Process-Based Quality Management in Care: Adding a Quality Perspective to Pathway Modelling

Abstract

Care pathways (CPs) are used as a tool to organize complex care processes and to foster the quality management in general. However, the quality management potentials have not been sufficiently exploited yet, since the development, documentation, and controlling of quality indicators (QIs) for quality management purposes are not fully integrated to the process standards defined by CPs. To support the integration of a quality perspective in CPs, the paper addresses the questions which and how quality concepts can be integrated into the process documentation in order to support managers, health service providers, and patients. Therefore, we extended the widely accepted modelling language “Business Process Model and Notation” (BPMN) with a quality perspective. The conceptualization is grounded on a systematic literature review on (quality) indicator modelling. Together with previous work on the conceptualization of QIs in health care, it provided the basis for a comprehensive domain requirements analysis. Following a design-oriented research approach, the requirements were evaluated and used to design a BPMN extension by implementing the quality indicator enhancements as BPMN meta model extension. All design decisions were evaluated in a feedback workshop with a domain expert experienced in quality management and certification of cancer centres on national and international level. The approach is demonstrated with an example from stroke care. The proposed language extension provides a tool to be used for the governance of care processes based on QIs and for the implementation of a more real-time, pathway-based quality management in health care.