Service Redesign Resource

What is process redesign?

Many patient pathways in hospitals and health services have become cumbersome and obstructive. Some of them have evolved over time, with additional steps being added in response to new policies and protocols, staff changes or administrative requirements. Rarely do staff take the time to map pathways from the patient’s perspective in order to identify the steps that don’t add value for the patient and therefore shouldn’t be a part of the process. Process redesign is about finding the quickest and most efficient pathway possible without compromising patient quality and safety.

Patient pathways are just one example of processes. Process redesign is equally applicable to improving supply chain processes and other processes that involve the movement of goods, equipment or objects such as pathology or pharmacy services.

Why do it?

Simpler processes can mean:

Fewer errors
Lower costs
Better use of existing resources
Better patient access to services
Improved relationships (both between staff and with patients) because everyone is less frustrated.

The following two articles are from a Medical Journal of Australia Supplement published in early 2008. They argue the case for clinical process redesign in the health system and give examples of redesign success stories in Australia. Accessing eMJA requires free registration. Once you are registered, you will be able to access all of the eMJA articles linked from this site.

Health Services under siege: the case for clinical process redesign from eMJA

Patient journeys: the process of clinical redesign

Process Review - Why Look at our Processes - JISC Infonet - UK
JISC infoNet aims to be the UK's leading advisory service for managers in the post-compulsory education sector promoting the effective strategic planning, implementation and management of information and learning technology.

Don’t we need consultants to do process redesign?

It is easy to view process redesign as a formidable task that requires “specialists” to do it. It’s also tempting to think: “There is no-one with the skills in our team to undertake a process redesign project”. It can feel a bit like a home renovation project that’s been put off for too long – "let’s just call in the professionals and get it done". And while there are probably people out there who have more experience with process redesign (and home renovating) than you and your team do – if you take it on yourselves, you might be surprised at how well you can do it. Just like with the renovating, you might even do a better job than the professionals because you and your team have to live with the results which means you'll take more care to get a lasting job rather than just a superficial patch-up. You’ll also save yourself money and develop new skills and knowledge along the way. Use some of the tools in the next section – Where are we now? to help you take a fresh look at your team.

Who else is doing it?

Examples of improvement outcomes in the Australian health system

Redesigningcare - Flinders Medical Centre, South Australia
The Redesigning Care program was initiated at Flinders Medical Centre (FMC) during the winter of 2003. The main aim was to address the increasing demand for emergency services and elective surgery in the hospital.

FMC soon became one of the first hospitals in Australia to use lean thinking to redesign hospital processes across the whole spectrum of clinical care.

Clinical process redesign for unplanned arrivals in hospitals from the eMJA. Reports on a system-wide redesign for unplanned hospital attendances in over 60 hospitals in NSW.

Applying clinical process redesign methods to planned arrivals in New South Wales hospitals. Reports on results in redesign of surgery undertaken by the Area Health Services in 96 NSW hospitals.

Redesigning care at the Flinders Medical Centre: clinical process redesign using “lean thinking” has enabled the hospital to provide safer and more accessible care during a period of growth in demand.

Victorian initiatives

Redesigning hospital care program in Victoria. Presents the framework for a four-year statewide initiative that will deliver significant health service improvements through applying process redesign methodologies in Victorian public hospitals.

The Better Skills, Best Care - Workforce design strategy website has information about workshops and projects that are being run as a part of the strategy to address workforce redesign issues in the Victorian health system. This site also has a range of tools and resources that are useful for workforce and other redesign projects

Reports on a Physiotherapy led orthopaedic clinic at the Northern Hospital – eMJA article December 2007. This project was funded by the Better Skills, Best Care initiative.

The Victorian Health Services Management Innovation Council’s Seeding Grants Program
Financial support was provided to successful health services to develop, implement and evaluate innovative management approaches through specific projects.

Where do we start?

Start by Defining the Process, being specific about its beginning and end points. It may be that the logical beginning and end points of the process lie outside the area that you have responsibility for in which case you would want to work with the other departments, units or organisations who have responsibility for those parts of the process.

After that, process redesign may follow a set of steps that include:

Analysis ie Where are we now? and Where do we want to be?
Process improvement ie How do we get to there?
Evaluation and maintenance ie What happens when we get there?

There is a whole range of process improvement frameworks that you might have heard about including:

This resource doesn’t follow any particular one of these frameworks but draws broadly from the process redesign principles underpinning these methodologies.

Further reading:

Womack , Jones D Lean Thinking, Banish waste and create wealth in your corporation London: Simon & Schuster 1998

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