See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/340069002

Hospital Operations Management: An Exploratory Study from Brazil and

Portugal

Chapter · March 2020

DOI: 10.1007/978-3-030-43616-2_8

CITATIONS READS

0 3,959

2 authors:

Thiago Souza Rui M Lima

University of Minho University of Minho
19 PUBLICATIONS   42 CITATIONS    209 PUBLICATIONS   1,490 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

MSIE4.0 - Curriculum Development of Master’s Degree Program in Industrial Engineering for Thailand Sustainable Smart Industry View project

Curriculum Development of Master’s Degree Program in Industrial Engineering for Thailand Sustainable Smart Industry (MSIE4.0) View project

All content following this page was uploaded by Thiago Souza on 25 January 2021.

The user has requested enhancement of the downloaded file.

 Hospital Operations Management:
An Exploratory Study from Brazil
and Portugal

Thiago Souza and Rui M. Lima(&)

Department of Production and Systems, ALGORITMI Center,

School of Engineering of University of Minho, Guimarães, Portugal
rml@dps.uminho.pt

Abstract. This study aims to analyze the main dimensions related to Hospital
Operations Management (HOM) through workshops held in four hospitals in
Brazil and Portugal with the participation of 60 hospital management profes-
sionals. The dimensions of the HOM were adapted from the literature and the
most important area according to the professionals was described as “Planning,
Scheduling and Control of Hospital Operations”, with 91% importance. Other
areas were also relevant as Patient Flow Management, Quality and Supply
Chain Management. After discussion of the main topics, the researchers
involved present a management scheme about Hospital Operations Management
in order to guide other researchers and hospital managers on the subject.

Keywords: Hospital Operations Management
Healthcare
Patient flow

Lean Healthcare

1 Introduction

Hospitals have been focusing on decreasing costs and there is considerable energy
being put into improving hospital operations. In this context it is needed to look at
strategies of operations, management of the capacity, technology and location of the
installation [1]. Health managers have adopted management techniques from other
industries with the objective of increasing the efficiency of their processes and reducing
costs, adapting to a restrictive budgetary dynamic in the health area. The application of
such techniques to the area of Operations Management (OM), which traditionally deals
with production capacity management, supply chain, planning and quality [2] is evi-
denced. In this context, the use of Operations Management and Lean Thinking tech-
niques with the objective of eliminating waste, increasing productivity and maximizing
delivery of value to the customer [3, 4] also emerges.
OM focuses on the systematic orientation of the processes involved in the pro-
duction of products and services. Such an area requires a holistic view of the processes,
with great impact on the costs necessary to operate an organization. OM concepts apply
to the entire production chain and these concepts are also applicable to non-operational
fields such as marketing, finance and information technology [5] and healthcare.

© Springer Nature Switzerland AG 2020

Z. Anisic et al. (Eds.): IJCIEOM 2019, LNMUINEN, pp. 69–77, 2020.
https://doi.org/10.1007/978-3-030-43616-2_8
70 T. Souza and R. M. Lima

In the context of Hospital Operations Management (HOM), Dobrzykowski et al. [6]

conducted a survey to analyze Operations Management and Supply Chain Management
in hospitals, their main topics or areas, what methodological approaches in this field of
knowledge, and discuss the future of research in the area. These results show that the
frequency of studies increased significantly from 1995 and 2000 and remained at
maximum levels since that time. Sixteen topics were synthesized in four major areas.
These are: Introduction and key questions of service management; Strategies and
objectives of service operations; Design of service operations; Planning, scheduling
and control of service operations. This is a good starting point to understand the OM in
Hospital environment, but more and deeper studies are needed to identify best practices
for improvement of performance in Hospital OM. The objective of this study is to
identify and represent the perspective of professionals about the main areas of Oper-
ations Management in the hospital environment, through exploratory workshops with
hospital managers. This will create the ground basis for identification and/or devel-
opment of new models, practices and methods to improve the HOM.

2 Hospital Operations Management

Operations Management (OM) is a key function for organizations, since it coordinates

from the planning, supplying, scheduling, control and transformation activities of a
production system [7]. Currently, globalization has influenced the field of OM going
through a continuous change and including areas of study extending the boundaries of
the operation function. The challenge of defining OM limits remains a problem, but
efforts to integrate such functions over the last decade can cite the major research areas
of OM in the present: Inventory control; Aggregating planning; Forecasting;
Scheduling; Capacity planning; Purchasing; Facility location; Facility layout; Process
design/technology; Maintenance; Quality; Work measurement; Strategy; Distribution;
Quality of working life; Project Management; and Services [8].
The OM discipline has, over the years, developed a set of laws related to the
operations productivity phenomenon. Productivity is defined as output per unit of input
resource, e.g. units produced per hour of work or per hour of machine [9]. Five laws are
cited by Schmenner and Swink [9], which are:
– Law of Variability: the greater the random variability, whether it is required or
inherent in the process itself or in the processed items, the less productive the
process.
– Law of Bottleneck: The productivity of an operation is improved by eliminating or
better managing its bottlenecks. If a bottleneck cannot be eliminated in any way,
say, by adding capacity, productivity can be increased by maintaining a consistent
output through it.
– Law of Scientific Methods: Labor productivity i.e. production per worker-hour of
work can be improved in most cases by the application of methods and movement
of Scientific Management.
– Law of Quality: Productivity can often be improved, as quality, that is, compliance
with customer-valued specifications is improved and waste is reduced. Several
 HOM: An Exploratory Study from Brazil and Portugal 71

techniques of quality movement may be responsible for these improvements. This

may be a more controversial law. It is stated as a probabilistic law that does not
need to be maintained in all situations, for example, not in close to zero situations,
but has been demonstrated in the majority.
– Law of Factory Focus: Factories that focus on a limited set of tasks will be more
productive than similar factories with a broader set of tasks. This is the influential
observation of Wick Skinner, drawn from his study of factories in a variety of
factories.
Service operations management is the term used to cover the activities, decisions
and responsibilities of managers in service organizations. Service operations managers
are responsible for providing services to the organization’s customers, where a service
is the combination of results and experiences of a customer [10].
From OM hospitals need to maximize their income with the available resources,
taking into account different requirements of flexibility, delivery, reliability and
acceptable clinical results for the design, planning, implementation and control of
management mechanisms between patient flows, diagnostic, therapies and support
activities [6].
Dobrzykowski et al. [6] conducted a research to analyze Operations Management
and Supply Chain Management in hospitals, their main areas are described in sixteen
topics synthesized in four major areas as presented in Table 1.

Table 1. Classification of HOM topics - adapted from [6].

Nº Topic/section Category description
Topic 1 Introduction and key issues in service management
1 1.1 Introduction and key issues in service management
Topic 2 Strategies and objectives of service operations
2 2.1 Service management
3 2.2 General aspects of operations strategy and objectives
4 2.3 Strategic quality issues in services
5 2.4 Service productivity
6 2.5 Information technology and new technologies in services
7 2.6 Supply chain strategies and objectives
Topic 3 Service operations project
8 3.1 Selection and design of the service delivery system
9 3.2 Design of long-term capacity/capacity and demand decisions
10 3.3 Design of service operations in supply chains
Topic 4 Planning, scheduling and control of service operations
11 4.1 Planning, scheduling and control of service operations
12 4.2 Planning, scheduling, and capacity control
13 4.3 Short-term planning and control
14 4.4 Inventory management and control
15 4.5 Design, measurement and compensation of service work
16 4.6 Planning, scheduling, and control in supply chains
72 T. Souza and R. M. Lima

3 Methods

The method chosen for the study was based on the realization of workshops with
managers of 4 hospitals based in Portugal and Brazil to explore the understanding and
applications related to the theme of Operations Management focused on the hospital
environment. This exploratory study contemplated a total of 60 professionals from the
most varied formations, as: Accounting Sciences, Administration, Computer Science,
Economy, Hospital Management, Hospitality, Human Resources, Law, Medicine,
Nursing, Pharmacy and Biochemistry, Psychology, Radiology, Social Service and
Systems Analysis.
The workshops, in short, were structured between a theoretical and a practical
moment. At the theoretical moment the researchers approached the topics of Hospital
Operations Management based on the chosen literature and set out for a practical
moment of discussion and adaptation of the themes between the groups. At the end of
the workshop a structured questionnaire was answered by the participants containing
basic professional data, research questions and questions to identify the main topics and
subtopics related to Hospital Operations Management that hospitals have been using or
want to apply in their flows.
Three workshops were conducted to gather information through focus groups and
questionnaires, so the researchers of this study developed a generic model to represent
the main dimensions of HOM and a final workshop was held to present the scheme and
validate it. As initial results of the questionnaire we have a total of participants in 60%
with more than 10 years of experience in hospital management; 32% with 5 to 10 years
and 8% with 1 to 5 years of experience. 100% of respondents answered that the theme
of the workshop was relevant to the academic and business field.

4 Workshop Results

As a result of the workshops, adapting some terms according to the health profes-
sionals, and regarding the large area of HOM we have (Table 2): IV. Planning,
scheduling and control of hospital operations with 91% of greater relevance; III. Design
of hospital operations with 72%; II. Strategy of hospital operations with 70%; and I.
Introduction and key issues of operations management with 45%.
In relation to the sub-areas of HOM, the results of the workshops demonstrate:
IV A. Planning, scheduling and control of the flow of patients with 91% relevance
classification; III A. Capacity management and demand management with 89%; II B.
Hospital quality strategic issues with 81%; IV B. Stock management and control with
79%; II C. Hospital productivity with 74%; II E. Strategies and objectives of the supply
chain with 74%; II D. Information technology and new technologies in hospitals with
72%; II A. General aspects of the hospital operations strategy with 66%; III B. Design
of hospital operations in supply chains with 57%, and, I A. Introduction and key
management issues with 38%.
 HOM: An Exploratory Study from Brazil and Portugal 73

Table 2. Result of the questionnaires – areas and sub-areas adapted from [6].
HOM areas % “very relevant”
IV. Planning, scheduling and control of hospital operations 91%
III. Design of hospital operations 72%
II. Strategy of hospital operations 70%
I. Introduction and key issues of operations management 45%
HOM sub-areas % “very relevant”
IV A. Planning, scheduling and control of the flow of patients 91%
III A. Capacity management and demand management 89%
II B. Hospital quality strategic issues 81%
IV B. Stock management and control 79%
II C. Hospital productivity 74%
II E. Strategies and objectives of the supply chain 74%
II D. Information technology and new technologies in hospitals 72%
II A. General aspects of the hospital operations strategy 66%
III B. Design of hospital operations in supply chains 57%
I A. Introduction and key management issue 38%

Other sub-areas were frequently cited during the workshops with the goal of further
studies, such as: Finance and Cost Management, People Management and Commu-
nication, Engineering and Maintenance called as Support Operations.

5 HOM Scheme

After analysing results, the researchers understood that area IV really should be an
important field as presented by practitioners and that area III is closely related to this
area. Thus, in the model of this study, the hospital operations project is integrated with
the planning and control of hospital operations, called “Hospital PPC”. The Hospi-
tal PPC is divided between two major streams: patients, and materials and medicines.
And are supported by “Operations Support” such as: Finance and Cost; Engineering
and Maintenance; People Management and Communication; and, Information Tech-
nology. All planning, flow and support operations are guided by a “Hospital Operations
Strategy” and measured by Quality and Productivity KPIs (Fig. 1).
According to the exploratory study contained in this article, the areas of HOM are
better detailed and described for a better understanding of the development of the work
analyzing researchers in these fields according to the current literature:
74 T. Souza and R. M. Lima

Fig. 1. Hospital Operations Management scheme.

5.1 Operations Strategy

The literature referring to the strategy in operations management is not completely clear
[11]. However, although Operations Management and Operations Strategy cannot be
totally separated, they have different characteristics and approach problems in a dif-
ferent way. Operations Management is an activity of resources and processes that
produce and deliver goods and services. An organization has a production function, as
it has a set of products and/or services. The Operations Strategy is concerned with the
overall objectives of the organization related to the operations implementation, that is,
it is concerned with the whole business. Therefore, Slack and Lewis [11] conclude that
“operations” are not always “operational”.

5.2 Production Planning and Control

Every organization, whether of any nature, has the central function of producing some
output for an end customer. For this organization to be effective in this delivery, the
organization’s managers must understand and apply certain fundamental principles of
production planning and control the process that permeates their operations. The ser-
vice organization approach to planning and control may come up against at least four
major reasons that generally provide the greatest influence on how PPC is designed in
service organizations: Timing, Customer Contact, Quality, Inventory [12]. The plan-
ning and control of the production of a hospital can be synthesized in two general
flows: patients and materials/medicines.
Flow of patients – Hospitals typically divide the patient’s flow by acuity or func-
tion, taking an effort to shorten waiting times, promote safety, and organize the per-
son’s picture [13]. Operational performance indicators are closely related to patient
flow [14]. It is always important to visualize and monitor the flow of patients and to
obtain models for the organization of these flows is paramount. Currently, some main
 HOM: An Exploratory Study from Brazil and Portugal 75

approaches are used to model flow between them: queuing theory and process model
simulation [15].
Flow of materials and medicines – McKone-Sweet et al. [16] in their study raised
some problems related to Supply Chain Management (SCM) in hospitals such as:
Conflicting goals across supply chain; Lack of data and performance measures;
Availability of IT systems; Need for education of materials managers and supply chain
professionals and executives; Group purchasing organizations practices that support
hospitals. The importance of the flow of materials and drugs in the hospital context, due
to the investments estimated in inventory between 10% and 18% of total hospital
revenues, prompts discussions in SCM and inventory management [17]. Hospitals need
to engage improvements across the SCM (external and internal) to manage inventory
[18].

5.3 Operations Support

According to Porter [19] in the value chain view there are primary activities related to
the operation and production of a good or service and supporting activities that support
the primary activities. There are several support activities in an organization, such as:
Firm infrastructure; Human resources management; Technology development;
Procurement.

5.4 KPIs
Indicator systems are the basis for performance management in hospitals and present
several main dimensions used to measure hospital performance, such as: Clinical
efficiency; Production efficiency; Personnel; Social accountability and reactivity;
Safety, and Focus on patient [20].

6 Conclusion

OM tries to respond to the challenges presented since its initial studies and to succeed,
research needs to build theories and test them by influencing business leaders. OM
needs to periodically rebuild its core and use it as a platform to interface with other
areas of managerial knowledge and OM being the custodian within the business
context of managing value-adding processes from Taylor to Toyota continuing to
evolve [21]. This study concludes that the areas of HOM are broad and require greater
depth of study and that, among the professionals associated with Hospital Manage-
ment, the area that has attracted the most attention is Planning, Scheduling and Control
of Hospital Operations, for Patient Flow Management and Materials and Medicines
Management.
OM has used Lean Thinking tools and concepts to add more value and sustain-
ability to the measures of excellence that companies use in process evaluation and
improvement [22]. Thus, HOM’s connection with improvement philosophies such as
Lean Healthcare is necessary to avoid the risk of thinking in “silos”, rather than in
flows (lean).
76 T. Souza and R. M. Lima

As a suggestion of future studies, the authors indicate the replication of this

exploration and other hospitals from diverse regions and the creation of models and
frameworks that interpret HOM in a global way indicating general techniques and tools
for the management and improvement of hospital operations.

Acknowledgements. This work was partially supported by projects UIDCEC003192019 and

POCI-01-0145-FEDER-030299, from Portugal.

References
1. McDermott, C., Stock, G.N.: Hospital operations and length of stay performance. Int.
J. Oper. Prod. Manag. 27(9), 1020–1042 (2007)
2. Marcinko, D.E., Hetico, H.R.: Hospitals & Healthcare Organizations: Management
Strategies, Operational Techniques, Tools, Templates and Case Studies. CRC Press, Boca
Raton (2013)
3. Graban, M.: Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement.
CRC Press, Boca Raton (2016)
4. Taghizadegan, S.: Essentials of Lean Six Sigma. Butterworth-Heinemann, Oxford (2010)
5. Castle, D., Jacobs, F.R.: APICS Operations Management Body of Knowledge Framework.
APICS, Chicago (2008)
6. Dobrzykowski, D., Deilami, V.S., Hong, P., Kim, S.C.: A structured analysis of operations
and supply chain management research in healthcare (1982–2011). Int. J. Prod. Econ. 147
(Part B), 514–530 (2014)
7. Render, B., Heizer, J.: Operations Management. International Edition. Pearson Education
Inc., Upper Saddle River (2004)
8. Bayraktar, E., Jothishankar, M.C., Tatoglu, E., Wu, T.: Evolution of operations manage-
ment: past, present and future. Manag. Res. News 30(11), 843–871 (2007)
9. Schmenner, R.W., Swink, M.L.: On theory in operations management. J. Oper. Manag. 17
(1), 97–113 (1998)
10. Johnston, R., Clark, G.: Service Operations Management: Improving Service Delivery.
Pearson Education, Upper Saddle River (2008)
11. Slack, N., Lewis, M.: Operations Strategy. Pearson Education, Upper Saddle River (2002)
12. Chapman, S.N.: The Fundamentals of Production Planning and Control. Pearson/Prentice
Hall, Upper Saddle River (2006)
13. Oredsson, S., Jonsson, H., Rognes, J., Lind, L., Göransson, K.E., Ehrenberg, A., Asplund,
K., Castren, M., Farrohknia, N.: A systematic review of triage-related interventions to
improve patient flow in emergency departments. Scand. J. Trauma Resusc. Emerg. Med. 19
(1), 43-1–43-9 (2011)
14. Armony, M., Israelit, S., Mandelbaum, A., Marmor, Y.N., Tseytlin, Y., Yom-Tov, G.B.: On
patient flow in hospitals: a data-based queueing-science perspective. Stoch. Syst. 5(1), 146–
194 (2015)
15. Kolker, A.: Process modeling of emergency department patient flow: effect of patient length
of stay on ED diversion. J. Med. Syst. 32(5), 389–401 (2008)
16. McKone-Sweet, K.E., Hamilton, P., Willis, S.B.: The ailing healthcare supply chain: a
prescription for change. J. Supply Chain Manag. 41(1), 4–17 (2005)
17. Gary Jarrett, P.: Logistics in the health care industry. Int. J. Phys. Distrib. Logist. 28(9–10),
741–772 (1998)
 HOM: An Exploratory Study from Brazil and Portugal 77

18. Bhakoo, V., Singh, P., Sohal, A.: Collaborative management of inventory in Australian
hospital supply chains: practices and issues. Int. J. Supply Chain Manag. 17(2), 217–230
(2012)
19. Porter, M.E.: The value chain and competitive advantage. In: Barnes, D. (ed.) Understanding
Business: Processes, pp. 50–66. Routledge, London (2001)
20. Ioan, B., Nestian, A.S., Tita, S.M.: Relevance of key performance indicators (KPIs) in a
hospital performance management model. JEEMS 2012(1), 74169-1–74169-15 (2012)
21. Voss, C.A.: Operations management – from Taylor to Toyota – and beyond? Br. J. Manag. 6
(s1), S17–S29 (2005)
22. Kleindorfer, P.R., Singhal, K., Van Wassenhove, L.N.: Sustainable operations management.
Prod. Oper. Manag. 14(4), 482–492 (2005)

View publication stats