Case Study #1: Healthcare Service Model
Healthcare in British Columbia
Before we get to performance measures, we need a Service Model. The Service Model describes services and outputs directly related to outcomes required to achieve our objective. Together with objectives, the Service Model ensures that performance measures are aligned with objectives, and that all members of the team are literally on the same page with respect to what we’re trying to achieve, what needs to be done, and why.
I like models. Models provide insight into complex systems. I’ve developed and applied numerical, statistical, and simulation models for biological populations and for enterprises (public sector, private sector) to turn data into information to support decisions. Models enable us to understand a system, and predict its behaviour. We can identify and test key assumptions to refine or even refute the model. They also enable us to test scenarios (aka business use cases). If it doesn’t work on paper, it probably won’t work in real life, and it’s better to fail in a simulation than in real life.
A high-level Service Model for an enterprise is a conceptual model that describes services and outputs necessary to achieve enterprise objectives. It is a conceptual model that describes the “what and why” of service delivery. The Service Model is then implemented as an Organisational Model or Enterprise Model comprised of various roles responsible for one or more services, the “how, who, where” of service delivery. Objectives drive services which drive organization, not the other way round. The Service Model is the essential link between objectives and implementation. It is sufficient and comprehensive. It enables innovation and collaboration where team members can propose, evaluate, and embrace new ways of doing things to achieve a common goal. This is particularly important for established enterprises like healthcare where the business model may be obsolete.
With apologies to my Enterprise Business Architect friends (yes, I have friends), I’ve developed a simplified Patient-centric Healthcare Service Model (Figure 1). We can divide services into two main groups: Patient-facing Services and Support Services. Patient-facing Services directly contribute to patient health and include Prevention, Diagnosis, Treatment, and Care. Support Services for a professional service enterprise like healthcare include Licensing (qualifications), Testing and Imaging, Practice Standards (best practices), Information and Communications (applications, information technology), and Resources (e.g. equipment, facilities, administration, human resources, finance).
Front-office service and back-office support is a pattern common to many enterprises. Professional service organisations often have a qualifications function (e.g. MD, Project Management Professional), and good ones have a best practices function (e.g. Pharmacy and Therapeutics Ctte, Centres of Expertise) to ensure efficient, effective, and consistent service delivery across the enterprise.
The main insights from the Service Model are pretty obvious. Don’t waste patient-facing resources on support services. We can make best use of healthcare professionals by ensuring they practice to their full scope delivering healthcare services and participating in the development of practice standards, not performing support services. Second, there may be opportunities to unpack services from roles that are over-subscribed (e.g. primary care physicians) and assign them to other roles that are under-utilised (Hint: yes there are).
For our Case Study #1: Healthcare in British Columbia, we now have the following elements of our transformation project:
High-level Service Model
We know what we’re trying to accomplish, the services and products we need to achieve our objectives, and why. These are drafts. They don’t need to be perfect, just perfectly good to guide the next step.
We now need performance measures to benchmark the enterprise, and evaluate transformation initiatives and overall performance of our healthcare system.
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