外文翻譯--業(yè)務(wù)流程再造——治本還是治標(biāo)？以一個(gè)英國(guó)醫(yī)療保健的視角來(lái)看（英文）

1、Business process re-engineering – saviour or just another fad?One UK health care perspectiveAnjali Patwardhan Health Service Management Centre, Birmingham, UK, and Dhruv Patwardhan University of Newcastle, Newcastle upon

2、 Tyne, UKAbstractPurpose – 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 re

3、cently 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 th

4、e 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

5、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 servic

6、es. 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

7、 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 proce

8、ss 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 b

9、usiness 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 rev

10、iewed 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. Tw

11、o UK pilot studies, however, add useful insights.Keywords Business process re-engineering, Total quality management, Continuous improvement, Medical management, Health services, United KingdomPaper type ViewpointHistory

12、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

13、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 st

14、udy lasting eight-months. The aim was to look at the applicability of industrial quality-improvement methods to health care. Support included free consulting,The current issue and full text archive of this journal is ava

15、ilable atwww.emeraldinsight.com/0952-6862.htmBPR – saviour or just a fad?289Received 29 November 2006 Revised 10 February 2007 Accepted 25 May 2007International Journal of Health Care Quality Assurance Vol. 21 No. 3, 200

16、8 pp. 289-296 q Emerald Group Publishing Limited 0952-6862 DOI 10.1108/09526860810868229BPR key features Health care’s BPR approach means starting with clean slate and rethinking services using a patient-focused approach

17、. With the benefit of hindsight BPR identifies delays caused by unnecessary steps or potential errors that are built into processes. It is presumed that redesigning processes by removing these errors dramatically improve

18、s care quality. The BPR approach, therefore, raises expectations about dramatic results. Consequently, high returns on investment are anticipated. The process, planned strategically, is explained in Taylor’s BPR framewor

19、k (wikipedia, 2006):. defining BPR’s purpose and goal;. identifying requirements that meet clients’ needs;. defining project scope, including appropriate activities such as process mapping;. assessing the environment usi

20、ng, for example, force-field analyses;. re-engineering business processes and activities;. implementing redesigned processes; and. monitoring redesign success and failure.BPR vs TQM Comparing BPR with other popular quali

21、ty management methods helps us to appreciate and highlight key features in a health care context (Harvey and Millett, 1999). TQM or continuous quality improvement (CQI) refers to programmes and initiatives that emphasise

22、 incremental improvement in work processes and outputs over an open-ended time period. In contrast, BPR refers to discrete initiatives intended to radically redesign and improve work processes within a time frame. Some p

23、eople think TQM is best suited to quality in health care improvement though it is an incremental stepwise, slow but holistic approach. In practice, TQM and BPR are customer-oriented and both encourage managers and practi

24、tioners to take a customer view point. Both are team approaches that involve process control. The TQM protagonists assume that existing health care practices and systems are principally right but improvements are needed.

25、 The BPR supporters, on the other hand, assume that health care systems and practices are flawed and need replacing. Those using TQM expect and believe in stepwise increments in performance as opposed to BPR experts who

26、look for dramatic results. TQM aims to improve all levels for all stakeholders and at all steps, while BPR aims at specified areas only. Standardisation and supporting documentation is a TQM key point. Believing in consi

27、stent and cost-effective performance and minimising process or system defects, prevents rather than corrects problems (Field and Swift, 1996). Those that use the BPR approach, on the other hand, are flexible and assume t

28、hat standardisation increases process complexity (Harvey and Millett, 1999). Nevertheless, BPR is a drastic change leading to staff resistance. Moreover, it is a top-down approach, so management support and commitment is

29、 vital to success. Innovation, therefore, is a risky process when used for “sick organisations”. The TQM incremental method, on the other hand, follows a gradual approach that is mostly bottom-up. It involves employees a

30、nd often based on Deming’s principles that direct improvements through plan-do-study-act (PDSA) cycle. TQM, therefore, is suitable for improving quality in any organisation, although some amendments to suit context may b