Improving home care: Knowledge creation through engagement and design

• Author: Mikko Ketokivi,Johan Groop,Mahesh Gupta,Jan Holmström
• Date: 01 November 2017
• DOI: http://doi.org/10.1016/j.jom.2017.11.001
• Published date: 01 November 2017

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Journal of Operations Management

journal homepage: www.elsevier.com/locate/jom

Improving home care: Knowledge creation through engagement and design

Johan Groop

a

, Mikko Ketokivi

b

, Mahesh Gupta

c

, Jan Holmström

d,∗

a

Aalto University and Nordic Healthcare Group, Finland

b

IE Business School, IE University, Spain

c

University of Louisville, United States

d

Aalto University, Finland

ARTICLE INFO

Accepted by: Dr. V. Daniel R. Guide

Keywords:

Design science

Problem solving

Practical problems

Health care

Home care

Theory of Constraints

ABSTRACT

In this paper, we apply a design science approach to help a Northern European city improve the efficiency of its

home care delivery system. Our proposed solution emerges as a synthesis of applying Goldratt's Theory of

Constraints and the principles of variable-demand inventory replenishment. The improved system exhibits both

more level resource utilization and higher productivity due to more efficient capacity utilization. In addition to

improving system efficiency, we gain insights into how authentic operations management problems can be

addressed through design research. A crucial aspect of empirically-rooted practical problems is that they always

involve multiple stakeholders with only partially overlapping preferences. Consequently, one must not assume or

ascribe an a priori system objective, instead, it must arise from explicit empirical analysis of the relevant sta-

keholders. Another characteristic of authentic problems is that they are always embedded in an institutional

context that sets significant boundary conditions to the feasibility of solutions. These boundary conditions are an

important reminder of the complexity of empirically-rooted managerial problems.

1. Introduction

If Mrs. Johnson has to move into an assisted-living facility because

she needs help with her daily insulin injections, everybody loses. As we

get older, living in our own homes as long as possible is not only a

matter of personal preference, it is also more cost effective for cities and

states to develop systems and infrastructure to promote assisted home

living. If successful, such promotion lowers the unnecessary influx of

senior citizens into assisted-living facilities and the health care system

more generally. With this general objective in mind, the city of Espoo,

the largest suburb of Helsinki, Finland, reached out to us for help in

designing and improving a city-wide home care system. The pressing

problem stemmed from baby boomers reaching the age where they

required assistance in increasingly larger numbers, yet, the resources

allocated to home care had not increased proportionately. The system

would need to be more efficient to ensure the requisite quality of care.

The key questions regarding the design of the home care system fall

squarely in the domain of operations management (OM) research (e.g.,

Eveborn et al., 2006; Eveborn et al., 2009): How should the daily travel

routes of nurses be planned? How should overall caregiver capacity

allocation be planned? These are the questions we were asked to ad-

dress. Our task was to help build, evaluate, and, if needed, redesign a

home care delivery system.

The extant literature on the topic is commendable as it has led to

many improvements of the home care system particularly in the

Scandinavian countries (Eveborn et al., 2009) and the Benelux countries

of Belgium, the Netherlands, and Luxembourg (Duque et al., 2015). Of

course, the problem is not limited to these countries, as scholars in the

United States have observed similar challenges in the organization and

coordination of home care (e.g., Osborn et al., 2014). We seek to

complement this research by focusing on the problem in the authentic

field setting. This is important, because a common denominator in

much of the research literature on home care is that the problem and

the objective are taken as given:

“When viewing the daily planning as a scheduling problem, the

objective is to create a schedule that allocates visits to staffmem-

bers. The efficiency of the plan is judged by the amount of travel

time it requires and how well it has succeeded in allocating all visits

to staffmembers. The quality is judged by how well continuity is

kept with staffmember visits to each client.”(Eveborn et al., 2006:

964).

The premise embraced in this passage is echoed in much of the

literature on home care systems. The underpinning assumption is that

the nature of the problem and the objectives are a priori known (Begur

et al., 1997; Duque et al., 2015; Yuan et al., 2015). But how problems

https://doi.org/10.1016/j.jom.2017.11.001

Received 8 November 2015; Received in revised form 31 August 2017; Accepted 9 November 2017

∗

Corresponding author.

E-mail addresses: johan.groop@nhg.fi(J. Groop), mikko.ketokivi@ie.edu (M. Ketokivi), mahesh.gupta@louisville.edu (M. Gupta), jan.holmstrom@aalto.fi(J. Holmström).

Journal of Operations Management 53–56 (2017) 9–22

Available online 21 November 2017

0272-6963/ © 2017 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/).

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