Representing process: the contribution of a re-engineering frame

The first aim of this paper is to bring empirical evidence from an atypical organizational setting to the debate surrounding the currency of business process re-engineering, which some commentators have dismissed as a damaging "fad". The second aim is to suggest how the process orientation advocated by re-engineering can facilitate a creative visualization of organizational process and a participative approach to redesign. The paper is based on the experience of an acute teaching hospital seeking to reduce patient delays affecting the work of the operating theatres department. The project began towards the end of 1994, was overseen by a hospital steering committee, was conducted by a small internal project team (with researcher as member), and was based initially on a process mapping exercise. The elective surgical in-patient process (one of the hospital's "core processes"), from referral to discharge, was mapped using the knowledge of project team members, interview and survey data from 39 respondents, informal discussions with over 50 other hospital staff, and from a photo-documentation and photo-elicitation procedure. Interviews, survey questionnaires, informal discussion and the photo-elicitation sessions were also used to develop a wide series of recommendations from staff with respect to redesigning the patient process and reducing theatre delays.