Business process re‐engineering – saviour or just another fad?

Abstract

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. Business process re-engineering is examined as a quality management tool using past and recent publications. 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". 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.