Are You Having Trouble Keeping Your Operations Focused?

Robert S. Huckman

Article | Harvard Business Review | September 2009

Are You Having Trouble Keeping Your Operations Focused?

Abstract

As a business broadens over time, it can lose the operational edge that led to its original success. Core strengths atrophy, efficiency or quality suffers, and sharper rivals close in to take advantage of the loss of focus. In his classic article "The Focused Factory" (HBR May-June 1974), Wickham Skinner proposed that manufacturers whose product lines had proliferated create specialized units, each dedicated to a distinct task. To make this economically feasible, he suggested the plant within a plant, or PWP, model, whereby an existing facility is physically and organizationally divided into autonomous operations. Many organizations—from airlines to hospitals to department stores—have since adopted the model, in the form of focused units that share people, equipment, and other assets to some extent. But they've found it difficult to implement. That's because, the author writes, they don't give every unit narrowly defined objectives; they underestimate the challenges related to sharing resources; they don't fully consider to what degree best practices, knowledge, and talent should be shared; and they don't anticipate the political tensions that can arise. Huckman provides guidelines for setting clear objectives, getting the boundaries between units right, establishing rules for sharing, and customizing performance criteria. And, he says, leaders must continually remind units of their individual and collective goals and purposes whenever decisions about resources, performance measurement, and compensation are made.

Keywords: Business Units; Business Growth and Maturation; Goals and Objectives; Resource Allocation; Operations; Performance Efficiency;

Format: Print

6 pages

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Citation:

Huckman, Robert S. "Are You Having Trouble Keeping Your Operations Focused?" Harvard Business Review 87, no. 9 (September 2009): 90–95.

Article | Annals of Emergency Medicine

The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding

Brian Franklin, Sharif Vakili, Robert S. Huckman, Sarah Hosein, Nicholas Falk, Katherine Cheng, Maria Murray, Sheila Harris, Charles A. Morris and Eric Goralnick

Delayed access to inpatient beds for admitted patients contributes significantly to emergency department (ED) boarding and crowding, which have been associated with deleterious patient safety effects. To expedite inpatient bed availability, some hospitals have implemented discharge lounges, allowing discharged patients to depart their inpatient rooms while awaiting completion of the discharge process or transportation. This conceptual article synthesizes the evidence related to discharge lounge implementation practices and outcomes. Using a conceptual synthesis approach, we reviewed the medical and gray literature related to discharge lounges by querying PubMed, Google Scholar, and Google and undertaking backward reference searching. We screened for articles either providing detailed accounts of discharge lounge implementations or offering conceptual analysis on the subject. Most of the evidence we identified was in the gray literature, with only three peer-reviewed articles focusing on discharge lounge implementations. Articles generally encompassed single-site descriptive case studies or expert opinions. Significant heterogeneity exists in discharge lounge objectives, features, and apparent influence on patient flow. Although common barriers to discharge lounge performance have been documented, including underuse and care team objections, limited generalizable solutions are offered. Overall, discharge lounges are widely endorsed as a mechanism to accelerate access to inpatient beds, yet the limited available evidence indicates wide variation in design and performance. Further rigorous investigation is required to identify the circumstances under which discharge lounges should be deployed as well as how discharge lounges should be designed to maximize their effect on hospitalwide patient flow, ED boarding and crowding, and other targeted outcomes.

Keywords: health care delivery; emergency room; operations improvement; operations management; Health Care and Treatment; Service Delivery; Operations; Management; Performance Improvement; Service Operations;

Citation:

Franklin, Brian, Sharif Vakili, Robert S. Huckman, Sarah Hosein, Nicholas Falk, Katherine Cheng, Maria Murray, Sheila Harris, Charles A. Morris, and Eric Goralnick. "The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding." Annals of Emergency Medicine 75, no. 6 (June 2020): 704–714. View Details

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This Viewpoint discusses the shifting landscape of health care financing, regulation, and delivery as a result of the coronavirus pandemic, and discusses regulatory and other changes that need to be in place if telehealth and physician practice and hospital mergers become the “new normal” once the pandemic is controlled.

The pandemic crisis is almost certain to change many American industries. It would be a shame if health care is not one of them. A number of major practices have been altered to help the country cope with the extraordinary demands that the pandemic has imposed on the health care system. This article argues that the changes should include allowing physicians to practice across state lines, the broader use of telemedicine, the expansion of the health care workforce, and a new model for health care insurance.

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Are You Having Trouble Keeping Your Operations Focused?

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