Service Management of Special Care Units: Lessons Learned in Manufacturing

Introduction

Recent studies have stated a pronounced interest of healthcare executives and practitioners in taking service quality to a higher level, often adopting leading techniques in other industries. Therefore, a useful way to introduce the concept of managing service of special care units is to relate it to another well known type of organizations, the management of manufacturing firms. Applying the lessons learnt by manufacturers' efforts to improve their production processes can be transferred to healthcare, thus reducing a patient length of stay, providing a higher quality of care, maintaining hospital sustainability and raising patients' satisfaction (Burge, 2008; Kenagy, Berwick, & Shore, 1999).

This article critically reflects upon the value of some of the approaches that have been attempted in healthcare organizations during the last decades. After considering their weaknesses, the article offers a novel perspective with which managers and clinicians can improve care. This paper is based on the authors’ experience with implementing ISO 9001:2000 in a neonatal intensive care unit in a prominent public hospital in Israel, during 2006-2008.

The literature review of the management of service organizations shows that a comparison between manufacturing and service organizations is both useful and valid even though service organizations differ from manufacturing organizations. Wilderom (1991) defines service sector organizations as work units with a production process in which there is direct interaction between clients or customers and providers of the services, in which the output is intangible, almost impossible to store and has a considerable degree of variety. The feeling is that service is people-intensive, while the rest of the economy is capital-intensive. These distinctions are largely spurious. There are no such things as service industries. There are only industries whose service components are greater or less than those of other industries. Everybody is in service (Levitt, 1972). He claims that to improve the quality and efficiency of services, companies must apply the kind of technocratic thinking which in other fields has replaced the high-cost and erratic elegance of the artisan with the low cost, predictable munificence of the manufacturer. Services may be created out of standard elements or modules that can be combined for the individual customer at the moment of purchase. Thus the content of the service is standardized, but the standard elements can be combined in many ways when delivered (Sundbo, 1994). The industrialization of service production will become more standardized and designed and the production process will be systematically planned as in manufacturing. The tendency towards modulization brings the form of service production closer to the contemporary form of production in manufacturing. Industrialized tendencies in service management incorporate more systematic organizations and management of service production. It is often done by using term service operations (Johnston, 2005; Jones, 1989). Various management aspects developed in manufacturing firms may be adopted in service firms: price as a competitive factor, productivity, quality, strategy development and technology development (Sundbo, 1994). Since service firms aim to design standard elements which can be mass-produced, they attempt to form the production process as systematically as possible. This makes it more possible to plan and control the service production process, thus improving quality as well as reducing costs, so that productivity is increased. The similarities in development between service and manufacturing were also pointed out by Ochel and Wegner (1987) in an analysis of global business change. Traditionally, the manufacturing industry is supposed to use more technology that the service industry. But, the use of technology in services has increased (Rajan, 1985).