Measuring business process management in UK financial services

Discussion paperThere is a growing interest in the nature and significance of business processes both within the business community and in management research. For many researchers, process has evolved from its re-engineering origins to become a powerful tool for understanding and explaining business activity. Within this new paradigm, effective Business Process Management (BPM) is viewed as a pervasive and profound business challenge. A number of case studies have explored how companies react to this challenge and several recurring themes have emerged: for example, companies must fully identify their business processes, and introduce 'end to end' process measurement and management. However, these themes have not yet been synthesised into a single model capable of being measured. In the absence of such a model, it is difficult to explain why some companies are more active and effective in managing business processes than others. This paper reports on a collaborative exercise carried out with a large UK Bank to develop and test such a model in an empirical context. The findings suggest that the model is both valid and pragmatic. The results were used by the Bank to identify and implement business improvements. More importantly, the model provides a platform for assessing process performance across the financial services sector and underpinning future explanatory research. The paper concludes that BPM was an important consideration for the Bank, supporting the emerging paradigm, and recommends further research from within this perspectiv

'Second Generation' process thinking: a case study from UK financial services

Paper presented at British Academy of Management Conference, Harrogate, 2003.This paper traces the emergence of 'second generation' process thinking in a large UK Bank. In common with many companies, the bank had vigorously embraced the BPR revolution in the early 1990s, only to find the targeted benefits elusive and new challenges take priority. More recently, process has re-emerged as a force within the bank. This time however, the focus is not on radical change, but a more mature and sustained programme of 'end to end' process management. As part of the new drive, a collaborative research exercise was launched to develop a generic model for measuring the effectiveness of Business Process Management (BPM). A synthesis of current research was used to identify the key dimensions of BPM and translate them into a robust measurement instrument. Following an initial pilot, a comprehensive process audit was carried out. The findings recognised that the Bank had developed a strong process infrastructure, but found deployment limited with an ongoing focus on local performance rather than full 'end to end' management. The findings were presented to the management team and used to develop a process improvement programme, focusing on rapid deployment and enhanced communication. As such, the research demonstrates the compatibility of developing theory with the delivery of practical value to business managers. The paper concludes that there is evidence of new process thinking and invites researchers to monitor its future development and impact on the business community

Analysing the Role of BPM in Driving Customer Satisfaction

Achieving high levels of customer satisfaction is a core issue for any business. This paper presents the results of an empirical analysis, based on longitudinal data from a large UK bank on drivers of customer satisfaction. The results indicate that process management is a critical driver of TSQ and a fundamental component for attaining high levels of customer satisfaction. The paper proposes a comprehensive quantitative analysis using the structural equation modelling (SEM) methodology to explore the contribution of factors that drive customer satisfaction especially the role of BPM as a key driver

Customer satisfaction and service quality in UK financial services

Draft version published as discussion paperThis paper reports the results of a longitudinal study into the drivers of customer satisfaction in a large UK Bank. The findings confirm the significance of staff satisfaction and service quality, suggested by the service profit chain literature, but dispute that this comprises a simple linear relationship. The findings also question the pre-eminence afforded to the soft elements of the service encounter suggested by much of the Services Marketing literature. A five year study of the relationship between customer satisfaction and the technical and functional aspects of service quality suggests that technical service quality plays a critical role in determining customer satisfaction. Further analysis identifies Business Processes Management as a significant driver of technical service quality

Laparoscopic-Assisted Resection of Colorectal Malignancies: A Systematic Review

OBJECTIVE: To compare the safety and efficacy of laparoscopic-assisted resection of colorectal malignancies with open colectomy. METHODS: Two search strategies were devised to retrieve literature from the Medline, Current Contents, Embase, and Cochrane Library databases until July 1999. Inclusion of papers was determined using a predetermined protocol, independent assessments by two reviewers, and a final consensus decision. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials, case series, or case reports. Fifty-two papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding, and chance. RESULTS: Little high-level evidence was available. Laparoscopic resection of colorectal malignancy was more expensive and time-consuming, but little evidence suggests high rates of port site recurrence. The new procedure’s advantages revolve around early recovery from surgery and reduced pain. CONCLUSIONS: The evidence base for laparoscopic-assisted resection of colorectal malignancies is inadequate to determine the procedure’s safety and efficacy. Because of inadequate evidence detailing circumferential marginal clearance of tumors and the necessity of determining a precise incidence of cardiac and other major complications, along with wound and port site recurrence, it is recommended that a controlled clinical trial, ideally with random allocation to an intervention and control group, be conducted. Long-term survival rates need to be a primary aim of such a trial

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research