Business Process Management techniques for health services: Experiences and Application

Abstract Number: 002-0557 Business Process Management techniques for health services: Experiences and Application Second World Conference of POM and 15th Annual POM Conference, Cancun, Mexico, April 30 – May 3, 2004. Jose M Framinan, Industrial Management, School of Engineering, University of Seville Avda. de los Descubrimientos s/n E 41092 Seville, Spain Email: [email protected] Tel: (int) + 34954487214 Carlos Parra, University Hospitals “Virgen del Rocío” Avda. Manuel Siurot s/n E 41013 Seville, Spain Email: [email protected] Tel: (int) + 34955012015 José M. De la Higuera, University Hospitals “Virgen del Rocío” Avda. Manuel Siurot s/n E 41013 Seville, Spain Email: [email protected] Tel: (int) + 34955012015 Back to "Search By Author" Rafael Ruiz-Usano, Industrial Management, School of Engineering, University of Seville Avda. de los Descubrimientos s/n E 41092 Seville, Spain Email: [email protected] Tel: (int) + 34954487210 Juan M. Melero, University Hospitals “Virgen del Rocío” Avda. Manuel Siurot s/n E 41013 Seville, Spain Email: [email protected] Tel: (int) + 34955012015 Back to "Search By Author" Abstract In this paper, we present our experience in a Business Process Management (BPM) project for public hospitals. This project is supported by a research network whose overall goal is to develop new health services based on telemedicine. In order to do so, different decisionsupport and planning methodologies and tools are supported in order to produce new organizational models for efficiently support health services. Among these, we focus on the process-oriented approach rather than the traditional function-oriented approach to health services. According to this approach, health processes must first be identified and modeled in order to simulate the resulting models and seek for alternatives in a BPM context. Since it is more than likely that the new processes to be implemented may imply the redesign of (at least) part of the current information and communication system, a formal description model suitable for software development (i.e. UML diagrams) should also be produced. Back to "Search By Author" 1. Introduction Re-designing and re-engineering new health services are becoming an important issue for hospital managers and responsible for Health Systems. In the developed countries, the aging of the population has led to the increase of a new type of users in the Health Systems. These users (customers) do not require their continuous hospitalization, but some kind of continuous monitoring, treatment, and assessment at their own houses. Hence, hospitals and health systems must provide substantially different services that those currently supported. Therefore, it is of great interest to design and implement these new health services, aiming also at the integration of telemedicine, understood – in a rather broad sense – as IT applied to healthcare. This is the context in which the project presented in this paper has been carried out. The project is being supported by a research network of 13 nodes, most of them hospitals or tightly linked to the National Health System. The overall goal of the research network is to provide a set of tools (models, methodologies, hardware and software) to facilitate the design, implementation and assessment of new health services using telemedicine. To achieve this goal, a number of home care processes have been chosen as use cases (i.e. home care of terminal patients, home care of post-surgical patients, and the home care of chronic patients). Within the overall goal, a number of specific goals have been established, referring to particular aspects of telemedicine. To achieve these, five Working Packages have been set up, being each one of the packages leaded by one node of the network. From the different working packages, WP1 should address a number of issues related to the new organizational models for health services. This working package is lead by the hospital Back to "Search By Author" “Virgen del Rocío” in Seville (largest hospital in Spain in terms of the number of patients), and the Industrial Management Research Group, from the School of Engineering, University of Seville. The specific goals within this WP are the following: - To develop a methodology for Health Services (HS) process modeling. According to the review carried out in the next section, there are few experiences in HS process modeling. Therefore, one of the objectives is to adapt or combine general Business Process Modeling (BPM) methodologies for their application in the healthcare sector. - To provide the network with a number of as-is models representing how the aforementioned use cases are currently being offered in the hospitals. The aim is to promote discussion among the nodes members on how these services should be offered, particularly taking into account the integration of telemedicine. - To provide to-be models that represent an improvement over the as-is models and may serve as reference models for the rest of the nodes in the research network. Since it is expected that some of the functions in the to-be models are to be implemented by means of IT support, a formal description model suitable for software development (i.e. UML diagrams) should also be produced. In this paper, we describe the experiences encountered in the development of the project. The rest of the paper is organized as follows: In the next section, we briefly review the related (and rather scarce) literature on applications of BPM to the healthcare sector. After, Back to "Search By Author" we describe the context in which the project is being developed, focusing on the specific obstacles encountered and the requirements posed to the BPM techniques and tools to be employed. In Section 4, we review the ARIS methodology and the IDS Scheer products and show how these match the requirements stated in the previous section. Next, we describe the approach followed in the project, and in Section 6 we briefly elaborate on the experience gained in this project. 2. Related literature A (business) process may be defined as a set of related tasks that are carried out within a business or organization in order to obtain certain output (Davenport and Short 1990). These tasks such create value for the customer of the business or organization (Gunasekaran and Kobu 2002). Business Process Redesign (BPR) refers to those initiatives aimed to obtaining significant improvements in the organization by means of the increasing the efficiency and effectiveness of key business processes (Wastell et al. 1994). BPR includes two different approaches: - Top-down approaches seeking radical changes in the organization, such as ‘business process re-engineering’ (Hammer 1990) and ‘process innovation’ (Davenport 1993). - Initiatives of small scope within a bottom-up approach seeking incremental improvements in the organization (business process improvement) (Harrington 1991). Back to "Search By Author" In general, the suitability of both approaches remains an open question (MacIntosh 2003). Indeed, the authors of the seminal works on business process re-engineering state that, in practice, the changes introduced in the organizations by means of re-engineering have not been as radical as initially expected (see e.g. Champy 1995, or Hammer and Stanton 1995). Besides, it is usual that in a reengineering project where radical improvements in the processes are being studied, some small improvements can be found, so both approaches can be seen as complementary and not excluding ones (Kelada 1996). Once a process has been targeted for re-design, it is required to model it with certain degree of detail. Therefore, Business Process Modeling (BPM) is consider to be a core part of the BPR and of systems analysis in general (Flynn 1992, Wastell et al. 1994). From an information system viewpoint, BPM is the description of the control flow of a process (Green and Rosemann 2002). From a process viewpoint, a hospital consists of a high number of processes linked through a client/server relationship (Amberg and Gräber 1996). Therefore, the methodologies, techniques and tools applied for BPM in companies can be also applied to the healthcare sector. In fact, most Hospital Information Systems (HIS) are being re-oriented towards healthcare processes (Reichert et al. 1998). Although rather scarce, there have been some attempts to apply BPM techniques to the healthcare services. For instance, Waring and Wainwright (2002) describe how several processes in a hospital are modeled. Maij et al. (2002) describe process modeling for a University Medical Center in the Netherlands. Amber and Gräber (1996) carry out the Back to "Search By Author" modeling of the processes of a hospital in order to implement a HIS. Wastell et al. (1994) analyze a number of processes in a hospital and study a number of improvement proposals based on the application of IT. Their analysis is focused on the external patients, and RADs (Role Activity Diagram) are employed as modeling technique. Finally, Sprengel et al. (2003) carry out an analysis of image diagnostic processes in two German hospitals. To the best of our knowledge, there are no published references on BPM in the health sector with the aim of analyze the introduction of telemedicine in the processes under consideration. 3. Context of the Project In this section, we present the specific context in which the project is being developed. Specifically, we describe the obstacles found and the requirements set up in the beginning of the project. With respect to the obstacles, there are a number of critical issues that have been identified. Some of them are consistently described as common to any BPM project, so we focus on the specific obstacles that we regard as characteristic of the healthcare sector. These are the following: • Manual functions. Most of the key functions are manually performed and there are little chances that they can be automated in the near future. The duties to be carried out by the surgeons constitute an example of the above. Back to "Search By Author" • Function-oriented organizations. Due to the high degree of specialization required to carry out the different activities, hospitals are usually strongly function-oriented organizations composed of several units (e.g. X-ray, surgery, etc.) with a great degree of de-centralization among these, particularly regarding resources and funding allocation. This causes a lack of process-oriented view that makes difficult to carry on BPM projects. • Skepticism on applying BPM solution to health services. Despite being techniques widely applied, the intrinsic characteristics of the healthcare sector seem to be the reason for the common belief –expressed by many users– that BPM techniques are of dubious usefulness for improving health services. Regarding the project requirements, in the context of BPM it is important to distinguish among methodologies, techniques, and tools. Methodologies are modeling paradigms. Each methodology can be supported by one or more modeling techniques. Modeling techniques refer to the set of symbols, diagrams and other notation employed to describe and analyze the system under consideration. Finally, techniques may be supported by software applications that support modeling tasks and act as model repository. For a detailed description of methodologies, techniques, and tools, the reader is referred to Kettinger et al. (1997). With respect to the modeling technique requirements, the following requirements on the modeling technique have been posed at the beginning of the project: Back to "Search By Author" Coordinar quien realizará la primera visita Facultativo C.P. Ingresar Ingreso realizado Facultativo C.P. Seleccionado médico Seleccionado médico y enfermero Realizar primera visita conjunta con evaluación Recibir al familiar Recibir derivación Familiar recibido Realizar primera visita médica con evaluación Visita realizada Paciente en consulta de especialidad Paciente en consulta M.F. Paciente hospitalizado Paciente en A.Urgencias Ingreso realizado Ingresar Historia Clínica Datos clínicos Datos funcionales Salida del proceso Datos del grado de conocimiento del paciente Datos religiosos Datos socio-familiares Equipo cuidados paliativos Salida del proceso Administrativo Atender a domicilio Paciente derivado de otro hospital Salida del proceso Llamada realizada Gestionar paciente hospitalizado Gestión realizada Salida del proceso Historia Clínica Datos clínicos Datos funcionales Datos del grado de conocimiento del paciente Datos religiosos Datos socio-familiares Administrativo Equipo cuidados paliativos Atender a domicilio Facultativo C.P. Facultativo C.P. Equipo cuidados paliativos Figure 1. First level model of a home care use case Back to "Search By Author" 6. Lessons learned In this paper, we have presented the experiences encountered in a BPM project for the healthcare sector. Although the project is far from being over, the following comments can be done based in past developments: • The ARIS methodology and the software tool ARIS Toolset have proved to be suitable for this project. They have matched most of the project’s requirements, particularly these regarding the ease of understanding by non-experts in modeling. We have found no difficulties when explaining the meaning of the different elements of the EPC, and the use of filters provided by the software tool has allowed us to reduce the number of elements to the minimum required to describe the processes. As one of the objectives has been obtaining simulation models, the OR operator has been forbidden. An additional reason for disallowing this operator has been that it was detected that the users could employ it to hide the logical behavior of some process that was not entirely clear for them. • The elaboration of a glossary has been proved to be extremely important for the project. The glossary has served to facilitate the development of future models as well as to ease the understanding of the published models by the rest of the network. • Simulation is being the key for model validation. In this project, simulation is not only employed for performing what-if analysis, but to validate the dynamic aspects Back to "Search By Author" of the models. Aside, it has been used to extract the knowledge of the process from the users, as in some cases the users agreed with static models but did not agree with the simulation results. • The integration of process models with UML remains an open question. Although it is possible to obtain UML diagrams from the EPCs, this mapping is far from being automatic. We believe that most of the difficulties steam from the fact that obtaining UML diagrams from business process models implies crossing the boundaries between process-orientation and function-orientation. 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(1990), “The new industrial engineering: information technology and business process redesign”, Sloan Management Review, Summer, pp. 11-17. Flynn D. (1992), Information system requirements: determination and analysis, McGraw- Hill, Maidenhead. Gartner Group (2002), Gartner Group Report. Available at http://www.gartner.com. Green P., and Rosemann M, (2002), “Integrated Process Modelling: An Ontological Evaluation”, Information Systems 25, pp. 73-87. Gulledge T., and Sommer R. (2002), “Business process management: public sector implications”, Business Process Management Journal 8, pp. 364-376. Gunasekaran A., and Kobu B. (2002), “Modelling and analysis of business process reengineering”, International Journal of Production Research, 40, pp. 2521-2546. Hammer M. (1990), “Reengineering work: Don't automate, obliterate”, Harvard Business Review, July-Aug, pp. 104-112. Hammer M., and Stanton S. (1995), The Reengineering Revolution: A Handbook, Harper Business, New York. 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