Improving long-term care provision: towards demand-based care by means of modularity

BackgroundAs in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes.MethodsStarting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software.ResultsOur data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services.ConclusionThe adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to elaborate on how to further enable demand-based provision of long-term care by means of modularity.

[1]  Fabrizio Salvador,et al.  Toward a Product System Modularity Construct: Literature Review and Reconceptualization , 2007, IEEE Transactions on Engineering Management.

[2]  A D Kaluzny,et al.  Building client centered systems of care: choosing a process direction for the next century. , 2000, Health care management review.

[3]  Martin Fortin,et al.  Prevalence of Multimorbidity Among Adults Seen in Family Practice , 2005, The Annals of Family Medicine.

[4]  B. Meijboom,et al.  Labour supply in the home care industry: A case study in a Dutch region. , 2006, Health policy.

[5]  Bert Meijboom,et al.  Demand-based Provision of Housing, Welfare and Care Services to Elderly Clients: From Policy to Daily Practice Through Operations Management , 2009, Health Care Analysis.

[6]  Marc H. Meyer,et al.  Creating a platform-based approach for developing new services , 2001 .

[7]  L. Casalino,et al.  Focused factories? Physician-owned specialty facilities. , 2003, Health affairs.

[8]  Alex Hill,et al.  A review of modular strategies and architecture within manufacturing operations , 2009 .

[9]  Richard M J Bohmer,et al.  Medicine's Service Challenge: Blending Custom and Standard Care , 2005, Health care management review.

[10]  K. Stange The Problem of Fragmentation and the Need for Integrative Solutions , 2009, The Annals of Family Medicine.

[11]  M. Hossein Safizadeh,et al.  An empirical analysis of financial services processes with a front‐office or back‐office orientation , 2003 .

[12]  Pauliina Ulkuniemi,et al.  Modularity in developing business services by platform approach , 2008 .

[13]  Marcela Miozzo,et al.  Modularity and innovation in knowledge intensive business services: IT outsourcing in Germany and the UK , 2005 .

[14]  Hau L. Lee,et al.  Mass Customization at Hewlett-Packard : The Power of Postponement , 1999 .

[15]  Mark Leach,et al.  Theory Testing Using Case Studies in Business-to-Business Research , 1999 .

[16]  Katrien G. Luijkx,et al.  Diversity among the elderly, diversity in approach , 2007 .

[17]  John R. Weisz,et al.  Modularity in the design and application of therapeutic interventions , 2005 .

[18]  J. Whitney Case Study Research , 1999 .

[19]  J. Klein,et al.  Using industrial processes to improve patient care , 2004, BMJ : British Medical Journal.

[20]  Juliana Hsuan,et al.  Service Architecture and Modularity , 2009, Decis. Sci..

[21]  Moreno Muffatto,et al.  Platform strategies in international new product development , 1999 .

[22]  R. Grol,et al.  Quality of integrated care for patients with nonsmall cell lung cancer , 2007, Cancer.

[23]  Qiang Tu,et al.  Measuring Modularity-Based Manufacturing Practices and Their Impact on Mass Customization Capability: A Customer-Driven Perspective , 2004, Decis. Sci..

[24]  P.M.A. van Bilsen,et al.  Care for the elderly; an exploration of perceived needs, demands and service use , 2007 .

[25]  Izak Benbasat,et al.  The Case Research Strategy in Studies of Information Systems , 1987, MIS Q..

[26]  R. Langlois,et al.  Standards, Modularity, and Innovation: The Case of Medical Practice , 1997 .

[27]  Marjan van den Akker,et al.  Multimorbidity's many challenges , 2007, BMJ : British Medical Journal.

[28]  K. Seers Qualitative data analysis , 2011, Evidence Based Nursing.

[29]  William L. Berry,et al.  Approaches to mass customization: configurations and empirical validation , 2000 .

[30]  Carliss Y. Baldwin,et al.  Managing in an age of modularity. , 1997, Harvard business review.

[31]  B. Siegel,et al.  Care of the frail elderly in developed and developing countries: The experience and the challenges , 2002, Aging clinical and experimental research.

[32]  Kathleen M. Eisenhardt,et al.  Theory Building From Cases: Opportunities And Challenges , 2007 .

[33]  P. Bower,et al.  Patient-centredness: a conceptual framework and review of the empirical literature. , 2000, Social science & medicine.

[34]  Nigel Slack,et al.  Operations management , 1994 .

[35]  P. Kotler,et al.  Principles of Marketing , 1983 .

[36]  Marc H. Meyer,et al.  Applying platform design to improve the integration of patient services across the continuum of care , 2007 .

[37]  M. Young,et al.  Health services research , 2008, Journal of General Internal Medicine.

[38]  Kathleen M. Eisenhardt,et al.  Architectural Innovation and Modular Corporate Forms , 2001 .

[39]  R. Herzlinger,et al.  Consumer-driven health care: implications for providers, payers, and policy-makers. , 2004, Healthplan.

[40]  L. Berry,et al.  Health Care , 2007 .

[41]  Jon Sundbo,et al.  Modulization of service production and a thesis of convergence between service and manufacturing organizations , 1994 .

[42]  Jean Hartley,et al.  Case study research , 2004 .

[43]  I. Woittiez,et al.  Client demands and the allocation of home care in the Netherlands. A multinomial logit model of client types, care needs and referrals. , 2003, Health policy.

[44]  R. Herzlinger,et al.  Consumer-driven health care. , 2009, JAMA.

[45]  Christopher A. Voss,et al.  Case research in operations management , 2002 .

[46]  Bert Meijboom,et al.  Networks for integrated care provision: an economic approach based on opportunism and trust. , 2004, Health Policy.

[47]  Jocelyn Cornwell,et al.  What’s the difference between a hospital and a bottling factory? , 2009, BMJ : British Medical Journal.

[48]  Juliana Hsuan Mikkola,et al.  Supply-chain integration: implications for mass customization, modularization and postponement strategies , 2004 .

[49]  Melissa A. Schilling Toward a General Modular Systems Theory and Its Application to Interfirm Product Modularity , 2000 .

[50]  Elena Rusticelli,et al.  Improved Health System Performance through better Care Coordination , 2007 .

[51]  Per-Erik Liss,et al.  Health Care Need: Meaning and Measurement , 1993 .

[52]  John Saunders,et al.  Principles of Marketing: 2nd European Edition , 1999 .

[53]  M. Broekhuis,et al.  Improving client-centred care and services: the role of front/back-office configurations. , 2009, Journal of advanced nursing.

[54]  K. Eisenhardt Building theories from case study research , 1989, STUDI ORGANIZZATIVI.

[55]  M. Fortin,et al.  Multimorbidity's many challenges , 2007, BMJ : British Medical Journal.

[56]  M.J.N. Rijckmans,et al.  Positioning the individual in health care. A typology of the demand-oriented and demand-driven approaches , 2005 .

[57]  L. G. Zomerdijk Design decisions in the front office - back office issue , 2000 .

[58]  Jack R. Meredith,et al.  Building operations management theory through case and field research , 1998 .

[59]  L. De Bleser,et al.  Defining pathways. , 2006, Journal of nursing management.

[60]  Bert Meijboom,et al.  Modular care and service packages for independent living elderly , 2010 .