samba e v 3 1

January 2005

SAMBA

Structured Architecture for

Medical Business Activities

Process and concept analysis of the workflow in care of an individual

subject of care in Swedish health care.

SAMBA – Structured Architecture for Medical Business Activities

2

This document

Name: Structured Architecture for Medical Business Activities Acronym: SAMBA Issue date: 2005-01-18 Issue number: 3 Revision number: 1 Contains SAMBA process model version 2.1 Contains SAMBA concept model version 2.0 This is an English edition of the Swedish project report SAMBA version 3.0 issued 2004-11-30. Translation by Magnus Fogelberg, fogare/Evama Medici HB, [email protected] This document is property of Evama Medici HB and may not be used outside CEN (Comité Européen de Normalisation) and ISO (International Organization for Standardization) without written permission by Evama Medici HB. Copyright © 2005 Evama Medici HB Evama Medici HB Ingatorpsgatan 5 SE-412 62 GÖTEBORG, Sweden Tel +46 73 986 47 17 Fax +46 31 16 99 36 E-mail [email protected]


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Index

Foreword to the English edition ..................................................... 4

1. Scope .......................................................................................... 5

2. Normative references.................................................................. 6

3. Terms and definitions ................................................................. 7

4. Description of the process modelling view ............................... 11

5. The process model for description of the health care enterprise13

6. Implementation areas .............................................................. 15

7. The process ”Care of an individual subject of care” described

from a three tiers process perspective .................................. 16

8. Process models ........................................................................ 18

9. Concept models ........................................................................ 25


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Foreword to the English edition

The final report of the SAMBA project is a revised and condensed description of the three-tiered process model presented in the first report of the project August 2003 (in English November 2003). Responses from the national enquiry have been considered in the revision.

In this document the terms are translated from Swedish to English according to harmonisation rules of ISO 860. Some terms in the Swedish edition are translations of terms in prEN 13940-1:2004, and they are used with their original English terms and definitions.

The Swedish edition of SAMBA version 3.0 uses a notation of the process model slightly different from the one used in the preliminary SAMBA document. In this document, thin blue arrows show the course of the refinement objects, while thick red arrows show the workflow within and between the three parallel processes.

This is the final document of the SAMBA project. Process models imported from earlier SAMBA documents should be replaced by the models from this document if a reference to SAMBA is made. The graphs are composites of bitmap and vector graphics and cannot be marked and copied. Therefore they are available as jpeg images at the Evama website www.evama.se/samba. The website lists the images with the same numbers as in this document.


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1. Scope

The mission of SAMBA has been to develop a process model for the workflow of Swedish health care in the care of an individual subject of care. The work has included analysis of process models previously developed by several Swedish counties. It was evident that it is difficult to create a uniform model corresponding to the lot of variants which the former models provided. The differences between the former models proved to be due to the fact that they had been created from different perspectives. It was therefore of the uttermost importance to identify a common perspective and purpose of the process model.

Within the scope of SAMBA a method to depict a process model was developed, which elucidates all integral parts of the process. The model has been divided into three parts. It consists of a core process, which is the clinical process in health care. The model also consists of a management process, which monitors and evaluates the clinical process based on the mandate to provide health care, and a communication process dealing with information and interaction with the surrounding world.

Analysis and definition of the concepts encompassed in the process model has been within the scope of SAMBA. The conceptual work consists of textual terminological definitions and concept models depicted in UML, Unified Modeling Language.

The SAMBA model has become a tool which can be used for enterprise analysis as basis for organisational decisions not only in connection to development of information systems but also in the organisational development which is not tied to the use of IT.


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2. Normative references

ISO 704 Terminology work — Principles and methods.

ISO 1087-1:2000 Terminology work - Vocabulary. Part 1: Theory and application.

ISO 10241 International terminology standards - Preparation and layout.

SFS 1998:531 Lag om yrkesverksamhet på hälso- och sjukvårdens område. (Swedish)

EN ISO 9000 Quality management systems – Fundamentals and vocabulary (ISO 9000:2000).

EN ISO 9001 Quality management systems – Requirements (ISO 9001:2000).

prEN 13940-1:2004 Health informatics - System of concepts to support continuity of care – Part 1: Basic concepts (“CONTsys”).

Object Management Group. OMG Unified Modeling Language Specification. Version 1.5, March 2003. http://www.omg.org


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3. Terms and definitions

This chapter lists terms used in this document, its process model and concept model. Terms referred in the definitions which themselves are not used in this document but are defined in prEN 13940-1:2004 or ISO 9000:2000 have a reference to the applicable standard.

3.1

activity

deliberate act

3.2

activity list

list of activities (3.1) in the programme of care (3.26) which are available because of availability of resources (3.28)

3.3

applicable activity

health care activity (3.13) which is listed in the programme of care (3.26) NOTE Every health care activity (3.13) has a purpose. The health care objective (3.15) describes the desired change of the health issue thread (3.21). A health care activity (3.13) which is regarded adequate to participate to this change is called applicable activity (3.3) and is listed in the programme of care (3.26).

3.4

available applicable activity

applicable activity (3.3) which can be performed because of availability of resources (3.28)

3.5

available resource

resource (3.28) which can be used

3.6

booked activity

available applicable activity (3.4) which has been decided regarding location and time and which has been provided own resources (3.28)

3.7

booked resource

available resource (3.5) which has been reserved for a health care activity (3.13) which is to be performed

3.8

care mandate

health mandate [prEN 13940-1:2004] assigned to, and accepted by, a health care provider (3.19) to perform health care activities (3.13) for a subject of care (3.32) , as well as to manage locally the information related to the health of that subject of care (3.32) [prEN 13940-1:2004]


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3.9

care requirement

requirement [ISO 9000:2000] of health care activities (3.13) based on health issues (3.20)

3.10

demand for care

demand expressed by a health care party (3.17) that health care activities (3.13) be provided to a subject of care (3.32) [prEN 13940-1:2004]

3.11

discharge message

summary of what has been performed and achieved during the care process (3.25) EXAMPLE Discharge letter, informative discussion with the subject of care (3.32) or relative, lab report, x-ray report.

3.12

event

act outside control of the process (3.25) with impact on the process (3.25) NOTE Every activity (3.1) in the process (3.25) is deliberate and has a purpose. In an ideal situation the purpose will always be achieved. If an activity (3.1) in another process (3.25) has an impact on the process (3.25) being analysed, that activity (3.1) is perceived by the process (3.25) as an event (3.12). Then the course of the process (3.25) may be another than the expected one. Such an exception from the desired course may be negative or positive with regard to the desired result of the process (3.25). EXAMPLE Surgical complication (anatomy and tissue reacts in an unexpected manner), electric failure, contamination in a medicinal product, hardware failure, spontaneous recovery when the patient is awaiting therapy.

3.13

health care activity

activity (3.1) performed for a subject of care (3.32) by a health care agent [prEN 13940-1:2004] with the intention of directly or indirectly improving or maintaining the health of that subject of care (3.32) [prEN 13940-1:2004]

3.14

health care commitment

mission which a health care provider (3.19) makes a commitment to execute by offering at least one health care activity (3.13) to a subject of care (3.32) with the purpose to influence at least one identified health issue (3.20) of that subject of care (3.32) NOTE The health care commitment (3.14) is the promise by the health care provider (3.19) to provide care. This means that the health care provider (3.19) accepts and confirms the pending care mandate (3.8) issued by means of the demand for care (3.10). When a health care commitment (3.14) has been stated, an effective care mandate (3.8) exists and will be the framework for all activities (3.1), planning, assessments and evaluations of the health care process (3.25) and its outcome.


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3.15

health care objective

desired ultimate achievement of a programme of care (3.26) [prEN 13940-1:2004]

3.16

health care organisation

organisation [ISO 9000:2000] involved in the direct provision of health care activities (3.13) [prEN 13940-1:2004]

3.17

health care party

organisation [ISO 9000:2000] or person involved in the process (3.25) of health care [prEN 13940-1:2004]

3.18

health care professional

person authorised by law or official regulations to be involved in the direct provision of health care activities (3.13) [prEN 13940-1:2004]

3.19

health care provider

health care professional (3.18) or health care organisation (3.16) involved in the direct provision of health care activities (3.13) [prEN 13940-1:2004]

3.20

health issue

issue related to the health of a subject of care (3.32), as defined by a specific health care party (3.17) [prEN 13940-1:2004]

3.21

health issue thread

defined association between health issues (3.20), as decided by one or several health care parties (3.17) [prEN 13940-1:2004]

3.22

matched condition

perceived condition (3.23) which has been assessed in relation to the service repository (3.31) of the health care provider (3.19)

3.23

perceived condition

health condition of a person as perceived by a health care professional (3.18)

3.24

preceding perceived condition

perceived condition (3.23) which is input to a health care activity (3.13)


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3.25

process

set of interrelated or interacting activities (3.1) which transforms inputs into outputs [EN ISO 9000:2000]

3.26

programme of care

description of planned and duly personalised activities (3.1) bundles adopted by one healthcare organisation (3.16), typically informed by one or more protocols [prEN 13940-1:2004], addressing one or more health issues (3.20), accounting for one or more health issue threads (3.21), and encompassing all health care activities (3.13) to be performed for a subject of care (3.32) by one or more health care parties (3.17) [prEN 13940-1:2004]

3.27

quality outcome

comparison between actual outcome and desired outcome (purpose) of an activity (3.1) NOTE The concept describes how the actual outcome differs from that stated in the purpose and is therefore a measurement of quality [ISO 9000:2000] and, when applicable, a description of exceptions.

3.28

resource

phenomenon which makes an activity (3.1) possible EXAMPLE Health care professional on duty, operation theatre time slot, instruments ready to use, consultation rooms, bed in a ward, prepared medicinal products.

3.29

resource provided activity list

list of activities (3.1) listed in the programme of care (3.26) which have been booked

3.30

resulting perceived condition

perceived condition (3.23) after a performed health care activity (3.13)

3.31

service repository

repository of health care activities (3.13) which can be made available at a health care provider (3.19) NOTE The service repository (3.31) describes which kinds of activities (3.1) the health care provider (3.19) is able to perform, not which activities (3.1) that are available for the moment.

3.32

subject of care

person seeking to receive, receiving, or having received health care activities (3.13) [prEN 13940-1:2004, modified]


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4. Description of the process modelling view

Process is defined in ISO 9000: set of interrelated or interacting activities which transforms inputs into outputs. SAMBA has supplemented the definition with clarifying descriptions, one of which is more important than the others: a process handles one single refinement object. In ISO 9000 input is the refinement object. SAMBAs clarification means that only one object is refined in each process. It is altered (refined) by the activities of the process and finally constitutes the output. Other objects are also handled in the process, but they are resources or management objects, that are casually used and may be returned or consumed by the activities. But these objects are never part of the final product (the output).

The process contains activities. Every activity may be regarded as a process, because it has the task to achieve the transformation of the refinement object. The activity is managed by management objects and makes use of resource objects. In that way the process functions on different levels of detail.

Processes on different levels of detail with refinement object, management, and resources.

SAMBA has used a three-tiered process modelling technique to divide the work flow in the enterprise. This technique appears to be universal.

The central process is a core process, where the objective of the enterprise is achieved. The refinement object of the core process is what finally is to be the product (output) of the process, a service, a thing or a condition. In manufacture the input is the raw material, the output the finalised product. In a service process the input is the condition of that which shall be handled and the output the condition in the way it has been transformed during the process. At a travel agency the refinement object would be the journey planned by the customer. The input is the desire by the customer for a certain journey (n.b. not the statement of the desire). The output is the booked and sold journey (but not the ticket as document). All activities in the core process are managed by decisions. The decisions are made in the management process. The refinement object of the management process is a management instrument. It can be a project plan as basis for decisions on activities (in the core process), evaluation of the result of the core process activities, and finally decision to terminate the process package. At the travel agency the input of management process is


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the commission of the customer to the agency to arrange the journey. This commission is refined by the agency’s accepting of the commission and after that decisions at the agency on which transportation actors, hotels, etc. that shall be contacted for booking. The process also includes the verification of bookings. In the management process the travel agency finally finds that the requests of the customer have been fulfilled as far as possible, and the commission is declared terminated. The customer has a possibility to withdraw the commission during the course of the process, which leads to immediate termination of the process package without the refinement object of the core process being refined to the intended output. Outside the management process there is a communication process, which is the only interface to the surrounding world and other processes. The communication process handles information on the other processes and resources which are to be used in the entire process package. It is responsible for communication with other process packages. The refinement object is an information carrier. The input at the travel agency is the order of the customer. It may be written or spoken, but it always contains the information to the travel agency to start with. If it is sufficient a commission is considered to be present, and the management process starts. Through the communication process the customer will be informed about how the request is handled and how the matter proceeds, and the output is some kind of ticket or travel certificate, on paper, electronic or as an order code. It must always contain all necessary information to the customer for her to be able to make the journey.

In this way the three processes are encapsulated so that the clinical process is encompassed by the management process and the communication process is the outermost layer.

The three tiered process package.

The encapsulation of the processes has caused SAMBA to define a process package containing the three processes. It can be shown that every activity which is part of one of the processes is a process package itself with three encapsulated processes, and the communication process in such a package, in an activity, can interact with the communication process in a process package on any level of detail.


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5. The process model for description of the health care

enterprise

The result of the modelling technique used by SAMBA is that the work process “care of an individual subject of care” can be described as three processes running in parallel. There is no need for further processes to describe this core enterprise, but all three are necessary. The three processes are

• the clinical process, where the health condition of the subject of care is the refinement object. This is the subject of the health care core enterprise. The objective is to improve the health condition or at least make it known or officially stated (i.e. when the task is to issue a medical certificate). It may also be to keep a good health condition, minimise deterioration or decrease the risk for deterioration (i.e. an immunisation). You get knowledge of the health condition by perceiving it by means of investigations, and what you see in the clinical process is the perceived condition.

• the management process, where the care mandate is the refinement object. This concept is defined in CONTsys (prEN 13940-1:2004), the European project standard for concept supporting continuity of care. A care mandate is given to the health care provider in the demand for care stating that a person needs care. The demand for care may be a referral, a personal demand stated by a person on behalf of herself, or a legal order (sentence by court, application for compulsory treatment in hospital). The mandate is pending and gives authorisation to the health care provider to assess the need for care and her possibilities to handle the condition. If the health care provider has a service repository which can be used to handle the need for care, the mandate is confirmed by the healthcare provide with a health care commitment. Then the mandate becomes effective delineating the authorisation of the health care provider and stating the care mission. This is the first refinement of the care mandate. After that it will be further refined when the health care objective is decided and the programme of care established. Decisions to carry out planned activities or services are made in the management process as well as quality assessment regarding the result of the activities compared to their purposes. The mandate is terminated when no more activities can be used to improve the health condition of the subject of care, i.e. when the condition has been restored to the one described by the objective or the provider has no further activities or services to offer within the scope of the mandate. In the management process the quality management required according to ISO 9001 is carried out.

• the communication process, where information is refined. The input is the demand for care, which starts the communication process and thereby the total workflow of care. The communication process handles information on available resources, requisition of resources, communication with documentation systems, and finally information on the final result, that is the information given to the patient or the referring party as an informative discussion, discharge letter, replies to a referral etc.

As the communication process is the process which receives the first incoming object, the demand for care, and leaves the final product, the message of termination as e.g. a discharge letter, the communication process proves to interact with other processes in


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health care, such as documentation processes, resource handling processes, the administrative and financial processes of the organisation, care process of other health care providers concerning the same subject of care, the subject’s own process etc. It also interacts with the management process but not with the clinical process. All activities in the clinical process are deliberate and are triggered by decisions in the management process. The management process does not interact with the surrounding world, but alterations in the mandate are made known via the communications process.


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6. Implementation areas

The SAMBA model has been produced as a tool to describe and analyse the complex process ”care of an individual subject of care”. The development of IT services requires different kinds of description clarifying the demands and requirements of the enterprise. Business models, information models, and data models are different kinds of descriptions which are necessary, as use cases and state charts. Models are simplifications of reality. Health care is a very complex enterprise which is described in many different shapes, with different managements and a lot of actors with various professional background and different roles. To catch this multitude in one model in common is of course difficult but anyhow necessary, as this complex business has to cooperate in the care of the individual subject of care. If health care wants an IT support covering all the enterprise, through different business areas, crossing management boarders and across different professions, this process has to be described in a comprehensive model with a number of common concepts able to carry and cover the process. SAMBA describes a general process model consisting of three parallel processes which continuously cooperate. By means of the SAMBA three tiered model a tool is provided to analyse the relations between different processes requiring parallel supporting IT systems. At the same time, the model gives a possibility to describe every part of the enterprise. By means of the three tiered process model it is possible to analyse:

• communication between different health care providers • how the demand for care is sent and received • how resources are reviewed, ordered, and booked • communication of messages between subject of care and health care provider • decisions in the process • time aspects • how and where clinical data are recorded and used • which knowledge support are required, e.g. method description • process management rules of the enterprise

The primary purpose of the SAMBA model is to analyse information flow around the care of an individual subject of care, to formulate the requirements for IT support. By means of such analyses the model can be the basis for information and data models, but it can also be a support for description of coherent IT services and IT service structure, which is necessary when supplier architecture for common IT support in health care is to be described. The SAMBA model may also be used for other purposes, e.g. quality management, safety analysis, and follow up of delays and costs.


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7. The process ”Care of an individual subject of care”

described from a three tiers process perspective

The purpose of healthcare is to influence the condition of the subject of care in order to improve it, keep it, or to minimise an inevitable deterioration. Therefore a process which only handles the condition of the patient should be identified. It is the core process, and it is called clinical process. This process will however not be able to work on its own, but there is a need for interaction with a management process and a communication process, which keep those names in the health care process package. Together they form what we usually call the care process. In the management process all decisions, evaluations and planning actions are carried out, and the communication process handles all information running through the process and between the care process and other process packages. The care process starts when a demand for care is received by a healthcare provider. It is a collection of information that is received, and this is done in direct interaction with the surrounding world. Therefore the communication is first one to start. At the end of the communication process the information in the demand for care has been refined so that data on diagnosis and treatment suggestions can be delivered by the process. The ideal situation is when the final information is a message that the problems described in the demand for care have been solved. Anyhow it is the information tied to the demand for care which has been refined through the communication process, but only thanks to interaction with the management process and indirectly also the clinical process. If a demand for care has been verified and found to contain information on health issues which a person needs help to get solved, the management process starts. It is the potential mandate which triggers the management process. The information in the demand for care gives the healthcare provider a commission to try to solve the problems. This commission, the mandate, may be accepted by the healthcare provider by means of a health care commitment. If so, the mandate will be refined in the sense that it is provided a basis for decision when results of clinical activities are added (from the clinical process). Objective for the care is decided and tied to the mandate. The care will be structured within the framework of the mandate in programmes of care on different levels. Decisions on the contents of programmes of care and performance of activities are made in the management process. The last refinement phase of the mandate is when the health care objective is considered to be achieved or when no more appropriate activities are available. The mandate can be revoked by the subject of care is regarded satisfactorily treated. A revocation decision will manage a discharge message in the communication process. The information in the demand for care is about the health condition. This is the triggering resource in the clinical process, which starts when the health care professional perceives the condition as described in the demand for care. If this condition proves to be possible to handle by means of the activities covered in the service repository of the health care provider, the information is supplemented so that all health issues of topic interest can be identified. This information is a resource in the management process when the health care objective is defined and programme of care is to be established. Activities in the clinical process will influence the condition until it is no longer possible to


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handle at the health care provider. Either the patient is free of problems or there is a lack of accurate activities. This clinical information is sufficient to stop the clinical process and be basis for a decision on termination of the mandate in one form or another. If the subject of care has to been taken care of by another health care provider, this decision will cause a health care activity of making a demand for care to that other health care provider. The objective will then be to transfer the subject of care. When a health care commitment has been stated of the other health care provider, the objective has been fulfilled, and the mandate can be terminated. The subject of care or the one who has issued the demand for care can revoke the mandate anytime during the care process. This leads to termination of all three processes.

Contents of the three parallel processes


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8. Process models

8.1 Overview of the process (work flow)

Through the entire care process there is a communication with the documentation process. This is shown distinctly by placing the documentation process as a resource layer in this graph. In every activity there is a documentation process which may be modelled separately. The communication process illustrates information exchange with other care processes and resource management.

Take care of an individual subject of care

Vård-begäran

Hänvisadvårdbegäran

Mål ivårdplan

Vårdaenskildpatient

Planeraaktiviteter

Utföraplaneradeaktiviteter

Utvärderaresultat avaktiviteter

Avvecklavård-

åtagande

Mottaga ochbedöma

vårdbegäran

Vård-åtagande Bedöma och

prioritetsättavårdbehov

Vårddokumentation

Avsluts-meddelande

Åtgärdattillstånd

Vård-plan

Utvärderatvårdbehov

Demand for care

Receive and assess demand for care

Health care commitment Assess and

set priority to care requirements

Health care objective

Referred demand for care

Plan activities

Programme of care Perform

planned activities

Treated condition

Evaluate result of activities

Evaluated care requirements Withdraw

health care commitment

Discharge message

Health care documentation

Take care of an individual subject of care


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Kommunikationsprocess

Styrprocess

Klinisk process

Mottaga ochbedöma

vårdbegäran

Vård-begäran

Mottagavårdbegäran

Mottagenoch noteradvårdbegäran

Besluta ombedömning

Verif ieradvårdbegäran

Identif ierahälsoproblem

Uppfattattillstånd Matcha mot

vårdutbud

Matchattillstånd

Besluta omhälso- och

sjukvårdsmandat

Hänvisadvårdbegäran

Kommunicerabeslut

avseendevårdåtagande

Vård-åtagande

8.2 The start of the care process

The demand for care is received in the communication process as the first part of that information complex which is the refinement object of the communication process.

The act to verify the demand for care is an activity in the management process. When the demand for care has been verified, it forms the pending mandate which justifies its further assessment.

The health condition of the patient is described in the demand for care. The perception of the health condition is the input object in the clinical process, where the health issues are identified.

The perceived condition is matched against the care service repository of the health care provider which leads to a decision whether a health care commitment can be stated or the demand for care shall be further referred.

Perceived condition

Identify health issue

Match against care service repository

Matched condition

Clinical Process

Management process

Decide on assessment

Verified demand for care

Decide on care mandate

Health care commitment

Receive and assess demand for care

Referred demand for care

Accepted demand for care

Demand for care

Communication process

Receive demand for care

Received and noted demand for care

Communicate decision on demand for care


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Styrprocess

Klinisk process

Bedöma ochprioritetsättavårdbehov

Preciserahälsoproblem

HälsoproblemBedöma

vårdbehov

Behovsbedömttillstånd

Definieraproblem-komplex

Problem-komplex Prioritetsätta

ochformulera

mål

Mål ivårdplan

Inhämtakompletterandeinformation f

vårdåtagandet

Vård-åtagande

8.3 Assessment and setting of priority of care requirements

When the health care commitment has been stated and has confirmed the care mandate, the health issues are delimited by communication with other health care providers, review of older records, etc. Based on this more precise perception of the health condition and the delimited health issues, the requirements for care can be assessed. In the management process decisions are made about which of the health issues are to be dealt with, and a health issue thread can be defined. Within this health issue thread, priority and objectives are set, which will guide planning of care.

Assessment and setting of priority of care requirements

Clinical Process

Delimit health issues

Health issues

Assess care requirements

Condition assessed concerning care requirements

Management process

Health care commitment

Define health issue thread

Health issue thread Set priority

and objective



Get supplementary information

Information from demand for care supplemented by request


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Styrprocess

Klinisk process

Planeraaktiviteter

Mål ivårdplan

Inventeraresurstillgång

Tillgängligaresurser

Bokaresurser

Resurssattvårdplan

Fastställavårdplan

Aktivitetsplanerattillstånd

Vård-plan

Matchatillstånd och

mål motaktiviteter

8.4 Planning of care

A programme of care cannot be established based only on the health issue thread and the health care objective. It must also be provided with resources, and information about them is fetched in the communication process. A clinical assessment of how the resources shall be used and which activities shall be performed with regard to the health issues is the basis for the programme of care. When it has been established it is the management tool within the framework of the care mandate.

In order to realise the programme of care in practical work resources must be reserved/allocated by booking.

Plan activities

Clinical Process

Management process



Match condition and objective against activities

Activity planned condition

Programme of care

Establish programme of care

Survey resource availability

Available resources

Book resources

Resource provided activity list


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Styrprocess

Klinisk process

Utföraplaneradeaktiviteter

Resurssattvårdplan

Kommuniceraföreslagen

vårdplan medpatient

Besluta omgenomförandeav planerade

aktiviteter Beslut attgenomföra

aktiviter

Utförautredandeaktiviteter

Utretttillstånd

Utfärdavårdbegäran

(remiss)

Bedömatillstånd

Bedömttillstånd

Omprövamål i

vårdplanMål i

vårdplan

Matcha målmot

tillgängligaaktiviteter

Förnyavårdplan

Vård-plan

Bokaresurser

Resurssattaktivitetslista

Besluta omgenomförandeav planerade

aktiviteter

Utföraåtgärdandeaktiviteter

Beslut attutföra

aktivitet


Aktivitets-lista

8.5 Performance of activities

Investigating activities have the purpose to increase the understanding of the patient’s condition. The assessed condition makes it possible to reconsider the health care objective, to make a new survey of available activities, and to update the programme of care. After resource allocation treating activities of the programme of care can be performed. As well investigating as treating activities can be performed by the health care provider. The activity may however alternatively be an external one in a supportive process (lab, x-ray, other health care provider) or a demand for transfer of the care responsibility (e.g. to plan discharge to another clinic or to community care).

Perform planned activities

Clinical Process

Management process




Communicate the programme of care with the subject of care

Issue demand for care

Match objective against available activities

Activity list

Book resources

Decide performance of planned activities

Decide performance of planned activities Decision to

perform activities

Decision to perform activities

Reconsider health care objective


Programme of care

Update programme of care

Perform investigating activities

Investigated condition

Assess condition

Assessed condition

Perform treating activities

Treated condition


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Styrprocess

Klinisk process

Utvärderaresultat avaktiviteter

Utvärderaåtgärdattillstånd

Utvärderattillstånd

Kontrollerakvalitet

Kvalitets-utfall

Bedömakvarvarandevårdbehov



8.6 Evaluate

When treating activities have been performed and the condition after these activities has been assessed, a comparison between expected and actual outcome has to be made. The difference is a measure of quality of the performed work. If the result is the expected one the health care objective can be kept unchanged and the programme of care further realised. If the result is better or worse than expected, the objective must be reconsidered and the programme of care updated. If the health care objective is reached there is no longer reason for a health care commitment, and the care mandate can be terminated.

Evaluate the result of activities


Management process

Clinical Process

Treated condition Evaluate

treated condition

Evaluated condition

Evaluate remaining care requirements

Evaluated condition with respect to care requirements

Check quality

Quality outcome


24


Styrprocess

Klinisk process

Avvecklavård-

åtagande

Utvärderamål i

vårdplan


Fortsattvårdåtagande

Avvecklingsbartvårdåtagande

Besluta omavveckling avvårdåtagande

Avslutavårdåtagande

Mandatatt

avsluta

Avsluts-meddelande

8.7 Termination of mandate

If the health care objective has been achieved, the health care commitment shall be withdrawn. This means ideally that the health issues which have created a need for care no longer exist. This will be communicated by means of a discharge message (which equals to a lab report, an x-ray report, a discharge letter, and an informative discussion with the subject of care).

If the health care objective has not been achieved after investigation and treating activities, but there are remaining care requirements, the health care commitment is kept and the care mandate will still be effective. The process will iterate.

If there is a need to transfer care responsibility to another health care provider, a demand for care shall have been issued as an activity in the process, and an acceptance of that demand for care (health care commitment of the other provider leading to a new mandate) is equal to a fulfilled health care objective.

Withdrawal of health care commitment


Management process

Clinical Process Evaluated condition with respect to care requirements

Evaluate health care objective

Continued health care commitment

Health care commitment to be withdrawn

Decide to withdraw health care commitment

Mandate to terminate

Withdraw health care commitment

Discharge message


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9. Concept models

9.1 Demand for care

9.2 Perceived condition


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9.3 Matched condition


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9.4 Health care commitment, care mandate


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9.5 Programme of care, health care objective


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9.6 Activity list, resources


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9.7 Activity, purpose, result

samba e v 3 1

Documents