50
the condition and needs of a client with other professionals to agree on which care
and service package a client can or needs to be offered. However, a closer look at the
reasons for performing activities in either the BO or FO shows that there could be
many other motives for performing activities in either place (
Table 3.1).
Table 3.1 shows the advantages of FO and BO work. Some of the advantages listed are
based on empirical studies, which were not undertaken in the healthcare or welfare
sectors. We have added some possible additional advantages of both types of work
that are particularly relevant in healthcare and welfare.
Performing activities in the front office enables delivery of additional experiences to
clients and makes in-process monitoring, control and feedback possible (Larsson and
Bowen, 1989, Chase and Hayes, 1991, Safizadeh et al., 2003). Additional emotional
support can also be given in healthcare. New wishes and needs can be signalled earlier
and services can be delivered quickly and adjusted to a wide range of client demands.
Back office activities have the advantage of performance efficiency and the optimal
use of resources (Chase et al., 1984). In healthcare, consultations with peers usually
take place in the BO.
In addition to the decision to perform activities in either FO or BO, another design
decision involves the coupling of FO or BO activities within specific jobs. Activities
can be coupled in a specific job to provide flexible and responsive services or to reduce
idle time (reduction of cost, higher productivity). Alternatively, they can be decoupled
Modular
Care Provision
Table 3.1 Advantages of performing specification activities in front office or back office
Front office
Back office
Opportunities
to customize the service
1, 2
Provision of additional services
3
Possibility
of controlling quality with
clients and provide in-process feedback
3
Instant
provision
3
Physical presence of client (system)
1, 4
Efficiency potential
1, 2, 4
Possibilities for specialization and centralization
5
Efficient use of resources (no
wasted time due to
clients not showing up)
4
Additional in healthcare
Creating a ‘personal face’ for the
providing organization(s)
Provision of additional experiences (trust,
confidence,
faith in the provision)
Capable of dealing with a high level of
uncertainty
and ambiguity in demand
Additional in healthcare
More convenient and
easier to coordinate multi-
and interdisciplinary care
Possibility
of controlling quality, e.g. by peers
1
Chase 1978;
2
Larsson & Bowen, 1989;
3
Zomerdijk & De Vries, 2007;
4
Chase & Tansik 1983;
5
Metters & Vargas,
2000.
51
to exploit employee expertise (high quality, customised service delivery) or to realize
potential efficiency benefits (cost) (Metters and Vargas, 2000). These coupling or
decoupling approaches add fresh ideas to FO/BO configurations as, for example, they
emphasize that coupling activities in one job can offer new strategic opportunities
such as costs savings or a focus on high quality service and customer relations. One
study of banking processes showed that coupled jobs prevent handovers, which can
enhance efficiency and quality as workers have broad tasks and client knowledge is
concentrated in one job (Zomerdijk and De Vries, 2007). For clients, coupled jobs
offer the likelihood of meeting as few different workers as necessary. For example,
when dealing with outpatient consultations, the FO providers may also execute the
follow-up work themselves. In contrast, decoupled processes enable centralization,
specialization and counterchecks. They also offer more options for matching workers
and tasks (Zomerdijk and De Vries, 2007). Decoupled jobs offer the opportunity to free
contact personnel for sales and service delivery. For instance, professionals provide the
service while clerical personnel provide administrative support (making appointments,
typing out medical letters).
Both FO and BO activities can be decoupled in order to present employees with the
opportunity to specialize in a certain task. A coupled job may be a combination of
FO and BO activities, or consist solely of FO or BO activities. In the case of primarily
FO activities, personal skills and ‘active’ knowledge (i.e., knowledge available on the
spot) are more relevant, while in the case of predominantly BO activities, supportive
knowledge and skills (administrative or professional) are required. Information
technology makes it possible to overcome the drawbacks of both coupled and
decoupled designs and to execute activities that were previously BO tasks in the FO or
the other way round. For example, an information system can enable the integration
of administrative tasks in the contact moments with clients, which eliminates follow-
up activities. Table 3.2 sums up the advantages and disadvantages of coupling and
decoupling; again, we draw a distinction between the advantages revealed through
our literature review and possible additional advantages for healthcare.
Tables 3.1 and 3.2 show the advantages of design decisions in terms of how each
decision contributes to different strategic objectives. In fact, strategic objectives are
a relevant contingency factor that should be considered when choosing a particular
configuration, which has been shown in much research (see, e.g. Mintzberg, 1979).
Organizational theory shows that the characteristics of demand are another important
contingency factor (Van de Ven and Delbecq, 1974, Mintzberg, 1979) that is also applied
in healthcare redesigns. For example, de Bleser et al. (2006) distinguish various types of
clinical pathways based on differences in the complexity of demand. Complexity implies
that patient demand comprises several, sometimes interrelated problems or that the
demand is not clear or unambiguous. In the case of ambiguity, the available information
Impr
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Chapt
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