Methodological support for business process redesign in healthcare : a systematic literature review

Background: The redesign of business processes in healthcare has received considerable interest from researchers and healthcare professionals. Various labels have been used to refer to the activity of rethinking the operations involved in providing care to patients, such as Business Process Redesign, Clinical Pathways, Lean and Quality Improvement. Due to the fragmented nature of the field, robust methodological support for redesigning business processes is lacking. This systematic literature review aims at establishing a rigorous and comprehensive methodological framework that assists in composing a method for generating process improvement ideas for the healthcare domain. In addition, this review offers recommendations for developing further methodological support. Research methodology: Structured electronic searches in Medline, ABI/Inform and INSPEC (Jan 1990 - July 2011) were complemented with systematic snowballing and an advisory committee consultation to identify a comprehensive census of literature. To select studies, two reviewers independently performed a relevance and quality screening procedure using detailed inclusion and exclusion criteria. Subsequently, two reviewers used a data extraction form to extract and code relevant data fragments in these studies. Results: Based on 61 studies that passed the screening procedure, a robust methodological framework is presented that contains an overview of 60 method options for six key choices to be made with regard to a business process redesign method: aim (8), actors (11), input (18), output (8), technique (10) and tool (5). In addition, six related recommendations are proposed. Conclusion: The developed methodological framework has the potential to advance methods for the generation of process improvement ideas in healthcare. The related recommendations offer traceable and concrete advice for this direction.