Flexibility in service operations: review, synthesis and research agenda

Tactical capacity planning under uncertainty - a capacity limitation analysis

PURPOSE

Tactical capacity planning is crucial when hospitals must cope with substantial changes in patient requirements, as recently experienced during the Covid-19 pandemic. However, there is only little understanding of the nature of capacity limitations in a hospital, which is essential for effective tactical capacity planning.

DESIGN/METHODOLOGY/APPROACH

We report a detailed analysis of capacity limitations at a Norwegian tertiary public hospital and conducted 22 in-depth interviews. The informants participated in capacity planning and decision-making during the Covid-19 pandemic. Data are clustered into categories of capacity limitations and a correspondence analysis provides additional insights.

FINDINGS

Personnel and information were the most mentioned types of capacity limitations, and middle management and organizational functions providing specialized treatment felt most exposed to capacity limitations. Further analysis reveals that capacity limitations are dynamic and vary across hierarchical levels and organizational functions.

RESEARCH LIMITATIONS/IMPLICATIONS

Future research on tactical capacity planning should take interdisciplinary patient pathways better into account as capacity limitations are dynamic and systematically different for organizational functions and hierarchical levels.

PRACTICAL IMPLICATIONS

We argue that our study possesses common characteristics of tertiary public hospitals, including professional silos and fragmentation of responsibilities along patient pathways. Therefore, we recommend operations managers in hospitals to focus more on intra-organizational information flows to increase the agility of their organization.

ORIGINALITY/VALUE

Our detailed capacity limitation analysis at a tertiary public hospital in Norway during the Covid-19 pandemic provides novel insights into the nature of capacity limitations, which may enhance tactical capacity planning.

Adapting to change: Exploring reverse migration as a coping strategy among internal migrants in Bangladesh

The COVID-19 pandemic has slowed down economic growth and disrupted labor markets throughout the world, including Bangladesh. A significant proportion of people lost income sources in the formal and informal sectors, triggering them to return to villages, and the transition introduces us to the new phenomenon known as "reverse migration". This study explores and synthesizes the COVID-19 induced changing patterns of migration and returnees' coping strategies based on their level of preparedness as well as resource mobilization. A mixed-method research approach was applied to conduct the research. The study area was Rangpur (Pirganj, Taraganj, and Kaunia). For collecting primary data, semi-structured survey questionnaires were used and conducted 84 field survey data, 12 Focus Group Discussions (FGDs), 6 In-Depth Interviews (IDIs), 2 Key Informant Interviews (KIIs), and participant observations. Descriptive statistics and thematic analysis with the assistance of NVivo software were used to present the findings of this study. The findings of the study revealed that the COVID-19 pandemic fueled informal job holders' returning to their homeland due to a low level of preparedness and mobilized resources. The study found that most respondents were in severe level unemployment. As a result, a lack of physical assets, they could not start new income-generating ventures and encountered food insecurity due to unexpected price hikes. The alarming result indicates that internal reverse migration is gendered, and the adverse impact is more prevalent among female migrants rather than male migrants. Along with the governmental organizations, the highlights of this study would be essential for non-governmental organizations and development practitioners.

Organizational E-Readiness for the Digital Transformation of Primary Healthcare Providers during the COVID-19 Pandemic in Poland

The COVID-19 pandemic has forced many countries to implement a variety of restrictive measures to prevent it from spreading more widely, including the introduction of medical teleconsultations and the use of various tools in the field of inpatient telemedicine care. Digital technologies provide a wide range of treatment options for patients, and at the same time pose a number of organizational challenges for medical entities. Therefore, the question arises of whether organizations are ready to use modern telemedicine tools during the COVID-19 pandemic. The aim of this article is to examine two factors that impact the level of organizational e-readiness for digital transformation in Polish primary healthcare providers (PHC). The first factor comprises operational capabilities, which are the sum of valuable, scarce, unique, and irreplaceable resources and the ability to use them. The second factor comprises technological capabilities, which determine the adoption and usage of innovative technologies. Contrary to the commonly analyzed impacts of technology on operational capabilities, we state the reverse hypothesis. The verification confirms the significant influence of operational capabilities on technological capabilities. The research is conducted using a questionnaire covering organizational e-readiness for digital transformation prepared by the authors. Out of the 32 items examined, four are related to the operational capabilities and four to the technological capabilities. The result of our evaluation shows that: (i) a basic set of four variables can effectively measure the dimensions of OC, namely the degree of agility, level of process integration, quality of resources, and quality of cooperation; (ii) a basic set of three variables can effectively measure the dimensions of TC, namely adoption and usage of technologies, customer interaction, and process automation; (iii) the empirical results show that OC is on a higher level than TC in Polish PHCs; (iv) the assessment of the relationship between OC and TC reveals a significant influence of operational capabilities on technological capabilities with a structural coefficient of 0.697. We recommend increasing the level of technological capability in PHC providers in order to improve the contact between patients and general practitioners (GPs) via telemedicine in lockdown conditions.

Impacts of COVID-19 induced food insecurity among informal migrants: Insight from Dhaka, Bangladesh

Food insecurity is one of the rising problems in Bangladesh, and it is severely prevalent among informal migrant workers. In this case, the COVID-19 pandemic has multiplied the food insecurity of informal migrant workers. This study explores and synthesizes the COVID-19 induced food insecurity impact among informal migrants and recommends policy actions to tackle the COVID-19 led food crisis in Bangladesh. A qualitative research approach, including in-depth interviews, four FGDs, and participant observation, has been applied to data collection from different parts of Dhaka city. A thematic approach to interpretive phenomenological analysis is followed in this study. The results show that COVID-19 induced lockdown significantly affects informal migrants' household food security. Most participants report severe complications due to food insecurity like consuming less food, price hiking, no fish or meat, potato, and vegetable. Food insecurity leads to migrant's chronic food shortage, starvation, malnutrition of mother and children, and unhealthy food. As a result, the way of life of informal migrants has been directed to more fragility and vulnerability during the pandemic; even they are not affordable to maintain a minimal level of family affairs and necessity. The findings of this study would be essential guidelines for the governmental and non-governmental organizations and development practitioners to address the food insecurity situations.

Creating Short-Term Volume Flexibility in Healthcare Capacity Management

It is well-known that unpredictable variations in supply and demand of capacity in healthcare systems create the need for flexibility. The main tools used to create short-term volume flexibility in the healthcare system include overtime, temporary staff from internal calling lists, moving staff across units, internal staffing pools, external staffing agencies, queuing patients, and purchasing care from external providers. We study the creation of short-term volume flexibility in healthcare systems to manage short-term capacity losses and demand fluctuations. A questionnaire was developed and distributed among healthcare managers in the Region Västra Götaland healthcare system. Respondents were asked to what extent they used each tool to create short-term flexibility in capacity. Data were analyzed using multiple regression analysis. Several significant tendencies were found, including that acute units use overtime and internal staffing pools to a larger extent, and queuing patients and external providers to a lesser extent than planned units. The prerequisites and required managerial approaches used to efficiently manage aggregate capacity in the system differ substantially between different parts of the system. These differences must be addressed when, for example, capacity pools are considered. These results serve as a stepping stone towards a more thorough understanding of efficient capacity management in healthcare systems.

Internal flexibility in health-care organizations: a value-laden perspective on sustainability

Purpose

This study aims to identify the constituents of internal flexibility in health-care organizations for achieving sustainability. The study incorporates resources-based theory and resource-dependence theory to illustrate how health-care organizations exhibit internal flexibility to redress environmental uncertainties and maximize organizational responsiveness.

Design/methodology/approach

This paper conducts a case study in a health-care organization to explore how health-care organizations acquire several resources for attaining internal flexibility. A survey of health-care professionals was conducted to assess the relationships using partial least squares-structural equation modeling.

Findings

In the present study, the dimensions of internal flexibility in health-care organizations are identified. This study also established internal flexibility as a higher-order factor and explained its underlying aspects as a value-laden perspective on sustainability.

Research limitations/implications

The study was conducted in the public health-care context in India. The framework needs to be tested in another context. The sample size for the study was limited to health-care experts, which could be extended to include the customer’s perspective.

Originality/value

The study contributes to the body of knowledge by identifying the specific dimensions of internal flexibility and explains as a higher-order factor. It enhances the understanding of sustainability from a flexibility perspective of the firm.