Process management in hospitals: an empirically grounded maturity model

work of W. Edwards Deming has convinced industry that must first measure quality and then emphasise process to improve quality. In response to Deming's arguments and in light of perception that software industry is unable to produce quality products on schedule, and within budget, more software development organisations are now emphasising process measurement, monitoring, and assessment. This paper describes what is meant by software process and discusses an approach for its measurement and improvement. INTRODUCTION Unreliable software makes big news, from emergency services disasters to social security payment blunders. Improved software quality is essential to ensure reliable products and services, and gain customer satisfaction. While software development has existed for more than four decades, we failed so far to make as an industry and as an engineering discipline rather than craft. Developing reliable and usable software that is delivered on and within budget still represents difficult endeavour for many organisations. As role of software becomes increasingly critical for businesses as well as for human lives, problems caused by software products that are late, over budget, or that do not work, become magnified. If lives are lost or people inconvenienced due to incapable computer software, news media is there to make big stories. Organisations are realising that their fundamental problems is immaturity of their software process. Robert Lai (1993) proposes that process improvement is second maturity wave of software industry. He states that the first wave of software was developed using waterfall model in 1970's. Today we are Transactions on Information and Communications Technologies vol 8, © 1994 WIT Press, www.witpress.com, ISSN 1743-3517 216 Software Management in midst of second wave maturity movement as we attempt to formally define development process and best ways to continuously improve it (Lai 1993). Taking lead in this area has been Watts Humphrey (Humphrey 1989, 1990, 1991), and Software Engineering Institute (SEI) at Carnegie Mellon University. SEI started in 1986 to develop process maturity framework to help organisations appraise maturity of their software process, and to provide guidance for organisations to improve their software process capability. A brief description of framework was released in September 1987, including maturity questionnaire. SEI evolved model and questionnaire into 5 -Level Capability Maturity Model (CMM) in 1991. In February 1993, released CMM version 1.1 (Paulk et al 1993). This paper discusses software process and describes capability maturity model (CMM). It also shows how CMM can be used as basis to measure maturity of software process of an organisation and plan its improvement. SOFTWARE QUALITY AND PROCESS IMPROVEMENT In his book Quality is Free Phil Crosby states that: Quality is free. It is not gift, is free. What cost money are unqualify of things all actions that involve not doing jobs right first time (Crosby 1980). If such statement is true for many disciplines, is particularly true for evidence is abundant in number of software products which exceeded their budget, were produced late, failed to satisfy user requirements, and are full of bugs. demand for improved software quality is increasing to ensure reliable products and services. benefits of improved quality comes in form of reduction in failure costs. For software projects failure costs include (DTI 1992): • costs of correcting defects, both before and after delivery • overruns against and budget • unnecessary high maintenance costs • indirect costs which users incur due to poor quality software link between process maturity and software quality is expressed in premise that The quality of software system is governed by quality of process used to develop and maintain it. One stumbling block to improving software quality seems to be that not enough attention is paid to overall development process itself. While software professionals typically devote their to developing, testing or documenting software products, no one has prime responsibility for improving software process. Experience has shown that if Transactions on Information and Communications Technologies vol 8, © 1994 WIT Press, www.witpress.com, ISSN 1743-3517 Managing Systems 217 no one is working on software process, orderly improvement is unlikely. process certainly won't improve itself, rather, most likely, will deteriorate over time. Continuous improvement can occur only if process infrastructure is in place. Watts Humphrey argues in an early article published in Datamation, April 1989 that: Without work on process, there will be little or no progress in improving software. THE SOFTWARE PROCESS Adopting process view of software development represents revolutionary change in perspective. A process orientation to software development involves elements of structure, focus, measurement, ownership, skills, and supporting technology. In this section we investigate what is meant by software process. What Is Software Process According to Webster's dictionary, process is a system of operations in producing something .. series of actions, changes, or functions that achieve an end result. Chambers Concise Dictionary defines process as a series of actions or events .. sequence of operations or changes undergone. IEEE defines process as a sequence of steps performed for given purpose. In general business context, process is defined as a structured, measured set of activities designed to produce specified output for particular customer or market (Davenport 1993). These definitions put strong emphasis on HOW work is done, in contrast to product focus's emphasis on WHAT. Accordingly, process can be considered as a specific ordering of work activities across and place, with beginning, an end, and clearly identified inputs and outputs: structure for action. In this paper we will adopt following definitions quoted in (Humphrey 1990, Paulk et al 1993) are intended to encompass software throughout its life, which covers new development, enhancement, and repair. software process is The set of activities, methods, and practices used in production and evolution of software. software engineering process is The total set of software engineering activities needed to transform user's requirements into software. Transactions on Information and Communications Technologies vol 8, © 1994 WIT Press, www.witpress.com, ISSN 1743-3517 218 Software Management People and Software Process Software development is still people-intensive activity. Talented people are most important element in any software organisation. Even if you get best people available, if they do not follow common process, if everyone wrote in different programming languages, used different conventions, or didn't co-ordinate their design and code changes with their peers, results will be chaos. Successful software organisations have learned that even best professionals need structured and disciplined environment in which to do cooperative work. Software organisations that do not establish such disciplines condemn their people to endless hours of repetitively solving technically trivial problems. obvious fact is that attracting best people is vital, but is also essential to support them with an effectively managed software process. Technology and Software Process Another myth is widespread belief that some technologically advanced tool or method will provide magic answer to software crisis. This is not only wrong, but is dangerous. Organisations which jumped on bandwagon of CASE tools, and ended up in failure and wasted and effort have learned their lesson hard way. Just ask yourself before introducing technology: What do I want to automate? In absence of defined, practised, and managed process, introducing automation can lead to increased chaos. There are several factors which limit effective use of software technology: an illdefined process, inconsistent process implementation, and poor process management. Software technology cannot be fully effective until these problems have been properly addressed. Need for Defined Process If no effort is made to define and enhance software development process across whole organisation, each software development project latches on to its own tools, methods, and practices with little guidance available on how to use them. This ad hoc approach will not be sufficient to tackle task of developing complex software systems. goal of software process management is to enable organisations to produce software that meets cost, schedules, and quality objectives. principles are same that underpins statistical process control-principles that have been successfully used in controlling scientific experiments and in high -volume manufacturing operations. Statistical concepts have been found to be just as applicable to software development as they are to production of manufactured goods such as motor cars. Applying such concepts will only be possible if there is defined and managed process. Software Process Models Transactions on Information and Communications Technologies vol 8, © 1994 WIT Press, www.witpress.com, ISSN 1743-3517

PurposeThe purpose of this paper is to report the production of the key process areas (KPAs) for an e‐capability maturity model for construction organisations, based on drivers and barriers to e‐procurement.Design/methodology/approachPrevious researchers have recognised the positive consequences of possessing a model to sustain the embedment of any business process within an organisation. The capability maturity model progressed into one of the most internationally recognised since the release of the Software Capability Maturity Model (CMM) in 1991. Since then, many CMMs have been developed. This paper reports on how a CMM based on drivers and barriers to e‐procurement identified in Eadie et al. can be developed to form the KPAs in the formation of a model to gauge the maturity of an organisation in relation to e‐procurement.FindingsIt was found that factor analysis could be used as a data reduction technique to reduce the 20 drivers and 32 barriers identified as being applicable to e‐procurement in construction, to 12 KPAs: Quality management system; Cost management system; Intergroup coordination; Time management system; Operational analysis; Organisational change management system; Integrated teaming; Governance management system; Requirements development; Knowledge management system; Integration management system; and Organisational environment.Originality/valueThis paper provides particulars of a research project which uses factor analysis to produce a set of KPAs from the drivers and barriers identified in Eadie et al. These KPAs are then subjected to a mapping process linking them to maturity levels to develop a CMM to analyse the e‐procurement capability of construction organisations. This mapping will be reported in a later paper. This e‐readiness of organisations will indicate the current state of a construction organisation in terms of its readiness to carry out e‐procurement. The paper describes in detail the identification of the KPAs.

PurposeThe purpose of this paper is to explore how process management (PM) can support small- and medium-sized enterprises (SMEs) in pursuing sustained competitive advantage. For this purpose, a dynamic capabilities (DC) lens was used.Design/methodology/approachA narrative literature review and a multiple case study with an action research approach at two road freight transport companies were used.FindingsPM provides structure and system thinking to support the development of competitive advantage. Concerning PM, management of knowledge, management style and process orientation are key factors for the generation of competitive advantage for SMEs.Research limitations/implicationsThis study contributes to PM literature by studying its support for and implementation at SMEs. Furthermore, the study contributes to the literature on DC by providing concrete examples of activities linked to such capabilities.Practical implicationsThis study contributes to practitioners by providing examples of implementing PM and identifying competitive advantage, connected with PM elements.Social implicationsThis study has social and environmental implications for the quality of life of the Swedish people.Originality/valueThis paper contributes to clarifying the connection between the research fields of quality management and DC to explore how PM can support SMEs in pursuing sustained competitive advantage.

By using the diagnosis related groups(DRGs) method, we analyze and compare the rationality and feasibility of outcomes and human resources distribution of clinical specialties and health care professionals. It may increase the hospital management levels and feasibility. The introduction of DRGs for the majority of hospital management may enhance the performance evaluation and human resource levels in the hospitals. Key words: DRGs; Hospital management; Performance evaluation; Human resources

Changes in the innovative development of the domestic construction industry associated with the transition to a new technological order lead to the conclusion that automation and management of the construction object life cycle business processes consist in the creation of object-oriented automated technologies for each stage of the cycle based on a common data environment and an consolidated building (structure) information models, virtually representing various parts of investment, design, as-built and operational documentation. The domain area of the article is buildings life cycle, where the object of research is the formalization of technologies for automating the construction objects life cycle. The processes of the life cycle stages are technologically different, and if the general purpose of the project documentation content is to create a safe, healthy and comfortable living environment for people, then the main semantic attribute of the life cycle stages is the activity of decision makers on the management of these processes. Their activities are always object-oriented and supported by appropriate technologies at all stages. The structure of stages in the life cycle of buildings and structures contains various domain areas of activity for these specialists. The article proposes the development of a methodology for constructing automated technologies for managing of the construction objects life cycle stages, based on the practical application of the Markov algorithms theory conclusions, formulated as a Constructive Direction. This Direction asserts that any virtual or material object always has a Constructive Process implementing it. "Digitalization" as the basis for "Big Data" collection and accumulation, "artificial intelligence" as the rules for generating constructive objects, business processes automation as the practical implementation of for Constructive Process technologies and particular construction objects generation, are based on the concept of Constructive Direction. It is proposed to formally represent any automated Constructive Process (K-process) as the structure of a generative grammar model. Based on the formulated conceptual and methodological approaches for the lifecycle stages, a schematic diagram for building of automated K-process technologies models is proposed. This will reduce risks and costs, increase the development efficiency of lifecycle automated technologies. The final conclusion of the study is an indication for creating a new technological order and generating conditions for a safe, healthy and comfortable life of people in virtual and natural environments while expensive and time-consuming object-oriented automated technologies of the life cycle stages support have been developing.

The Software Engineering Institute's Softwares Process Maturity Model was developed to provide a basis for assessing an organization's ability to perform software engineering activities. It also provides a guide for improving an organization's software engineering capability. The maturity model was designed on the basis of concepts associated with developing new, large, complex systems. This has led to difficulties in applying the model to organizations involved entirely in software maintenance. The author addresses the tailoring issues encountered in applying the software maturity model to a large maintenance organization at Paramax Space Systems Operation. It is concluded that the issues that arise when the Capability Maturity Model is applied to a software sustaining engineering organization are significant but do not prohibit the use of the model as a guide for software process improvement. Issues mainly arise with the treatment requirements and differences in project management needs. The primary tailoring issues are ones of wording as opposed to applicability to maintenance activities. >

Management of processes instead of functions has growing importance into the health care. Transition to hospital process orientation (HPO) changes the way physicians and other health professionals have used to practice before. Study was performed to explore factors affecting introduction of HPO in Latvian hospitals responding to significant external pressures during the years of economic crisis to detect the best practices used for process management implementation in clinical setting. To reach the research goal dissimilarities between current performance and management of hospitals were explored. As changes in hospital reimbursement system demand improved efficiency, hospital’s performance was measured by decrease in avoidable hospitalisations, and increase in usage of more cost effective alternatives to a full hospitalisation. A regression analysis was performed to evaluate correlations of hospitalisation rates in Latvian hospitals to various outpatient health services utilisation indicators. This was done to exclude influence of external factors on hospital performance and to prove the positive impact of HPO initiatives on hospitalisation rate. Afterward the performance of all regional hospitals was compared and the two most distinct hospitals were selected for further in depth analysis. Operational data of the selected hospitals and a set of structured interviews outlined the differences between both hospital’s managerial practices and factors affecting the introduction of process oriented initiatives. The theoretical research together with comparative analysis of approaches used in both hospitals served as a basis for elaboration of recommendations towards development of HPO and facilitation of the development of self-management competence of health professionals.

The diagnosis related groups(DRGs) method is applied in hospital management at both hospital and clinical department level. This technology enabled us to evaluate hospital medical services in general, objectively evaluate discipline development, and formulate individualized discipline guidelines, supporting scientific distribution of hospital resources. At the department level, the technology supported clinical departments in their discipline construction and quality management. The application of DRGs can improve fine management of hospitals. Key words: Diagnosis related groups; Hospital management; Medical services; Application

Although there is a growing body of evidence supporting the significance of servant leadership as a basic component in shaping the execution of TQM practices, the research has not fully examined the framework associated with servant leadership in terms of “customer focus, people management, process management, strategic planning, information and analysis” in general and in the information technology industry. Therefore, the authors conducted this empirical research examining the associations among servant leadership and the abovementioned TQM practices in the information technology industry. This empirical study also examined the mediating role of interfunctional coordination in TQM practices in the context of servant leadership. We gathered data from 335 leaders in 57 software companies in the information technology industry with at least a capability maturity model (CMM) level 3 to CMM5 companies providing software development and services. The data were collected from team leaders, project heads, project managers, lead testers, and higher-level managers of the marketing and operations management area. We investigated how servant leadership interacts with the application of these five TQM practice components and the mediating role of the interfunctional coordination construct in this interaction. To accomplish this goal, we empirically investigated a structural model and mediation models by bootstrapping and SEM with IBM AMOS (IBM, 2023). The model fit indices CMIN/DF 1.724, CFI 0.953, TLI 0.938, NFI 0.920, SRMR 0.049, RMSEA 0.049, and PCl close 0.624 indicate excellent model fit, and further investigation was carried out. The findings showed that putting TQM practices into practice was positively and directly correlated with servant leadership. Interfunctional coordination partially mediates TQM practices through servant leadership, with a positive association. The results confirm the influence of servant leadership on TQM practices in the information technology industry.

Patient Dumping: The Physician's Dilemma

Purpose There are many challenges in the development of a digital library (DL) and their complexity can be approached effectively with a maturity model. In a maturity model, the features of a phenomenon are divided into different levels and at each level, they are first improved before going on to the improvement or realization of the next level. The purpose of this study is to design a digital library maturity model (DLMM) in Iran. Design/methodology/approach The DLMM was designed using a qualitative approach, meta-synthesis and the Delphi technique. First, the maturity features of a DL were identified by assessing 68 sources of study concerning DLs and maturity models using meta-synthesis. The maturity features were then validated by experts using the three-round Delphi technique. Finally, the experts were asked to categorize these features into the five levels of the capability maturity model (CMM) as the base model. Findings By analyzing these sources, three categories, seven concepts and 35 codes for the maturity features of a DL were identified. The majority of previous studies focused on the use of hardware/software systems as the backup and empowerment of DLs and the concept of DL content. The maturity features were then validated by experts using the three-round Delphi technique. Like the base model, DLMM has five levels, and most features were categorized into the third and fourth levels by the experts. Features such as human resources, needs assessment of DL and readiness to create a DL were included in the second level. Originality/value This work adds the concept of the maturity model to the literature of DLs.

Asset service organisations often recognise asset management as a core competence to deliver benefits to their business; however, it is less clear about how organisations know whether their asset management processes are adequate. This paper contends that asset management maturity models, which combine best practices with identified competencies, may provide a useful approach to test the capacity of organisations to manage assets. Existing capability maturity models are subject to wide variations in their implementation and sophistication. Drawing on five dimensions of effective asset management - spatial, temporal, organisational, statistical and evaluation - as identified by Amadi-Echendu et al. (2010), this paper undertakes a comprehensive comparative analysis of six existing maturity models to identify the gaps in key process areas. Results suggest incorporating these dimensions into an integrated approach to assess the maturity of asset-intensive organisations would provide a comprehensive approach towards assessing capabilities of asset service organisations.

The construction sector is under growing pressure to increase productivity and improve quality, most notably in reports by Latham (1994, Constructing the Team, HMSO, London) and Egan (1998, Rethinking Construction, HMSO, London). A major problem for construction companies is the lack of project predictability. One method of increasing predictability and delivering increased customer value is through the systematic management of construction processes. However, the industry has no methodological mechanism to assess process capability and prioritise process improvements. Standardized Process Improvement for Construction Enterprises (SPICE) is a research project that is attempting to develop a stepwise process improvement framework for the construction industry, utilizing experience from the software industry, and in particular the Capability Maturity Model (CMM), which has resulted in significant productivity improvements in the software industry. This paper introduces SPICE concepts and presents the results from two case studies conducted on design and build projects. These studies have provided further in‐sight into the relevance and accuracy of the framework, as well as its value for the construction sector.

Capability maturity models (CMM), an out growth of the decades old quality movement, and originally developed by Carnegie Mellon University's Software Engineering Institute for the US Defense Department in the 1980s as a way to improve software engineering, has become the inspiration for similar models addressing every aspect of public management by governments around the world. CMM posits several evolutionary stages that organizations must pass through to achieve increasingly higher levels of capability in achieving quality. Stages are determined by research evidence, expert opinion, best practices and evaluations. While CMM has produced some impressive gains, it has drawn criticism for lacking a theoretical underpinning, exorbitant costs, being somewhat subjective and lack of success in many organizations. The field has no universal agreed upon standards, so it may be necessary to create an organization to study and vet various CMM applications. The field as it matures presents an excellent opportunity to study public management in the context of organizations employing CMM.

The European software industry has become accustomed to the application of quality management systems (QMS) based on ISO 9000 as a strategy for software quality improvement. The Capability Maturity Model (CMM) has not seen widespread use within Europe Precisely because the CMM appears impressive in its usefulness it is worth examining its strengths and weaknesses so that we can assess its likely impact on the European software industry. The paper summarises the fundamental weaknesses of the CMM and also considers the benefits the CMM has to offer to existing ISO certified organisations. Conversely, we highlight the lack of attention to detail in the CMM to issues which are addressed in the ISO standard. We also assess the likely impact of Spice and Bootstrap, the European alternatives to the CMM.