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,
