Service Innovation in Hospital Emergency Department:

Job Centric Approach

Individual Coursework for MANG6279: Service Innovation Management

Lecturer: Vadim Grinevich

by

Kania Audrint Defrindo (26527898)

Word count: 2599

Table of Contents Executive Summary ........................................................................ 3

1. Introduction ........................................................................... 4

1.1 Traditional approach ....................................................... 4

1.2 Job Centric Approach ...................................................... 5

2. How Job Centric Approach helps service Innovation in Hospital Emergency Department ................................................................. 8

2.1 The Value Process on Hospital Emergency Department ..... 8

2.2 Job Centric on Hospital Emergency Department ............... 10

4. Conclusion ................................................................................ 14

References .................................................................................... 15

Executive Summary

Hospitals nowadays are struggling with the pressure to improve the quality of their Emergency Department service. Recently, this pressure is reaching its limit. There are several complains from patients regarding waiting hours in urgent care. It is very crucial for hospital to pay attention more on service improvement on urgent care service due to its massive effect involving matter of life and death of their patients. This paper is trying to analyze the service performed in Emergency Department in hospital and suggest improvement through service innovation concept “Job centric approach”.

1. Introduction

The challenges faced by hospital emergency department are the most visible sign of pressure across health system. Long waiting time and clogging in emergency department is one of the common problem need to be tackled by hospital emergency department. There are several approaches commonly used to address this problem. Operational manager might use the value of “The more increase in demand the more needs to increase in supply”. The solution based on this value can lead hospital emergency department to increase their general practitioner or officer to diminish the clog or waiting time. Unfortunately it will solve the problem temporarily but not in the long run. There is another approach approved to be wholesome to address this problem which is through Job Centric approach. What makes it different with the usual approach is that this service innovation concept is trying to analyze this problem in the view of job customer needs to get done. This method is one of the secret to true service innovation for service firms nowadays including hospital emergency department.

1.1 Traditional approach Traditional approach stated that service is as unit of analysis rather than on the fundamental needs of the customer (Bettencourt, 2010; Christensen, Cook, & Hall, 2005). For Example, service quality research analyzes its service improvement opportunity by annual service survey or point of purchase. This approach is only able to access current service. There is limitation within traditional approach which is identifying and prioritizing opportunities for ground breaking service concept.

Traditional approach is depicted in the figure below

We need genuine innovation that is anchored in true customer need not simply enhancing existing service offer.

1.2 Job Centric Approach There is a better approach to get insight of customer need. This approach is needed by companies to enable them, identifying opportunities for breakthrough service offering. A study by Bettencourt & Ulwich (2008 cited by Bettencourt etal.,2013) demonstrated that It is trying to find insight why customer hire service and expand this view to consider related customer job and more encompassing customer process .This approach is simply explained by Peter Drucker’s statement: “What the customer buys and considers value is never a product. It is always utility — that is, what a product does for him.” Product and customer characteristics are poor indicators of customer behavior. Customer intention buying product or service doesn’t necessarily depend on demographic or product category (Clayton M. Christensen, Scott D. Anthony, Gerald Berstell and Denise Nitterhouse, 2007).

In simple form, this approach consist of 4 steps as shown

To illustrate the steps, we will examine of the firm in transportation gaining success by implementing this approach.

1.2.1 Step 1: Determine what jobs or jobs customer are trying to get done by using current services and support This step requires active partnership with customer to uncover what jobs they are trying to accomplish. This process is not taking simply by asking a question to customer because customer has a limited frame in reference (Ulwick,2002). It has to go way beyond it. Manager should direct question regarding the value that

customer are trying to accomplish by hiring the service or product. First actions can be taken by scanning customer firm touch point. For example this transportation gain an insight after conducting little research with their customer with question “ What is customer goal while she/he is interacting with front office of firm (call center, driver, website)?” and the primary goals are checking the schedule, observing package trip, sit in the bus safely and comfortably.

1.2.2 Step 2: Determine whether jobs for which customer are hiring current service are part of a larger process. After finding several value of jobs need to get done from customer, Manager should try to analyze whether there is a larger process that encompass these simple jobs. This step is important because if jobs for which customer have hired a company’s service are part of a larger process, it is likely that there are other elements overlooked by company’s manager and competitor as well. (Betterncourt et al.,2013). In our case transportation company, Manager gets the insight that there are two larger processes in their customer’s view: punctuality and safety while on board.

1.2.3 Step 3: Determine what opportunity exist to help customer get their jobs done This step is taken by capturing customer outcome in the entire job and determine which customer outcomes are important but poorly satisfied (Betterncourt et al.,2013) As in our case, manager of transport get the insight that the opportunity to help customer get the jobs done is by increasing safety level of their passengers and monitor the driver on punctuality with the schedule.

1.2.4 Step 4: Invest time, talent, and resources in value creation that will be most meaningful to customer and most differentiated from competitor. After knowing the opportunity, company can focus on time, talent and resources on unmet customer need then later company should consider innovation both in how service is delivered and what services are delivered (Betterncourt et al., 2013) Manager transport comes up with an innovative solution to invest with technology to address these two problems. It invest with the application to track their driver through

GPS and application name Brainstat to monitor the level of awareness, focus, and stress of their driver to guarantee the safety level of their passengers. The insight that the manager transport gained here is somehow useful to create a competitive advantage over its rival. Compare with the traditional way of approach, transport manager might just want to add more vehicles operating in a shift to avoid long queue in bus stop rather than trying to analyze the actual jobs need to get done by their customer. It avoids a company to innovate on the same platform or offering with the other competitor.

2. How Job Centric Approach helps service Innovation

in Hospital Emergency Department

2.1 The Value Process on Hospital Emergency Department

We use the typical Hospital Emergency Department described in case study by Pavlos Delias (2013). The Hospital has two Emergency Departments (ED). The first one, ED1, runs 16 hours per day and the second one, ED2, 24 hours per day. Generally, patients that arrive between 08:00 and 23:00 have to pass through registration. Depending on the triage (red cases = extremely important), patients can skip registration and examination at ED1 and are sent directly to ED2.

When patients arrive at the emergency department prior to 23:00, they have to register at the registration office in ED1. The patients will provide information like their name, age, etc., and have to pay 5 euro for the examination. Afterwards, they have to wait at the waiting room. A nurse will ask the patient about their problems and will characterize the level of the triage. The patients that arrive by the ambulance are sent directly to ED2. Furthermore, patients with urgent problems, like, for example, cardiological incidences or serious accidents, receive the highest priority level (red) and are sent directly to ED2.

The process scope at ED2 is twofold. Firstly, patients who enter the emergency department of the hospital after 23:00 will be served by ED2 because ED1 is closed. Secondly, the normal ED2 process treats patients that face serious problems with their health (belonging to the yellow and red scale of triage). When a patient enters the room of diagnosis the nurse will check the temperature, blood pressure, and heartbeat. Then the physician will provide an initial examination. Depending on the level of triage, a patient waits for the lab results at the waiting room or in bed.

When the physician delivers the results of the examination, there are three possible next steps. If the case is serious, the patient is sent to the appropriate department of the hospital. Alternatively, the patient may receive a prescription and is sent back home. The third choice is to decide that the patient will stay at the wards of the emergency department in order to make more lab tests.

2.2 Job Centric on Hospital Emergency Department

Step 1: Determine what jobs or jobs customer are trying to get done by using current services and support First we identify touch point of hospital emergency department. There are several touch points of hospital emergency department such as: ambulance, call line, and general practitioners, and sign posting. We then try to analyze what jobs they are trying to accomplish by interacting with these touch points. By interacting with call line, customer wants to get information or help from emergency department, get to know what the immediate cure of their disease is. Interacting by ambulance, customer wants to get immediate treatment and get transported to the

appropriate department of their disease in the hospital immediately. By interacting with general practitioner in hospital is obviously because they want to get diagnosed from their disease or illness. They also want to get the post medical treatment after treatment in emergency department. By interacting with sign posting in hospital emergency department, patients want to get brief and clear path where to go while they are in that department. Step 2: Determine whether jobs for which customer are hiring current service are part of a larger process. After breaking down the customer jobs by identifying customer’s goal while she/he is interacting with front office of hospital, Next step is by seeing whether these goals are encompassed in larger process. Observing the goal customer want to get done through call line center is that they are not merely looking for ambulance or help to come in to their house but they are looking for advice on how to immediately response the disease on their own. The other thing is that in ambulance, patient only wants to get diagnosed immediately without any delay after they reach hospital. Then we can conclude that patient’s larger process here is clear workflow system in emergency department. They do not want to be kept waiting while they reach hospital no matter what the reason is. Moreover, there are some patients who come to the emergency department directly but their situation is not that urgent. They just want to get immediate care of their illness. This situation worsens waiting time for the other urgent patients who really need emergency care. That is why these two major problems happened: Clogging time in emergency department and long waiting time for patient to get treatment in emergency department Step 3: Determine what opportunity exist to help customer get their jobs done

We have got an insight of what the real problem is and now we are trying to determine the opportunity exist to help customer get their jobs done. Two major problems can be addressed by improving the touch points in hospital emergency department such as call line, ambulance, general practitioner, and sign posting. We can also collaborating with other department in hospital to deliver comprehensive healthcare to all the patients in emergency department and invest on technology to improve the workflow of system in emergency department.

Step 4: Invest time, talent, and resources in value creation that will be most meaningful to customer and most differentiated from competitor Next step after observing the opportunity is considering innovation both in how service is delivered and what services are delivered. Improving touch points in hospital emergency department can be broken down into several points: a. Call line

We need to acknowledge that several phone calls to hospital emergency department do not always need ambulance or immediate response. It happens because Urgent and emergency care services are currently often highly fragmented and generate confusion among patients about how and where to access care (Lattimer et al 2010). So basically, we can improve this touch point by evaluating the condition of patient when they call. Then we can categorize the needs of the patient whether they need emergency help, urgent care or only want to get simple medical treatment on their own. This can be done by separating call line number between urgent and less urgent condition to society. This call line center should be well integrated with the ambulance and general practitioner available in health emergency department.

b. Ambulance To improve touch point in ambulance and diminishing waiting time and clogging in health emergency department, ambulance service should get an authority to perform urgent treatment towards patient within ambulance. If ambulance service can handle this problem by their service then there is no need to transport patient into emergency room which will reducing clog in emergency department. Besides, Ambulance service should be equipped with the GPS technology so that they can reach hospital as soon as possible.

c. General practitioner For those patients who come directly to the hospital emergency department, there should be practitioner ready in their position. This general practitioner should identify first what condition patient undergo through their triage. Then they have to decide whether this patient should go to which level of emergency room (minor or major illness). The other important to fulfill the need of the customer to get treatment after medical check in emergency department is by having electronic medical records. This medical records will be connected with patient records and track their condition while they are discharged from hospital. Other thing that can be improved here is by gaining partnership with social care to address this patient while they are in their own home.

d. Sign Posting In Emergency department, somehow sign posting plays a key role for customer to get informed of the workflow in hospital. Instead of using traditional sign posting, we can use technology of RFID (Radio Frequency Identification) on patient’s ID to track patients flow. Emergency department should also provide effective and efficient sign posting to help patient choose the right service within the department.

4. Conclusion

There are a lot of problems need to be addressed in hospital emergency department and there are many ways to address it. This paper has explored the opportunity exist within the system through service innovation concept ‘Job Centric Approach’. This Job Centric Approach is one of approach to increase customer experience while hiring product or service. In hospital emergency department, we can address these problems by improving the touch points in hospital emergency department such as call line, ambulance, general practitioner, and sign posting. Collaborating with other department in hospital or social care to deliver comprehensive healthcare to all the patients after their treatment is consider important. The other innovation could be investing on technology to improve the workflow of system in emergency department such as RFID system. By using Job centric approach, we are shifting the focus from service back to the customer.

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