Abstract
Organ donation and transplantation services portray a sub-system of modern healthcare organizations, which is a complex adaptive system. Across the world, there is a marked gap between the numbers of available organs for transplant and potential recipients in the waitlist. To date, researchers have struggled to comprehend the reasons for these disparities, yet the subject received relatively little attention from the system’s perspective. The outcome of organ transplantation requires the coordinated effort of many actors like donors, recipients, families, physicians, transplant coordinators and other hospital staff. They may belong to cross-functional departments and institutions, often operating with different motivations and objectives. In this study, we use Situation-Actor-Process (SAP) and Learning-Action-Performance (LAP) inquiry model, to systematically inquire the organ donation in India. With SAP-LAP, we attempt to understand the complexities and interactions among the current situation, involved actors and processes affecting organ donation at the macro- and micro-level of policy formation. The SAP part brings an insight into the present condition of the organ donation system in India. A model representing flexible interaction among situation, actors and processes is developed for a better systemic understanding. Then, LAP fetches the learning followed by the suggested actions that need to be taken for improving the performance of the organ donation system. Through a case study conducted in an Indian hospital, we explore the reasons for operational inefficiencies at the micro-level. The study identified non-value-adding activities like waiting, excess motion, inappropriate processing and defects; and value-adding activities like training intensivist, training transplant coordinator, raising awareness among family members, excess inventory and use of information and communication technology. The research brings up multiple, self-adjusting, unpredictable and interacting pathways that lead from a potential organ donor to an organ receiver, thus targeting process improvement through a holistic approach.
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References
Alagoz, O., Maillart, L. M., Schaefer, A. J., & Roberts, M. S. (2007). Choosing among living-donor and cadaveric livers. Management Science, 53(11), 1702–1715.
Aldrighetti, R., Zennaro, I., Finco, S., & Battini, D. (2019). Healthcare supply chain simulation with disruption considerations: A case study from northern Italy. Global Journal of Flexible Systems Management, 20(1), 81–102.
Arshinder, K. A., & Deshmukh, S. G. (2007). Supply chain coordination issues: An SAP-LAP framework. Asia Pacific Journal of Marketing and Logistics., 19(3), 240–264.
Bastian, N. D., Munoz, D., & Ventura, M. (2016). A mixed-methods research framework for healthcare process improvement. Journal of Pediatric Nursing, 31(1), e39–e51.
Business Standard. (2016). Organ donation: Huge gap between demand & supply, says govt. https://www.business-standard.com/article/pti-stories/organ-donation-huge-gap-between-demand-supply-says-govt-116030801027_1.html.
Camgoz-Akdag, H., & Beldek, T. (2019). Process improvement in a radiology department. Business Process Management Journal. https://doi.org/10.1108/BPMJ-03-2019-0109.
Chand, P., Thakkar, J. J., & Ghosh, K. K. (2018). Analysis of supply chain complexity drivers for Indian mining equipment manufacturing companies combining SAP-LAP and AHP. Resources Policy, 59, 389–410.
Clemen, R. T., & Winkler, R. L. (1993). Aggregating point estimates: A flexible modeling approach. Management Science, 39(4), 501–515.
Cohen, L. (1999). Where it hurts: Indian material for an ethics of organ transplantation. Daedalus, 128(4), 135–165.
Dahlgaard, J. J., Pettersen, J., & Dahlgaard-Park, S. M. (2011). Quality and lean health care: A system for assessing and improving the health of healthcare organisations. Total Quality Management and Business Excellence, 22(6), 673–689.
Davey, S., Raghav, S. K., Singh, J. V., Davey, A., & Singh, N. (2015). A comparative evaluation of public health centers with private health training centers on primary healthcare parameters in India: a study by data envelopment analysis technique. Indian Journal of Community Medicine, 40(4), 252–257.
DGHS (Directorate General of Health Services). (2016). https://dghs.gov.in/content/1353_3_NationalOrganTransplantProgramme.aspx.
Elias, A. A. (2019). Strategy development through stakeholder involvement: A New Zealand study. Global Journal of Flexible Systems Management, 20(4), 313–322.
Ertin, H. (2014). Organ donation and transplantation medicine: ethical framework and solutions. Turkish Journal of Business Ethics, 7(2), 104–120.
Esposito, M., Kapoor, A., & Goyal, S. (2012). Enabling healthcare services for the rural and semi-urban segments in India: When shared value meets the bottom of the pyramid. Corporate Governance: The International Journal of Business in Society., 12(4), 514–533.
Healey, B. J. (2008). An economic model for distributing body organs. Journal of Economics and Economic Education Research., 9(1), 71–78.
Husain, Z. S., & Pathak, R. D. (2002). A technology management perspective on collaborations in Indian automobile industry: A case study. Journal of Engineering Technology Management, 19(2), 167–201.
IRODaT Report (2020). International Registry of Organ Donation and Transplantation. https://www.irodat.org/img/database/pdf/IRODaT%2520Newsletter%25202019.pdf.
Kabra, G., & Ramesh, A. (2015). Analyzing ICT issues in humanitarian supply chain management: A SAP-LAP linkages framework. Global Journal of Flexible Systems Management., 16(2), 157–171.
Kak, A. (2004). Strategic management, core competence and flexibility: Learning issues for select pharmaceutical organizations. Global Journal of Flexible Systems Management, 5(4), 1–16.
Kessler, J. B., & Roth, A. E. (2014). Getting more organs for transplantation. The American Economic Review, 104(5), 425–430.
Khari, C., & Sinha, S. (2018). Organizational spirituality and knowledge sharing: A model of multiple mediation. Global Journal of Flexible Systems Management, 19(4), 337–348.
Koh, H. K., Jacobson, M. D., Lyddy, A. M., O’Connor, K. J., Fitzpatrick, S. M., Krakow, M., et al. (2007). A statewide public health approach to improving organ donation: The Massachusetts Organ Donation Initiative. American Journal of Public Health, 97(1), 30–36.
Kumar, P. S., & Anbanandam, R. (2020). Theory building on supply chain resilience: A SAP–LAP analysis. Global Journal of Flexible Systems Management. 1–21.
Kwon, I. W. G., Kim, S. H., & Martin, D. G. (2016). Healthcare supply chain management; strategic areas for quality and financial improvement. Technological Forecasting and Social Change, 113, 422–428.
Lai, A. L., CeRes, J. D., & CeRes, S. H. L. (2007). Exploring cadaveric organ donation: A mortal embodiment perspective. Journal of Marketing Management, 23(5–6), 559–585.
Majumdar, S. K., & Gupta, M. P. (2001). E-business strategy of car industry: SAP–LAP analysis of select case studies. Global Journal of Flexible Systems Management, 2(3), 13–28.
Mangla, S. K., Kumar, P., & Barua, M. K. (2014). A flexible decision framework for building risk mitigation strategies in green supply chain using SAP–LAP and IRP approaches. Global Journal of Flexible Systems Management, 15(3), 203–218.
Matesanz, R. (2016). How to be no. 1 in donations. IESE Insight. 67–71.
Mauch, T. J., & Bratton, S. L. (2014). Organ transplantation and donation: Why minority groups need more organs but donate less—it’s complex! Critical Care Medicine, 42(6), 1546–1548.
Mesich-Brant, J. L., & Grossback, L. J. (2005). Assisting altruism: Evaluating legally binding consent in organ donation policy. Journal of Health Politics, Policy and Law, 30(4), 687–718.
Morse, C. R., Afifi, W. A., Morgan, S. E., Stephenson, M. T., Reichert, T., Harrison, T. R., et al. (2009). Religiosity, anxiety, & discussions about organ donation: Understanding a complex systemof associations. Health Communication, 24(2), 156–164.
Naik, S., & Srivastava, M. (2017). A study on relevance of professional training to healthcare housekeeping aide through SAP-LAP inquiry. Indian Journal of Public Health Research & Development, 8(4), 743–750.
Pandey, A., Sahota, P., Nattanmai, P., & Newey, C. R. (2017). Variability in diagnosing brain death at an academic medical center. Neuroscience Journal. 2017. Article ID 6017958.
Ram Jat, T., & San Sebastian, M. (2013). Technical efficiency of public district hospitals in Madhya Pradesh, India: A data envelopment analysis. Global Health Action, 6(1), 217–242.
Ravi, V. (2014). Reverse logistics operations in automobile industry: A case study using SAP-LAP approach. Global Journal of Flexible Systems Management, 15(4), 295–303.
Sahi, M., Kanvinde H. & Kavitha S. (2014). Myths, misconceptions and the reality of organ donation. Transplantation Research: https://www.mohanfoundation.org/organ-donation-transplant-resources/Myths-Misconceptions-and-the-Reality-of-Organ-Donation.asp.
Sharma, J. K., & Narang, R. (2011). Quality of healthcare services in rural India: The user perspective. Vikalpa, 36(1), 51–60.
Shetty, U., & Pakkala, T. P. M. (2010). Technical efficiencies of healthcare system in major states of India: An application of NP-RDM of DEA formulation. Journal of Health Management, 12(4), 501–518.
Sindhu, A., Ramakrishnan, T. S., Khera, A., & Singh, G. (2017). A study to assess the knowledge of medical students regarding organ donation in a selected college of Western Maharashtra. Medical Journal of Dr. DY Patil Vidyapeeth., 10(4), 349.
Singh, N., & Shalender, K. (2014). Success of Tata Nano through marketing flexibility: A SAP–LAP matrices and linkages approach. Global Journal of Flexible Systems Management, 15(2), 145–160.
Social Work Foot Prints. (2015). https://www.socialworkfootprints.org/articles/organ-shortage-crisis-and-health-care-revisiting-the-challenges-and-prospects.
Söylemez, M., & Tarhan, A. (2016). The use of maturity/capability frameworks for healthcare process assessment and improvement. In International conference on software process improvement and capability determination (pp. 31–42). Springer, Cham.
Sulania, A., Sachdeva, S., Jha, D. N., Kaur, D., & Sachdeva, R. (2016). Organ donation and transplantation: An updated overview. MAMC Journal of Medical Sciences, 2, 18–27.
Sushil, (1997). Flexible systems management: An evolving paradigm. Systems Research and Behavioral Science, 14(4), 259–275.
Sushil, (2000). SAP-LAP models of inquiry. Management Decision, 38(5), 347–353.
Sushil, (2001a). SAP-LAP framework. Global Journal of Flexible Systems Management, 2(1), 51–55.
Sushil, (2001b). SAP-LAP models. Global Journal of Flexible Systems Management, 2(2), 55–61.
Sushil, (2001c). Flexsy Tools. Global Journal of Flexible Systems Management, 2(3), 45–50.
Sushil, (2009). SAP-LAP linkages — a generic interpretive framework for analyzing managerial contexts. Global Journal of Flexible Systems Management, 10(2), 11–20.
THOA Rules. (2014). Transplantation of human organs act rules. National Organ and Tissue Transplant Organization. https://notto.nic.in/act-end-rules-of-thoa.html.
Truog, R. D. (2014). Defining death: getting it wrong for all the right reasons. Texas Law Review, 93, 1885.
UNOS. (2015). United Network for Organ Sharing. Annual Report. https://www.unos.org/data/.
Vaishnavi, V., & Suresh, M. (2020). Assessing the readiness level of healthcare for implementing agility using fuzzy logic approach. Global Journal of Flexible Systems Management, 21(2), 163–189.
Varjavand, R. (2013). Legalized market for human kidneys: A wrong solution to a right problem. Journal of Management Policy and Practice, 14(4), 91–102.
Weihrich, H. (1982). The TOWS matrix – a tool for situational analysis. Long Range Planning., 15(2), 54–60.
Wellington, A. J., & Sayre, E. A. (2011). An evaluation of financial incentive policies for organ donations in the United States. Contemporary Economic Policy, 29(1), 1–13.
Yeung, I., Kong, S. H., & Lee, J. (2000). Attitudes towards organ donation in Hong Kong. Social Science & Medicine, 50(11), 1643–1654.
Zargooshi, J. (2001). Quality of life of Iranian kidney “donors”. The Journal of Urology, 166(5), 1790–1799.
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Dhakate, N.N., Joshi, R. Analysing Process of Organ Donation and Transplantation Services in India at Hospital Level: SAP-LAP Model. Glob J Flex Syst Manag 21, 323–339 (2020). https://doi.org/10.1007/s40171-020-00251-9
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DOI: https://doi.org/10.1007/s40171-020-00251-9