Business Process Management techniques for health services: Experiences and Application

Abs ac Numbe : 002-0557 Business P ocess Managemen echniques o heal h se ices: Expe iences and Applica ion Second Wo ld Con e ence o POM and 15 h Annual POM Con e ence, Cancun, Mexico, Ap il 30 – May 3, 2004. Jose M F aminan, Indus ial Managemen , School o Enginee ing, Uni e si y o Se ille A da. de los Descub imien os s/n E 41092 Se ille, Spain Email: [email p o ec ed] Tel: (in ) + 34954487214 Ca los Pa a, Uni e si y Hospi als “Vi gen del Rocío” A da. Manuel Siu o s/n E 41013 Se ille, Spain Email: ca los.pa a.sspa@jun adeandalucia.es Tel: (in ) + 34955012015 José M. De la Higue a, Uni e si y Hospi als “Vi gen del Rocío” A da. Manuel Siu o s/n E 41013 Se ille, Spain Email: ca los.pa a.sspa@jun adeandalucia.es Tel: (in ) + 34955012015 Back o "Sea ch By Au ho " Ra ael Ruiz-Usano, Indus ial Managemen , School o Enginee ing, Uni e si y o Se ille A da. de los Descub imien os s/n E 41092 Se ille, Spain Email: [email protected] Tel: (in ) + 34954487210 Juan M. Mele o, Uni e si y Hospi als “Vi gen del Rocío” A da. Manuel Siu o s/n E 41013 Se ille, Spain Email: ca los.pa a.sspa@jun adeandalucia.es Tel: (in ) + 34955012015 Back o "Sea ch By Au ho " Abs ac In his pape , we p esen ou expe ience in a Business P ocess Managemen (BPM) p ojec o public hospi als. This p ojec is suppo ed by a esea ch ne wo k whose o e all goal is o de elop new heal h se ices based on elemedicine. In o de o do so, di e en decision- suppo and planning me hodologies and ools a e suppo ed in o de o p oduce new o ganiza ional models o e icien ly suppo heal h se ices. Among hese, we ocus on he p ocess-o ien ed app oach a he han he adi ional unc ion-o ien ed app oach o heal h se ices. Acco ding o his app oach, heal h p ocesses mus i s be iden i ied and modeled in o de o simula e he esul ing models and seek o al e na i es in a BPM con ex . Since i is mo e han likely ha he new p ocesses o be implemen ed may imply he edesign o (a leas ) pa o he cu en in o ma ion and communica ion sys em, a o mal desc ip ion model sui able o so wa e de elopmen (i.e. UML diag ams) should also be p oduced. Back o "Sea ch By Au ho " 1. In oduc ion Re-designing and e-enginee ing new heal h se ices a e becoming an impo an issue o hospi al manage s and esponsible o Heal h Sys ems. In he de eloped coun ies, he aging o he popula ion has led o he inc ease o a new ype o use s in he Heal h Sys ems. These use s (cus ome s) do no equi e hei con inuous hospi aliza ion, bu some kind o con inuous moni o ing, ea men , and assessmen a hei own houses. Hence, hospi als and heal h sys ems mus p o ide subs an ially di e en se ices ha hose cu en ly suppo ed. The e o e, i is o g ea in e es o design and implemen hese new heal h se ices, aiming also a he in eg a ion o elemedicine, unde s ood – in a a he b oad sense – as IT applied o heal hca e. This is he con ex in which he p ojec p esen ed in his pape has been ca ied ou . The p ojec is being suppo ed by a esea ch ne wo k o 13 nodes, mos o hem hospi als o igh ly linked o he Na ional Heal h Sys em. The o e all goal o he esea ch ne wo k is o p o ide a se o ools (models, me hodologies, ha dwa e and so wa e) o acili a e he design, implemen a ion and assessmen o new heal h se ices using elemedicine. To achie e his goal, a numbe o home ca e p ocesses ha e been chosen as use cases (i.e. home ca e o e minal pa ien s, home ca e o pos -su gical pa ien s, and he home ca e o ch onic pa ien s). Wi hin he o e all goal, a numbe o speci ic goals ha e been es ablished, e e ing o pa icula aspec s o elemedicine. To achie e hese, i e Wo king Packages ha e been se up, being each one o he packages leaded by one node o he ne wo k. F om he di e en wo king packages, WP1 should add ess a numbe o issues ela ed o he new o ganiza ional models o heal h se ices. This wo king package is lead by he hospi al Back o "Sea ch By Au ho " “Vi gen del Rocío” in Se ille (la ges hospi al in Spain in e ms o he numbe o pa ien s), and he Indus ial Managemen Resea ch G oup, om he School o Enginee ing, Uni e si y o Se ille. The speci ic goals wi hin his WP a e he ollowing: - To de elop a me hodology o Heal h Se ices (HS) p ocess modeling. Acco ding o he e iew ca ied ou in he nex sec ion, he e a e ew expe iences in HS p ocess modeling. The e o e, one o he objec i es is o adap o combine gene al Business P ocess Modeling (BPM) me hodologies o hei applica ion in he heal hca e sec o . - To p o ide he ne wo k wi h a numbe o as-is models ep esen ing how he a o emen ioned use cases a e cu en ly being o e ed in he hospi als. The aim is o p omo e discussion among he nodes membe s on how hese se ices should be o e ed, pa icula ly aking in o accoun he in eg a ion o elemedicine. - To p o ide o-be models ha ep esen an imp o emen o e he as-is models and may se e as e e ence models o he es o he nodes in he esea ch ne wo k. Since i is expec ed ha some o he unc ions in he o-be models a e o be implemen ed by means o IT suppo , a o mal desc ip ion model sui able o so wa e de elopmen (i.e. UML diag ams) should also be p oduced. In his pape , we desc ibe he expe iences encoun e ed in he de elopmen o he p ojec . The es o he pape is o ganized as ollows: In he nex sec ion, we b ie ly e iew he ela ed (and a he sca ce) li e a u e on applica ions o BPM o he heal hca e sec o . A e , Back o "Sea ch By Au ho " we desc ibe he con ex in which he p ojec is being de eloped, ocusing on he speci ic obs acles encoun e ed and he equi emen s posed o he BPM echniques and ools o be employed. In Sec ion 4, we e iew he ARIS me hodology and he IDS Schee p oduc s and show how hese ma ch he equi emen s s a ed in he p e ious sec ion. Nex , we desc ibe he app oach ollowed in he p ojec , and in Sec ion 6 we b ie ly elabo a e on he expe ience gained in his p ojec . 2. Rela ed li e a u e A (business) p ocess may be de ined as a se o ela ed asks ha a e ca ied ou wi hin a business o o ganiza ion in o de o ob ain ce ain ou pu (Da enpo and Sho 1990). These asks such c ea e alue o he cus ome o he business o o ganiza ion (Gunaseka an and Kobu 2002). Business P ocess Redesign (BPR) e e s o hose ini ia i es aimed o ob aining signi ican imp o emen s in he o ganiza ion by means o he inc easing he e iciency and e ec i eness o key business p ocesses (Was ell e al. 1994). BPR includes wo di e en app oaches: - Top-down app oaches seeking adical changes in he o ganiza ion, such as ‘business p ocess e-enginee ing’ (Hamme 1990) and ‘p ocess inno a ion’ (Da enpo 1993). - Ini ia i es o small scope wi hin a bo om-up app oach seeking inc emen al imp o emen s in he o ganiza ion (business p ocess imp o emen ) (Ha ing on 1991). Back o "Sea ch By Au ho " In gene al, he sui abili y o bo h app oaches emains an open ques ion (MacIn osh 2003). Indeed, he au ho s o he seminal wo ks on business p ocess e-enginee ing s a e ha , in p ac ice, he changes in oduced in he o ganiza ions by means o e-enginee ing ha e no been as adical as ini ially expec ed (see e.g. Champy 1995, o Hamme and S an on 1995). Besides, i is usual ha in a eenginee ing p ojec whe e adical imp o emen s in he p ocesses a e being s udied, some small imp o emen s can be ound, so bo h app oaches can be seen as complemen a y and no excluding ones (Kelada 1996). Once a p ocess has been a ge ed o e-design, i is equi ed o model i wi h ce ain deg ee o de ail. The e o e, Business P ocess Modeling (BPM) is conside o be a co e pa o he BPR and o sys ems analysis in gene al (Flynn 1992, Was ell e al. 1994). F om an in o ma ion sys em iewpoin , BPM is he desc ip ion o he con ol low o a p ocess (G een and Rosemann 2002). F om a p ocess iewpoin , a hospi al consis s o a high numbe o p ocesses linked h ough a clien /se e ela ionship (Ambe g and G äbe 1996). The e o e, he me hodologies, echniques and ools applied o BPM in companies can be also applied o he heal hca e sec o . In ac , mos Hospi al In o ma ion Sys ems (HIS) a e being e-o ien ed owa ds heal hca e p ocesses (Reiche e al. 1998). Al hough a he sca ce, he e ha e been some a emp s o apply BPM echniques o he heal hca e se ices. Fo ins ance, Wa ing and Wainw igh (2002) desc ibe how se e al p ocesses in a hospi al a e modeled. Maij e al. (2002) desc ibe p ocess modeling o a Uni e si y Medical Cen e in he Ne he lands. Ambe and G äbe (1996) ca y ou he Back o "Sea ch By Au ho " modeling o he p ocesses o a hospi al in o de o implemen a HIS. Was ell e al. (1994) analyze a numbe o p ocesses in a hospi al and s udy a numbe o imp o emen p oposals based on he applica ion o IT. Thei analysis is ocused on he ex e nal pa ien s, and RADs (Role Ac i i y Diag am) a e employed as modeling echnique. Finally, Sp engel e al. (2003) ca y ou an analysis o image diagnos ic p ocesses in wo Ge man hospi als. To he bes o ou knowledge, he e a e no published e e ences on BPM in he heal h sec o wi h he aim o analyze he in oduc ion o elemedicine in he p ocesses unde conside a ion. 3. Con ex o he P ojec In his sec ion, we p esen he speci ic con ex in which he p ojec is being de eloped. Speci ically, we desc ibe he obs acles ound and he equi emen s se up in he beginning o he p ojec . Wi h espec o he obs acles, he e a e a numbe o c i ical issues ha ha e been iden i ied. Some o hem a e consis en ly desc ibed as common o any BPM p ojec , so we ocus on he speci ic obs acles ha we ega d as cha ac e is ic o he heal hca e sec o . These a e he ollowing: • Manual unc ions. Mos o he key unc ions a e manually pe o med and he e a e li le chances ha hey can be au oma ed in he nea u u e. The du ies o be ca ied ou by he su geons cons i u e an example o he abo e. Back o "Sea ch By Au ho " • Func ion-o ien ed o ganiza ions. Due o he high deg ee o specializa ion equi ed o ca y ou he di e en ac i i ies, hospi als a e usually s ongly unc ion-o ien ed o ganiza ions composed o se e al uni s (e.g. X- ay, su ge y, e c.) wi h a g ea deg ee o de-cen aliza ion among hese, pa icula ly ega ding esou ces and unding alloca ion. This causes a lack o p ocess-o ien ed iew ha makes di icul o ca y on BPM p ojec s. • Skep icism on applying BPM solu ion o heal h se ices. Despi e being echniques widely applied, he in insic cha ac e is ics o he heal hca e sec o seem o be he eason o he common belie –exp essed by many use s– ha BPM echniques a e o dubious use ulness o imp o ing heal h se ices. Rega ding he p ojec equi emen s, in he con ex o BPM i is impo an o dis inguish among me hodologies, echniques, and ools. Me hodologies a e modeling pa adigms. Each me hodology can be suppo ed by one o mo e modeling echniques. Modeling echniques e e o he se o symbols, diag ams and o he no a ion employed o desc ibe and analyze he sys em unde conside a ion. Finally, echniques may be suppo ed by so wa e applica ions ha suppo modeling asks and ac as model eposi o y. Fo a de ailed desc ip ion o me hodologies, echniques, and ools, he eade is e e ed o Ke inge e al. (1997). Wi h espec o he modeling echnique equi emen s, he ollowing equi emen s on he modeling echnique ha e been posed a he beginning o he p ojec : Back o "Sea ch By Au ho " Coo dina quien ealiza á la p ime a isi a Facul a i o C.P. Ing esa Ing eso ealizado Facul a i o C.P. Seleccionado médico Seleccionado médico y en e me o Realiza p ime a isi a conjun a con e aluación Recibi al amilia Recibi de i ación Familia ecibido Realiza p ime a isi a médica con e aluación Visi a ealizada Pacien e en consul a de especialidad Pacien e en consul a M.F. Pacien e hospi alizado Pacien e en A.U gencias Ing eso ealizado Ing esa His o ia Clínica Da os clínicos Da os uncionales Salida del p oceso Da os del g ado de conocimien o del pacien e Da os eligiosos Da os socio- amilia es Equipo cuidados palia i os Salida del p oceso Adminis a i o A ende a domicilio Pacien e de i ado de o o hospi al Salida del p oceso Llamada ealizada Ges iona pacien e hospi alizado Ges ión ealizada Salida del p oceso His o ia Clínica Da os clínicos Da os uncionales Da os del g ado de conocimien o del pacien e Da os eligiosos Da os socio- amilia es Adminis a i o Equipo cuidados palia i os A ende a domicilio Facul a i o C.P. Facul a i o C.P. Equipo cuidados palia i os Figu e 1. Fi s le el model o a home ca e use case Back o "Sea ch By Au ho " 6. Lessons lea ned In his pape , we ha e p esen ed he expe iences encoun e ed in a BPM p ojec o he heal hca e sec o . Al hough he p ojec is a om being o e , he ollowing commen s can be done based in pas de elopmen s: • The ARIS me hodology and he so wa e ool ARIS Toolse ha e p o ed o be sui able o his p ojec . They ha e ma ched mos o he p ojec ’s equi emen s, pa icula ly hese ega ding he ease o unde s anding by non-expe s in modeling. We ha e ound no di icul ies when explaining he meaning o he di e en elemen s o he EPC, and he use o il e s p o ided by he so wa e ool has allowed us o educe he numbe o elemen s o he minimum equi ed o desc ibe he p ocesses. As one o he objec i es has been ob aining simula ion models, he OR ope a o has been o bidden. An addi ional eason o disallowing his ope a o has been ha i was de ec ed ha he use s could employ i o hide he logical beha io o some p ocess ha was no en i ely clea o hem. • The elabo a ion o a glossa y has been p o ed o be ex emely impo an o he p ojec . The glossa y has se ed o acili a e he de elopmen o u u e models as well as o ease he unde s anding o he published models by he es o he ne wo k. • Simula ion is being he key o model alida ion. In his p ojec , simula ion is no only employed o pe o ming wha -i analysis, bu o alida e he dynamic aspec s Back o "Sea ch By Au ho " o he models. Aside, i has been used o ex ac he knowledge o he p ocess om he use s, as in some cases he use s ag eed wi h s a ic models bu did no ag ee wi h he simula ion esul s. • The in eg a ion o p ocess models wi h UML emains an open ques ion. Al hough i is possible o ob ain UML diag ams om he EPCs, his mapping is a om being au oma ic. We belie e ha mos o he di icul ies s eam om he ac ha ob aining UML diag ams om business p ocess models implies c ossing he bounda ies be ween p ocess-o ien a ion and unc ion-o ien a ion. 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