originally written this article for a magazine HealthBiz Insights)