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This article aims to describe the thinking behind MASSE, a project in Finland that helps address the fragmentation of care and patient journey disruptions for long-term care. It outlines the conceptualization of an information technology (IT)-assisted solution and presents preliminary findings and research problems in this ongoing project.

The project employs a service engineering and design science approach with the objective of addressing chronic and multimorbid patients in specialized multiprovider environments. It does this by applying information and communication technologies and organizational design. The project has been a cocreative effort with ongoing interviews and workshops with various stakeholders to inform the conceptualization of a solution, an intermediary step before the implementation phase.

Patient journey disruptions occur when caregivers do not know what to do in specific situations. A potential solution is a virtual care operator (VCO) with a personalized patient card that would enable service ecosystem actors to integrate and coordinate their tasks. This article presents the basic design principles of such a solution.

Conceptual ideas and preliminary results only indicative.

Systemic integration efforts like those ongoing in Finland can benefit from the VCO concept encouraging a more collaborative way of thinking about integrative solutions and opening up new avenues of research on business implications and ecosystem strategies.

The VCO concept answers to the continuity of care, the rising costs of health care and the growing numbers of patients with chronic disease and multimorbidity whose care remains fragmented and uncoordinated.

Taking an ecosystem approach to care integration and addressing interoperability issues are on the cutting edge of healthcare system transformation.

Modularity promises to relieve problems of complexity in service systems. However, limited evidence exists of its application in specialized hospital services. The purpose of this paper is to identify enablers, constraints, and outcomes of modularization in specialized hospital services.

A qualitative comparative study of a hematology unit with modular service architecture and an oncology unit with integral service architecture in a university hospital is performed to analyze the service architectures, enablers and constraints of modularization, and outcomes.

A framework and five propositions combining the characteristics of specialized hospital services, enabling activities, and outcomes of modularization were developed. Modular service architecture was developed through limiting the number of treatment components, reorganizing production of standardized components into a separate service unit, and standardizing communication and scheduling in interfaces. Modularization increased service efficiency but diluted ownership of services, decreased customization, and diminished informal communication. This is explained by the specific characteristics of the services: fragmented service delivery, professional autonomy, hierarchy, information asymmetry, and requirement to treat all.

Modularization can increase efficiency in specialized hospital services. However, specific characteristics of specialized care may challenge its application and limit its outcomes.

The study identifies enabling activities and constraints that hospital managers should take into account when developing modular service systems.

This is the first empirical study exploring the enablers, constraints, and outcomes of modularization in specialized hospital services. The study complements literature on service modularity with reference to specialized hospital services.

In healthcare, there is limited knowledge of and experience with patient choice management. The purpose of this paper is to focus on patient choice, apply and test demand-supply-based operating (DSO) logic integrated with clinical setting in clarifying choice contexts, investigate patient’s choice-making at different contexts and suggest context-based choice architectures to manage and develop patient choice.

Prenatal screening and testing in the Helsinki and Uusimaa Hospital District (HUS), Finland, was taken as an example. Choice points were contextualized by using the DSO framework. Women’s reflections, behaviors and experience at different choice contexts were studied by interviewing women participating in prenatal screening and testing. Semi-structured interview data were processed by thematic analysis.

By applying DSO logic, four choice contexts (prevention, cure, electives and continuous care) were relevant in the prenatal screening and testing episode. Women had different choice-making in prevention and cure mode contexts regarding choice activeness, information needs, social influence, preferences, emotion status and choice-making difficulty. Default choice was widely accepted by women in prevention mode and individual counseling can help women make informed choice in cure mode.

The authors apply the DSO model to contextualize the patient choice in one care episode and compare patient choice-making at different contexts. The authors also suggest the possible context-based choice architectures to manage and promote patient choice

Quality management methods have been introduced into health care with variable success. Industrial approaches, such as standardization, are not always applicable professional services, because of fundamental differences in conceptions of aims and the predictability of the results of action. Processes in health care can be classified into standard, routine and non‐routine depending on the level of repetition and amount of variation, variety and uncertainty. Quality problems are different in each type: standard processes may produce deviations from targets, routines errors in classification, and non‐routines failures in interpretation. Different management approaches for each type are discussed. A metaphor to assist discussion, The Broom, is introduced.

The purpose of this paper is to clarify healthcare quality’s ontological and epistemological foundations; and examine how these lead to different measurements and technologies.

Conceptual analysis.

Small quality denotes conformance to ex ante requirements. Big quality includes product and service design, based on customer requirements and expectations. Healthcare quality can be divided into three areas: clinical decision making; patient safety; and patient experience, each with distinct measurement and improvement technologies.

The conceptual model is expected to bring clarity to constructing specific definitions, measures, objectives and technologies for improving healthcare.

This paper claims that before healthcare quality can be defined, measured and integrated into systems, it needs to be clearly separated into ontologically and epistemologically different parts.

Understanding and depicting service operations is important, as the contractual agreements have become more complex, particularly in offshore outsourcing. The purpose of this paper is to introduce the Service Machine as a metaphor and a parsimonious conceptual framework for analyzing outsourced service operations in a Business‐to‐Business‐to‐Consumer context. Conventional machines have frames or platforms that connect various components. The equivalent of a machine in services is a system of contracts linking a client, a service provider, and the end‐users. Clients have the interest to know how, when, where, by whom and with what instructions are their operations being produced. As a result depicting both the service operations and the contractual framework becomes increasingly important.

Through a review of the existing theoretical literature on outsourcing, operations management, contracting and governance, the paper explores a new conceptual model for governing outsourcing arrangements using an inbound voice call center as an example.

The paper argues that although several theoretical domains indirectly shed light on governing outsourcing and offshoring relationships, they typically approach the issue either from a contractual, governance, or process level. The paper elaborates on the assumptions that governance is needed in outsourced services, service production processes and contractual relations both need to be mapped, and the possibility of process‐contract co‐evolution studied.

The paper contributes to the outsourcing literature and to operations management research by developing a new conceptual framework, the Service Machine, for governing service operations in an outsourcing arrangement.

The purpose of this paper is to present a conceptual framework that would enable the effective application of time based competition (TBC) and work in process (WIP) concepts in the design and management of effective and efficient patient processes.

This paper discusses the applicability of time‐based competition and work‐in‐progress concepts to the design and management of healthcare service production processes. A conceptual framework is derived from the analysis of both existing research and empirical case studies.

The paper finds that a patient episode is analogous to a customer order‐to‐delivery chain in industry. The effective application of TBC and WIP can be achieved by focusing on through put time of a patient episode by reducing the non‐value adding time components and by minimizing time categories that are main cost drivers for all stakeholders involved in the patient episode.

The paper shows that an application of TBC in managing patient processes can be limited if there is no consensus about optimal care episode in the medical community.

In the paper it is shown that managing patient processes based on time and cost analysis enables one to allocate the optimal amount of resources, which would allow a healthcare system to minimize the total cost of specific episodes of illness. Analysing the total cost of patient episodes can provide useful information in the allocation of limited resources among multiple patient processes.

This paper introduces a framework for health care managers and researchers to analyze the effect of reducing through put time to the total cost of patient episodes.

The purpose of this paper is to explore different units of analysis applicable to the analysis of healthcare service supply chains.

The paper is based on a literature review, conceptual analysis and two case studies based on process mapping and longitudinal analysis of patient episodes.

Process management is appropriate in situations where there is a structured flow with a sufficient volume of similar repetitions. In the case where there are significant amounts of exceptions, a process can be decomposed into service events that can be defined and managed as part of a supply chain.

The cases are based on data sets that do not allow empirical generalization.

The use of longitudinal patient episode data elicits problems in the process flow, such as delays and variable sequences. The use of events as a unit of analysis enables routinization in situations with exceptions and irregular sequences.

The service event is an original concept that links healthcare operations management to service‐oriented architectures and the service‐dominant logic.

Business process reengineering (BPR) is following a typical maturity cycle as a business fad. Some of the more radical and flashy elements are omitted as the basic principles integrate into common sense and business and engineering school curricula. The ways of evaluating benefits become more precise. This is illustrated by three case studies, in which the benefits are classified into customer perceived value, cost savings and business option value. The latter is not a direct consequence of an implemented reengineering project, but a set of new abilities that an organization must exercise separately as a part of a strategy process. This provides a conceptual link between reengineering and some of its critics arguing for a more proactive approach to value creation. The lasting contribution of the reengineering movement is the insistence on using both technology and organizational change together.

The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations.

First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies.

The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes.

Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination.

Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organization’s strategy and key performance indicators.

Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care.