Agility in medical treatment processes - A model-based approach

The economic view on today’s health care organizations insists on the integration of standardized process descriptions by Clinical Pathways and information technology (IT). The individuality of several treatments then again requires mechanisms for a flexible and agile alignment oft a treatment process at any time. This paper delineates an IT-system for an agile execution of medical treatment processes based on process models of Clinical Pathways. It will be shown which information occurs and where it can be used in terms of an agile process management and a continuous process improvement. 1 Agile processes in health care In the era of the system of Diagnosis Related Groups (DRG) and growing competition in terms of quality and efficiency, a comprehensive quality and process management is a fundamental part of modern healthcare organizations [Wie04]. In this context, clinical pathways have been established as a promising tool, addressing evidence-based expertise of clinical practice guidelines and describe organization-specific recommendations for action and best practices. Next to effective treatment of patients, these highly standardized process descriptions allow an improvement of economic efficiency in terms of cost and duration of treatment. Thus, they are additionally enhancing the quality of care and patient satisfaction. Simultaneously, medical treatment processes must consider several factors that preclude a complete standardization. Clinical pathways are characterized by a variety of decisions that are made during the execution and treatment of the patient. These decisions consider the patient’s individuality and enable a unique course of treatment. In combination with appropriate IT systems, clinical pathways can officiate as decision-support instruments and submit treatment proposals. However, the final decision is always taken by the attending physician. Consequently, there is a dependency between the resulting treatment process and the medical expertise. Not least, changes of the evidence-based knowledge of clinical practice guidelines by new scientific insights and also changes of the legal frameworks are affecting medical treatment processes. These explanations suggest that the real individual course of treatment of a patient is difficult to plan and hardly predictable in detail. On the one hand, clinical pathways as well as IT systems must feature components and mechanisms to facilitate and flexibly design the planning. In terms of a genuine process agility on the other hand, it must be possible to adequately respond to unexpected impacts. Hence, innovative information systems and solutions are needed to meet these requirements. The integration of a multitude of actors involved and the pooling of services in a network of medical providers leads to a high degree of complexity of the treatment processes which is beyond the complexity of traditional industrial processes [EK07]. Currently, existing workflow technologies can cope with this complexity inadequately. Though there is a discrepancy between the possible potential and the prior use of modern information technology in hospitals [EK07, LR07]. The current focus of research is still at the conceptual level. This paper will show, how to support a hospital’s process organization and how the integration of the individual layers can be made up to the IT on the basis of modeled process knowledge. An IT system for planning and executing medical treatment processes using process models of clinical pathways will be outlined. The focus of the work is also on the identification and implementation of flexible and agile process components and mechanisms to respond agile to individual impacts during the execution of clinical pathways. The results will be consolidated in a concluding section and provide an approach for integrating a comprehensive agile process management in health care. 2 Model-supported process management 2.1 Agility vs. Flexibility The further use of the central terms flexibility and agility requires an unequivocal distinction between these two elements. Flexibility in the context of medical treatment processes is described as the ability of reacting quickly and experienced to changing conditions (diagnosis, results of examinations) by changing between predefined and predictable scenarios and the corresponding necessary actions [VF98]. A flexible treatment process is characterized for example through the disposability of various alternatives of treatment. The execution of these alternatives that have been identified previously is controlled by decisions. In addition agility stands out due to the ability to handle unexpected and unpredictable changes [SZ99]. Agile treatment processes or rather IT-Systems which are supporting those provide corresponding mechanism for responding adequately to effects that did not attract interest during the planning process because of their unpredictability. Thus, the individuality of the respective patient can be regarded perfectly. 268 Martin Burwitz, Hannes Schlieter, Werner Esswein