Tilburg University Modular Care Provision

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is inconsistent or unequivocal such that multiple and conflicting interpretations of a 
problem are possible (Molleman et al., 2008). In addition to complexity of demand, 
distinctions can be made in the degree of diversity or variety of demand (see, e.g. 
Slack et al., 2007); organizations can supply services to populations with more or less 
diversity or variety in demand. Taking these contingency factors into account, we have 
constructed a framework of various FO/BO configurations (Table 3.3). 
Table 3.3 shows four FO/BO configurations that aim to perform well in terms of both 
clients’ needs and wishes and efficiency. ‘Employee A’ is used to referring to an employee 
working in the FO; ‘employee B’ works in the BO. All the design options highlight the 
need for early involvement of clients in the process to enable ‘first-time right’ diagnosis, 
and to enhance the transparency of the potential offerings of a home care or healthcare 
organization such as a nursing home. The four configurations focus on the specification 
phase – the part of operations in which mutual understanding is created about what 
should, can and will be delivered – at this phase offers the most potential for switching 
tasks between FO and BO and the coupling or decoupling of activities.
Configuration I implies that employee A discusses a wide variety of care services with 
patients and clients. These workers have ‘active’ knowledge of the integrated services 
on offer and the social skills to communicate these well to clients. With employee A, 
the client determines which services will be supplied and the same or another employee 
may actually deliver the services. This configuration stresses the importance of high 
quality (no mistakes) and customized service delivery. The broad scope of the task and 
Modular Care Provision
Table 3.2  Decoupling or coupling back office (BO) and front office (FO) activities in jobs
1
Chase et al. 1984; 
2
Metters & Vargas 2000; 
3
Larsson & Bowen 1989; 
4
Zomerdijk & De Vries 2007.
Effects
Impact on performance 
Coupling activities 
within one job
Concentration of knowledge on 
clients’ wishes and needs 
1, 2
Quality (client-centred)
Facilitates interaction 
3
Quality (fewer mistakes)
Decrease in number of handovers 
4
 
Quality (fewer mistakes)
Reduces idle time in cases where BO 
activities are performed during idle 
time 
3
Optimal use of resources
Employees have broad tasks 
4
Work satisfaction
Decoupling 
activities within 
more than one job
Specialized workers
2
Better match between task and 
worker
4
 
Lowering costs in cases where BO 
activities are sealed off 
3
All effects increase quality (technical 
nursing quality) and work satisfaction
Additional for healthcare
Makes peer review possible
Additional for healthcare
Increases technical (nursing) quality

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the worker’s autonomy mean that idle time can be reduced, which saves costs. Other 
employees could execute some administrative tasks in the BO, but most of these tasks 
will be performed by employee A as well. 
Front-/back-office Configuration II emphasizes the highly professional character of 
client-centred care and services. BO employees are specialists in the specification of 
client-centred and often integrated care and services. Employee A makes an inventory 
Impr
oving clien
t-c
en
ter
ed car
e and ser
vic
es
Chapt
er 3
Table 3.3  Four design options for front office/back office (FO/BO) configurations in home care 
and welfare
Demand
Low complex care and services
High complex care and services
High diversity 
Configuration I
Employee A determines together with 
client needs and wishes of client and the 
service package 
Specification activities are mostly 
performed in FO
Coupled process: employee A performs 
most of the tasks
Employee A: high level of autonomy
Employee A is highly social and 
professionally educated
Configuration II
Employee A determines together with 
client a list of needs and wishes, and 
employee A consults employee(s) B 
Specification activities are performed in 
both FO and BO
Decoupled process: multiple employees 
involved 
Employees A and B: both moderate level of 
autonomy
Employee A is socially educated and 
Employee B is professionally educated 
Strategic objectives
High personal service delivery, minimum of 
handovers
Strategic objectives
High personal service delivery, optimal use 
of specialized BO employees
Low diversity 
Configuration III
Employee A determines together with 
client the needs and wishes, and the 
service package 
Specification activities are mostly 
performed in FO
Coupled process: employee A performs 
most of the tasks
Instruments for standardizing the 
specification process are developed in BO 
and used in FO
Employee A: moderate level of autonomy
Employee A makes use of standard list of 
choice options
Configuration IV
Employee A makes inventory of specific 
needs and wishes of client; employee 
B determines the service package (BO 
activity)
Specification activities are mostly 
performed in BO
Decoupled process: multiple employees 
involved 
Instruments for standardizing the 
specification process are developed in BO 
and used in both FO and BO
Employee A: low level of autonomy
Employees A and B make use of a standard 
list of choice options
Strategic objectives
Quick delivery, no idle time and minimum 
of handovers, customized delivery by 
adapting standard deliveries to specific 
needs
Strategic objectives
Low costs through standardization and 
optimal use of BO employees, customized 
delivery by adapting standard deliveries to 
specific needs

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