Engineering cellular organisation and operation for effective healthcare delivery supply chains

The purpose of this paper is to provide a comprehensive description, justification and modus operandi for implementation of cellular operations within healthcare delivery supply chains. The methodology outlined has a sound theoretical basis, has been proven in a wide range of market sectors (including hospitals) and hence qualifies for consideration as a contribution to “new management theory”.

Approach is based on the well established management‐by‐projects (MBP) methodology for analysis, design and effective implementation of change. There is detailed coverage of the five‐step MBP programme with specific applications in healthcare. The importance of “people involvement” as a core requirement is demonstrated via the set‐up of task forces to design and operate such cells. These groups integrate cognate activities so as to provide seamless patient flow within the healthcare delivery process. MBP is derived from a systems perspective. This in turn is concerned with maintaining quality, reducing uncertainty, smooth transference, synchronisation, schedule adherence, and minimisation of throughput times.

The outputs from case studies executed in a large UK teaching hospital confirm the substantial benefits accruing from cellular operation. In both materials supplies and urology admission processes significant improvements result form adoption of the MBP change methodology. This includes substantive 50 per cent reduction in patient throughput times, plus 25 per cent increase in bed utilisation. Measurable cost benefits are achieved in materials supply, especially via simplification of ordering systems.

The healthcare applications demonstrate the applicability of MBP within this specialised scenario. However, the solutions depend on the innovatory capability of the relevant task forces who execute the projects. Since these necessarily include participation by coal‐face “players”, i.e. doctors, nurses, support staff, etc. advised by internal “change experts” the solutions adopted are shaped to be the best and most appropriate “local” schema.

It is essential that task forces be properly constituted, well trained, well advised, and actively practice the plan‐do‐check‐act cyclic route of well‐tested improvement. “Train‐Do” is the key. However, in healthcare especially, the “Elephant Must Be Eaten in Bite Sized Chunks”. In other words the organisation needs visible progressive change, unit‐by‐unit, thus avoiding saturation of scarce resources.

Brings together the MBP methodology and cellular organisational concepts into an integrated, sustainable, systems based approach to the analysis, design and implementation of effective change.