Another concept to have received much attention in recent years is that of business
process re-engineering (BPR). The pioneers of BPR are generally acknowledged as Hammer
and Champy who define it as:
The fundamental rethinking and radical redesign of business processes to achieve dramatic
improvements in critical, contemporary measures of performance, such as cost, quality, service
and speed.
82
Their approach has two principal features: (i) a completely fresh start, or blank sheet of
paper approach, to organisational redesign ignoring past history or present structure or
practices; and (ii) a process-orientation approach to organisational analysis centred
around a horizontal review of all activities involved in the process, or set of activities,
in the delivery of a product or service to the customer.
BPR is concerned with the total restructuring of the organisation. It starts from how
one would like the organisation to be and works backward in an effort to achieve real
gains in organisational performance, and delivery of products or services. Stewart sug-
968
PART 8 IMPROVING ORGANISATIONAL PERFORMANCE
An NHS trust on the south coast of England launched a
TQM initiative. It was based on the simple idea of lighting
fires of enthusiasm. The initial idea came from a chief exec-
utive who had spent a six-month scholarship at an
American business school. It worked by setting up small
quality-improvement groups and allowing staff to come up
with their own ideas for improvement. Money and
resources were available to help these ideas come to
fruition and there was plenty of evaluation to see what
could be learned from them. One of the initiatives was
based at a long-stay geriatric hospital which had long been
a source of negative press stories and the feeling in the
local population was that none of them would like to end
their days there.
Managers at the hospital set up a quality-improvement
group in the different wards. This was accompanied by a
delayering exercise, and empowering front-line nurses – or
named nurses as they are known – to take more decisions
and come up with ideas for improvement. The leader of this
project was a sister on the ward who wholeheartedly
endorsed the approach, but as she describes it, there were
teething problems to start with.
Over the first few months the named nurses kept
coming up and asking me for permission to do
things. I used to say to them: ‘Just go away and do
it. Come back and tell me when you have. I will sup-
port you.’ It was really difficult for them to
understand that they had the power to do something,
and there was a budget available for them to use.
However, after a while they really threw themselves
into it. We had a lot of new projects that really trans-
formed the hospital. A lot of the projects were simple
but really added to the quality of the people’s lives.
For instance, when we started asking patients what
they wanted, we found out that their wishes were
quite simple.
There were three main things. Firstly, they didn’t
have their own underwear. They all went into a sort of
communal melting pot. Also they weren’t given any
choice over the way their hair was cut. A person
would turn up on a certain day, and would cut their
hair all in the same way. A third source of irritation
was that they had no say in what they were called.
Some wanted to be referred to and spoken to as Mrs
Smith, for instance, others wanted to be known by
their first name.
We made changes immediately to put these things
right. But probably the most exciting example was
when a nurse came to me to say she wanted to take
one of our long-term residents to see her brother.
The resident had been with us for over 20 years, and
had not seen any member of her family in the whole
of that time. The nurse, on her own initiative, had
managed to track down this resident’s brother, and
had found he was in a nursing home just down the
coast. The nurse would never have done this in the
past. What happened next was the nurse hired a car,
which her husband drove, and the two of them made
contact with the brother, and they all went down to
visit him. They have done it several times since.
Before empowerment and TQM this never would
have happened.
(Source: S. Morris, G. Willcocks and E. Knasel, How to Lead a Winning Team,
The Institute of Management and Pitman Publishing (1995), pp.132–3.
Reproduced with permission from Kogan Page Ltd.)
Quality counts: TQM in an NHS trust
EXHIBIT 23.3
BUSINESS PROCESS RE-ENGINEERING (BPR)