No cure for all evils: Dutch obstetric care and limits to the applicability of the focused factory concept in health care

Purpose
– The purpose of this paper is to report on a study investigating the limits of the applicability of the focused factory concept (FFC) in health care. The case setting comes from the Dutch obstetric care system, which is organised by principles in sync with the FFC; the organisation for “simple” pregnancies (independent midwifery practices) is fully separated from that for “complex” pregnancies (obstetric departments in hospitals). The paper investigates the degree of fit between how the Dutch obstetric care system is organised and how it operates (internal fit).

Design/methodology/approach
– This study analyses one year of patient data from one obstetric hospital department and from one midwifery practice in its immediate geographical proximity. Data were collected regarding the medical condition, consultations, and delivery. These data were used to test the degree to which the obstetric care system operates in line with the FFC; one would expect the midwifery practice to operate as a “line process”, and the obstetric department as a “jobbing process”.

Findings
– Findings suggest that the Dutch obstetric care sector is designed in line with the FFC, but does not operate accordingly. Root causes for this misalignment can be found in the characteristics of the medical condition of pregnancy.

Research limitations/implications
– The fact that the data concern only one region must raise caution for generalisation. However, the fact that medical conditions, which can be assumed to be universal, lead to an intrinsic mismatch between the FFC organisation and medical operational reality, suggests that this paper may have broad implications for theory and practice.

Practical implications
– For the Dutch obstetric case system, this paper is one in a series that casts doubts on the sustainability of the two‐tiered system. For obstetric care in general, integrated care seems preferable to the FFC. For health care in general, this paper suggests that caution is required in applying the FFC. Moreover, in OM research for health care, more efforts should be made to understand how medical conditions affect the daily operational processes and, hence, the organisational design.

Originality/value
– Most of the studies focusing on the applicability of the FFC look at financial and medical outcomes. This paper is original in that it looks at what drives these outcomes, i.e. the degree of fit between strategy, organisational design and operational performance.