Logistics management operationalised in a healthcare context : Understanding care chain effectiveness through logistics management theories and systems theory

Sammanfattning: Healthcare improvements is constantly relevant and an important topic. Healthcare is frequently being called upon to be more cost-efficient and still fulfil demands regarding waiting times, quality and availability. Experience from structural changes in other contexts gives reason to be positive about the potential for logistics improvements in the healthcare sector as well. From a logistics perspective patients pass different care functions, units, organisations and health facilities. It is assumed that logistics management knowledge applied in healthcare can lead to lower costs, shorter waiting times, better patient service, shorter treatment times and increased capacity. This dissertation therefore presents an exploration of how logistics management theories can be operationalised in a healthcare context to understand care chain effectiveness.Theoretically, the operationalisation is done by systems theory creating compatibility between logistics management theories and the healthcare context. As a first step, features for a logistics system forms features for achieving care chain effectiveness. High care chain effectiveness is thus a desired condition and the care delivery system is the tool to achieve it. As the final step in the operationalisation the features for care chain effectiveness are in turn used to analyse today’s practices. Empirically, the research is based on qualitative data from a single case study with multiple units of analysis. It includes four care units at one of Sweden’s university hospitals, where the data is gathered through interviews, insight into management systems and document analysis. One of the main results is the 21 areas identified for analysing today’s practices by means of features for care chain effectiveness. Another main result is the four important concepts revealed through the operationalisation:Lead time - the episode of care from order to delivery as the amount of time for patient cases between first contact with healthcare and the last.Patient order fulfilment - fulfilment of patients’ needs, broken down into several smaller steps performed over time within different care units in one or several organisations, consisting of five sub-processes - order handling, diagnosis, treatment, follow-up, and discharge.True demand – patients’ needs that is to be met and thus sets what care to deliver, i.e. the production plan and the subordinate resource plan.System boundaries - defines which care units to include when focusing on the care delivery system’s performance as a whole and should be more important than the performance and productivity of each individual care unit.A number of direct suggestions for care chain improvement can also be found in the concluding remarks, for example that objectives linked to economic influx or penalty narrow the system and that lead time data on an aggregated level is needed to cover episodes of care. The theoretical contribution of the dissertation is to the field of logistics management through the methodological development of using these theories in a new context. The managerial contribution is to healthcare managers through providing opportunities to improve care chains primarily by means of a greater understanding of care delivery systems.