A process architecture pattern and its application to designing health services: emergency case

Abstract

Purpose The purpose of this paper is to present a process architecture pattern for designing particular components of a complex service. The proposal emphasizes the design of the service production flow component, following modularity ideas, which determines the sequence of actions needed to generate a high quality and efficient service. The authors report its applications to the design of the flow in a single emergency department (ED) case. Design/methodology/approach In complex services, production design is usually lacking because production activities are not clearly defined and, in many cases, they are dynamically determined as the service is produced according a client’s particular needs. In health services, for example ED, this generates a chaotic production flow that uses resources very inefficiently. The methodology uses a reference architecture, integrating it with disciplines – modularity, analytics and evaluation methods – that provide ideas for formally designing these complex services. This is mainly justified by the fact that, in many such services, no formal design exits and their production processes are the result of practice evolution. Findings Methodology was applied to the ED of a large public hospital. The authors first analyzed ED’s production and performance data. The authors found two patients’ groups that used more than 90 percent of resources. Therefore, design focused on these groups, defining specialized production lines for them and with physical space remodeled by an architecture project, resulting in well-defined separated workflows for each production line. Design also includes coordination with complementary shared services, including specialists consultations’ requests and execution, and request, processing and reception of laboratory and radiology examinations. The authors implemented new workflows producing a decrease of 26 percent in patients’ delays. More detailed results based on three months of observations also showed, for example, a reduction in examinations waiting times of 80 percent and an increase in the consultation resolution for cardiological patients from 24 to 80 percent in the same day, which means a significant quality increment. Research limitations/implications Thus, the authors conclude the plausibility of the idea they proposed that an important design problem in health services, in terms of potential improvements in capacity utilization, is production design. This provides the opportunity to reduce investing large amounts of resources in new hospitals and to instead use the alternative to generate large amounts of capacity by production performance improvements. Practical implications The authors are replicating the approach in other hospitals with extensions to inpatient and ambulatory services. Social implications Approach produces better service in public hospitals, which is a problem in emergencies in the world. Originality/value Formal design approach in health production services is proposed that provides great value by generating capacity, due to better use of resources, that reduces investment needs in new facilities.