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Questions from Day 1

    1.       Provide an example of a combined good/service.
    2.       What is servitization?
    3.       What is effectiveness and efficiency? How are they related?
    4.       Harley questions

    5.       Which are the legislative risks associated with international supply chains?
    6.       Which are the strategies that help mature supply chain organisations to embed the
             concept of risk into their strategy?
    7.       How must supply chain organisations change with the times to ensure ongoing
             success?
    8.       What is the holistic view in sustainability?
    9.       Which trends are identified in the article?




Dr. Elias A. Hadzilias – OCI February 2012                                                   1
SUPPLY CHAIN COMPLEXITY:
                                   Dealing with a Dynamic System




Dr. Elias A. Hadzilias – OCI February 2012                         2
Complexity definition

    An intricately structured and variable system
    Highly sensitive in its adjustment to the initial
     conditions or to even minor changes, creating a vast
     number of development possibilities
    A large collection of interacting components
    Difficult to understand or examine due to its design
     and/or operations
    A system in process, changing and developing over
     time



Dr. Elias A. Hadzilias – OCI February 2012                  3
Supply Chain Complexity Study

     Conducted by PRTM
      Management consultants
      and MIT in 2006.

     80 percent of the
      participating companies
      believed their supply chains
      to be highly complex.

     Almost 60 percent of the
      participants also thought
      that their supply chain had a
      high infrastructure cost
      basis.
Dr. Elias A. Hadzilias – OCI February 2012   4
Three main aspects of complexity

    Operational complexity
    Logical complexity
    Administrative complexity

    The article analyses the first 2 aspects.




Dr. Elias A. Hadzilias – OCI February 2012      5
Operational complexity factors

     Diverse logistics with numerous transportation options (sea,
      land and air), requiring that organisations make daily
      decisions to remain competitive.

     Unpredictable influences on supply times, such as port
      strikes, natural disasters, etc., forcing businesses to increase
      their level of safety stock to maintain the level of service.

     Navigation of foreign regulations and legal restrictions.

     The need for professional cultural and linguistic specialisation
      in order to benefit from the opportunities offered by the
      global economy.
Dr. Elias A. Hadzilias – OCI February 2012                               6
Globalisation forces

     Management of several production sites simultaneously
     Specialisation of production centers
     A need for customer/supplier proximity in order to minimise
      transport and distribution costs
     Risk management and disaster recovery plans
     Reduced flexibility in the event of production line failures
     Planning process complexities and capacity balancing
      headaches
     Making decisions on what to manufacture, where to
      manufacture it and where to source raw materials
     Overall management and control of inventories and processes


Dr. Elias A. Hadzilias – OCI February 2012                       7
Number of products/services




Dr. Elias A. Hadzilias – OCI February 2012   8
Informational (logical) complexity

    Bullwhip effect




    Demand?
    Price fluctuations?
    Sales promotion campaigns?
Dr. Elias A. Hadzilias – OCI February 2012   9
Solution: prevention, reduction and management




    Prevention of complexity is achieved by analysing the root causes of
     complexity and quantifying it as a monetary value, permitting a
     comparison of complexity costs with the commercial benefit of each root
     cause.
    Reduction in complexity is obtained through a proper balance between
     centralised and decentralised planning. Another approach is by building a
     streamlined and optimal operational and business model, which pushes
     the differentiation point closer to the customer…

 Dr. Elias A. Hadzilias – OCI February 2012                                      10
Reduction in complexity




Dr. Elias A. Hadzilias – OCI February 2012   11
Complexity management examples
  Southwest Airlines: same
   vessel type
  Toyota: internal
   standardisation
  Dell: innovative business                 http://www.transbus.org/reseaux/59000.html
   model

  In-class complexity discussion
            IKEA: ?
            Easyjet: ?
            Transpole: ?
            Greek railway: ?



Dr. Elias A. Hadzilias – OCI February 2012                                            12
Conclusions
 SOLUTIONS TO COMPLEXITY ISSUES

     Reduction of “long tail” customers, catalog numbers, suppliers with low
      sales turnover which increase complexity without adding value.

     Continuous examination of item costs along the supply chain (landed cost
      analysis) and emphasis on local procurement/production decisions,
      reducing total supply chain complexity.

     Pushing the differentiation point, understanding end customer demand,
      standardisation of elements of which the customer is not aware and
      involving the supply chain in product development processes, thus
      avoiding unnecessary complexity along the chain.

     Local and lean management versus centralised,              multi-system
      management to reduce supply chain complexity.
Dr. Elias A. Hadzilias – OCI February 2012                                       13
THE COMPLEXITY IMPERATIVE:
                                   HOW FINANCIAL SERVICES FIRMS
                                      MUST GRAPPLE WITH THE
                                    FUNDAMENTAL REALITY THAT
                                  THEIR BUSINESS OPERATIONS AND
                                    SYSTEMS ARE TOO COMPLEX




Dr. Elias A. Hadzilias – OCI February 2012                         14
Complexity characteristics

     Too many process or product variants
     Too many interdependencies and interfaces
     Process bottlenecks and fragmentation
     Technology legacy proliferation
     Lack of structure and clear rules
     High cost and management effort attributed to running and
      improving the organization


   Executives rarely use the words “managing complexity” when describing the
   challenge of upgrading the operational performance of their organizations.
   Instead, they struggle to cope with the symptoms of complexity – issues that
   have arisen out of underlying business decisions, policies and practices over
   time.
Dr. Elias A. Hadzilias – OCI February 2012                                         15
Barriers to overcome complexity

     Complexity is structural; deeply-embedded in the business
      and operating models of their institutions.
     Complexity is cultural; organizations have been
      unintentionally designed to produce complexity based on
      behavior that has driven profits over the last several years.
     The linkages between delivery systems and product
      organizations have grown in an unstructured manner instead
      of being engineered to avoid unnecessary complexity.
     Without clear top-down definition of value to the customer,
      organizations will freelance and create overly complex
      operations, processes and systems.



Dr. Elias A. Hadzilias – OCI February 2012                            16
Trade-Off between Cost and Value of Complexity




Dr. Elias A. Hadzilias – OCI February 2012       17
Dimensions of complexity




Dr. Elias A. Hadzilias – OCI February 2012   18
Business model complexity drivers

     One of the major sources of complexity in financial
      institutions is the proliferation of products, distribution
      channels, pricing, customer segments and locations.
     In seeking to enhance a product feature, such as interest
      terms or account bundling, banks all too often simply added a
      new product where they lacked a product framework (i.e.,
      structured, modular, hierarchical) that could differentiate
      between a new product, an existing product variant, a new
      product feature, a product parameter, or the associated
      service dimensions – and facilitate rationalization.




Dr. Elias A. Hadzilias – OCI February 2012                            19
Operations and process complexity drivers




Dr. Elias A. Hadzilias – OCI February 2012   20
Information technology complexity drivers

    Inflexible, outdated code
    Overlapping and redundant systems
    Excessive patching and interfacing
    Technology proliferation
    Competing IT standards, vendors, architectures and
     philosophies
    Immature or under-developed IT management
     practices




Dr. Elias A. Hadzilias – OCI February 2012                21
Governance and organizational complexity drivers

    Structures, governance models, planning and
     budgeting processes create non-value adding
     complexity.
    Autonomous organizations, along with decentralized
     incentives, motivate business heads to optimize their
     own units’ performance at the expense of
     externalizing complexity costs to the wider group.
    Most often, there is no business-aligned “operating
     architecture” that would define the overall target
     operational blueprint across business model,
     operations and IT in a clear and binding way.

Dr. Elias A. Hadzilias – OCI February 2012                   22
Case study from the financial sector

    Major consumer finance company had a complex
     product, process and IT architecture that was
     restricting its growth and had driven unit costs to
     levels far above peer averages.
    The company decided to launch a “back to basics”
     program aimed at reducing complexity front-to-back,
     targeting a 10% revenue lift and a 30% cost
     improvement within two years.
    As a starting point, the company focused on
     simplifying its product portfolio.


Dr. Elias A. Hadzilias – OCI February 2012                 23
Key characteristics of the reengineering project




Dr. Elias A. Hadzilias – OCI February 2012          24
Reengineering roadmap to complexity reduction

    Benchmark the organization against best-in-class
     peers
    Uncover the complexity drivers that need to be
     remedied
    Develop a simplified target operating model
    Execute and manage change




Dr. Elias A. Hadzilias – OCI February 2012              25
MASTERING COMPLEXITY
                                    CAPTURE THE HIDDEN OPPORTUNITY




Dr. Elias A. Hadzilias – OCI February 2012                           26
Portfolio complexity drives operational
  complexity across the value chain




Dr. Elias A. Hadzilias – OCI February 2012   27
1st step: collect information

    Revenues and costs by product
     line and profit or cost center
    Production volumes by
     production location and
     product line                            Cost picture
    Cost, capacity, and utilisation of           by
     equipment                               product line
    Overhead related to support
     functions
    Inbound, outbound and
     intraplant logistics.
Dr. Elias A. Hadzilias – OCI February 2012                  28
2nd step: quantify and model three key factors

    Scale: the effect of volume on costs per unit

    Efficiency: relative productivity, utilisation (average
     and peak), and process complexity (automation,
     handovers, and standardisation)

    Factor costs: input costs (such as labour), operating
     costs (such as fuel or IT) and logistics costs (such as
     shipping)



Dr. Elias A. Hadzilias – OCI February 2012                     29
3rd step: create cost/value matrix




Dr. Elias A. Hadzilias – OCI February 2012   30
Eight strategies for mastering complexity

    Make complexity transparent
    Apply the “80/20” rule
    Optimise the whole, not the separate silos
    Segregate complexity into separate systems
    Bundle features together to “standardise” complexity
    Define plant and asset roles
    Identify roadblocks—and delayer
    Challenge assumptions and model new scenarios



Dr. Elias A. Hadzilias – OCI February 2012                  31
Conclusions
    Most complexity-reduction efforts target existing structures
     and processes.
    Thinking out of the box can propel a company forward by
     orders of magnitude, leaving “business as usual”—and the
     competition—in the dust.
           What would our business model look like if we offered only one
            product?
           If we outsourced all manufacturing?
           If we sold only online?
           If we sold only to China?
           What impact would these changes have on production, logistics, sales,
            and financial performance?
    Henry Ford’s zero-complexity approach to automobile
     production proved to be a breakthrough. “People can have the
     Model T in any color—so long as it’s black”.
Dr. Elias A. Hadzilias – OCI February 2012                                          32
A FRAMEWORK TO GRASP THE
                      COMPLEXITY OF HEALTHCARE OPERATIONS
                       IN ORDER TO IMPROVE PERFORMANCE




Dr. Elias A. Hadzilias – OCI February 2012                  33
The research questions

    Which aspects or factors cause complexity of
     healthcare operations?

    How can these different aspects be elaborated into a
     framework to analyse and assess the complexity of a
     particular healthcare operation in order to improve
     performance?




Dr. Elias A. Hadzilias – OCI February 2012                  34
The 4 complexity aspects

    Input uncertainty
    Routing complexity and routing variety
    Amount of shared resources
    Concurrent resource availability




Dr. Elias A. Hadzilias – OCI February 2012    35
Input uncertainty

     Input uncertainty is defined as a function of the number of
      input possibilities in a given healthcare process.
     A large range of patients with different demands increases
      the input uncertainty.
     An increase in the number of input possibilities increases the
      information requirements with respect to required capacity.
     Input uncertainty can refer to uncertainty on both the unit
      level and that of the individual health care process: in that
      case it concerns the activities required, the routing, the
      timing of activities, and the production or process time of
      activities.



Dr. Elias A. Hadzilias – OCI February 2012                             36
Reducing uncertainty: the focused factory

     In 1969, Skinner described in his seminal paper* an
      electronics manufacturer that served a heterogeneous
      customer base in three industries.
     The three customers had different expectations: one
      emphasised low costs, the second product reliability, and the
      third fast new product introduction.
     Yet, the company had decided to serve all markets from a
      single factory.
     This, Skinner submitted, was an unfocused factory par
      excellence, which from a normative point of view is bad
      manufacturing strategy.

    * Skinner, W., 1969. "Manufacturing - missing link in corporate strategy", Harvard Business
    Review, vol. 50, no. 3, pp. 136-145.
Dr. Elias A. Hadzilias – OCI February 2012                                                  37
Routing complexity and routing variety

    Routing complexity refers to the number of separate
     activities and resources in a healthcare operation,
     the relationship between these activities and
     resources and their restrictions.
    The number of different routings of patients in one
     patient group is called the routing variety.




Dr. Elias A. Hadzilias – OCI February 2012                 38
Reducing routing variety and complexity: the
  clinical pathway
    Clinical Pathway: Critical Path Method (CPM) or
     Program Evaluation Technique (PERT)




Dr. Elias A. Hadzilias – OCI February 2012             39
Amount of shared resources

     A characteristic of a hospital unit, a specialty or a patient
      group is that it often shares resources with other units,
      specialties or groups in the same hospital in order to achieve
      high utilisation rates.
     These shared resources seriously complicate the effective
      control of the flows of patients and hamper the achievement
      of high service levels.
     Examples are the beds of an intensive care unit, a physician’s
      capacity, and the rooms in the operating theatre.
     The benefits of shared resources in terms of high utilisation
      rates should be weighed against the drawbacks in terms of
      longer lead-times due to waiting times.


Dr. Elias A. Hadzilias – OCI February 2012                             40
Addressing the shared resources: dedicated and
  contracted resources
     A solution is to dedicate resources to a specified group of
      patients, or to a specialty.
     Another solution is to contract resources for specified periods
      in which these resources are shared between two or more
      specialties, i.e. time-shared resources.




Dr. Elias A. Hadzilias – OCI February 2012                              41
Concurrent resource availability

     The simultaneous availability of resources complicates
      planning activities, and can result in waiting times, under-
      utilisation of resources and high coordination costs.
     Especially, when expensive and scarce resources are involved,
      the necessity for the simultaneous availability of different
      resources complicates the control of these healthcare
      operations.




Dr. Elias A. Hadzilias – OCI February 2012                            42
Addressing concurrent resource availability:
  healthcare teams and integrated jobs
     The need for having resources available at the same time, has
      motivated hospitals to develop both collaborating healthcare
      teams and integrated jobs.
     Collaborating healthcare teams deal with complexity by
      integrating the required coordination mechanisms in their
      way of working, e.g. the multidisciplinary meeting or the use
      of boundary spanners, also known as cross-functional liaisons.
     Integrated jobs, such as the physician assistant, the nurse
      practitioner or the hospital physician, integrate several
      required resources into one job. Often, these jobs are
      oriented to patient domain rather than to a medical specialty.



Dr. Elias A. Hadzilias – OCI February 2012                             43
The proposed framework to analyse and assess
  the complexity of a healthcare operation
     Determine which healthcare operation needs to be analysed
      and assessed.
            Organise the patients in 2-3 groups
     Make a description of the healthcare operation.
            Use enterprise modelling techniques
     Elaborate the four complexity aspects in such a way that the
      causes of complexity of a healthcare operation can be
      diagnosed.
            Analyse the corresponding elements included in Table 2
     Make a diagnosis and analysis of the planning and control
      activities used to reduce complexity.
            Cost/benefit analysis for the feasibility of the project


Dr. Elias A. Hadzilias – OCI February 2012                              44
Testing the framework in the cardiology unit of a
  Dutch hospital
     Description of the healthcare operation: interviews with
      cardiologists, nurses, lab assistants and administrators, and
      observations
     Diagnosing and analysing complexity aspects: interviews
      with different healthcare providers, administrators and their
      executives, document analysis, and data from agenda and
      admission information systems
     Planning and control activities: semi-structured interviews
      with different healthcare providers involved and their
      executives.
     Lead-time: data from information systems, and additional
      measurements of waiting times.


Dr. Elias A. Hadzilias – OCI February 2012                            45
Research results and conclusions

    Table 3…

    The article provides a method to analyse and assess
     complexity in order to improve different logistical
     performance indicators.




Dr. Elias A. Hadzilias – OCI February 2012                 46

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Day2 oci

  • 1. Questions from Day 1 1. Provide an example of a combined good/service. 2. What is servitization? 3. What is effectiveness and efficiency? How are they related? 4. Harley questions 5. Which are the legislative risks associated with international supply chains? 6. Which are the strategies that help mature supply chain organisations to embed the concept of risk into their strategy? 7. How must supply chain organisations change with the times to ensure ongoing success? 8. What is the holistic view in sustainability? 9. Which trends are identified in the article? Dr. Elias A. Hadzilias – OCI February 2012 1
  • 2. SUPPLY CHAIN COMPLEXITY: Dealing with a Dynamic System Dr. Elias A. Hadzilias – OCI February 2012 2
  • 3. Complexity definition An intricately structured and variable system Highly sensitive in its adjustment to the initial conditions or to even minor changes, creating a vast number of development possibilities A large collection of interacting components Difficult to understand or examine due to its design and/or operations A system in process, changing and developing over time Dr. Elias A. Hadzilias – OCI February 2012 3
  • 4. Supply Chain Complexity Study  Conducted by PRTM Management consultants and MIT in 2006.  80 percent of the participating companies believed their supply chains to be highly complex.  Almost 60 percent of the participants also thought that their supply chain had a high infrastructure cost basis. Dr. Elias A. Hadzilias – OCI February 2012 4
  • 5. Three main aspects of complexity Operational complexity Logical complexity Administrative complexity The article analyses the first 2 aspects. Dr. Elias A. Hadzilias – OCI February 2012 5
  • 6. Operational complexity factors  Diverse logistics with numerous transportation options (sea, land and air), requiring that organisations make daily decisions to remain competitive.  Unpredictable influences on supply times, such as port strikes, natural disasters, etc., forcing businesses to increase their level of safety stock to maintain the level of service.  Navigation of foreign regulations and legal restrictions.  The need for professional cultural and linguistic specialisation in order to benefit from the opportunities offered by the global economy. Dr. Elias A. Hadzilias – OCI February 2012 6
  • 7. Globalisation forces  Management of several production sites simultaneously  Specialisation of production centers  A need for customer/supplier proximity in order to minimise transport and distribution costs  Risk management and disaster recovery plans  Reduced flexibility in the event of production line failures  Planning process complexities and capacity balancing headaches  Making decisions on what to manufacture, where to manufacture it and where to source raw materials  Overall management and control of inventories and processes Dr. Elias A. Hadzilias – OCI February 2012 7
  • 8. Number of products/services Dr. Elias A. Hadzilias – OCI February 2012 8
  • 9. Informational (logical) complexity Bullwhip effect Demand? Price fluctuations? Sales promotion campaigns? Dr. Elias A. Hadzilias – OCI February 2012 9
  • 10. Solution: prevention, reduction and management  Prevention of complexity is achieved by analysing the root causes of complexity and quantifying it as a monetary value, permitting a comparison of complexity costs with the commercial benefit of each root cause.  Reduction in complexity is obtained through a proper balance between centralised and decentralised planning. Another approach is by building a streamlined and optimal operational and business model, which pushes the differentiation point closer to the customer… Dr. Elias A. Hadzilias – OCI February 2012 10
  • 11. Reduction in complexity Dr. Elias A. Hadzilias – OCI February 2012 11
  • 12. Complexity management examples  Southwest Airlines: same vessel type  Toyota: internal standardisation  Dell: innovative business http://www.transbus.org/reseaux/59000.html model  In-class complexity discussion  IKEA: ?  Easyjet: ?  Transpole: ?  Greek railway: ? Dr. Elias A. Hadzilias – OCI February 2012 12
  • 13. Conclusions SOLUTIONS TO COMPLEXITY ISSUES  Reduction of “long tail” customers, catalog numbers, suppliers with low sales turnover which increase complexity without adding value.  Continuous examination of item costs along the supply chain (landed cost analysis) and emphasis on local procurement/production decisions, reducing total supply chain complexity.  Pushing the differentiation point, understanding end customer demand, standardisation of elements of which the customer is not aware and involving the supply chain in product development processes, thus avoiding unnecessary complexity along the chain.  Local and lean management versus centralised, multi-system management to reduce supply chain complexity. Dr. Elias A. Hadzilias – OCI February 2012 13
  • 14. THE COMPLEXITY IMPERATIVE: HOW FINANCIAL SERVICES FIRMS MUST GRAPPLE WITH THE FUNDAMENTAL REALITY THAT THEIR BUSINESS OPERATIONS AND SYSTEMS ARE TOO COMPLEX Dr. Elias A. Hadzilias – OCI February 2012 14
  • 15. Complexity characteristics  Too many process or product variants  Too many interdependencies and interfaces  Process bottlenecks and fragmentation  Technology legacy proliferation  Lack of structure and clear rules  High cost and management effort attributed to running and improving the organization Executives rarely use the words “managing complexity” when describing the challenge of upgrading the operational performance of their organizations. Instead, they struggle to cope with the symptoms of complexity – issues that have arisen out of underlying business decisions, policies and practices over time. Dr. Elias A. Hadzilias – OCI February 2012 15
  • 16. Barriers to overcome complexity  Complexity is structural; deeply-embedded in the business and operating models of their institutions.  Complexity is cultural; organizations have been unintentionally designed to produce complexity based on behavior that has driven profits over the last several years.  The linkages between delivery systems and product organizations have grown in an unstructured manner instead of being engineered to avoid unnecessary complexity.  Without clear top-down definition of value to the customer, organizations will freelance and create overly complex operations, processes and systems. Dr. Elias A. Hadzilias – OCI February 2012 16
  • 17. Trade-Off between Cost and Value of Complexity Dr. Elias A. Hadzilias – OCI February 2012 17
  • 18. Dimensions of complexity Dr. Elias A. Hadzilias – OCI February 2012 18
  • 19. Business model complexity drivers  One of the major sources of complexity in financial institutions is the proliferation of products, distribution channels, pricing, customer segments and locations.  In seeking to enhance a product feature, such as interest terms or account bundling, banks all too often simply added a new product where they lacked a product framework (i.e., structured, modular, hierarchical) that could differentiate between a new product, an existing product variant, a new product feature, a product parameter, or the associated service dimensions – and facilitate rationalization. Dr. Elias A. Hadzilias – OCI February 2012 19
  • 20. Operations and process complexity drivers Dr. Elias A. Hadzilias – OCI February 2012 20
  • 21. Information technology complexity drivers Inflexible, outdated code Overlapping and redundant systems Excessive patching and interfacing Technology proliferation Competing IT standards, vendors, architectures and philosophies Immature or under-developed IT management practices Dr. Elias A. Hadzilias – OCI February 2012 21
  • 22. Governance and organizational complexity drivers Structures, governance models, planning and budgeting processes create non-value adding complexity. Autonomous organizations, along with decentralized incentives, motivate business heads to optimize their own units’ performance at the expense of externalizing complexity costs to the wider group. Most often, there is no business-aligned “operating architecture” that would define the overall target operational blueprint across business model, operations and IT in a clear and binding way. Dr. Elias A. Hadzilias – OCI February 2012 22
  • 23. Case study from the financial sector Major consumer finance company had a complex product, process and IT architecture that was restricting its growth and had driven unit costs to levels far above peer averages. The company decided to launch a “back to basics” program aimed at reducing complexity front-to-back, targeting a 10% revenue lift and a 30% cost improvement within two years. As a starting point, the company focused on simplifying its product portfolio. Dr. Elias A. Hadzilias – OCI February 2012 23
  • 24. Key characteristics of the reengineering project Dr. Elias A. Hadzilias – OCI February 2012 24
  • 25. Reengineering roadmap to complexity reduction Benchmark the organization against best-in-class peers Uncover the complexity drivers that need to be remedied Develop a simplified target operating model Execute and manage change Dr. Elias A. Hadzilias – OCI February 2012 25
  • 26. MASTERING COMPLEXITY CAPTURE THE HIDDEN OPPORTUNITY Dr. Elias A. Hadzilias – OCI February 2012 26
  • 27. Portfolio complexity drives operational complexity across the value chain Dr. Elias A. Hadzilias – OCI February 2012 27
  • 28. 1st step: collect information Revenues and costs by product line and profit or cost center Production volumes by production location and product line Cost picture Cost, capacity, and utilisation of by equipment product line Overhead related to support functions Inbound, outbound and intraplant logistics. Dr. Elias A. Hadzilias – OCI February 2012 28
  • 29. 2nd step: quantify and model three key factors Scale: the effect of volume on costs per unit Efficiency: relative productivity, utilisation (average and peak), and process complexity (automation, handovers, and standardisation) Factor costs: input costs (such as labour), operating costs (such as fuel or IT) and logistics costs (such as shipping) Dr. Elias A. Hadzilias – OCI February 2012 29
  • 30. 3rd step: create cost/value matrix Dr. Elias A. Hadzilias – OCI February 2012 30
  • 31. Eight strategies for mastering complexity Make complexity transparent Apply the “80/20” rule Optimise the whole, not the separate silos Segregate complexity into separate systems Bundle features together to “standardise” complexity Define plant and asset roles Identify roadblocks—and delayer Challenge assumptions and model new scenarios Dr. Elias A. Hadzilias – OCI February 2012 31
  • 32. Conclusions  Most complexity-reduction efforts target existing structures and processes.  Thinking out of the box can propel a company forward by orders of magnitude, leaving “business as usual”—and the competition—in the dust.  What would our business model look like if we offered only one product?  If we outsourced all manufacturing?  If we sold only online?  If we sold only to China?  What impact would these changes have on production, logistics, sales, and financial performance?  Henry Ford’s zero-complexity approach to automobile production proved to be a breakthrough. “People can have the Model T in any color—so long as it’s black”. Dr. Elias A. Hadzilias – OCI February 2012 32
  • 33. A FRAMEWORK TO GRASP THE COMPLEXITY OF HEALTHCARE OPERATIONS IN ORDER TO IMPROVE PERFORMANCE Dr. Elias A. Hadzilias – OCI February 2012 33
  • 34. The research questions Which aspects or factors cause complexity of healthcare operations? How can these different aspects be elaborated into a framework to analyse and assess the complexity of a particular healthcare operation in order to improve performance? Dr. Elias A. Hadzilias – OCI February 2012 34
  • 35. The 4 complexity aspects Input uncertainty Routing complexity and routing variety Amount of shared resources Concurrent resource availability Dr. Elias A. Hadzilias – OCI February 2012 35
  • 36. Input uncertainty  Input uncertainty is defined as a function of the number of input possibilities in a given healthcare process.  A large range of patients with different demands increases the input uncertainty.  An increase in the number of input possibilities increases the information requirements with respect to required capacity.  Input uncertainty can refer to uncertainty on both the unit level and that of the individual health care process: in that case it concerns the activities required, the routing, the timing of activities, and the production or process time of activities. Dr. Elias A. Hadzilias – OCI February 2012 36
  • 37. Reducing uncertainty: the focused factory  In 1969, Skinner described in his seminal paper* an electronics manufacturer that served a heterogeneous customer base in three industries.  The three customers had different expectations: one emphasised low costs, the second product reliability, and the third fast new product introduction.  Yet, the company had decided to serve all markets from a single factory.  This, Skinner submitted, was an unfocused factory par excellence, which from a normative point of view is bad manufacturing strategy. * Skinner, W., 1969. "Manufacturing - missing link in corporate strategy", Harvard Business Review, vol. 50, no. 3, pp. 136-145. Dr. Elias A. Hadzilias – OCI February 2012 37
  • 38. Routing complexity and routing variety Routing complexity refers to the number of separate activities and resources in a healthcare operation, the relationship between these activities and resources and their restrictions. The number of different routings of patients in one patient group is called the routing variety. Dr. Elias A. Hadzilias – OCI February 2012 38
  • 39. Reducing routing variety and complexity: the clinical pathway Clinical Pathway: Critical Path Method (CPM) or Program Evaluation Technique (PERT) Dr. Elias A. Hadzilias – OCI February 2012 39
  • 40. Amount of shared resources  A characteristic of a hospital unit, a specialty or a patient group is that it often shares resources with other units, specialties or groups in the same hospital in order to achieve high utilisation rates.  These shared resources seriously complicate the effective control of the flows of patients and hamper the achievement of high service levels.  Examples are the beds of an intensive care unit, a physician’s capacity, and the rooms in the operating theatre.  The benefits of shared resources in terms of high utilisation rates should be weighed against the drawbacks in terms of longer lead-times due to waiting times. Dr. Elias A. Hadzilias – OCI February 2012 40
  • 41. Addressing the shared resources: dedicated and contracted resources  A solution is to dedicate resources to a specified group of patients, or to a specialty.  Another solution is to contract resources for specified periods in which these resources are shared between two or more specialties, i.e. time-shared resources. Dr. Elias A. Hadzilias – OCI February 2012 41
  • 42. Concurrent resource availability  The simultaneous availability of resources complicates planning activities, and can result in waiting times, under- utilisation of resources and high coordination costs.  Especially, when expensive and scarce resources are involved, the necessity for the simultaneous availability of different resources complicates the control of these healthcare operations. Dr. Elias A. Hadzilias – OCI February 2012 42
  • 43. Addressing concurrent resource availability: healthcare teams and integrated jobs  The need for having resources available at the same time, has motivated hospitals to develop both collaborating healthcare teams and integrated jobs.  Collaborating healthcare teams deal with complexity by integrating the required coordination mechanisms in their way of working, e.g. the multidisciplinary meeting or the use of boundary spanners, also known as cross-functional liaisons.  Integrated jobs, such as the physician assistant, the nurse practitioner or the hospital physician, integrate several required resources into one job. Often, these jobs are oriented to patient domain rather than to a medical specialty. Dr. Elias A. Hadzilias – OCI February 2012 43
  • 44. The proposed framework to analyse and assess the complexity of a healthcare operation  Determine which healthcare operation needs to be analysed and assessed.  Organise the patients in 2-3 groups  Make a description of the healthcare operation.  Use enterprise modelling techniques  Elaborate the four complexity aspects in such a way that the causes of complexity of a healthcare operation can be diagnosed.  Analyse the corresponding elements included in Table 2  Make a diagnosis and analysis of the planning and control activities used to reduce complexity.  Cost/benefit analysis for the feasibility of the project Dr. Elias A. Hadzilias – OCI February 2012 44
  • 45. Testing the framework in the cardiology unit of a Dutch hospital  Description of the healthcare operation: interviews with cardiologists, nurses, lab assistants and administrators, and observations  Diagnosing and analysing complexity aspects: interviews with different healthcare providers, administrators and their executives, document analysis, and data from agenda and admission information systems  Planning and control activities: semi-structured interviews with different healthcare providers involved and their executives.  Lead-time: data from information systems, and additional measurements of waiting times. Dr. Elias A. Hadzilias – OCI February 2012 45
  • 46. Research results and conclusions Table 3… The article provides a method to analyse and assess complexity in order to improve different logistical performance indicators. Dr. Elias A. Hadzilias – OCI February 2012 46