2. Theoretical Framework

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MASTER THESIS MATTHIJS POLMAN

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A Research on the Management of Switches Between Processes in the Dutch Public Sector

Word count: 11.922 Master Thesis

Master Supply Chain Management

Faculty of Economics and Business, University of Groningen

August 24^th, 2016

S.M. Polman BSc.

S2350556

Assessor/university dr. S.A. de Blok

Co-assessor/university prof. dr. D.P. van Donk

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Abstract

In public organizations, the management of switches between different service delivery processes is not always easy. This is caused by laws and regulations that restrict the amount of information that can be shared between the involved organizations.

Furthermore, these organizations have autonomous roles, which makes it difficult to cooperate and to exchange information. Moreover, they have to manage a trade-off between delivering quality to customers and delivering an efficient service to society.

Therefore, research is performed on process switches and the underlying mechanisms or prerequisites for managing process switches in public organizations. Literature about process switches in various sectors is reviewed and indicates the following underlying mechanisms: planning & coordination, trained professionals, and ICT. It is researched whether these underlying mechanisms from literature influence the management of process switches in public organizations and its most important aspect: a flow of information. This can be valuable for these organizations, in order to know to which mechanisms they can pay attention for increasing the quality of process switches. The research results are based on a multiple case study, consisting of 10 cases. These cases are locations where organization A and organization B work together in the public service chain to deliver their service to their specific customers.

10 semi-structured interviews with employees from both organizations delivered the data for this research. By making use of the 3 underlying mechanisms from theory, and the found underlying mechanism “standardization”, public organizations can deliver efficient and high quality services. These underlying mechanisms help the organizations to achieve a flow of information, which leads to better process switches.

Then, a better service can be delivered to customers and society.

Key words: Public sector, management of process switches, flow of information, planning and coordination, people and training, ICT, and standardization.

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1. Introduction

All Dutch civilians receive public services. Whether it is applying for a passport or filling in forms for a restitution of income tax, everyone is faced with an interaction with governmental agencies for receiving a public service every now and then.

Governmental agencies might have to do this service delivery, in more complex situations, via different processes. The switches between those processes are conducted to deliver an efficient service that fits the customer’s need. Nowadays, society demands more efficiency in the public sector, which enlarges the importance of good management of process switches.

Process switches are, in this research, defined as the switch from one process to another within a service delivery process. After a process switch, the service has to be delivered in a new context, via different methods and/or with different actors. Process switches are difficult to manage for public organizations, because the switch between contexts demands them to cooperate inter-organizationally. This is particularly difficult because the involved organizations have their own objectives for delivering the service (Pekkanen and Niemi, 2013), such as serving the contradictory interests of their specific target groups. For controlling these process switches, it is needed to get a better understanding of what process switches are and what the underlying mechanisms are for managing them.

According to literature on process switches, successful process switches require a well-defined plan, trained professionals performing them, and a transfer of digital information, which is supported by a proper ICT system (Coleman, 2003). These requirements for a successful process switch are considered as underlying mechanisms. Naylor, Aiken, Kurtzman, Olds, and Hirschman (2011) found that a poor process switch can lead to unnecessary high rates of (health) service usage, as well as gaps in quality of care (and service). These gaps in quality and efficiency are often caused by miscommunication between the involved organizations (Naylor et al., 2011).

When process switches go wrong, information does not flow properly, files get lost, and customers have to tell the same story several times, which can cause annoyance.

This results in dissatisfied customers and society being discontent about inefficient public services. Research on process switches in the public sector is, therefore,

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desirable, as successful process switches have the potential to be beneficial for everyone in society.

In this research, process switches at two cooperating organizations in the Dutch public sector are studied. This setting deserves attention because there is a low degree of integration in the Dutch public sector, which leads to ineffective sharing of information (Algemene Rekenkamer, 2012). The setting has various characteristics. One of them is that the involved parties have autonomous roles (Pekkanen and Niemi, 2013), which contributes to the low degree of integration. The employees are highly skilled professionals and have to hand over sensitive and private information about customers to each other. This exchange of information is hindered by laws and regulations (Yang and Maxwell, 2011), as it is not always allowed to exchange information because of privacy issues. Moreover, the involved parties are forced to work with each other, as they cannot select their chain partners (Pekkanen and Niemi, 2013), which is not always easy for them. Additionally, the organizations have to be objective towards their customers, as they have to serve every citizen equally (Pekkanen and Niemi, 2013).

The delivered services are highly customized and sometimes need to be initiated unexpectedly, which makes them unpredictable (Pekkanen and Niemi, 2013). It is challenging for the organizations, which all have their specific target groups, to deliver a highly customized service, based on unexpected events, with process switches being involved. The autonomous roles of the involved organizations, the unpredictability of events, and regulations (including the need for efficiency) make the public sector an interesting setting for this research.

Although important mechanisms for managing process switches in healthcare have been discussed in literature (Coleman, 2003), many aspects of process switches in the public sector still remain to be elucidated. These process switches have, to the best of the author’s knowledge, not been studied before. It is unknown whether process switches in the public sector require a different management approach than process switches in other sectors. In order to cross the gap in knowledge about the management of process switches and to increase our understanding of what is important for managing them in a public setting, the following research question is stated:

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What are the underlying mechanisms for managing process switches in the public sector in order to achieve a flow of information?

The research question is of academic relevance because it adds new knowledge to the field of managing process switches, as it is yet unknown whether the selected underlying mechanisms from theory are also applicable in the public sector. Existing theory about process switches in other sectors is applied in a new setting. The managerial contribution is that the research will explore which aspects of these underlying mechanisms are important for the management of process switches and the creation of a flow of information in the study setting. The research question will be answered by doing a multiple case study on process switches at two organizations which, together, deliver a service in the Dutch public sector. The case study analyses how the process switches work at the involved organizations and explores what is important for successfully managing them. Case study design fits best for this explorative research, as it helps in building theory (Voss, Tsikriktsis and Frohlich, 2002).

This thesis will continue with a description of process switches and an exploration of the literature in the theory section in chapter 2. Then, the methodology for the case study research will be explained in chapter 3. By following this methodology, the research is performed, which will lead to the results in chapter 4. Based on these results, a discussion can be conducted in chapter 5. Thereafter, conclusions will be drawn and recommendations for further research will be given in chapter 6.

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2. Theoretical Framework

2.1 Process switches and a flow of information

Process switches are, in this research, defined as the switch from one process to another within a service delivery process. An example of a process switch is illustrated in the following figure:

Figure 1: Process switch

At the start of the traditional process, a case is registered and an intake is done. Then the case is prepared (in step 1), and information from the involved organizations and customers is collected. Based on the collected information, the decision is made whether a process switch is needed. Process switches are executed because the initial chosen approach (traditional process) is not always the optimal process for finalizing a case. Therefore, it can be decided (step 2) to continue the service delivery via another service delivery process (an alternative/optimized process). After the process switch (step 3), the case has to be received (step 4) and to be finalized (step 5 in the optimized/alternative process) in its new context. In this new context, other organizations and/or actors will be working on it. Also, it often happens that other methods and systems are used in the alternative process. These characteristics distinguish a process switch from a relatively simple information handover between actors in a single context.

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An example of such a process switch is found in healthcare. In the traditional process, patients are treated in hospitals. Due to external pressures in the public sector, i.e. the desire to work more efficiently and to do more with less money, patients are now often transferred to a treatment process at home where they are treated via home care. This alternative or optimized process fits better with the patient’s needs. Society wants public organizations to deliver efficient services. Process switches make this efficient service delivery possible. In case the most cost-efficient way is not an option, a specific, costlier approach (in this example the traditional process in a hospital) can be used to deliver the service. Therefore, it is important to choose the service delivery process that best fits with the customer’s and society’s needs, and that is, given the circumstances of the case, the most efficient process.

During process switches (step 3 in figure 1), it is important that information flows between the involved processes and actors at the process switch. This flow of information makes sure that the alternative/optimized process is properly informed about the details of a case and is important for the success of process switches.

Therefore, “information flow” is included in the conceptual model (figure 4) as the most important aspect of a process switch (figure 2). The information that is collected in the traditional process should be properly transferred to the alternative process, as the availability of information helps in establishing a good service for the customer. For the creation of a flow of information, it is important that the information is of high quality (Moberg, Cutler, Gross and Speh, 2002) that it is accessible (for the involved chain partners) (Ramayah and Omar, 2010), that it flows timely (Moberg et al., 2002), and that it is transparent (Folinas, Manikas, and Manos, 2006). These four concepts are used as characteristics of a flow of information. The following figure summarizes a process switch, its most important element: a flow of information, and the characteristics of a flow of information:

Figure 2: Process switches, a flow of information and its characteristics Process switches

Flow of information Characteristics:

- Quality - Accessibility - Timeliness - Transparency

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2.2 Underlying mechanisms for managing process switches

In the previous paragraph, process switches and a flow of information have been explored. In this section, the underlying mechanisms for the management of process switches will be discussed. The underlying mechanisms are selected based on the underlying mechanisms in the article of Coleman (2003). Literature about these underlying mechanisms was found by conducting a literature review on various contexts in which process switches occur. These contexts have been selected via an iterative process, in which insights from the healthcare context led to new insights from contexts in which similar process switches happen. For this literature review the following search terms were used: “coordinating transitional care”, “planning transitional care”, “transitional processes”, “training for transitional processes”,

“managing rush orders”, “training in the public sector” and “ICT for process switches”.

For this literature search, the Smart Cat library of the University of Groningen, and Google Scholar were used. The reviewed articles are peer reviewed. Articles are screened on abstract, introduction, and conclusion for process switches in (public) organizations and their expected underlying mechanisms. Articles were selected for this theory section when they provided insights for the management of process switches. Roughly 60 articles have been scanned and about 20 articles have been selected for this theory section, which can be found in figure 3. Articles are selected based on their theoretical contribution on process switches and on the number of citations by other authors. Once a relevant article was found, a forward search was conducted in Google Scholar, in order to find out whether the insights about the topics had progressed over time. Figure 3 provides an overview of the insights from the literature review on process switches. For every mechanism, it is described from which context literature on process switches was found. Subsequent paragraphs will go into more detail on the findings of the literature review.

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2.2.1 Planning and coordinating process switches

The importance of planning is described for process switches in transitional care, in which it can improve the quality of a care transition (Coleman, 2003). Because many process switches in healthcare happen unplanned, patients do not know what their role is and they cannot be prepared on what is going to happen to them (Coleman and Berenson, 2004). When a planning is lacking, information is more difficult to be

Mechanism Literature stream (Context)

What is found?

Planning and coordination

Transitional care

Rush orders

Planning transitional care (Coleman and Berenson, 2004).

Planning makes transition comfortable (Holland and Harris, 2007).

Coordination of a process switch (Crowley et al., 2011).

Company’s reaction to a rush order (Xiong et al., 2002).

Be flexible, timely delivery leads to satisfaction of customer (Beamon, 1999).

Trained Professionals

Transitional care

Public sector

Training needed (Coleman and Berenson, 2004) (McDonagh et al., 2004) (Ouchida et al., 2009).

Training increases quality of transition (McDonagh et al., 2004).

Training gets more attention (Laugaland et al., 2012).

Training helps in understanding each other’s roles (Kroll and Moynihan, 2015).

Train people to achieve a better cooperation and to have a better understanding about the whole system (Marks et al., 2002).

Train people for better planning, task coordination, and empowerment (Aguinis and Kraiger, 2009).

ICT Transitional care

Channel management

ICT systems improve quality of transitional care and help in the handover of information (Georgiou et al., 2013).

Have ICT in place to support exchange of information. Human element is important when using ICT (Dobrzykowski and Tarafdar, 2015).

Online sales are increasing, which increases the difficulty of managing different channels and demands for good support of ICT (Sousa and Voss, 2006).

Conflicts between channels increase need for good process switch (Falk et al., 2007).

Figure 3: Insights about underlying mechanisms for the management of process switches

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exchanged between healthcare providers (Olsen, Østnor, Enmarker, and Hellzén, 2013), which makes the process switch less comfortable for patients, as their treatment plan is unclear. Holland and Harris (2007) stress the importance of planning the discharge of patients from a hospital, in order to achieve continuity of the healthcare process in the new context. By involving patients in the preparation of the process switch, they get a better understanding about their treatment, which can contribute to a quick recovery. The silo mentality in healthcare, in which every organization is acting as a single entity, also makes planning for process switches difficult (Coleman and Berenson, 2004). It causes organizations to act independently, and reduces the propensity to share information among each other. Counteracting this silo mentality will give healthcare providers in different institutions a stimulus to share information with each other, to communicate, and to prepare patients for process switches when developing the overall care plan (Coleman and Berenson, 2004).

Planning process switches is also about prioritization. The importance of prioritization is found in production environments in the private sector. The public sector can learn from companies in the private sector, as private companies have a higher incentive to work efficiently, because of competition. Moreover, they are, in general, experienced in delivering customized services, because customers pay for customized services from the private sector. These companies use forecasting for their production planning and scheduling. Sometimes, there are rush orders, which are the last minute orders.

Companies usually receive rush orders after their production plans have been concluded. Rush orders are needed when demand unexpectedly changes or when production processes fail. In those situations, process switches are conducted and appropriate and reasonable response from the producer is important as it puts strain on customer relationship and services (Xiong, Tor, Khoo, and Bhatnagar, 2002). When a rush order comes in, the company has to decide whether it wants to produce this order and whether it wants to switch processes to the rush order (and let normal orders wait). Beamon (1999) describes the ability to adapt to rush orders, in addition to the normal orders, as delivery flexibility. Having a flexible supply chain, that is able to deal with disruptions/rush orders, leads to increased customer satisfaction (Beamon, 1999).

A flexible supply chain is able to deal with process switches and can deliver its products via various processes to the customer. With rush orders, it is challenging to serve the interests of all customers. By prioritizing the orders, companies can give attention to

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the orders that need the most attention. For planning process switches, it is therefore important that a right prioritization strategy is used, in order to make sure that customers’ interests are served best. Once process switches are needed, it is important that companies are flexible in fulfilling the service via different channels.

Coordination is another important aspect of process switches. The need for coordination of process switches is found in literature on transitional care. In the past, it was common that one healthcare practitioner had a controlling role in orchestrating the core functions of the sending and receiving teams at process switches (Coleman and Berenson, 2004). More recently, the national trend in the U.S. indicated that healthcare providers have limited the focus of their scope much more on a single setting (Wachter and Goldman, 2002). This specialization reduces the integration between the healthcare providers, contributes to the aforementioned ‘silo mentality’ in healthcare, and makes it more difficult to coordinate and to conduct a successful process switch.

Moreover, for process switches it is important to have standard working procedures and plans for dealing with certain types of customers, in which all the expected steps are covered. This is particularly important because many mistakes in public service supply chains are caused by human factors in the exchange of information at process switches and because the environment is information based (Hines, Martins and Beale, 2008). This environment, where public organizations have autonomous roles, increases the need to cooperate and to share information. Information sharing can be improved by managing the cooperation between different processes or organizations.

It might be wise to have a coordinator who monitors the processes and who manages the cooperation and the exchange of information at process switches (Crowley, Wolfe, Lock and McKee, 2011).

The reviewed literature shows the need to plan and prepare the involved parties for process switches by establishing initial plans and blueprints for conducting process switches. Moreover, it is important to coordinate the occurrence of process switches, by having a coordinator in place who monitors the progress of a process switch. This need for planning and coordination might be increased because of the high degree of customization and the unpredictability of events in the public sector.

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2.2.2 Training professionals for process switches

As Coleman (2003) identified, it is important for process switches that the professionals who perform them are adequately trained. In the past, not much attention was given to education for process switches in healthcare, but in recent years, education has dramatically increased (Laugaland, Aase and Barach, 2012). The education made sure that healthcare providers followed procedures and were able to manage the discharge process of complex patients better (Ouchida, LoFaso, Capello, Ramsaroop and Reid, 2009). In a survey on healthcare professionals, McDonagh, Southwood and Shaw (2004) found that 43% of the sampled 263 British rheumatology healthcare professionals had educational needs for doing their jobs better. A quarter of the respondents indicated a lack of perceived confidence in key areas of transitional care and conducting process switches (McDonagh et al., 2004). The second most named educational need was a need for education on transitional issues, such as frameworks how to deal with transitional care and training on intra- and interorganizational planning (McDonagh et al., 2004). In healthcare, it is thus important to train the professionals on how to perform process switches. Increased knowledge about procedures and planning will help in conducting the process switch accurately and with less mistakes, which will lead to less rework and more satisfied customers.

Research shows that training can also have another outcome, as it leads to shared mental models, which means that colleagues will understand each other’s roles and behaviour in a larger system better (Kroll and Moynihan, 2015). This increased understanding has little to do with acquiring new knowledge, but is more about sharing knowledge. Research has shown that a better understanding of the larger system leads to better collaboration within teams (Marks, Sabella, Burke et al., 2002). In their review of literature on training, (Aguinis and Kraiger, 2009) found that training directly relates to increased performance, but also indirectly leads to increased performance, as it leads to things such as: communication, empowerment, planning, and task coordination within and between teams. In such a way, training about working procedures also leads to a better understanding between the involved parties, and can lead to better cooperation, which will help in conducting process switches. All these aspects of training can be valuable for the organizations in the public sector, because the involved parties have a high degree of autonomy, but have to work in close collaboration in order to conduct process switches successfully.

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2.2.3 ICT for process switches

For healthcare professionals, it is important to have good ICT systems to make sure that process switches go well (Coleman, 2003). The possession of the right information at the right moment can be supported by means of ICT, such as an electronic health record (EHR), or digital prescriptions. Dobrzykowski and Tarafdar (2015) underscore the need for adoption of IT systems in order to improve information exchange, but it should be accompanied by social interaction. A process switch is not only done via ICT, but also requires personal interaction between the involved professionals who give additional clarification about a case. Moreover, there are always customers involved in process switches, who might desire face-to-face explanation on certain decisions. This means that the digital transfer of information for process switches should always be accompanied by personal interaction between the involved service providers (mutually and with customers). According to Georgiou, Marks, Braithwaite and Westbrook (2013), it is important to have ICT systems that can standardize the transfer procedures between healthcare providers in long-term care in different contexts, which will lead to higher reliability and increased efficiency. This usage of ICT for transferring information is also important for process switches, because information has to flow between public service providers. A literature review on IT systems in healthcare of Buntin, Burke, Hoaglin and Blumenthal (2011) shows that the adoption of IT systems in healthcare environments leads to higher efficiency in the service provision. This is also of importance for process switches in the public sector, as the ICT contributes to doing the work more efficiently, with less rework, and with fewer mistakes. ICT should make information digitally accessible before, during, and after process switches, in order to make sure that both contexts can work with the same information. Moreover, ICT can prevent the loss of information, as paper-based information is more difficult to store. This will make sure that information that is created in the one context will be retrievable in the other context, after the process switch.

According to Yang and Maxwell (2011), decisions about IT are important factors for inter-organizational information sharing in the public sector. These decisions can be about handling private information via IT systems and making sure that heterogeneous IT systems can cooperate well and exchange information when process switches happen (Yang and Maxwell, 2011).

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For the management of different channels, it is also important to have reliable ICT systems that can facilitate the switch between them. During the first years of this millennium, a strong growth is observed in offering services via various channels, such as online- and physical channels (Sousa and Voss, 2006). Because customers perceive a declining difference between online and offline, it is important that multichannel companies can easily switch between both channels and offer their service/products via both channels simultaneously. Service delivery via multiple channels increases the chance that one or more channels fit the needs of the customers. Public organizations deliver their service also via various channels and choose the channel that best fits the customer’s needs. However, management of a multichannel service is difficult, because process switches have to be conducted between different channels, which have autonomous roles and which have a low integration. Therefore, performance of the total channel system suffers due to conflicts between the channels (Falk, Schepers, Hammerschmidt and Bauer, 2007). These conflicts can be about the challenge to align different channels (Falk et al., 2007). The management of this alignment demands for good ICT systems.

ICT can support a flow of information at process switches, as it makes information accessible for the right people (via authorizations). Moreover, ICT can make sure that information is exchanged quickly, which makes sure that information flows timely. Also, ICT can make information transparent, as all authorized people can see progression, which makes it easy to hold people accountable for their actions. With good ICT systems, that support the exchange of information, switching between channels can be facilitated. This can help public organizations and their customers by providing transparency on the different processes, and can help them in the choice of processes that best fit with the customer’s and society’s need.

2.3 Conceptual model

In the reviewed literature, mechanisms are mentioned that are of importance for managing process switches in their respective sectors. The insights from the literature review lead to three underlying mechanisms or prerequisites for the management of process switches in the public sector. The findings from the case study will be

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compared to the insights of the literature review. The conceptual model can be found in figure 4:

Figure 4: Conceptual model: The underlying mechanisms for the management of process switches in the public sector

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3. Methodology

3.1 Research method

The methodology that will be used for this research is case research. Case research is used because it can analyse the current situation regarding process switches at the involved organizations. Case study research is described as an objective, in-depth investigation of a contemporary phenomenon in which the researcher has little control over the event, but also aims to generalize across a larger set of cases of the same general type (Yin, 2009). According to Voss et al. (2002), case research can bring up new ideas and insights, and can help in developing new theories, which will increase the understanding of process switches. According to Yin (1994), case study research can help in expanding theory by combining new empirical insights with existing knowledge. This research is conducted based on a multiple case study at the involved organizations. This type of case study best fits with the aim of this research, as it describes a similar process at 10 different locations (cases), which allows for comparison of procedures and work methods. According to Voss et al. (2002), multiple cases reduce the risk of observer bias. The unit of analysis for this research is defined as process switches in the public sector. The researched cases are 10 locations in The Netherlands where process switches are conducted by the involved organizations.

3.2 Description of the case context and case selection

The organizations that are involved in this research work together in delivering their service to the Dutch society. Organization B has a leading role in delivering this service.

Organization A has a supporting role in delivering the service of organization B, as it targets a specific group of people who have to be involved in the service delivery process. The information that is provided by organization A can help organization B in delivering a better service to the target group of organization A. The organizations did not want to be named in the research, and are therefore anonymized. The involved organizations deliver their service to society via two processes: a fast process and a standard process. The fast process is the main working process, which aims to deliver the service in a limited amount of time. The standard process is the process that is chosen when the fast process is not suitable. The fast working procedure has been introduced a few years ago and has to become the major working procedure via which 80% of the cases is served, as it is more efficient. When it turns out that a customer

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cannot be served via the fast process, or when the initial chosen process turns out not to be the right process, the process switches to standard. In the standard process, more time and attention can be given to the involved parties for the service delivery.

As was described in the introduction, a process switch leads the service delivery process to a new context, in which other actors will be working on the case. Also, different methods are used, to do research on a broader scale. The records of the involved parties have to be transferred from the fast to the standard process. It differs per location how many process switches are conducted, but participants estimate that about 50% of the cases that were initially handled as a fast case have to switch to the standard procedure. This underlines the importance of successfully managing process switches, as they frequently occur. There are challenges in organizing a flow of information between both processes because it is difficult to transfer this information between the involved professionals. The research context fits with the goal of this research, as there are process switches involved, about which is unknown how they exactly work and what is important for managing them in order to improve the quality.

The cases and the participants for the research are selected in close collaboration with the involved organizations. All cases have to deal with the process switch between the fast and standard process, and at every location people have their own working procedures for dealing with it. This allows for a comparison between the different locations. Conducting 10 interviews on these locations gives the opportunity to do research in sufficient depth, as it provides a large sample of locations where these process switches are conducted. Moreover, it increases the internal validity of the research, as the findings of the different interviews can be compared to each other.

For internal validity, it is also important to be aware of maturation; people might give different answers as the research progresses. Therefore, multiple interviews are conducted with the same interview list, in order to have standardized interviews that can be compared to each other. In appendix III and IV, more information can be found about the cases.

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3.3 Data collection

Data is collected from the earlier described cases by conducting 10 semi-structured interviews and by doing observations at 8 visited locations in the period between May 26^th and June 10^th 2016. In most cases, an interview is performed with two local employees. One employee is working for organization A, and the other for organization B. The participants of the interviews were selected by the management of organizations A and B, based on their ability to answer the interview list. Per case, the roles and job titles of the participants varied, but in general, the participants were employees with several years of working experience at their respective organizations.

In 2 cases, cases 3 and 9, just one employee of organization A is interviewed due to limited capacity of organization B. Therefore, these participants could only describe the situation regarding their own organization. In case 10, an interview was not possible due to limited capacity. Therefore, the interview guide was answered via e- mail by an employee of organization A. This case provided less information than the other cases and has less value for this research. No observations could be done in person at the cases that were interviewed via telephone or e-mail.

The interviews are semi-structured. This gives the advantage that respondents can give their opinions of the problem, which sometimes contains complex and sensitive issues (e.g. personal data of customers). Another advantage is that a semi-structured interview offers the possibility of probing for clarification of the answers (Barriball and While, 1994), which is useful for explorative research. For the interviews, an interview protocol (in Dutch) is used, which can be found in Appendix I. The interview protocol was set up in close consultation with the coordinating professionals at the involved organizations and the supervisor of this project at the University of Groningen. The interview guide is based on the desire of the involved organizations to obtain an overview of the current situation at the 10 cases, and the desire of the researcher to do academic research on process switches in the public sector. The interview guide is exchanged with the involved organizations several times, in order to check for completeness and to ask for suggestions and additions. The protocol is approved by all parties. The usage of an interview and observation protocol (Appendices I and II) contribute to the reliability of the research, and allows for replication of the study. The concepts of the conceptual model were integrated in the interview guide in order to operationalize them. General questions were asked, such as: “How does the switch

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between both processes work at this location?” and “What would you change to improve the quality of the process switch?”. An example of a question regarding the main concepts was: “What should be arranged (regarding the concepts coordination, people and training, and ICT) to make sure the process switch is conducted well?”. All interviews are recorded on tape and are subsequently transcribed verbatim. According to Voss et al. (2002), tape recording and transcribing verbatim reduce the risk of observer bias and increase the internal validity of the research. The following figure provides an overview of the interviews:

Interview # Participating organization(s)

Date of the interview

Duration of the interview

Observation?

(5 to 10 minutes)

1 A + B 26-05-2016 45 minutes Yes

2 A + B 27-05-2016 45 minutes Yes

3 A 27-05-2016 35 minutes Yes

4 A + B 27-05-2016 50 minutes Yes

5 A + B 31-05-2016 45 minutes Yes

6 A + B 31-05-2016 50 minutes Yes

7 A + B 03-06-2016 50 minutes Yes

8 A + B 06-06-2016 60 minutes Yes

9 Via telephone A 10-06-2016 45 minutes No

10 Via e-mail A Via e-mail n.a. No

Figure 5: The interviews and observations at the different locations of both organizations in The Netherlands

3.4 Data analysis

The interviews are transcribed within 48 hours after their occurrence, as a transcription shortly after the interview helped the researcher and the participants to remember the situation well. This also contributes to construct validity, which is increased by letting the key informants review the research before it is finalised. The participants can help in determining whether the right operational measures are chosen and can prevent the researcher from being biased. With the right operational measures, the concepts can be studied better. The transcripts have been shared with the participants to verify the information, in order to make sure that the obtained data is accurate. An important element of research quality is the anonymity of the data and the participants, in order to ensure the ethical practice of anonymity (Hennink, Hutter and Bailey, 2011).

Therefore, transcripts are anonymized before they are shared with the thesis supervisor.

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Coding schemes (or within case analyses) are distilled from the transcripts. They are classified based on the expected underlying mechanisms for the management of process switches in the public sector. Per underlying mechanism, quotes are put in the within case analysis that are related to process switches. This helps to identify the subjects that are valuable for the research. The coding schemes can be found in Appendix IV and an example is given in figure 6. Also, case summaries have been created, supported by tables. These summaries present the ideas of the participants about the creation of process switches and a flow of information and what they indicate that is missing for process switches and the creation of a flow of information. They are created by scanning the transcripts for quotes on these topics. Also, the findings of the observations were used, in order to describe the similarities and differences between the locations. A distinction has been made between the things that enable a flow of information and the things that are missing for the creation of a flow of information. The summaries can be found in Appendix III and an example of a table can be found in figure 7.

The data analysis is performed following the three concurrent flows of Miles and Huberman (1994). These stages are: data reduction, data display, and conclusion drawing and verification. During the data reduction phase, the data from the transcripts was simplified, abstracted, and selected by following the coding procedure and discarding the irrelevant data. During the data display phase, the selected data is clearly represented by using tables. In the conclusion phase, the displayed data is used for drawing conclusions and for answering the research question. The coding process was done with AtlasTi software, the codes were then exported to Microsoft Excel, in which the subsequent data analysis was performed, in order to make sure that the data is displayed in an organized way.

For the data analysis, the following cycles of coding are used: descriptive coding, cycle coding, and thematic coding. During the first cycle of coding, only descriptive coding is used. With descriptive coding, the main message of a passage is summarized. This is done by giving the selected text a keyword that summarizes the passage (in the column Theme (cycle code)). The displayed quotes are directly linked to the research topics:

ICT, Planning & Coordination, and the renamed mechanism: People & Training, as it

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better represents the content of the quotes. Then, the second cycle of coding is applied. During that cycle, pattern coding and thematic coding are used. “Pattern codes help to identify an emergent theme, configuration or explanation” (Miles and Huberman, 1994, p.69). During this phase, the descriptive codes are linked to themes that are of importance for process switches (in the column Theme (cycle code)), which reduces the initial amount of data to a smaller number of analytic units (Miles and Huberman, 1994). These analytic units give an indication of the overarching themes for the research on process switches, by giving the quotes a label in the table. Once pattern coding is finished, thematic coding is used to link the cycle codes to a flow of information, which is the most important aspect of process switches.

Per interview location, a within case analysis is set up. This within case analysis aims to find out the emerging themes that are of importance for the management of process switches at a certain location. It displays the ideas, opinions, and thoughts of the participants, which can be used as a starting point for a generalized analysis in the cross case analysis. In the cross case analyses, it is counted how often quotes with a certain scope occurred in the interviews, which describes the importance of the topics.

Moreover, these topics are linked to the aspects of a flow of information. According to Ayres, Kavanaugh and Knafl (2003), the cross case analysis helps to distinguish between the information that is relevant for just one case and the information that is relevant for all cases. Subsequently, the reviewed literature is compared to the findings of the case study in the discussion, which contributes to the external validity of this research.

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Figure 6: Excerpt of the within case analysis of an interview location (quotes of the interview)

Underlying mechanism Link to flow of

information and what is arranged for a flow of information?

What is missing for creating a flow of information?

Planning and coordination

The information flows better because people have fixed schedules and work with the same colleagues.

Checks are performed to find out whether all files are complete for the switch.

(Influence on: quality)

-

People and training People get a better understanding about each other’s roles by taking a look at other locations and by inviting people who work in other offices.

All coordinators have the authorization to do a case in both processes, which allows them to keep the case with them before and during the switch. (Influence on: quality)

-

ICT Information is available digitally

and can be accessed when further research is needed.

(Influence on: accessibility)

The monitor can be extended with extra information, which allows employees to work more independently. (Influence on:

quality) Figure 7: Case summary of an interview location

Underlying mechanisms

for process switches Data reduction (descriptive coding) Theme (cycle code) Link to seamless flow of information (thematic code)

It depends a little bit. When it is busy, we do not have time to do everything properly, as it comes to organization A. But in principle, when we work neatly, that we do it digitally. We do the reporting in the ICT system, we print out the forms and hand

over the forms to our teamleader. We do the explanation orally. Problems with using ICT Transparency We have a monitor on which the cases are displayed. When you put your information

in there, you do not have to ask the coordinator how the case is doing…. When we know everything from the monitor, you do only have to go to the coordinator when

there are specialities Digitalization Accessibility

The forms arrive at organization B at location Y and they give the forms to us. We have a screening team of volunteers who check the forms for completeness and argumentation. When argumentation is not sufficient, the file is sent back to the

customer. Checks Quality

Yes, it happens that employees of organization B ask us to check a certain customer.

Then, we can look back in our systems what a colleagues has delivered. We can see

the details and specialities of the cases. Cooperation Accessibility

I hear from colleagues at the headquarters, where we do our training, and there we meet colleagues from other parts of the countries, and I heard that how we are doing on this location is different from how they are doing at other locations. At some locations, organization A has to fight for its information. At this location, my

experience is, that we do not have to fight for the customer. It is quite relaxed here. Standardization of procedures That is the new approach of the fast process. They want all coordiantors to have all

authorizations. (With those authorizations, they can handle the cases mostly

themselves). Training, mutual understanding

ICT

Planning and coordination

People and training

Quality

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4. Results

The aim of this research is to explore what process switches entail in the specific case situation and to explore what the underlying mechanisms are for successfully managing them in order to achieve a flow of information. In section 4.1 the findings about processes switches in the case situation are described. In section 4.2 the findings of the cross case analyses are presented.

4.1 Process switches in the context of the research

In the following figure, the findings about what a process switch at the researched organizations entails are illustrated:

Figure 8: Process switch in the context of the research

At the start of the process, an intake is done by organization B. Organization A brings in information about its target group which can be used in the decision making process.

During step 1, the decision is made whether a process switch is needed. A process switch is needed if a case needs more time and attention from the involved organizations, due to its complexity. The extra attention cannot be delivered via the fast process. This decision is made by organization B. Organization A can give an

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advice in the decision making process, in order to serve the interests of its target group best. When the decision is made to conduct a process switch, the involved organizations have to prepare the process switch and the flow of information from the one process to the other (step 2). The files from the fast process have to be transferred to the standard process. Organization B prepares this flow of information and determines which documents are transferred and which are not. During the actual process switch (step 3), the information has to flow from the one process to the other.

It differs per location how this information flows (paper-based or digitally).

Subsequently, the information from the fast process has to be received and registered in the standard process by organization B (step 4). After that, the chain partners of organization B have to receive the information from the fast process and have to determine which information has to be created again (because it was not involved in the switch) and which information has come over from the fast process. Once the dossier is complete, the case can be finalized via this standard process.

During the process switch, a flow of information between the 2 different processes is important. Process switches fail if the flow of information is not adequately prepared in step 2. Even with an adequate preparation, process switches can fail if there is no proper exchange of information in step 3 or no good reception of the information in step 4. This can be caused by issues such as: missing storage opportunities (in case a paper-based system is used), missing information on the details of a case, or miscommunication. A flow of information is, therefore, seen as the most important element of process switches. In the theoretical framework, a flow of information is characterized by quality, accessibility, transparency, and timeliness of the information.

In the findings, the underlying mechanisms for the management of process switches will be linked to these characteristics of a flow of information.

4.2 Findings of the case study

This section presents the most important findings of the multiple case study about the management of process switches via cross case analyses. In order to get to cross case analyses, first within case analyses have been set up. A more detailed analysis of the situation at the researched cases can be found in the case descriptions in Appendix III and the within case analyses in Appendix IV. Per underlying mechanism,

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a table with cross case findings is presented. In these cross case analyses, presented in figures 9, 10, and 11, the elements that are most often mentioned are categorized per underlying mechanism. Per quote, it is indicated how often a similar quote is found in other interviews in the column “# of times mentioned”, which teaches us about the relevance and occurrence of the mentioned aspects. Then, it is indicated in which interviews such quotes were mentioned. The quotes are linked to a thematic description or cycle code. These thematic descriptions are then linked to the characteristics of a flow of information. The findings of the cross case analyses teach us how the underlying mechanisms are used to manage process switches at the involved organizations and to create a flow of information.

4.2.1 Findings regarding planning and coordination

Figure 9: Cross case analysis for planning and coordination

Figure 9 makes clear that planning and coordination are important for managing process switches and describes to which aspects attention is given. All cases have coordinators who coordinate the progress of the service delivery and who prepare process switches. In order to monitor progression, there is the assistance of ICT in the office by means of a monitor, on which all cases are displayed, ranked on basis of their due date. The coordinator regularly updates this monitor with information from the chain partners so that everyone is updated. This helps all chain partners to know which cases need more research and are expected to switch to the standard process. At 5 of the 10 locations, it was described that the accessibility of information is increased because all chain partners work together in one room in the fast process and cooperation can be coordinated: “Here you can often speak to each other and you know how cases are doing, that is something that is completely missing in the standard process” (I.7). This proximity makes sure that information can be shared easily and that all chain partners can cooperate in preparing the process switch. For the switch, it is important that communication lines are short and supported by ICT. This increases

for process switches # of times mentioned Data reduction (descriptive coding) Iv. 1 Iv. 2 Iv. 3 Iv. 4 Iv. 5 Iv. 6 Iv. 7 Iv. 8 Iv. 9 Iv. 10 Theme (cycle code) Link to seamless flow of information (thematic code) 7 of 10 "The cooperation between organizations B and C should be

organized well" (I.1) x x x x x x x Cooperation

3 of 10

"Sometimes there is a lower quality, communication is not good, reporting is not good, and the checks afterwards (need attention), then there is not sufficient monitoring" (I.4)

x x x

Checking 4 of 10

"It is double work, we enumerate a part of the (work) already at fast. Then, at standard we have to do that all over again.

That is a shame… You make a new appointment with a consumer you have already spoken to" (I.3)

x x x x

Procedures 5 of 10

"That is why we are located in one room. If I need to know something from a chain partner, then I can ask that

immediately" (I.6) x x x x x

Proximity Accessibility

4 of 10

"The [coordinator] is the spider in the web. He or she has to oversee everything (at the fast process)". (I.5) At the standard process: "It is the reviewer who has to register everything and who manages the case" (I.3)

x x x x

Coordinating role Transparency Planning and coordination

Quality

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the accessibility and transparency of information before, during and after process switches.

Moreover, it is found that the coordination of process switches is about managing formal and informal ways of cooperation. In 7 of the 10 interviews the need for formal cooperation was described: "The cooperation between organization A and organization B should be organized well. They should communicate well with each other about a case (when it switches, red.)" (I.1). Formal cooperation can be described by standardized procedures, agreements on work structures, and the formal exchange of information (via dossiers and ICT systems). The standardization of work procedures makes it easier to conduct process switches, as it makes clear to all chain partners how process switches should be conducted and reduces the number of mistakes. In 5 of the 10 interviews, the need for informal cooperation was described: "I think that the fast process is super handy… (person is working at the regular process, red.) … I always use the fast process. When I need information, I first call the (people from the, red.) fast process. They have the information immediately available" (I.1). This quote shows that informal cooperation is needed because information does not always flow properly at process switches via formal cooperation. The informal cooperation consists of sharing information face-to-face on the work floor and informal phone calls to retrieve additional information from the other process. Both ways of cooperation lead to increased quality of a flow of information at a process switch.

For planning process switches, there was less evidence found. However, in interviews 3 and 6, some aspects of planning process switches were mentioned. Customers can be prepared for their process switch, by preparing the required documentation before it occurs. The employees at those locations actively help the customers with the preparation. Location 6 also works with a fixed planning of employees, as it increases cooperation within the team and as it provides the customer with a fixed contact person to discuss their case and to prepare for the process switch. The involved organizations can increase their attention towards the planning aspect, in order to increase cooperation within the teams and to ease the process switch for the receivers of the service. Coordination, however, has, according to the findings of the case study, a more important role for the management of process switches.

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Based on the findings of the cross case analysis in figure 9, it can be concluded that coordination is an important factor for creating a flow of information. Attention should be given to coordination, formal and informal ways of cooperation, and the standardization of procedures. Planning turned out to be less important in this case, but can be used to prioritize cases and to prepare all chain partners for process switches. Planning and coordination lead to quality, transparency and accessibility of information at a process switch.

4.2.2 Findings regarding people and training

Figure 10: Cross case analysis for people and training

Figure 10 makes clear to which aspects of the renamed concept “people and training”

attention is given. It was found that not all employees follow the guidelines and procedures that were provided by their employers. Improved knowledge on these topics is desired by the participants, in order to make sure that everybody is heading in the same direction. In 6 of the 10 interviews, following procedures was indicated as an important aspect: “Knowledge dilutes very quickly. I see that as a coordinator, and it annoys me. There are instructions and procedures, just follow them!” (I.5). By following the rules and procedures, people will work standardized and the chance of mistakes and miscommunication is reduced, which increases the quality of information at process switches.

Not all employees know the guidelines and procedures for conducting process switches: “Mistakes are made at the registration of customers, because people register differently or count differently. When there is (clarity about the registration, red.) in the system, then there is clarity about what to do” (I.3). Knowledge about these procedures can be increased by providing training and will lead to an improved quality of process switches. When people have knowledge about procedures and follow them, they will work in a standardized way. This contributes to standardized information that is unambiguous and of higher quality. Such information will make it easier to conduct process switches, as it is easy to interpret.

for process switches # of times mentioned Data reduction (descriptive coding) Iv. 1 Iv. 2 Iv. 3 Iv. 4 Iv. 5 Iv. 6 Iv. 7 Iv. 8 Iv. 9 Iv. 10 Theme (cycle code) Link to seamless flow of information (thematic code) 6 of 10

"Knowledge dilutes very quickly. I see that as a coordinator, and it annoys me. There are instructions and procedures, just follow them!" (I.5)

x x x x x x

Following procedures 4 of 10 "Providing people with knowledge about what everybody's

role is in the chain" (I.8) x x x x Mutual understanding

5 of 10

"the average knowledge stops at "[the consumer has the right to be present in the production process]". The other important things are not known to us. I think we can gain a lot there" (I. 7)

x x x x x Knowledge about chain

partners' processes Transparency

People and training Quality

2. Theoretical Framework

Abstract

Table of Contents

1. Introduction

2. Theoretical Framework

3. Methodology

4. Results