<p>There is a growing interest within organisations today to focus on the core processes, i.e. the processes that create value for the intended customer, in order to stay compatible within the ever-fiercer competition. To have full control of the key processes may be a great step forward towards a more lean and effective organisation, not only for profit seeking companies but also for public welfare institutions like health care. Software aimed at supporting a process focus is continuously being developed and one such family of programs is commonly referred to as process managers.</p><p>A process manager lets the people in an organisation who have complete knowledge of the processes model these without requiring them to have expert knowledge of computers and programming. Once a process has been defined graphically according to a predefined modelling language, it can be deployed and monitored. The process manager software takes care of the routing of messages between actors, both human as well as non-human (e.g. other applications), and it drives the individual errand forward according to how the process flow has been defined in the model. However, applying a process manager approach in health care processes requires a certain amount of caution. Messages sent between actors in health care organisations are often of a delicate nature since they may contain sensitive information, such as illness, mental state, family situation and similar, that is related to an identifiable individual. There are also other aspects of security that need to be addressed besides the confidentiality aspect. For example, it must be guaranteed that the information is correct and not altered during transfer, the information must be available when needed and it should be possible to trace a message to its sender, among other things.</p><p>This work identifies a set of security requirements from the literature that need to be fulfilled in health care organisations when applying a process manager approach. With these requirements as a basis, a process manager system is evaluated with regards to security and the conclusion is that future versions need improvement on some points. Future work is also suggested that could help to explore the area further.</p>

There is a growing interest within organisations today to focus on the core processes, i.e. the processes that create value for the intended customer, in order to stay compatible within the ever-fiercer competition. To have full control of the key processes may be a great step forward towards a more lean and effective organisation, not only for profit seeking companies but also for public welfare institutions like health care. Software aimed at supporting a process focus is continuously being developed and one such family of programs is commonly referred to as process managers. A process manager lets the people in an organisation who have complete knowledge of the processes model these without requiring them to have expert knowledge of computers and programming. Once a process has been defined graphically according to a predefined modelling language, it can be deployed and monitored. The process manager software takes care of the routing of messages between actors, both human as well as non-human (e.g. other applications), and it drives the individual errand forward according to how the process flow has been defined in the model. However, applying a process manager approach in health care processes requires a certain amount of caution. Messages sent between actors in health care organisations are often of a delicate nature since they may contain sensitive information, such as illness, mental state, family situation and similar, that is related to an identifiable individual. There are also other aspects of security that need to be addressed besides the confidentiality aspect. For example, it must be guaranteed that the information is correct and not altered during transfer, the information must be available when needed and it should be possible to trace a message to its sender, among other things. This work identifies a set of security requirements from the literature that need to be fulfilled in health care organisations when applying a process manager approach. With these requirements as a basis, a process manager system is evaluated with regards to security and the conclusion is that future versions need improvement on some points. Future work is also suggested that could help to explore the area further.

Recent events throughout the world and in the US lend support to the belief that another terrorist attack on the US is likely, perhaps probable. Given the potential for large numbers of casualties to be produced by a blast using conventional explosives, it is imperative that health systems across the nation consider the risks in their jurisdictions and take steps to better prepare for the possibility of an attack. Computer modeling and simulation offers a viable and useful methodology to better prepare an organization or system to respond to a large scale event. The real question, given the shortage, and in some areas absence, of experiential data, could computer modeling and simulation be used to predict the resource requirements generated by this type of event and thus prepare a health system in a defined geographic area for the possibility of an event of this nature? Research resulted in the identification of variables that surround a health system at risk, the development of a computer model to predict the injuries that would be seen in an injured survivor population and the medical resources required to care for this population. Finally, methodologies were developed to modify the existing model to match unique health system structures and processes in order to assess the preparedness of a specific geographic location or health system. As depicted in this research, computer modeling and simulation was found to offer a viable and usable methodology for a defined geographic region to better prepare for the potential of a large scale blast event and to care for the injured survivors that result from the blast. This can be done with relatively low cost and low tech approach using existing computer modeling and simulation software, making it affordable and viable for even the smallest geographic jurisdiction or health system.

This thesis reports on research focuses on how to deal with the fact that the organization and processesof today’s health and social care are becoming ever more complex as a consequence of societal trends, including an aging population and an increased reliance on care at home. The overall research goal is to suggest ways in which IT-based solutions can enable and leverage collaboration and coordination insituations where a co-morbid patient is subject to care delivered simultaneously by several different professionals and organizations. Patient-centered care is defined as quality health and social care achieved through a partnership between informed and respected patients, their families, and coordinated health and social care teams who conduct care activities according to jointly determined care plans. Against a background of several years of research on patient-centered collaborative care using adesign science approach, using techniques such as focus groups, interviews, and document studies, the author of the thesis has further pursued the work in a project named CoCare. Results show that the care required in aging societies is both a social and a technical challenge. Meeting this challenge will require a redesign of today's health and social care processes in order to focus more clearly on patient needs and values, and poses demands on information services allowing to share knowledge of the patient’s health and social situation among involved care providers. An important aspect of the increased complexity is that a single patient may need care from several autonomous care providers in parallel, particularly patients with co-morbidities. This clearly requires effective coordination of care activities, which poses further demands on information services to support this task. A set of issues involving patient-centered collaborative care is identified and analyzed. The thesis introduces the notions of the Patient-Centered Care Process (PCCP) and a conglomeration of suchprocesses. A conglomeration comprises a set of PCCPs that concern the same patient, that are overlapping in time, and that share the overall goal of improving and maintaining the health and socialwell-being of the patient. The PCCP is inspired by the well-known PDCA cycle and comprises the four phases of assessing the patient situation (ASSESS), planning care activities (PLAN), performingcare activities (DO) and following up care (CHECK) for the patient. Based on a number of key standards, such as HL7, HISA and CONTsys, the thesis introduces a Patient-Centered Information Model (PCIM). A set of information services, together constituting a Coordination Hub, is proposed. The information services aim to help formal as well as informal carers (including the patient) inconducting care according to the PCCP The thesis contributes to a deeper understanding of care processes and suggests ways to achieve patient-centered collaborative care that better contributes to creating value for the patient as an individual.

<p>This study proposes that poor understanding of the structures, processes and outcomes of organisations seriously hampers collaboration between professional groups in care organisations. Three care settings were investigated: follow-up of patients with heart disease, an intensive care unit and care services for older people.</p><p>The overall aim was to investigate how people understand structures, processes and outcomes in care organisations. The participants were patients, patient representatives, healthcare professionals, managers and politicians.</p><p>A qualitative approach was used. Thematic analysis and grounded theory were employed in analysing the data.</p><p>Despite considerable efforts, no major changes took place over a 7-year period as to how cardiac follow-up services were understood. The system of cardiac follow-up services was found fragmented in its organisation and in the way individuals understood it. The results indicate that care professionals, patients and leaders have dissimilar understandings. The data suggest that care is organised from a professional-centred perspective rather than from a holistic worldview of the patients’ total context. Leaders in intensive care perceive their organisation as a learning organisation. However, in daily work healthcare tends to function to what can be described as a mass production approach to care. This state of conflict caused confusion and chaos among the leaders. The municipal elderly care services and the county council’s geriatric organisation had difficulties in co-ordination. Older people were perceived as passive recipients of healthcare, rather than as consumers whose well being and outcome were a reflection to the quality of the service.</p><p>The study concludes that despite the major changes that have taken place in the Swedish health and elderly care organisations over the past years, healthcare professionals’ understanding of their work has gone largely unchanged. Their understanding of care structures and processes did not change despite outside pressures. Lack of understanding of what others understand hampers development with the result that care organisations risk stagnation.</p>

This study proposes that poor understanding of the structures, processes and outcomes of organisations seriously hampers collaboration between professional groups in care organisations. Three care settings were investigated: follow-up of patients with heart disease, an intensive care unit and care services for older people. The overall aim was to investigate how people understand structures, processes and outcomes in care organisations. The participants were patients, patient representatives, healthcare professionals, managers and politicians. A qualitative approach was used. Thematic analysis and grounded theory were employed in analysing the data. Despite considerable efforts, no major changes took place over a 7-year period as to how cardiac follow-up services were understood. The system of cardiac follow-up services was found fragmented in its organisation and in the way individuals understood it. The results indicate that care professionals, patients and leaders have dissimilar understandings. The data suggest that care is organised from a professional-centred perspective rather than from a holistic worldview of the patients’ total context. Leaders in intensive care perceive their organisation as a learning organisation. However, in daily work healthcare tends to function to what can be described as a mass production approach to care. This state of conflict caused confusion and chaos among the leaders. The municipal elderly care services and the county council’s geriatric organisation had difficulties in co-ordination. Older people were perceived as passive recipients of healthcare, rather than as consumers whose well being and outcome were a reflection to the quality of the service. The study concludes that despite the major changes that have taken place in the Swedish health and elderly care organisations over the past years, healthcare professionals’ understanding of their work has gone largely unchanged. Their understanding of care structures and processes did not change despite outside pressures. Lack of understanding of what others understand hampers development with the result that care organisations risk stagnation.