On the tension between standardized and customized policies in healthcare: The case of length-of-stay reduction

Hospitals increasingly adopt standardized policies as a way to improve the efficiency of healthcare delivery. One key policy has been to reduce a patient's length of stay, which is commonly perceived as an effective means of improving patient outcome, as well as reducing the cost per procedure. We put this notion to the empirical test by using a database of 183,712,784 medical records of patients in the English NHS between 1998 and 2012, studying the effects of the NHS's policy of decreasing length of stay for hernia patients. While we found it to be an effective way of reducing the cost per procedure, on aggregate, we also found that it increases the risk of readmission and of death for vulnerable and elderly patients, unduly increasing the long-term failure costs of the operation for these patient groups. Based on our findings we propose a differentiated policy to selectively decrease length of stay, which we estimate could save up to US$565 per non-emergency hernia procedure (a 19.97% reduction in the cost per procedure). We outline the implications of our findings for medical practice, and discuss the wider theoretical contributions to the wider standardization-customization debate in healthcare operations management

Lean in healthcare: the unfilled promise?

In an effort to improve operational efficiency, healthcare services around the world have adopted process improvement methodologies from the manufacturing sector, such as Lean Production. In this paper we report on four multi-level case studies of the implementation of Lean in the English NHS. Our results show that this generally involves the application of specific Lean 'tools', such as 'kaizen blitz' and 'rapid improvement events', which tend to produce small-scale and localised productivity gains. Although this suggests that Lean might not currently deliver the efficiency improvements desired in policy, the evolution of Lean in the manufacturing sector also reveals this initial focus on the 'tool level'. In moving to a more system-wide approach, however, we identify significant contextual differences between healthcare and manufacturing that result in two critical breaches of the assumptions behind Lean. First, the customer and commissioner in the private sector are the one and the same, which is essential in determining 'customer value' that drives process improvement activities. Second, healthcare is predominantly designed to be capacity-led, and hence there is limited ability to influence demand or make full use of freed-up resources. What is different about this research is that these breaches can be regarded as not being primarily 'professional' in origin but actually more 'organisational' and 'managerial' and, if not addressed could severely constrain Lean's impact on healthcare productivity at the systems level. © 2011 Elsevier Ltd

The past, present and future of China's automotive industry: a value chain perspective

The economic growth and industrial development in China over the last decade has been of considerable interest to industry and policy-makers alike, and also been subject of many academic studies. Considerable research on the macro-economic growth and process of industrialisation, as well as the subsequent increase in the domestic demand has been reported. In case of the automotive industry, previous studies have analysed the rather complex industry structure, still dominated by a range of joint ventures between domestic and foreign manufacturers, and specifically commented on the potential and sustainability of domestic demand. In this study we aim to extend the focus by analysing the key features and challenges not only at the manufacturer, but also at the supplier and distribution tiers in the automotive supply chain in China. Reviewing the governmental policies that led the auto industry's development since 1950, we analyse the current capabilities and challenges at the different tiers in the automotive value chain, before concluding with an outlook on the factors impacting on the future development of the automotive industry in China

A systems perspective on the death of a car company

Purpose – The aim of this paper is to understand how large and apparently successful organizations enter spirals of decline that are very difficult to reverse. The paper examines the case of Rover, once one of the largest car producers in the world, which collapsed in 2005. An analysis of strategic and operational choices made over a period of 40 years investigates the reasons for, and consequences of, a growing mismatch between the context faced by the company (industry dynamics, market conditions) and its operational capabilities, a mismatch that ultimately brought about the company's demise. Design/methodology/approach – The paper is based on interviews with 32 people, including senior managers (including four chief executives), government ministers and union officials who were key decision makers within, or close to, the company during the period 1968 and 2005. Secondary sources and documentary evidence (e.g. production and sales data) are used to build up a historical picture of the company and to depict its deteriorating financial and market position from 1968 onwards. Findings – The company was formed from a multitude of previously independent firms as part of a government‐sponsored agenda to build a UK National Champion in the car industry. The merged company failed due to several factors including poor product development processes, poor manufacturing performance, difficult labour relations, a very wide product portfolio and a lack of financial control. Although strenuous efforts were made to address those issues, including periods of whole or part ownership by British Aerospace, Honda and BMW, the company's position deteriorated until eventually production volumes were too low for viable operation. Practical implications – The case of Rover highlights the importance of what has been termed “the management unit” in complex systems. The management unit comprises processes and routines to deal with challenges such as managing product portfolios, connecting strategic and operational choices, and scanning and responding to the environment. In the case of Rover, a number of factors taken together generated excessive load on a management unit frequently operating under conditions of resource scarcity. We conclude that viewing corporate failure from a systems perspective, rather than in terms of shortcomings in specific subsystems, such as manufacturing or product development, yields insights often absent in the operations management literature. Originality/value – The paper is of value by showing corporate failure from a systems perspective, rather than in terms of shortcomings in specific subsystems, such as manufacturing or product development; and yields insights often absent in the operations management literature. The Rover case featured in the paper demonstrates the usefulness of systems ideas to understanding at least some types of failure, not as an alterative to capability‐based approaches, but in addition to them

An Investigation into Supplier Responsiveness: Empirical Evidence from the Automotive Industry

Purpose – The ability of a manufacturing system to respond to customer demand in a timely fashion is widely accepted as a source of competitive advantage. While quick response concepts at system level have been widely discussed in a range of industry sectors, such as textile, electronics and fast moving consumer goods, few studies so far have specifically investigated the responsiveness of the component supply chain. This exploratory study hence aims to reconcile the considerable ambiguity that exists around the concept of supplier responsiveness, supported by an empirical investigation into the automotive parts industry. Design/methodology/approach – The study analyses the responsiveness of first‐tier automotive suppliers in Europe. The research is based on a multi‐method approach comprising of a survey, coupled with in‐depth processing mapping and complimenting interviews of production control staff at a subset of the surveyed companies. Findings – The findings suggest that supplier responsiveness is constrained by both endogenous factors originating from within their own manufacturing operations, as well as exogenous factors related to both their respective up‐stream and downstream tiers. Furthermore, the study highlights how first‐tier suppliers are “squeezed” between demanding vehicle manufacturers on the one hand, and an unresponsive raw material supply base on the other, constraining their overall ability to respond to changing market requirements. Research limitations/implications – The conclusions derived from this research are bound by the sample these are drawn from, and additional large‐scale analyses are suggested as further research. Originality/value – While the concept of “responsiveness” has been widely discussed in the supply chain literature, this debate has largely remained in the realms of qualitative description. Few studies have empirically addressed the issue of supply chain responsiveness, and if so, often focused on a subset of factors (e.g. schedule variations) only. In this paper, an holistic approach to responsiveness is adopted that aims at identifying the key variables that impact on supply chain responsiveness, as well as providing quantitative evidence to support these claims

The Three Dimensions of Responsiveness

Purpose – The concept of responsiveness has been widely discussed, yet so far most of this discussion has remained qualitative in nature. The purpose of this paper is to develop a conceptual model identifying the key factors that determine the responsiveness of a supply chain system, which – once quantified – provide a unique profile of each supply chain setting towards the appropriate supply chain strategy. Design/methodology/approach – The paper reviews existing contributions and synthesises these into a conceptual model of responsiveness. The model is applied using three case studies from the automotive and electronics industry. The case research is based on value stream mapping, semi‐structured interviews, and site visits. Findings – Three key findings could be established: first, the concept of responsiveness has a simple logic that aligns itself to a wide range of manufacturing strategies. However, underlying this remit is a complex interaction of an array of key variables, and it was found that previous contributions largely have only addressed a subset of these. Second, these key variables can be grouped into three categories or dimensions of responsiveness – product, process and volume – to provide a holistic understanding of responsiveness and its key determinants. Third, due to the large involved, there cannot be one single “holy grail” concept of how responsiveness can be achieved, neither does one single approach apply to entire sectors. Research limitations/implications – A great variety of variables needs to be considered in order to provide a balanced view of all three dimensions of responsiveness, thus the case analyses remain at a necessarily high level. Practical implications – The paper provides guidelines for management on how to align their supply chain strategy to volume, product and process contingency factors in order to balance responsiveness to customer demand and supply chain efficiency. Originality/value – The paper aims to elevate a discussion that previously has been held mostly at a conceptual level beyond the qualitative description, and thus addresses a key shortcoming in the current debate

Why there is no insignificance for a relevant question

Defining the Ph.D. research topic is a non-trivial task, and will influence a young scholar's career way beyond the actual defence of the thesis. This note makes a case for allowing the research topic to be inspired by real-world problems and phenomena, and to let the world of practice challenge the resulting findings. This, it is argued, will lead to a personally more satisfying and sustainable research career, as well as act as an effective safeguard against so called “insignificant” or “counter-intuitive” findings

The Genealogy of Lean Production

Lean production not only successfully challenged the accepted mass production practices in the automotive industry, significantly shifting the trade-off between productivity and quality, but it also led to a rethinking of a wide range of manufacturing and service operations beyond the high-volume repetitive manufacturing environment. The book ‘The machine that changed the World’ that introduced the term ‘lean production’ in 1990 has become one of the most widely cited references in operations management over the last decade. Despite the fact that the just-in-time (JIT) manufacturing concept had been known for almost a decade prior, the book played a key role in disseminating the concept outside of Japan. While the technical aspects of lean production have been widely discussed, this paper sets out to investigate the evolution of the research at the MIT International Motor Vehicle Program (IMVP) that led to the conception of the term ‘lean production’. Furthermore, the paper investigates why – despite the pre-existing knowledge of JIT – the program was so influential in promoting the lean production concept. Based on iterating series of interviews with the key authors, contributors and researchers of the time, this paper presents an historical account of the research that led to the formulation and dissemination of one of the most influential manufacturing paradigms of recent times