Five main processes in healthcare: a citizen perspective (2024)

Abstract

A citizen point of view on the healthcare system, its processes and their improvement is emphasised. From this point of view, five main processes are identified: Keeping Healthy, Detecting Health Problems, Diagnosing Diseases, Treating Diseases and Providing for a Good End of Life. The citizen should be looked upon as a cocreator of value and improvement of these processes.

Five main processes

The concept ‘work process’ has been used for a very long time1 to denote sets of repeatable value creating activities subject to improvement.2 Shewhart3 4 also emphasised the process as a means to produce value for the customer, but with a varying quality. By identifying and removing assignable causes of variation, the process could be made predictable with only chance causes of variation left in the process. Donabedian5 was an early proponent of the use of the process concept in healthcare. He identified the importance of looking at the organisational structure6 and the processes involved in producing outcomes for the patients. Batalden and Stoltz,7 basing their contributions very much on Deming,8 9 extended the concept to systems by describing a general framework for quality improvement in healthcare.

Processes can be studied from a department, organisation10 or industry perspective. If we focus on the complete healthcare system, it would be natural also to look upon the processes from a citizen's point of view. From that perspective, the following five main processes are identified (figure 1).

Discussion

Of course, these processes do not occur in neat succession; they may be in operation simultaneously, in parallel or iteratively. In happy situations, the first transforms into the last one. However, if any one of the four first processes goes wrong, subsequent processes will suffer as indicated in the illustrations above. When planning for improvement and allocating resources to the healthcare system, a systems view should be taken, and each and all of these interconnected processes should be considered; improvements made that impact citizens earlier in their life will be more valuable and usually more cost-efficient.

In the west of Sweden, steps have been taken to organise cancer processes from a patient/citizen point of view. This work is part of an action research project to gain more knowledge on improvement programmes that take this broad view of health. Process owners have been identified for each of 23 types of cancer. These owners have responsibility for the complete cancer system for their assigned cancer type. In addition, improvement work has begun on two generic subprocesses that span all the cancer types. The adoption of learning mechanisms to foster continual improvement of these processes is crucial.11

Taking the citizen's perspective on healthcare processes also requires a systems view and is an important step in the increased involvement of the citizens/patients in the improvement of healthcare processes. The citizens are not just receiving value from the healthcare system; they are also active partners in their operation and should be important partners in its improvement. They should be seen as cocreators of value12 rather than only subjects to the production in the healthcare processes.

Acknowledgments

We want to express our gratitude to the editors, anonymous reviewers and S Lifvergren, for valuable comments and suggestions.

References

1. ↵
   1. Babbage C

   . On the Economy of Machinery and Manufactures, 1832. http://www.gutenberg.org/dirs/etext03/cnmmm10.txt (accessed 22 Jul 2010).

2. ↵
   1. Gilbreth LM

   . Psychology of Management 1914. http://www.gutenberg.org/files/16256/16256-h/16256-h.htm (accessed 22 Jul 2010).

3. ↵
   1. Shewhart WA

   . Economic Control of Quality of Manufactured Product. Milwaukee, WI: American Society for Quality Control, 1980 (originally published 1931).

4. ↵
   1. Shewhart WA

   . Statistical Method from the Viewpoint of Quality Control. Washington, DC: Graduate School of the Department of Agriculture, 1939.

5. ↵
   1. Donabedian A

   . Evaluating the quality of medical care. Milbank Mem Fund Q 1966;44(Suppl):166–206.

   OpenUrlCrossRefPubMedWeb of Science

6. ↵
   1. Glickman SW,
   2. Baggett KA,
   3. Krubert CG,
   4. et al

   . Promoting quality: the health-care organization from a management perspective. Int J Qual Health Care 2007;19:341–8.

   OpenUrlAbstract/FREE Full Text

7. ↵
   1. Batalden PB,
   2. Stoltz PK

   . A framework for the continual improvement of health care. Jt Comm J Qual Improv 1993;19:424–47.

   OpenUrlPubMed

8. ↵
   1. Deming WE

   . Out of the Crisis. Cambridge, MA: Center for Advanced Engineering Study, Massachusetts Institute of Technology, 1986.

9. ↵
   1. Deming WE

   . New Economics for Industry, Government and Education. Cambridge, MA: MIT Press, 1993.

10. ↵
    1. Hellström A,
    2. Lifvergren S,
    3. Quist J

    . Process management in healthcare: investigating why it's easier said than done. J Manuf Techn Management 2010;21:499–511.

    OpenUrlCrossRef

11. ↵
    1. Cummings TG

    1. Shani AB,
    2. Docherty P

    . Learning by design. Key mechanisms in organization development. In: Cummings TG, ed. Handbook of Organization Development. Thousand Oaks, CA: Sage Publications, 2008.

12. ↵
    1. Iedema R,
    2. Merrick E,
    3. Piper D,
    4. et al

    . Co-designing as discursive practice in emergency health services: the architecture of deliberation. J Appl Behav Sci 2010;46:73–91.

    OpenUrlAbstract/FREE Full Text