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
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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
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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.
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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
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“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 ,
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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).
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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
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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.
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• 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 :
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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
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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
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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. P ocess o ien a ion ocus on
unc ions meaning ul o he cus ome and does no ca e abou unc ion e-use
whe eas he la e is he p ima y conce n o so wa e enginee ing models.
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Cu is B., Kellne M., and O e J., (1992), “P ocess modeling”, Communica ions o he
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