package to these segments, as the needs and wishes of these clients were too diverse.
For this group, the company opted for Configuration I, selecting FO employees with
excellent contact skills and a broad knowledge of the various services provided by the
merged organization. These FO employees had the skills and knowledge to match an
extensive range of needs to the required services. In the future, a database including
all available services should support the FO employees. In very rare cases, they may
consult BO employees with knowledge of specific services or combinations of services
(i.e. Configuration II).
In this case study, the ideas for redesigning the specification processes were highly
appreciated by all the divisions. Designing coupled jobs that combined client contact
with administrative and consultation tasks, and further investment in the development
of care and services modules (standardization) were favoured, because of the large
number of relatively simple and standard demands. If more customized or complex care
and service packages were at stake, the company chose the designs at the top of Table
3.3, usually Configuration I or, in very complex situations, Configuration II, in order
to make optimal use of the expertise available throughout the whole organization.
In conclusion, the organization opted for more coupled FO designs as they were
convinced they had to offer a ‘personal face’ to clients with a minimum of handovers,
so that the client has contact with only one employee who is capable of assessing the
need for additional services. As a merged entity, the organization had to convince
clients of their ability to deliver satisfactory services and, even though they are now a
large-scale
organization, that they are still able to provide customized services.
3.5 Discussion
This study shows how different FO/BO configurations can contribute in their own
way to the provision of both efficient and client-centred care, and it demonstrates the
application of different configurations in a home care ‘plus’ setting. The main idea
behind these configurations is to emphasize the need to consider which activities
should be executed in the FO, and how activities can be combined within specific
jobs. The study shows that performing activities in direct contact with customers is
not only useful for physical reasons (e.g. washing patients) and to clarify needs and
wishes, but also to increase clients’ care experiences by providing ‘a personal face’ and
complementary experiences such as warmth and confidence. Although FO activities
may be considered a costly way of providing services, efficiency can be increased by
making use of standardized modular care and services packages and IT solutions, and
by coupling FO and BO activities in one job. Furthermore, revenues can be increased
as FO workers have the explicit task of pointing out which complementary care and
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Care Provision
services could be needed and how these could be provided in an integrated way. All these
arguments are highly relevant in a healthcare market in which the provision of efficient
care is of the utmost importance in an increasingly competitive environment.
Second, this study demonstrates that coupling activities in one job can increase both
efficiency and the provision of client-centred care as, in this design, clients have
contact with fewer employees, handovers can be reduced, and idle time of FO workers
is avoided.
In our case environment, it appeared that identifying client segments and developing
care and service modules – in fact ways of standardizing the specification process –
supported the feasibility and attractiveness of the design options. Standardization
was achieved by identifying client segments and creating a modular way of providing
services. In one of the first contributions in the literature on modularity, Starr (1965,
p. 138) formulates the basic idea behind modularity as ‘design, develop and produce
[...] parts which can be combined in the maximum number of ways’. Nowadays,
modularization of products/services means that the individual components included
in a product/service are able to be changed or replaced independently, because each
component has a separate function (Baldwin and Clark, 1997, Fixson, 2005, Slack et
al., 2007). Therefore, for each client product and service distinctions can be easily
achieved through transformation or modification of components (Duray et al., 2000).
At the same time, the use of standard components reduces variety when making
these components, which allows for cheaper production. Therefore, for the combined
provision of home care and related welfare and domestic services, further research on
the applicability of modular production seems most relevant.
Another option for increasing the feasibility of each design option is using IT solutions.
Advanced IT systems enable various activities to take place at the same time, which
induces inherent coupling. More specifically, traditional BO activities, such as opening
and assigning files and making appointments, have become less complex, less place-
dependent and time-consuming, thanks to contemporary IT. For that reason, such
activities can be coupled and even be performed in the FO; in fact, previous BO
activities are now often interwoven into FO activities. The effect of IT systems on
different FO/BO configurations and, in turn, their impact on performance dimensions
is an interesting topic for further research.
3.5.1 Study limitations
An important limitation of this study being a single case study is that it is somewhat harder
to generalize the findings to other settings. However, our findings are also based on a
literature search, and the reinterpretation of those findings with respect to healthcare.
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