Transition to hospital process orientation: The case of regional hospitals in Latvia

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