Program and Service Delivery
Core concepts
Service delivery is the design, operation, and improvement of programs that deliver clinical and community value. Know the service blueprint (front-stage patient actions, back-stage staff actions, support processes) and patient journey mapping.
Quality frameworks: Donabedian's structure–process–outcome model. Structure = resources and settings; process = what is done; outcome = the result. Understand access dimensions (availability, affordability, accommodation, acceptability), throughput and cycle time, and capacity planning (demand vs supply of clinician hours).
Know standard work, care pathways/protocols, and clinical guidelines as tools that reduce unwarranted variation. Understand scheduling models (open access/same-day, wave, traditional) and their trade-offs between access and continuity. Recognize patient safety concepts: error types, near misses, root cause analysis, and failure mode effects analysis (FMEA) as proactive risk assessment.
Program evaluation uses process measures (was it delivered as designed?) and outcome measures (did it work?), plus cost-effectiveness when comparing options.
Traps
- Labeling a process measure as an outcome (e.g., "percent of patients receiving a dilated exam" is a process measure).
- Assuming same-day access always improves continuity - it can fragment care if not managed.
- Confusing root cause analysis (retrospective, after an event) with FMEA (prospective, before).
- Ignoring the patient's perspective when evaluating access.
Rule of thumb
Before improving a service, ask: Is the problem structure, process, or outcome? Fixing a process problem with more structure (equipment) usually fails.
Worked example
Long wait times. Structure: too few lanes. Process: inefficient check-in. Outcome: patient dissatisfaction. Measure each; the highest-leverage fix is usually the process step with the largest cycle time.