Towards the design of a process management approach for the delivery of unscheduled urgent and emergency healthcare

Abstract

Delivering effective urgent and emergency healthcare continues to challenge developed economies despite recent increased spending. The literature suggests that the current design of accident and emergency departments (A&E) does not reflect the process nature of the delivery of unscheduled urgent and emergency care. The research described in this thesis supports the development of a process model to strengthen unscheduled urgent and emergency healthcare delivery and improve A&E operations.
A comprehensive literature review is undertaken to investigate the extent and efficacy of process management in healthcare delivery. It shows that process management methods such as Business Process Re-engineering and Lean tend to be applied to individual departments. End-to-end process orientated approaches are scarcely applied.
Assessing access to urgent and emergency healthcare in England, a lack of process design and management is found which results in confusion for patients. Based on principles of process orientation, a new proposal is developed that features local urgent healthcare hubs.
To investigate the current process, an analysis of A&E providers by catchment area was carried out for London to understand how features of an area such as number of general practitioners affects demand in A&E. Combining catchment area analysis with regression, a novel methodology is demonstrated that indicates how demand for A&E is affected by local characteristics.
Using simulation analysis informed by Geographic Information System (GIS) location analysis, a new methodology is created to demonstrate the potential for a process orientated approach to management of urgent and emergency healthcare. Using a case study in the London Borough of Hounslow, an analysis was carried out, firstly, of the current situation; secondly, of a National Health Service (NHS) proposal and, thirdly, the proposal put forward for urgent healthcare hubs. Several scenarios are analysed in which patients are diverted to other services, to demonstrate the effects of changes of provision on patient access and queueing efficiency.

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ORCID for Honora Smith: orcid.org/0000-0002-4974-3011

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