A safety analysis approach to clinical workflows : application and evaluation

Clinical workflows are safety critical workflows as they have the potential to cause harm or death to patients. Their safety needs to be considered as early as possible in the development process. Effective safety analysis methods are required to ensure the safety of these high-risk workflows, because errors that may happen through routine workflow could propagate within the workflow to result in harmful failures of the system’s output. This paper shows how to apply an approach for safety analysis of clinic al workflows to analyse the safety of the workflow within a radiology department and evaluates the approach in terms of usability and benefits. The outcomes of using this approach include identification of the root causes of hazardous workflow failures that may put patients’ lives at risk. We show that the approach is applicable to this area of healthcare and is able to present added value through the detailed information on possible failures, of both their causes and effects; therefore, it has the potential to improve the safety of radiology and other clinical workflows

Improving root cause analysis through the integration of PLM systems with cross supply chain maintenance data

The purpose of this paper is to demonstrate a system architecture for integrating Product Lifecycle Management (PLM) systems with cross supply chain maintenance information to support root-cause analysis. By integrating product-data from PLM systems with warranty claims, vehicle diagnostics and technical publications, engineers were able to improve the root-cause analysis and close the information gaps. Data collection was achieved via in-depth semi-structured interviews and workshops with experts from the automotive sector. Unified Modelling Language (UML) diagrams were used to design the system architecture proposed. A user scenario is also presented to demonstrate the functionality of the system

Adaption of structured analysis design techniques methodology for construction project planning

The construction industry has been heavily criticised by researchers and governmental organisations for its performance especially excessive delay. Ballard and Howell (2003) indicated that only about 50% of the tasks on weekly work plans are completed by the end of the plan week. This is a result of a lack of either effective project planning or effective production control. It therefore seems the traditional approach of planning is insufficient to meet the current demand and complexity of construction projects. This paper proposes to critically evaluate the adaptation of Structured Analysis Design Techniques (SADT) methodology as a tool for project planning. SADT which was further developed into IDEF (Integrated Definition) techniques claims to be a complete methodology to provide the means of understanding complex production systems and aid the implementation of change. The use of this methodology has led to process improvement. The research uses a literature review followed by interviews with academics and practitioners to investigate their knowledge and understanding of SADT (IDEFO). The results of the interviews indicated that SADT (IDEFO) methodology is seldom known and used in the construction industry. However, this study indicates that SADT methodology appears to be an effective project planning tool. This study contributes to the limited project planning techniques in construction industry by exploring the possible adaption of SADT

A Process Modelling Framework Based on Point Interval Temporal Logic with an Application to Modelling Patient Flows

This thesis considers an application of a temporal theory to describe and model the patient journey in the hospital accident and emergency (A&E) department. The aim is to introduce a generic but dynamic method applied to any setting, including healthcare. Constructing a consistent process model can be instrumental in streamlining healthcare issues. Current process modelling techniques used in healthcare such as flowcharts, unified modelling language activity diagram (UML AD), and business process modelling notation (BPMN) are intuitive and imprecise. They cannot fully capture the complexities of the types of activities and the full extent of temporal constraints to an extent where one could reason about the flows. Formal approaches such as Petri have also been reviewed to investigate their applicability to the healthcare domain to model processes. Additionally, to schedule patient flows, current modelling standards do not offer any formal mechanism, so healthcare relies on critical path method (CPM) and program evaluation review technique (PERT), that also have limitations, i.e. finish-start barrier. It is imperative to specify the temporal constraints between the start and/or end of a process, e.g., the beginning of a process A precedes the start (or end) of a process B. However, these approaches failed to provide us with a mechanism for handling these temporal situations. If provided, a formal representation can assist in effective knowledge representation and quality enhancement concerning a process. Also, it would help in uncovering complexities of a system and assist in modelling it in a consistent way which is not possible with the existing modelling techniques. The above issues are addressed in this thesis by proposing a framework that would provide a knowledge base to model patient flows for accurate representation based on point interval temporal logic (PITL) that treats point and interval as primitives. These objects would constitute the knowledge base for the formal description of a system. With the aid of the inference mechanism of the temporal theory presented here, exhaustive temporal constraints derived from the proposed axiomatic system’ components serves as a knowledge base. The proposed methodological framework would adopt a model-theoretic approach in which a theory is developed and considered as a model while the corresponding instance is considered as its application. Using this approach would assist in identifying core components of the system and their precise operation representing a real-life domain deemed suitable to the process modelling issues specified in this thesis. Thus, I have evaluated the modelling standards for their most-used terminologies and constructs to identify their key components. It will also assist in the generalisation of the critical terms (of process modelling standards) based on their ontology. A set of generalised terms proposed would serve as an enumeration of the theory and subsume the core modelling elements of the process modelling standards. The catalogue presents a knowledge base for the business and healthcare domains, and its components are formally defined (semantics). Furthermore, a resolution theorem-proof is used to show the structural features of the theory (model) to establish it is sound and complete. After establishing that the theory is sound and complete, the next step is to provide the instantiation of the theory. This is achieved by mapping the core components of the theory to their corresponding instances. Additionally, a formal graphical tool termed as point graph (PG) is used to visualise the cases of the proposed axiomatic system. PG facilitates in modelling, and scheduling patient flows and enables analysing existing models for possible inaccuracies and inconsistencies supported by a reasoning mechanism based on PITL. Following that, a transformation is developed to map the core modelling components of the standards into the extended PG (PG*) based on the semantics presented by the axiomatic system. A real-life case (from the King’s College hospital accident and emergency (A&E) department’s trauma patient pathway) is considered to validate the framework. It is divided into three patient flows to depict the journey of a patient with significant trauma, arriving at A&E, undergoing a procedure and subsequently discharged. Their staff relied upon the UML-AD and BPMN to model the patient flows. An evaluation of their representation is presented to show the shortfalls of the modelling standards to model patient flows. The last step is to model these patient flows using the developed approach, which is supported by enhanced reasoning and scheduling

SAFE-FLOW : a systematic approach for safety analysis of clinical workflows

The increasing use of technology in delivering clinical services brings substantial benefits to the healthcare industry. At the same time, it introduces potential new complications to clinical workflows that generate new risks and hazards with the potential to affect patients’ safety. These workflows are safety critical and can have a damaging impact on all the involved parties if they fail.Due to the large number of processes included in the delivery of a clinical service, it can be difficult to determine the individuals or the processes that are responsible for adverse events. Using methodological approaches and automated tools to carry out an analysis of the workflow can help in determining the origins of potential adverse events and consequently help in avoiding preventable errors. There is a scarcity of studies addressing this problem; this was a partial motivation for this thesis.The main aim of the research is to demonstrate the potential value of computer science based dependability approaches to healthcare and in particular, the appropriateness and benefits of these dependability approaches to overall clinical workflows. A particular focus is to show that model-based safety analysis techniques can be usefully applied to such areas and then to evaluate this application.This thesis develops the SAFE-FLOW approach for safety analysis of clinical workflows in order to establish the relevance of such application. SAFE-FLOW detailed steps and guidelines for its application are explained. Then, SAFE-FLOW is applied to a case study and is systematically evaluated. The proposed evaluation design provides a generic evaluation strategy that can be used to evaluate the adoption of safety analysis methods in healthcare.It is concluded that safety of clinical workflows can be significantly improved by performing safety analysis on workflow models. The evaluation results show that SAFE-FLOW is feasible and it has the potential to provide various benefits; it provides a mechanism for a systematic identification of both adverse events and safeguards, which is helpful in terms of identifying the causes of possible adverse events before they happen and can assist in the design of workflows to avoid such occurrences. The clear definition of the workflow including its processes and tasks provides a valuable opportunity for formulation of safety improvement strategies

An approach to safety analysis of clinical workflows

A clinical workflow considers the information and processes that are involved in providing a clinical service. They are safety critical since even minor faults have the potential to propagate and consequently cause harm to a patient, or even for a patient's life to be lost. Experiencing these kinds of failures has a destructive impact on all the involved parties. Due to the large number of processes and tasks included in the delivery of a clinical service, it can be difficult to determine the individuals or the processes that are responsible for adverse events, since such an analysis is typically complex and slow to do manually. Using automated tools to carry out an analysis can help in determining the root causes of potential adverse events and consequently help in avoiding preventable errors through either the alteration of existing workflows, or the design of a new workflow. This paper describes a technical approach to safety analysis of clinical workflows, utilising a safety analysis tool (Hierarchically-Performed Hazard Origin and Propagation Studies (HiP-HOPS)) that is already in use in the field of mechanical systems. The paper then demonstrates the applicability of the approach to clinical workflows by applying it to analyse the workflow in a radiology department. We conclude that the approach is applicable to this area of healthcare and provides a mechanism both for the systematic identification of adverse events and for the introduction of possible safeguards in clinical workflows

Parametric Surfaces for Augmented Architecture representation

Augmented Reality (AR) represents a growing communication channel, responding to the need to expand reality with additional information, offering easy and engaging access to digital data. AR for architectural representation allows a simple interaction with 3D models, facilitating spatial understanding of complex volumes and topological relationships between parts, overcoming some limitations related to Virtual Reality. In the last decade different developments in the pipeline process have seen a significant advancement in technological and algorithmic aspects, paying less attention to 3D modeling generation. For this, the article explores the construction of basic geometries for 3D model’s generation, highlighting the relationship between geometry and topology, basic for a consistent normal distribution. Moreover, a critical evaluation about corrective paths of existing 3D models is presented, analysing a complex architectural case study, the virtual model of Villa del Verginese, an emblematic example for topological emerged problems. The final aim of the paper is to refocus attention on 3D model construction, suggesting some "good practices" useful for preventing, minimizing or correcting topological problems, extending the accessibility of AR to people engaged in architectural representation

The P3 platform: an approach and software system for developing diagrammatic model-based methods in design research

Many issues in design and design management have been explored by building models which capture the relationships between different aspects of the problem at hand. These models require computer support to construct and analyse. However, appropriate modelling tools can be time-consuming to develop in a research environment. Reflecting upon five design research projects, this paper proposes that such projects can be facilitated by recognising the iterative and tightly-coupled nature of research and tool development, and by attempting to minimise the effort of solution prototyping within this process. Our approach is enabled by a software platform which can be rapidly configured to implement many conceivable modelling approaches. This configurability is complemented by an emerging library of modelling and analysis approaches tailored to explore design process systems. The platform-based approach enables any mix of modelling concepts to be easily created. We propose it could thus help researchers to explore a wide range of questions without being constrained to existing conventions for modelling – or for model integration