Lean healthcare for reduction of the setup time in cardiac surgery: an analysis in a private hospital

Reducing processes setup time is one of the main purposes of Lean Manufacturing. This work has the goal to present an application of the combination of two Lean tools, the Ishikawa Diagram and the SMED methodology, to optimize the setup time between cardiac surgeries in the operating room of a private hospital. Initially, setup activities were mapped by drawing up a flowchart, and later a brainstorming session for the Ishikawa Diagram was done with the team to identify the possible causes of the delays. Following, the first two stages of the SMED (Single Minute Exchange of Die) methodology were applied, proposing the conversion of internal to external setup for the given activities. Although the hospital did not adopt the proposals while this study was built due to another project’s prioritization, a simulation of the new setup times showed that the total time reduction would be up to 20%. This corresponds to a capacity improvement of two cardiac surgeries per month, and in the absence of demand for this specialty, vacancies for other types of surgeries would also be opened, bringing gains in productivity and in the number of patients assisted

Un cadre de configuration des variantes de processus à travers la fouille de processus et le raisonnement sémantique : une application dans le cadre de la santé.

The efficiency of organizations relies on its ability to adapt their business processes according to changes that may occur in the dynamic environment in which they operate. These adaptations result in new versions of the process model, known as process variants. Thus, several process variants can exist, which aim to represent all the related contexts that may differ in activities, resources, control flow, and data. Thus, has emerged the concept of customizable process model. It aims to adapt the process model according to changes in the business context. A process model can be customized by representing the process family in one single model enabling to derive a process variant through transformations in this single model. As benefits, this approach enables to avoid redundancies, promotes the model reuse and comparison, among others. However, the process variant customization is not a trivial-task. It must be ensured that the variant is correct in a structural and behavioural way (e.g. avoiding disconnected activities or deadlocks), and respecting all the requirements of the application context. Besides, the resulting process variant must respect all requirements related to the application context, internal and external regulations, among others. In addition, recommendations and guidance should be provided during the process customization. Guidance help the user to customize correct process variants, i.e., without behavioural problems. Recommendations about the process context help the user in customizing process variants according specific requirements. Recommendations about the business context refers to providing information about the best practices that can improve the quality of the process. In this context, this research aims to propose a framework for customizing process variants according to the user’s requirements. The customization is achieved by reasoning on ontologies based on the rules for selecting a process variant and in the internal/external regulations and expert knowledge. The framework is composed by three steps. The first step proposes to identify the process variants from an event log through process mining techniques, which enable to discover the variation points, i.e., the parts of the model that are subject to variation, the alternatives for the variation points and the rules to select the alternatives. By identifying the process variants and their characteristics from an event log, the process model can be correctly individualized by meeting the requirements of the context of application. Based on these aspects, the second step can be developed. This step refers to the development of the questionnaire-model approach. In the questionnaire approach each variation point is related to a question, and the alternatives for each question corresponds to the selection of the process variants. The third step corresponds to apply two ontologies for process model customization. One ontology formalizes the knowledge related with the internal and/or external regulations and expert knowledge. The other refers to the variation points, the alternatives for them and the rules for choosing each path. The ontologies then are merged into one new ontology, which contain the necessary knowledge for customize the process variants. Thus, by answering the questionnaire and by reasoning on the ontology, the alternatives related with the business process and the recommendations about the business context are provided for the user. The framework is evaluated through a case study related to the treatment of patients diagnosed with acute ischemic stroke. As result, the proposed framework provides a support decision-making during the process model customization.Les organisations doivent relever le défi d'adapter leurs processus aux changements qui peuvent survenir dans l'environnement dynamique dans lequel elles opèrent. Les adaptations dans le processus aboutissent à plusieurs variantes de processus, c'est-à-dire dans différentes versions du modèle de processus. Les variantes de processus peuvent différer en termes d'activités, de ressources, de flux de contrôle et de données. Ainsi, le concept d'un modèle de processus personnalisable est apparu et il vise à adapter le modèle de processus en fonction des exigences d'un contexte spécifique. Un modèle de processus personnalisable peut représenter toutes les variantes de processus dans un modèle unique dans lequel les parties communes ne sont représentées qu’une seule fois et les spécificités de chaque variante sont préservées. Alors, grâce à des transformations dans le modèle de processus générique, une variante de processus peut en être dérivée. En tant qu'avantages, cette approche permet d'éliminer les redondances, favorise la réutilisation, entre autres. Cependant, la personnalisation des modèles de processus n'est pas une tâche triviale. La personnalisation doit assurer que la variante obtenue est correcte du point de vue structurel et comportemental, c'est-à-dire la variante obtenue ne doit pas présenter d'activités déconnectées, d’interblocages actifs ou d'interblocages, entre autres. En outre, la variante de processus doit satisfaire à toutes les exigences du contexte de l'application, aux réglementations internes et externes, entre autres. De plus, il est nécessaire de fournir à l'utilisateur des directives et des recommandations lors de la personnalisation du processus. Les directives permettent la personnalisation correcte des variantes de processus, en évitant les problèmes de comportement. Les recommandations concernant le contexte de l'entreprise rendent possible l'amélioration du processus et aussi la personnalisation des variantes en fonction des besoins spécifiques. Dans ce contexte, cette recherche propose un cadre pour la personnalisation des variantes de processus en fonction des besoins de l'utilisateur. La personnalisation est réalisée grâce à l'utilisation d'ontologies pour la sélection des variantes. Le cadre est composé de trois étapes. La première correspond à l'identification des variantes à partir d'un journal d'événements au moyen de techniques d'exploration de processus, qui permettent de découvrir des points de variation, c'est-à-dire les parties du processus sujettes à variation, les alternatives disponibles pour chaque point de variation et les règles de sélection des alternatives disponibles. L'identification des variantes de processus et de leurs caractéristiques à partir d'un journal des événements permet de personnaliser un modèle de processus en fonction du contexte de l'application. À partir de ces aspects, la deuxième étape peut être développée. Cette étape concerne le développement d'un questionnaire, dans lequel chaque question est liée à un point de variation et chaque réponse correspond à la sélection d'une variante. Dans la troisième étape, deux ontologies sont proposées. La première formalise les connaissances liées aux réglementations externes et internes et aux connaissances des spécialistes. La deuxième ontologie se réfère aux points de variation, aux alternatives existantes pour chaque point de variation et aux règles liées à la sélection de chaque alternative. Ensuite, ces ontologies sont intégrées dans une nouvelle ontologie, qui contient les connaissances nécessaires pour personnaliser la variante de processus. Ainsi, à travers le questionnaire et le raisonnement sémantique, la variante est sélectionnée et les recommandations concernant le processus d’affaires sont fournies en fonction de la sélection de l'utilisateur lors de la personnalisation du processus. Le cadre proposé est évalué au moyen d'une étude de cas liée au traitement des patients chez qui un AVC ischémique aigu a été diagnostiqué. Les recommandations obtenues grâce à l'approche développée fournissent un support pour la prise de décision lors de la personnalisation du modèle de processus.Organizações enfrentam o desafio de adaptar seus processos de acordo com mudanças que podem ocorrer no ambiente dinâmico em que operam. Adaptações no processo resultam em diversas variantes de processo, isto é, em diferentes versões do modelo de processo. As variantes de processo podem diferir em atividades, recursos, fluxo de controle e dados. Assim, surgiu o conceito de modelo de processo customizável, que tem como objetivo adaptar o modelo de processo de acordo com os requisitos de um contexto especifico. Um modelo de processo customizável pode representar todas as variantes de processos em um único modelo, no qual as partes comuns são representadas apenas uma vez e as especificidades de cada variante é preservada. Assim, por meio de transformações no modelo de processo genérico uma variante de processo pode ser derivada. Como benefícios, esta abordagem possibilita eliminar redundâncias, promove o reuso, entre outros. No entanto, a customização de modelos de processo não é uma tarefa trivial. A customização deve garantir que a variante obtida seja correta tanto do ponto de vista estrutural quanto comportamental, ou seja, a variante obtida não deve apresentar atividades desconectadas, livelocks ou deadlocks, entre outros. Além disso, a variante de processo deve respeitar todos os requisitos do contexto de aplicação, regulações internas e externas, entre outros. Em adição, é necessário fornecer ao usuário orientações e recomendações durante a customização do processo. Orientações permitem a correta customização de variantes de processo, evitando problemas comportamentais. Recomendações a respeito do contexto do negócio possibilitam a melhoria do processo e também a customização de variantes de acordo com requisitos específicos. Neste contexto, esta pesquisa propõe um framework para a customização de variantes de processo de acordo com os requisitos do usuário. A customização é realizada através do uso de ontologias para a seleção de variantes. O framework é composto de três passos. O primeiro corresponde a identificação das variantes a partir de um registro de eventos por meio de técnicas de mineração de processos, as quais possibilitam a descoberta dos pontos de variação, isto é, as partes do processo que estão sujeitos à variação, as alternativas disponíveis para cada ponto de variação e as regras para a seleção das alternativas disponíveis. A identificação das variantes de processo e suas características com base em um log de eventos, permite customizar um modelo de processo de acordo com o contexto de aplicação. Baseado nestes aspectos, o segundo passo pode ser desenvolvido. Este passo refere-se ao desenvolvimento de um questionário, no qual cada pergunta esta relacionada a um ponto de variação e cada resposta corresponde a seleção de uma variante. No terceiro passo, duas ontologias são propostas. A primeira formaliza o conhecimento relacionado às regulações externas e internas e o conhecimento de especialistas. A segunda ontologia referese aos pontos de variação, às alternativas existentes para cada ponto de variação e às regras relacionadas a seleção de cada alternativa. Em seguida, estas ontologias são integradas em uma nova ontologia, a qual contém o conhecimento necessário para customizar a variante de processo. Desta forma, por meio do questionário e do raciocínio semântico, a variante é selecionada e as recomendações a respeito do processo de negócio são fornecidas de acordo com a seleção do usuário durante a customização do processo. O framework proposto é avaliado através de um estudo de caso relacionado ao tratamento de pacientes diagnosticados com acidente vascular cerebral isquêmico agudo. As recomendações obtidas por meio da abordagem desenvolvida fornecem um suporte a tomada de decisão durante a customização do modelo de processo

Enhancing semantic interoperability in healthcare using semantic process mining

ISBN: 978-86-85525-18-6International audienceSemantic interoperability plays an important role in healthcare domain, essentially it concerns the action of sharing the meaning between the involved entities. The enterprises store all the execution processes data as event log files. The process mining method is one among the possible methods that enable the processes analysis behavior in order to understand, optimize and improve them. However, the standard process mining approaches analyze the process based only on the event log label strings, without consider the semantics behind this label. A semantic approach on the event logs might overcome this problem and could enable the use, reuse and sharing of the embedded knowledge. Most of the research developed in this area focuses on the process dynamic behavior or in clarifying the meaning of the event log label. Therefore, less attention has been paid in the knowledge injection perspective. In this context, the objective of this paper is to show a procedure to enhance the semantic interoperability through the semantic enrichment of event logs with domain ontologies and the application of a formal approach, named Formal Concept Analysis

Applying process mining and semantic reasoning for process model customization in healthcare

International audienceProcess flexibility plays a key role in high variability environments, such as healthcare. In this type of environment, the process model needs to change some elements to adjust to specific sets of requirements. Thus, this paper proposes a process model customizing method based on ontology and process mining. The method proposed is applied in customizing process models for acute ischemic stroke treatment. During process model customization, the method provides decision-making support for users, thereby ensuring a structurally correct process customization and enabling improves patient treatment by means of recommendations