Clinical Process Management in Traditional Agenda


Clinical Process Management



In this present paper, we will discuss the history of the clinical process, business process management, techniques used to manage the clinical process with its example, and application. On the basis of study, the conclusion has been made.
Clinical processes management is defined as the structural approach with the advent of care coordination between the meme and policies. The management includes a variety of intertwined processes as it is related to the single patient who is obvious and compelling. The process management helps to understand the process and deliver high-quality care. The processes are mainly divided into two categories, namely, direct and indirect (Aron, 2014). The direct care process includes the activities that occur as a result of patient care activities. The direct care process includes the activities what clinicians do and indirect care processes all the indirect activities such as registration, scheduling, billing, and appointment.  The processes are administrative in nature. The information system supports both the direct and indirect processes. The processes vary by patient, locations, and clinicians.
History of Clinical process: Traditionally the professional deals with the patients in semi-isolation. The close relation of the clinicians with the consumers as the center of attraction is the relatively new concept in the field of the clinical process.The advancement in the science and the medicine can be attributed to the human curiosity for developing new things and making the existence of science felt to everyone. There are many human subjects that have been involved in developing the theories for knowledge enhancement. The initial reference to the clinical trial is based on the Bible where there was a king who made some group of children eats meat and wine for some years.  Then these children were compared to the other children who were made to eat pulses and water (Nikneshan, 2014). It was observed that those who ate pulses were fitter than the other children. Thus, the clinical process was involved in coming to the conclusion regarding the diet of the people. 
In the 10th century, there was a Persian scientist who developed some drug for the betterment of the mankind, but he recommended that it should be first tested on the animals before starting to use it generally. He also set some rules for the trials of the clinical drug. These rules were: the drug must not be contaminated, it must be pure, use of the drug must happen on the simple disease, there must be at least two type of diseases on which the drug is tested, the drug quality should be able to match the strength of the disease, there should be measurement of the timings of the observations for ruling put the effects of the natural healing, the drug should have several trials and in those, the drug should show consistent performance, and the testing of  drug must happen  on the animals first and after that, it should be tested on the humans. The effects of the drugs on both may be different. These rules were important to be followed because there were many cases of abuse that were happening at the time of the World War II and in the name of science, the humans were suffering from the horrific experiments. A global response to those aristocracies was developed by the creation of the Nuremberg Code. This code laid a set of principles that were necessary to conduct the ethical human experimentation.  Then there was a person whose name was Dr. Alexander    and he submitted some points to the medical  research council to form the principles  for conducting the experiments, and these were benevolent towards the subjects of the study of the science (Bromberg, 2013). These were the ethical subjects, and the human experimentation was conducted successfully. There have been many changes in the principles, but the latest one has focused on the development of the standards that relate to the care that is taken in the developing countries. Also, there have been many doctrines that have been applied to the principles for regulating the medical community. Apart from the global standards, the medical community has also made efforts to control its practices and the ethical clinical trial procedures have been developed in the individual countries that develop their separate and individual clinical trials for regulating the medical practices.

Evaluation of Clinical process 

Analogous to business process management, the clinical process explains the activities of the process which includes the discovery, modeling, analysis, re-engineering, and measurement which is required by the management to utilize the direct and indirect care processes. The management of clinical process requires the understanding of properties. The properties include expected outcome of the registration process. The understanding of current stage of patient and is the physical exam which is an expected outcome and findings of the exam are recorded in the system. The outcome is information of the process. The processes include specific outcomes, initial points, consume information, utilization of resources, and it may be conducted from one person to another person (Mitchell, 2014). The development of the framework of clinical process management has certain issues. The issues include the absence of standard clinical processes. There is an absence of agreed expected outcomes, starting points, input and output information, and consumption of resources. There is an absence of standard terminology and no taxonomy is present for clinical processes. The process list of every organization is different, and it is developed by the company itself. There is no standard modeling and analytical approach which helps to guide the management of the clinical process. The business process management is adopted by clinical processes. The method of building process management is implemented in the clinical process management through possible approach which includes the following steps: the identification of current processes, determines the expected outcome, and then determines the efficiency, safety and effectiveness of the process, after that determine the requirement of human resource and their roles and responsibilities then delineate the needs of the resources and decide the monitoring process to handle the process (Möckel, 2014). The business process management suites AKA workflow technology which is an application development tool and it allows to develop aware process applications. It is very simple and cost-effective which helps to provide explicit process support. The identification of explicit process requirements creates other issues because there are no specific criteria to identify the requirements of the explicit process.

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The data concentric process system is focusing on capturing the data and represents the data. It is not geared to explicitly support data process. An intimate understanding of data is necessary for building the software which can support care processes and support the desired outcomes. The concentric data system is the process obvious. The criteria for deciding the clinical care system include the use of workflow technology which helps to determine the better process than a concentric data system. The traits of clinical process include: Communication intensive which is care coordination and PCMH, the process decides on the complex situations: diagnostic decision tree, treatment plans, and quantifiable dependencies which include time and critical health outcome, and high volume processes with recurring decisions such as results managements and others (E Caudle, 2014). The software support helps to overcome the problems of software developments. It helps to overcome the issues which include problem in creating the requirements for a process-aware system. The turning workflow analysis into the requirements of software is not the straight process. The modeling tools include flowcharts and swim-lanes which are not suitable to capture the level of details which helps to produce the requirements for the robust information system. The need of modeling and notation can turn into the requirements. If the goal is software development then the goal of workflow analysis shifts. For example, the workflow analysis helps to determine the extent at which any step of the process is executable. The information required must be recognized, and it must include mandatory outputs (Ayuso, 2013). The rule for changes in the steps must be exactly encoded. The clinical care comprises of the series of interacting the processes. The limitations of data concentric system include lack of support in decision making, care coordination, routine work of clinical process such as ordering medicines. The company must implement business process management approach which helps in managing the clinical settings.

Review & Implementation

The business process system can be applied to the businesses such as manufacturing, inventory, shipping, and others. It can be applied to the independent business such as construction companies needs steels. There is a care process management concept which applies the business process automation and the techniques of the optimization to the processes of clinical care in the environment of healthcare. The best practices are used for the BPM for improvement in the clinical outcomes without any change in the care processes is the displacement of the role of the healthcare workers. The individual practitioners help in the achievement of the healthcare excellence, and they focus on the fact that they have to become the best in the discipline of medicine. There are many independent providers in the industry, and there are several processes too that focus on the intervention. But the focus in the disciplines separately does  not guarantee the overall positive experience of the patient. 

BPM Methodology from discovery to implementation

The above diagram is the BPM Methodology from discovery to implementation.  In this, the BPM design has used many tools, and the techniques used for the design are interactive. It is the best practice, and it is applied in two ways that are, the end-to-end process is developed in iterations, and the first of it makes sure that the greatest value for the business is obtained. Then in the given iteration or the release, the gathering of the requirements never stops. There are playbacks by which the requirements are refined (Portney, 2015). 

Donabedian and Fishbone Model

The sub-sections ahead discuss the Donabedian and Fishbone model with examples. These models are applied within the healthcare organizations to ensure that the operational and other activities are moving ahead with efficiency. 

  • Donabedian Model: The model refers to the conceptual framework that is concerned with the examination of the health services. There are three aspects, structure, process, and outcomes. The purpose of the model is to ensure that the delivery of the service within the organization is being done with effectiveness (Donabedian, 20003). Moreover, it considers process and equipment that are utilized to provide the service. The impact of healthcare is also assessed throughout. There are certain criticisms for this model also. This model has been blamed for not able to utilize the antecedent characteristics. The Donabedian model is flexible and can be applied to various settings of healthcare. The year 2007 saw the implementation of this model in US Institute of Healthcare (Brien and Ghali, 2008). The benefits of this implementation that the management of the organization received periodic evaluation report which indicates where the organization stands on various quality measures. 

  • Fishbone Model: It is a form of causal diagrams that was developed by Ishikawa in the year 1968 (Ishikawa and Kaoru, 1968). The purpose of the model is to ensure that the organizational procedures are defect free and other potential defects have been prevented from the initial period. There are various aspects that are included in the fishbone such as people, environment, and others. The image below shows the example of fishbone model applied on scrap processing. 

The similar approach can be applied in the healthcare setting to ensure that the services are under consideration. The cause and effect of the processes ensures that the quality is being managed efffectively. 


In the end, it can be said the history of the clinical process, business process management, techniques used to manage the clinical process with its example, and the application has been discussed in the report. It is found that the approach of clinical processes management is structural. In the various organizations like the BPM, the management includes the variety of intertwined processes that are related to the single patient who is obvious and compelling. The process management has helped in understanding the process, and it has delivered high-quality care. The processes have been mainly divided into two categories, direct and indirect. The history of the clinical process can be related from the time when Bible was written, and the kings have also developed some tradition processes that were used by them and the organizations of that time. Analogous to business process management, the clinical process has been successful in explaining the activities of the process which includes the discovery, modeling, analysis, re-engineering, and measurement which is required by the management to utilize the direct and indirect care processes.  

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  • Ayuso, C., Millán, J.M., Mancheño, M. and Dal-Ré, R., 2013. Informed consent for whole-genome sequencing studies in the clinical setting. Proposed recommendations on essential content and process. European Journal of Human Genetics, 21(10), pp.1054-1059.

  • Brien SE & Ghali WA. Public reporting of the hospital standardized mortality ratio (HSMR): implications for the Canadian approach to safety and quality in health care. Open Medicine 2(3).

  • Bromberg, P.M., 2013. Awakening the dreamer: Clinical journeys. Routledge.

  • Donabedian, A. (2003). An introduction to quality assurance in health care. (1st ed., Vol. 1). New York, NY: Oxford University Press.

  • E Caudle, K., E Klein, T., M Hoffman, J., J Muller, D., Whirl-Carrillo, M., Gong, L., M McDonagh, E., Sangkuhl, K., F Thorn, C., Schwab, M. and AG Agundez, J., 2014. Incorporation of pharmacogenomics into routine clinical practice: the Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline development process. Current drug metabolism, 15(2), pp.209-217.

  • Ishikawa, Kaoru, (1968). Guide to Quality Control. Asian Productivity Organization. 

  • Mitchell, J., Revere, L. and Ayadi, M.F., 2014. Association of Clinical Decision Support Systems on Process of Care Measures and Quality Outcomes for Patients with Heart Failure. Academy of Information and Management Sciences Journal, 17(2), p.99.

  • Möckel, M., Searle, J., Hamm, C., Slagman, A., Blankenberg, S., Huber, K., Katus, H., Liebetrau, C., Müller, C., Muller, R. and Peitsmeyer, P., 2014. Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study. European heart journal, p.ehu178.

  • Nikneshan, D., Rabinstein, A., Holloway, R., Tu, J., Fang, J. and Saposnik, G., 2014. Abstract W P315: Cardio-Respiratory Arrest in Stroke (CAIS Study): Predisposing Factors, Clinical Features, Outcomes, and Process Measures. Stroke, 45(Suppl 1), pp.AWP315-AWP315.

  • Portney, L.G. and Watkins, M.P., 2015. Foundations of clinical research: applications to practice. FA Davis.

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