Business

process

re-engineering

–

saviour

or

just

another

fad?

One

UK

health

care

perspective

Anjali

Patwardhan

Health

Service

Management

Centre,

Birmingham,

UK,

and

Dhruv

Patwardhan

University

of

Newcastle,

Newcastle

upon

Tyne,

UK

Abstract

Purpose

–

Pressure

to

change

is

politically

driven

owing

to

escalating

healthcare

costs

and

an

emphasis

on

efficiency

gains,

value

for

money

and

improved

performance

proof

in

terms

of

productivity

and

recently

to

some

extent

by

demands

from

less

satisfied

patients

and

stakeholders.

In

a

background

of

newly

immerging

expensive

techniques

and

drugs,

there

is

an

increasing

consumer

expectation,

i.e.

quality

services.

At

the

same

time,

health

system

managers

and

practitioners

are

finding

it

difficult

to

cope

with

demand

and

quality

expectations.

Clinicians

are

frustrated

because

they

are

not

recognised

for

their

contribution.

Managers

are

frustrated

because

meaningful

dialogue

with

clinicians

is

lacking,

which

has

intensified

the

need

for

change

to

a

more

efficient

system

that

satisfies

all

arguments

about

cost

effectiveness

and

sustainable

quality

services.

Various

strategies,

originally

developed

by

management

quality

“gurus”

for

engineering

industries,

have

been

applied

to

health

industries

with

variable

success,

which

largely

depends

on

the

type

of

health

care

system

to

which

they

are

applied.

Design/methodology/approach

–

Business

process

re-engineering

is

examined

as

a

quality

management

tool

using

past

and

recent

publications.

Findings

–

The

paper

finds

that

applying

business

process

re-engineering

in

the

right

circumstances

and

selected

settings

for

quality

improvement

is

critical

for

its

success.

It

is

certainly

“not

for

everybody”.

Originality/value

–

The

paper

provides

a

critical

appraisal

of

business

process

re-engineering

experiences

in

UK

healthcare.

Lessons

learned

regarding

selecting

organisations

and

agreeing

realistic

expectations

are

addressed.

Business

process

re-engineering

has

been

evaluated

and

reviewed

since

1987

in

US

managed

health

care,

with

no

clear

lessons

learned

possibly

because

unit

selection

and

simultaneous

comparison

between

two

units

virtually

performing

at

opposite

ends

has

never

been

done

before.

Two

UK

pilot

studies,

however,

add

useful

insights.

Keywords

Business

process

re-engineering,

Total

quality

management,

Continuous

improvement,

Medical

management,

Health

services,

United

Kingdom

Paper

type

Viewpoint

History

of

quality

management

in

health

care

To

know

how

health

care

organisations

became

interested

in

industrial

quality

development

tools

and

how

business

process

re-engineering

(BPR)

emerged

as

an

option,

we

have

to

go

back

to

1987

when

the

Quality

Improvement

in

Health

Care

National

Demonstration

Project

(NDP)

was

launched

as

an

experiment

(Godfrey,

n.d.).

A

total

of

21

health-care

organisations

participated

and

promised

to

support

this

study

lasting

eight-months.

The

aim

was

to

look

at

the

applicability

of

industrial

quality-improvement

methods

to

health

care.

Support

included

free

consulting,