In the past weeks I have been asked several times what my recent paper on logistical social networks means for practice. I have asked the same question myself: what would I as a researcher advise myself as a consultant? In the next blogs I would like to focus on some projects I have worked on and how my research changed my perspective on these projects. First is Material Management (MM).
I have worked on MM in several hospitals over the past years, but mostly in Maastricht University Medical Centre (MUMC+). MUMC+ transformed its complete Operating Theatre Complex (OTC) over the past years into a very modern, innovative and spacious OTC (click here to see more of that). In the new OTC the material storage was centralized and located further away from the operating rooms (OR). Material logistical tasks are now executed by logistical staff, and not, like before, by OR nurses and nurse anesthetists. In order to support material management processes an IT system was designed, developed and implemented. A couple of research findings changed my perspective on this type of projects in which logistics, IT and building are all changed at the same time.
RESEARCH FINDING 1: hospital logistics is simply there, and to a large extent it is controlled by ‘voluntary workers’, whose primary task is not logistics. Traditionally the surgeon detemines the strategy (treatment) and OR nurses and nurse anesthetists arrange the materials for the surgery procedure, sometimes assisted by some logistical workers.
When the MM project started in 2014 we did not realise what this notion meant. We were then mainly talking about the building and the IT. A building design is stronger than whatever vision or management strategy. If it is designed, it’s more or less fixed in concrete. We were discussing planning deadlines, the enormous effort and cost, building and IT system design. Both the building and IT involved a lot of professionals: architects, IT engineers and project managers. We did talk to health care professionals, but not fully recognize their ‘voluntary’ logistics qualities and knowledge. By ‘voluntary’ I mean that logistics organization was not their primary task, but in practice they arranged it all. We did not really fully see or understand what important knowledge all these nurses and nurse anesthetists have (and neither did they themselves for that matter!). Most logistical working processes were undocumented at the time, which is very inconvenient for designing a building or IT system, which should both support these processes. Over time, as the project developed, we used several tools to make this knowledge explicit. And now we understand in what way material management processes can be improved further much better. How? See my next point.
RESEARCH FINDING 2: hospital logistics is organized in networks in which central agents play an important role in integrating tasks that are executed within the hospital’s subsystems. These ‘integrators’ are mainly nurses, medical secretaries and a few coordinators. They are in direct contact with both patients and physicians, and therefore they know what are relevant factors for organizing healthcare.
Second, through my research I started to think in terms of networks. When we started the project in 2014 we made a logistics concept with a small group of people. This was easy to coordinate and we quickly achieved results. But in the six years that followed, the network became very large – the Facility department, the Purchasing, IT and Finance department became involved – and the network became hard to oversee. If I needed data or wanted to achieve something, merely talking to the project leader or any manager, did not seem to lead to results. Data, information or clues on how to implement MM effectively, had to come from central people in the network. As soon as the social network in Slingeland Hospital became clear to me during my research, I realised that the people with the best information position are not the managers. They are the nurses, in this case the OR assistants, the nurse anesthetists, a handful of people who volunteered to act as coordinator. Later, also the logistical staff who the logistical tasks were outsourced to, conquered a central position in the network, and they too became important players in the network. For data collection but also for change management, these are the people to contact. For (project) managers or consultants this requires a different mindset, because it can be challenging to find the central agents and this kind of change management is easily be planned in time. But I now believe this is, in the end, the most effective way for change.
RESEARCH FINDING 3: 0.4% of the communication is about materials (the rest about patients, beds and staff).
There is little interaction about material management and this is because there is stock. Stock ensures that you do not have to coordinate about a particular surgery or situation, because you simply take something from the stack. By relocating the stock away from the operating rooms the communication needs and the network changed dramatically, more than we expected in advance. So, beside the technical aspects of this large transformation, the main key to succes is to change communication patterns.
RESEARCH FINDING 4: the hospital network may be vulnerable, with few coordinators and a lot of ‘voluntary’ logistical workers.
In the paper we state that the way hospital logistics is organized, may be vulnerable and expensive. There is a thin line between “complex” and “chaotic”. Now the MUMC has a team of professional logistical workers and the implicit knowledge of nurses has to be transformed into standardized and unambigious data so they are able to execute their tasks effectively. MUMC+ has standardized Bills-of-Materials, material names and codes in order to speak the same language, which is incredibly important for collaboration. The Material Management system thus lays the foundation for more structured and streamlined collaboration. But the social connections and interaction will remain indispensable.