Health care process modelling: which method when?

Objective The role of process modelling has been widely recognized for effective quality improvement. However, application in health care is somewhat limited since the health care community lacks knowledge about a broad range of methods and their applicability to health care. Therefore, the objectives of this paper are to present a summary description of a limited number of distinct modelling methods and evaluate how health care workers perceive them. Methods Various process modelling methods from several different disciplines were reviewed and characterized. Case studies in three different health care scenarios were carried out to model those processes and evaluate how health care workers perceive the usability and utility of the process models. Results Eight distinct modelling methods were identified and characterized by what the modelling elements in each explicitly represents. Flowcharts, which had been most extensively used by the participants, were most favoured in terms of their usability and utility. However, some alternative methods, although having been used by a much smaller number of participants, were considered to be helpful, specifically in understanding certain aspects of complex processes, e.g. communication diagrams for understanding interactions, swim lane activity diagrams for roles and responsibilities and state transition diagrams for a patient-centred perspective. Discussion We believe that it is important to make the various process modelling methods more easily accessible to health care by providing clear guidelines or computer-based tool support for health care-specific process modelling. These supports can assist health care workers to apply initially unfamiliar, but eventually more effective modelling methods

The suitability of care pathways for integrating processes and information systems in healthcare

Purpose: This paper examines the suitability of current care pathway modelling techniques for supporting business improvement and the development of information systems. This is in the light of current UK government policies advocating the use of care pathways as part of the £12.4 billion programme for IT and as a key strategy to reducing waiting times. Approach: We conducted a qualitative analysis of the variety in purpose, syntax and semantics in a selection of existing care pathways. Findings: Care pathways are typically modelled in an ad-hoc manner with little reference to formal syntax or semantics. Research limits: The research reviews a small selection of existing pathways. The feature set used for evaluation could be further refined. Future research should examine the suitability of applying existing process modelling techniques to care pathways and explore the motivations for modelling care pathways in an ad-hoc manner. Practical implications: The development of care pathways can aid process improvement and the integration of information systems. However, while syntax and semantics are not standardised the impact of care pathways in the work of Department of Health agencies, in particular Connecting for Health, is likely to be limited. Value: The results provide insight into the limitations of the state of the art in care pathway models. This highlights a significant omission in the Department of Health’s approach and identifies an important direction for further development that will aid Connecting for Health, healthcare organisations and healthcare professionals to deliver more effective services

Most important factors modelling health status of an individual and the population. Part 2

Introduction Many factors exert an effect on the state of health, which are difficult to determine unequivocally, because many of them act together, and only a few occur independently. They also differ with respect to number and the degree of intensity. The diversification of these factors from the territorial aspect, both in Poland and worldwide, requires many actions coordinated by the agencies of international organizations, mainly the World Health Organization. In order to identify and shape the strength of individual and interdependent factors modelling of the state of health it is necessary to undertake further efforts to unify the definitions of health, disease, and disability. In the whole scheme of medical care, the modelling of health status of an individual and the entire population is most important, in the area of actions for health promotion and prophylaxis, mainly on behalf of high quality programmes and the effectiveness of conducting these programmes. Objective The objective of the study was presentation of the significance of the selected health and social factors which may be of primary importance in maintaining and improvement of the state of health, both of an individual and the population. The detailed goals were: the discussion about these factors in the sphere of health promotion and anti-health behaviours, the level of health knowledge among the adult population and availability of health education, types of screening tests and determination of the trends in conducting studies in order to improve the health status and quality of life of an individual and the population. Description of the state of knowledge The literature reports available show that several strategic problem groups, which form sub-groups, contribute to the factors shaping the level of human health, including life style and quality of life, hazards in the  physical environment, many natural and geographic factors, opportunities for health education, and the quality of care provided by health services. Qualitative and organizational actions of health care teams functioning in local environments are of special importance in the improvement of the quality of health status of an individual, family, and population. The major areas of actions which are a basis for the maintenance and enhancement of the state of health are health promotion and prophylaxis, as well as rehabilitation understood as a process of stages of actions. Reports are increasingly more often published concerning the modelling of the processes for diagnosing and evaluation of a patient’s state of health. This is, among other things, the modelling of processes related with morbidity in cardiology, the concept of modelling of gossamer space structures in medical diagnosing and diagnosing of the health state of a patient, or the model of normalized life space with consideration of the selected health parameters. Summary Actions aimed at obtaining an improvement in the quality of modelling of the health status of an individual and the population should be based on systematic achievements in prevention studies, which provide possibilities for increasing control of own health of each person. A high quality of actions in the area of prophylaxis and health promotion may contribute to the selection of health promoting behaviours by increasingly larger population groups. An aware selection of such behaviours results in avoidance of risky behaviours, better skills in coping with stress, or selection of a pro-health life style. Efforts undertaken to increase pro-health knowledge lead to a systematic reduction in the incidence of so-called civilization diseases, which are currently a great public health problem

Application of Modelling Methods from Informatics in Evidence Based Health Care

The paper introduces the idea to use modelling methods from informatics for the further development of the Evidence Based Health Care (EBHC) in terms of both: its technology support as well as an aid for the development of its methodology. In the paper we briefly introduce the contents of the EBHC and its predecessor Evidence Based Medicine (EBM), their evolution, current state, its main limitations and consequent challenges. We also briefly introduce the principle of modelling in informatics and those semi-formal modelling methods and techniques which we regard as relevant for the given purpose, namely conceptual modelling, object life cycle modelling, and business process modelling. Using the example, based on existing EBHC practical guidelines for febrile seizures, we then illustrate the possibilities of the use of modelling techniques for an improvement of the EBHC processes and also the related possibilities of the exploitation of modelling techniques from informatics for further development of the EBHC methodology. In conclusions section we then summarize main opportunities of the application of modelling techniques from informatics in the field of EBHC and outline the needed future work

An agile business process improvement methodology

Adoption of business process improvement strategies are now a concern of most organisations. Organisations are still facing challenges and finding transient solutions to immediate problems. The misalignment between IT solutions and organisational aspects evolves across space and time showing discrepancies. Unfortunately, existing business process approaches are not according with continuous business process improvement involving business stakeholders. Considering this limitation in well-known Business Process (BP) methodologies, this paper presents a comparative study of some approaches and introduces agility in the Business Process and Practice Alignment Methodology (BPPAM). Our intention is to present observed problems in existing approaches and introduce agility in our proposal to address features, like the alignment between daily work practices and business process descriptions, in a simple and agile way. (C) 2017 The Authors. Published by Elsevier B.V

Technique for improving care integration models

Recent developments in technologies and improved life style have had a positive impact on prolonging human life contributing to the increasing elderly population. As a consequence, many countries (particularly developed ones) started to experience higher proportions of elderly people (over 65). This has consequently generated the need for care for the elderly that is necessitating the integration of health and social care to accommodate their complex needs. A number of modelling methods have been employed to assist those concerned to cope with health and social care but albeit separately. The literatures so far, identified several techniques that have been employed mostly to model the care integration. However, literatures also suggest that there are some challenges still persist when modelling integrated care. It can be argued that these techniques are not capable of handling the complexities associated with the requirements of integrated systems. This paper attempts to prove the reason why despite the fact that many models of integrated care have been developed, problems are still exist. Based on the literatures, the problems exist due to the unsuitable techniques used to model the IC systems as most of the developed models are using single technique. Therefore, new technique to improve the care integration model is suggested

An agile business process and practice meta-model

Business Process Management (BPM) encompasses the discovery, modelling, monitoring, analysis and improvement of business processes. Limitations of traditional BPM approaches in addressing changes in business requirements have resulted in a number of agile BPM approaches that seek to accelerate the redesign of business process models. Meta-models are a key BPM feature that reduce the ambiguity of business process models. This paper describes a meta-model supporting the agile version of the Business Process and Practice Alignment Methodology (BPPAM) for business process improvement, which captures process information from actual work practices. The ability of the meta-model to achieve business process agility is discussed and compared with other agile meta-models, based on definitions of business process flexibility and agility found in the literature. (C) 2017 The Authors. Published by Elsevier B.V

A survey of health care models that encompass multiple departments

In this survey we review quantitative health care models to illustrate the extent to which they encompass multiple hospital departments. The paper provides general overviews of the relationships that exists between major hospital departments and describes how these relationships are accounted for by researchers. We find the atomistic view of hospitals often taken by researchers is partially due to the ambiguity of patient care trajectories. To this end clinical pathways literature is reviewed to illustrate its potential for clarifying patient flows and for providing a holistic hospital perspective

An Ontology Approach for Knowledge Acquisition and Development of Health Information System (HIS)

This paper emphasizes various knowledge acquisition approaches in terms of tacit and explicit knowledge management that can be helpful to capture, codify and communicate within medical unit. The semantic-based knowledge management system (SKMS) supports knowledge acquisition and incorporates various approaches to provide systematic practical platform to knowledge practitioners and to identify various roles of healthcare professionals, tasks that can be performed according to personnel’s competencies, and activities that are carried out as a part of tasks to achieve defined goals of clinical process. This research outcome gives new vision to IT practitioners to manage the tacit and implicit knowledge in XML format which can be taken as foundation for the development of information systems (IS) so that domain end-users can receive timely healthcare related services according to their demands and needs

A review of historical developments of quality assessment in industry and healthcare

Purpose: This study reviewed the literature on the historical development of quality assessment methods in industry and in healthcare. A comparative analysis of quality methods in industry and healthcare was conducted to examine the gap between methods in the two sectors. An attempt was then made to examine the latest approaches to quality assessment in healthcare and finally a proposal has been offered for a more effective approach to tackling the problem of quality in healthcare. Design/methodology/approach: Firstly, a review of the evolution of quality assessment in industry and healthcare was conducted. This was based on books written by prominent experts in the field of quality. secondly, a study of the current approaches in healthcare was undertaken. Publications from varied sources were selected and reviewed. The literature consulted includes worldwide operations research and healthcare sources including dissertations, the internet and reference lists of relevant articles. The journal papers and conference proceedings were selected according to the following criteria: Objective: the study must be aimed at measuring or improving quality both. It could also be aimed at developing new ways of measuring the quality of health care; Method: observational studies, experimental trials or systematic reviews; Setting: study should be in a hospital setting and not narrowed to quality of clinical cares. Findings: This study showed that the concept of quality management and its control in healthcare is not as advanced as it is in industry. Moreover, it seemed that most researchers, who set out to assess quality of care in one way or the other, have had differing views of quality and the factors that contribute to its assessment. It was also deduced that the way forward in healthcare quality is the development of systems that give staff ownership and pride in a way that is akin to the era of the craftsmen