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A maturity model for BPM capability assessment in Dutch hospitals

J.F. Mens - 4140796 Master of Business Informatics Utrecht, 03 July 2016

Master Thesis “A maturity model for BPM capability assessment in Dutch hospitals” J. F. Mens

4140796

Supervisors: R.S. Batenburg, PhD M. R. Spruit, PhD J.P.P. Ravesteyn, PhD

Utrecht University Faculty of Science Graduate School of Natural Sciences Master of Business Informatics

Utrecht, 03 July 2016

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Abstract Background Dutch hospitals are dealing with a variety of challenges impacting the quality of healthcare. Hospitals are under pressure to provide high-quality healthcare at an acceptable cost. The population is aging and requires care from a variety of medical specialists. Meanwhile, the government and health insurers are demanding more transparency into the quality of healthcare and are stimulating free market competition. Hospitals are dealing with complex, multidisciplinary processes and a departmentalised organisational structure which make it difficult to adapt to these changing conditions. Business Process Management (BPM) is a discipline that can be utilised by organisations desiring to improve quality. Several BPM maturity models exist that assist in the assessment and improvement of business process management capabilities. The goal of applying such a model is reaching a higher level of business process management maturity, and thereby improve the quality of the product or service that is being delivered. However, no such model exists specifically for the healthcare domain which takes into account healthcare-specific conditions. In this study, a domain-specific BPM maturity model for the Dutch hospital industry is developed. Methodology The study was structured according to the Maturity Assessment Model Development Method. First, a literature study was conducted to identify the characteristics of general-purpose BPM maturity models and domain-specific process frameworks used in hospitals. A Delphi study was conducted among a panel of experts from Dutch hospitals and academia. A Delphi study constitutes a multi-round surveying technique for collecting rich data and reaching a consensus among a panel of experts . The selection of the capabilities identified by this panel was presented to a different, external panel of experts for validation. The model was further validated by developing a measurement instrument and applying it in one of the hospitals that was included in the Delphi study. Results Eleven existing BPM maturity models were analysed for their structure and contents. In addition, two domain-specific process frameworks were analysed. This lead to the establishment of five healthcare-specific maturity levels in the proposed healthcare-specific BPM maturity model. After three consecutive rounds, the Delphi study yielded a total of thirty-three capabilities relevant to Dutch hospitals, spread across five different factors: People, culture, governance, strategic alignment and IT. Validation of the capabilities by an external panel supported the consensus that was reached in the Delphi study. Application of the measurement instrument showed that the model accurately reflects the practical situation and helps to identify relevant points for improvement. Conclusions This study shows that the hospitals included in the panel are currently at a low-to-medium level of BPM maturity. They are aiming to improve their BPM maturity in the coming years and are implementing various projects to do so. The BPM maturity model developed in this study gives insight into the strong and weak points in regards to BPM capabilities, and helps to focus the efforts for future improvement. The model shows that capabilities related to people and culture are currently most influential in improving BPM maturity in hospitals. Further application of the model is needed to ensure generalisability.

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Acknowledgements This thesis is the final part towards achieving the degree of Master of Science in Business Informatics. The past years have been highly educational and provided me with the tools and knowledge to further develop myself in this field. Writing this thesis has been a challenging and interesting process. It would not have been possible without the advice and support of various people to whom I dedicate these acknowledgements. I would like to thank the following people for their contributions to this project: Pascal Ravesteijn for assisting in the formation of the research topic, providing valuable feedback and facilitating the project through the research group of process innovation & information systems. Ronald Batenburg for our interesting conversations on the subject of healthcare and for his guidance in performing this research. Marco Spruit for taking over Ronald’s position as first examiner and providing feedback in the final stages of the thesis. Sjaak Brinkkemper for acting as the second examiner in place of Marco. Furthermore, I would like the following people for their participation: Ben Ahlers, Bart van Hattem, Gijs Croonen, Paul Salverda, Christiaan Hol, Jasper Douma, Eveline Goldhoorn, Christine van Hartingsveldt, and Marc Rouppe van der Voort. Their expertise in healthcare was invaluable in completing this study. I would also like to thank my girlfriend Mirjam, my family and friends for their support during this process. Lastly, thanks go out to my friend and fellow student Koen for our many research-related and non-research-related conversations.

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Table of Contents Abstract ........................................................................................................................................................ III Acknowledgements ...................................................................................................................................... IV List of Tables ...............................................................................................................................................VII List of Figures ............................................................................................................................................ VIII Introduction ................................................................................................................................................... 1 1

Problem Statement ................................................................................................................................ 2

2

Relevance ............................................................................................................................................... 3 2.1

Practical Relevance................................................................................................................................ 3

2.2

Scientific Relevance............................................................................................................................... 4

3

Research Approach ................................................................................................................................ 6

4

Research Methods .................................................................................................................................. 8 4.1

Literature Review Method ..................................................................................................................... 9

4.2

Maturity Assessment Model Development Method ............................................................................. 10

4.3

Delphi Method ..................................................................................................................................... 12

5

Business Process Management & Maturity ......................................................................................... 15 5.1

The Business Process ........................................................................................................................... 15

5.2

Business Process Management (BPM) ................................................................................................. 16

5.3

BPM Maturity ...................................................................................................................................... 18

5.4

BPM Maturity Models .......................................................................................................................... 19

5.5

Conclusion........................................................................................................................................... 21

6

BPM in Dutch Hospitals ....................................................................................................................... 25 6.1

NIAZ Accreditation ............................................................................................................................. 25

6.2

JCI Accreditation ................................................................................................................................. 29

6.3

Quick Scan ........................................................................................................................................... 30

6.4

Conclusion........................................................................................................................................... 34

7

Delphi Study ......................................................................................................................................... 35 7.1

First Round Results ............................................................................................................................. 36

7.2

Second Round Results ......................................................................................................................... 38

7.3

Third Round Results ............................................................................................................................ 44

7.4

Conclusion........................................................................................................................................... 47

8

Validation............................................................................................................................................. 49

9

Towards a BPM Maturity Model for Dutch Hospitals.......................................................................... 53 9.1

Capabilities .......................................................................................................................................... 53

9.2

Maturity Levels .................................................................................................................................... 56

9.3 10 10.1

Model Application ............................................................................................................................... 57 Conclusions ...................................................................................................................................... 60 Limitations .......................................................................................................................................... 62 V

10.2

Future Research ................................................................................................................................... 63

Bibliography ................................................................................................................................................. 64 Appendix I.

Project Details ..................................................................................................................... 69

Supervisors ....................................................................................................................................................... 69 Author Details .................................................................................................................................................. 71 Appendix II.

BPM Maturity Model Descriptions ...................................................................................... 72

BPM Maturity Model (Rosemann & De Bruin, 2005a, 2005b) ........................................................................... 73 BPM Maturity Model (Fisher, 2004) .................................................................................................................. 75 BPR Maturity Model (Maull et al., 2003) ........................................................................................................... 76 Process and Enterprise Maturity Model (Hammer, 2007) ................................................................................. 78 BPO Maturity Model (Lockamy & McCormack, 2004; McCormack et al., 2009) ............................................... 80 Capability Maturity Model Integration for Services (SEI, 2010)........................................................................ 81 Process Maturity Ladder (PML) (Harmon, 2004) ............................................................................................... 83 Business Process Maturity Model (BPMM-OMG) (Weber et al., 2008) .............................................................. 85 Business Process Maturity Model (BPMM-Lee) (Lee et al., 2007) ..................................................................... 87 Process Performance Index (PPI) (Rummler-Brache Group, 2004) ................................................................... 90 Process Management Maturity Assessment (PMMA) (Rohloff, 2009a, 2009b).................................................. 92 Appendix III. Appendix IV. Appendix V.

Delphi Study Results Round One .................................................................................... 93 Delphi Study Results Round Two.................................................................................... 98 Delphi Study Results Round Three ................................................................................... 102

Appendix VI.

Application of the BPM Maturity Measurement Instrument ....................................... 109

Appendix VII.

Conference Paper .......................................................................................................... 112

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List of Tables Table 1 Mapping of capability areas between two BPMM models according to Rohloff (2011) ............................... 5 Table 2 Overview of research questions and methods ............................................................................................ 8 Table 3 Scoping and design characteristics of the maturity model for Dutch hospitals ........................................ 12 Table 4 Meta-overview of maturity model overviews found in existing literature ................................................ 20 Table 5 Meta-overview of BPM maturity model characteristics ............................................................................ 23 Table 6 Overview of responses for accreditation standards used in practice ........................................................ 31 Table 7 Overview of responses for management methods and models used in practice ....................................... 31 Table 8 Overview of responses for other initiatives related to process management ........................................... 32 Table 9 Current and expected BPM Maturity levels of respondent organisations ................................................. 32 Table 10 Process management success factors as experienced by the expert panel .............................................. 33 Table 11 Process management obstacles as experienced by the expert panel....................................................... 34 Table 12 Number of respondents per Delphi study round. .................................................................................... 35 Table 13 Factor ratings provided in the first Delphi round ................................................................................... 36 Table 14 Capability rankings for the strategic alignment factor ........................................................................... 39 Table 15 Capability rankings for the governance factor ........................................................................................ 39 Table 16 Capability rankings for the methods factor ............................................................................................ 40 Table 17 Capability rankings for the IT factor ....................................................................................................... 41 Table 18 Capability rankings for the people factor ............................................................................................... 41 Table 19 Capability rankings for the culture factor ............................................................................................... 42 Table 20 All capabilities and their weighted scores (factor score multiplied by capability score) ......................... 44 Table 21 Summary of agreement scores for the Delphi Study ............................................................................... 47 Table 22 Comparison of characteristics between the Dutch and Portuguese healthcare systems ......................... 49 Table 23 Factor rankings compared between the Delphi study and validation session ......................................... 50 Table 24 Comparison of scores for strategic alignment capabilities ..................................................................... 51 Table 25 Comparison of scores for governance capabilities .................................................................................. 51 Table 26 Comparison of scores for methods capabilities ...................................................................................... 51 Table 27 Comparison of scores for IT capabilities ................................................................................................. 51 Table 28 Comparison of scores for people capabilities ......................................................................................... 52 Table 29 Comparison of scores for culture capabilities ......................................................................................... 52 Table 30 Capabilities with notable scoring differences between Delphi panel experts and validation experts ..... 52 Table 31 A BPM Maturity Model for hospitals....................................................................................................... 56 Table 32 General characteristics of maturity levels and healthcare-specific maturity levels ................................ 57 Table 33 Maturity scores resulting from practical application of the model in a hospital .................................... 58 Table 34 Dimensions and measurement levels for the ten BPR dimensions (Maull et al., 2003) .......................... 77 Table 35 Process areas and their categories for each maturity level in the CMMI for Services (SEI, 2010) ........... 83 Table 36 Process areas and their related maturity levels according to BPMM-OMG (Weber et al., 2008) ............. 87 Table 37 The maturity level and related focus areas for the BPMM by Lee et al. (2007) ....................................... 88 Table 38 Characteristics of BPM maturity levels as defined by Lee et al. (2007) ................................................... 88 Table 39...