Just-in-Time Health and Human Services: A Client Approach

Abstract

Since the first article by Levitt (1972), much as been written on how to make service operations in general more productive (see, among others, Hesketh, 1986; Collier, 1987). With few exceptions, however, most of what has been written on the productivity of professionals is related either to the field of psychology and motivation or to office automation. As employment in the service sector keeps growing, and as the overall growth in productivity is slowed by this shift (Sharpe, 1988), the pressure is on to review the way we think about service delivery. This review should be aimed not only at reducing cost but also at trying to reconcile such cost reductions with better service to clients. The Japanese have proved very deft at creatively reformulating and resolving apparently insoluble problems. More specifically, there may be something for providers of health and human services to learn from the just-in-time (JIT) manufacturing philosophy. This paper first discusses the notion of efficiency as it pertains to manufacturing processes as well as to the Japanese philosophy of JIT. Efficiency in health and human service processes in particular is next discussed and the concepts of work flow, capacity, and division of work in these processes are introduced. The problems caused by inventories in professional service processes are then presented in more detail before looking at how they could be reduced. Finally, a discussion of the applicability of the approach proposed in this paper and of the potential implementation problems is presented.