BPM and Healthcare

Scott Francis
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ebizQ has an interesting two-page article on BPM and Healthcare titled “BPM: The healthcare industry’s prescription for serving patients better“, which uses the label BPM broadly (not specifically meaning “BPMS”):
For example, Nunn says, one facility used BPM to reduce the number of patient falls—a common problem among elderly people and those recovering from surgery. After analyzing data, the facility changed the layout of its beds so nurses could better keep an eye on patients when they got up at night to use the bathroom, which was when most falls were recorded. In another case, Nunn worked with a hospital trying to pinpoint why many of its heart-surgery patients were getting infections. By examining the entire process of surgery from admittance to discharge, Nunn’s team was able to determine that an autoclave, a machine for sterilizing instruments, was not working properly, even though its gauges indicated that it was reaching the proper temperatures. After the hospital replaced the machine, infection rates plummeted.
As I’ve said at other times, there’s a place for more “case” oriented approaches in hospitals and healthcare, but the case approach would *never* address changing the layout of beds, nor determining that the autoclave isn’t sterilizing sufficiently. To those that think that examining aggregate outcomes is irrelevant in patient care, I’m telling you, you are missing the boat.  Note that the above two examples I picked out don’t necessarily require BPM (six sigma analysis likely would turn this up), BPM can be the instrument for collecting and analyzing the data that allows the six sigma (or other experts) to determine root cause – or failing root cause, at least to identify correlation. This isn’t the first time we’ve pointed to good work by others, documenting the benefits of BPM to the healthcare business, and I’m sure it won’t be the last.

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  • Jeoff Wilks

    I’m trying to understand your point better. It sounds like you’re saying that “case” strategies make it harder to aggregate data. Please elaborate on why a case approach would never address changing bed layouts or find a malfunctioning autoclave.

    • Jeoff – I used “case” as shorthand for the ACM approach – proponents of which typically start with the presumption that no experts are involved designing the process, for example (no modeling, no BPMN, no integrations, etc.).  Processes like “treating a patient” allegedly can’t be managed by BPM, because they’re emergent, or unpredictable, or simply not known in advance. 

      ACM typically rejects scientific approaches to process, eschewing them in exchange for the ability of individual actors to define their processes (task lists, approvals, etc.) on the fly.  Obviously the ACM community isn’t of a single mind on these issues, but those are common threads if you read Keith Swenson’s blog, for example, or Jacob Ukelson’s, two of the more thoughtful writers on the subject.

      This blog: http://www.bp-3.com/blogs/2010/06/less-controversial-bpm-vs-case-management-comparison/
      gives a good example of how ACM tends to focus on the singular – how can I make the treatment of THIS patient better.  But BPM efforts are typically more focused on the aggregate – how can I improve average outcomes for all my patients moving through the hospital or treatment center.

      So, to answer your question – it isn’t that case strategies make it harder, or preclude aggregating data – it is just that the act of basing process improvements on that data is a BPM approach, not a “case” approach (or at least not an ACM approach) because it starts with the assumption that a process expert might know something the individual actors in the process don’t.  In the ACM approach, why would any data be tracked about the autoclave at all? It (a) requires integration, and (b) isn’t directly related to the process of treating the patient.  Why would one examine bed layout in aggregate rather than a particular patient’s bed location? 

      There’s no reason why ACM and BPM approaches to problem solving can’t be combined.  In fact, I consider it only one software market because they’re both addressing similar business problems, but with a different emphasis.  Two sides of the same coin of business process improvement and management, in my opinion.  Much like 5s and Lean are related, and complementary, but are not the same thing. And yet they tend to be applied together, by the same teams and experts. However, the ACM folks are trying to split it into a separate, distinct market, and often use doctors treating patients as a prime example of a place where BPM simply can’t help because the treatment can’t be known in advance … this article (and others like it ) are stark proof that this argument is simply wrong because it misses the whole point.