A Roadmap to Critical Redesign Choices That Increase the Robustness of Business Process Redesign Initiatives

The elaborate analysis of a business process (BP) typically informs its potential for business process redesign (BPR), but the latter is usually conducted in a non-systematic way. The purpose of this paper is the introduction of the Business Process Redesign Capacity Assessment (BP-RCA) framework that assesses the redesign capability of BP models, prior to their implementation. This study combines key redesign features introduced by domain experts, to a conceptual framework that takes into consideration an inclusive set of BPR components in three consecutive phases, towards facilitating organizations in the practice of redesign decision making. In this paper, an illustrative case study is used to present the initial phase (selection) of the framework. To assess the usability of the BP-RCA, the authors reviewed twelve established redesign initiatives from literature which proved to implicitly follow similar steps to the proposed framework. The findings indicate that the BP-RCA framework provides a systematic exploration of fundamental redesign aspects and can be used as a reliable measurement of the redesign capacity of candidate BP models. The framework also provides practitioners with the necessary methodology for increasing the BPR effectiveness, the robustness of the varying initiatives and the overall innovativeness of businesses.

Flow redesign to improve prostate cancer access and care at the public healthcare system in Sao Jose dos Campos, Brazil.

e13595 Background: Prostate cancer is the second most common cancer diagnosis in São José dos Campos (SJC) and the sixth cause of cancer mortality. Access to early diagnosis and treatment is one big challenge in the local public healthcare system (Sistema Único de Saude) due limited resources. Between 2018 and 2020 the healthcare public system of SJC redesigned the access flow for diagnosis and prostate cancer care in SJC is a mid-sized city (720,000 hab.) in Sao Paulo state, Brazil. Methods: The local SUS was designed to provide access to all patients with elevated PSA (>4.00µg) to a urologist for further evaluation and subsequent reevaluation if needed. This process created long queues and median time to access the few overburdened specialists available to over a year (410 days median), risking significant disease progression and stage upgrade. The flow redesign was done using lean and queue theory techniques and involved basically a new Fast Track to patients with PSA > 10.0µg with age between 50 and 79, considering the probability of 67% chance of prostate cancer (Catalona, et al. NEJM 1991; 324: 1156-61). Patients were referred from the primary care doctor straight forward to a biopsy and then to a medical oncologist, that would recommend further treatment, including a urologist evaluation. Patients with PSA between 4 and 10 would keep regular access to urology. The aim was to guarantee access to specialist up to 60 days from the first PSA > 4.0µg. Results: From April 2019 to September 2020, 277 patients (PSA > 10.0µg) were submitted to a biopsy through the Fast Track; 150 were positive (54,2%) for prostate cancer; and 72% with Gleason score 7 or higher. The diagnosis of prostate cancer from 2017 to 2020 increased over 300% (from 93 to 283), and access to treatment in less than 60 days increased from 15 to 140 patients in 2020. Patient with PSA > 4.0µg access to urology in less than 60 days also increased dramatically by eliminating several medical appointments and unneeded process steps (Table). Conclusions: The process redesign for patients with elevated PSA was able to provide access to care < 60 days for more than 80% of patients with elevated PSA or positive for prostate cancer by splitting high risk and low risk patients and using alternative flows to reduce urology overloaded agenda. Access to Urology for patients with PSA >4.00 < 10.00µg (not in Fast Track).[Table: see text]

Process redesign and daily management to improve cancer care access at the public healthcare system in Sao Jose dos Campos, Brazil.

6530 Background: Cancer is the second leading cause of death in Sao Jose dos Campos (SJC, a mid-sized city with 720,000 hab. in Sao Paulo state, Brazil) and the most relevant budget in tertiary care. The City Healthcare Authority created in October 2018 a team to manage and provide more effective and efficient cancer care and access to the public healthcare system by using process redesign and daily management tools (Previna Project). The aim was to guarantee access to cancer specialist and care up to 60 days form diagnosis, understanding that this can impact in cancer morbidity, mortality, and cost. Methods: The Previna was grounded in 4 major actions: (1) process redesign (2) escalated daily management system, (3) improve communication channels to all providers connecting primary care to specialized care, (4) and emergency access. (1) Process Redesign involved connecting and linking access to several providers and eliminating unnecessary steps or repeated orders in the system, it also involved alerts into the system for specific conditions like elevated PSA or CEA; positive fecal occult blood test; BIRADS 4-5 mammogram; abnormal PAP smears; and new screening protocols for prostate and colorectal cancer. (2) Daily Management involved internal daily discussions about capacity and review of system alerts or demands. Weekly discussions on specialized procedures including imaging, biopsies, chemo, radiation or surgery flows; and biweekly meetings with all providers (3 hospitals and 4 specialized practices). (3) Communication channels improvements involved a hotline to access flow managers for primary and secondary care units, specialist’s consultancy by phone, and (4) emergency access provided for units with special needs or urgent care requirements. All actions were connected by flow managers using alert systems, visual boards, kanban and similar tools to manage daily progress. Results: The access to cancer care and treatment up to 60 days improved from 2017 to 2020 almost two-fold with the Previna (Table). Cancer diagnosis also increased substantially, and it is expected to be related to previous periods underdiagnosed patients. Flow redesign also reduced median time to process Her2, ER and PR for breast cancer from 38 days in 2018 to 9 days in 2019 and 4 days in 2020, positively impacting treatment decisions. The hotline access reviewed and answered 2,389 demands from care providers between 2018 and 2020. Access to Cancer Care for ICD C00 – C97 (excl. C44 and C73) in SJC. Conclusions: The combined use of daily management, lean tools and flow redesign in the Previna was able to improve access and anticipate cancer diagnosis in a public healthcare system using simple and low-cost initiatives.[Table: see text]

Public services: a standard process model following a structured process redesign

PurposeDespite widespread adoption of business process reengineering (BPR) for better delivery efficiency of public services, a structured approach continues to elude the most value-adding phase of BPR: business process redesign. From another viewpoint, the rising currency of Whole-of-Government (WoG) and “shared services” initiatives signal an unmissable trend toward resource reuse across public service agencies (PSAs) through business process standardization (BPS). This research invokes BPS into process redesign to produce a process redesign framework (PRF) and deploys the same to build a standard process model (SPM) for services of the government of Albania (GoA).Design/methodology/approachThe methodology follows the design science research (DSR) paradigm, wherein best practices extracted from literature are synthesized with stakeholder inputs to design the PRF and SPM, both of which are then evaluated with case study research.FindingsAdoption of PRF/SPM on a WoG basis will not only reduce service lead time but also enable a variety of public services to share the same process, thereby further saving costs for GoA. The research outputs will accelerate reengineering and subsequent digitalization of public service operations.Research limitations/implicationsImplementing SPM will maximize resource reuse and help offer uniform and integrated public services to GoA's customers. It will also enable demand-driven staff mobilization across GoA agencies. The proposed PRF/SPM have limitations in that they consider only flow aspects of service processes with aspects of conversion being ignored.Originality/valueThis research fulfills the need for a systematic approach to process redesign and prepares GoA for a WoG treatment to its BPR efforts.

Technology-dependent pedagogical process redesign: leveraging lean methods

PurposeThis research compared the efficacy of process outcomes leveraging lean methods versus traditional pedagogy applied to dental education dependent on emerging technology. The pedagogical objective was to improve system efficiency without compromising traditional outcomes of effectiveness (quality).Design/methodology/approachThe research team tested the efficacy of a lean A3 framework to identify, remove waste and redesign a technology-dependent simulation laboratory course (CAD/CAM/IR Restorative Dentistry). Students were also sensitized to time-in-chair to introduce a stronger patient focus. Baseline data collected from a control group were statistically compared to the research group's data after the course redesign. In addition, course time allocations were measured and then compared.FindingsThe results showed the interventions significantly reduced procedure cycle times without compromising quality. Additionally, the course was more efficiently conducted as measured by course time allocations.Practical implicationsThis research demonstrated that the use of the A3 framework enhanced learning through process documentation, reengineering and systems optimization resolving issues of inefficiency associated with the CAD/CAM/IR pedagogy. This work is significant because it demonstrates the practice of using lean interventions to redesign and improve a technology-based healthcare course to maximize benefits.Originality/valueThis research is the first to examine how to leverage lean methods in a healthcare simulation laboratory, dependent on innovative technology, to educate and train future practitioners. This research applied statistical rigor in a controlled experiment to maximize its applicability and generalizability.

The Business Process Design Space for exploring process redesign alternatives

PurposeProcess redesign refers to the intentional change of business processes. While process redesign methods provide structure to redesign projects, they provide limited support during the actual creation of to-be processes. More specifically, existing approaches hardly develop an ontological perspective on what can be changed from a process design point of view, and they provide limited procedural guidance on how to derive possible process design alternatives. This paper aims to provide structured guidance during the to-be process creation.Design/methodology/approachUsing design space exploration as a theoretical lens, the authors develop a conceptual model of the design space for business processes, which facilitates the systematic exploration of design alternatives along different dimensions. The authors utilized an established method for taxonomy development for constructing the conceptual model. First, the authors derived design dimensions for business processes and underlying characteristics through a literature review. Second, the authors conducted semi-structured interviews with professional process experts. Third, the authors evaluated their artifact through three real-world applications.FindingsThe authors identified 19 business process design dimensions that are grouped into different layers and specified by underlying characteristics. Guiding questions and illustrative real-world examples help to deploy these design dimensions in practice. Taken together, the design dimensions form the “Business Process Design Space” (BPD-Space).Research limitations/implicationsPractitioners can use the BPD-Space to explore, question and rethink business processes in various respects.Originality/valueThe BPD-Space complements existing approaches by explicating process design dimensions. It abstracts from specific process flows and representations of processes and supports an unconstrained exploration of various alternative process designs.