1. The processes Clinical process
refinement object: patient condition including health issues
as peceived by healthcare professionals
Decision process
refinement object: mandate based on demand for care and
healthcare commitment, planning, decisions
In the following slides the backgroud colour is dimmed to increase contrast of the process objects.
These are the refinement objects of the three parallel processes.
Communication process
refinement object: information on resources,
documents, messages

2. Demand for care Management process
decide on
assessment
decision not to assess
demand for care
The demand for care is received in the communication process.
Then there is a decision whether the demand for care shall be assessed for further action. It might turn out that it is not a demand for care, or the demand is presented where the subjects’s insurance is not effective, or the subject might have called at the wrong hospital.
The condition of the subject will be perceived by a healthcare professional from the information in the demand for care.
Communication process
receive
demand
for care
demand
for care
received
demand for care
refer
referred
demand

3. Demand for care Clinical process – health condition
assess
condition
perceived
condition
Management process – mandate
decision on
assessment
decision to assess
demand for care
The demand for care is received in the communication process.
Then there is a decision whether the demand for care shall be assessed for further action. It might turn out that it is not a demand for care, or the demand is presented where the subjects’s insurance is not effective, or the subject might have called at the wrong hospital.
The condition of the subject will be perceived by a healthcare professional from the information in the demand for care.
Communication process – information
receive
demand
for care
demand
for care
received
demand for care

4. Healthcare mandate Clinical process – health condition
not possible
to handle
match against
service repository
Management process –
mandate
decide on
care mandate no
mandate
The condition described in the demand for care is matched against the service repository of the healthcare provider. If there is no match, for instance the patient calls at the department for orthopedics with an eye problem, it is possible to decide that the demand for care is no matter for the provider, and the subject of care is referred, either to another health care provider or to take care of herself.
If there seems to be a possibility to help the patient, a health care mandate has been established and the process goes on with identifying of the health issues.
Communication process – information
refer
referred
demand

5. Healthcare mandate healthcare commitment
Clinical process – health condition
condition
possible
to handle
match against
service repository
identify
health issues
Management process – mandate
decide on
care mandate no
mandate
healthcare
mandate
The condition described in the demand for care is matched against the service repository of the healthcare provider. If there is no match, for instance the patient calls at the department for orthopedics with an eye problem, it is possible to decide that the demand for care is no matter for the provider, and the subject of care is referred, either to another health care provider or to take care of herself.
If there seems to be a possibility to help the patient, a health care mandate has been established and the process goes on with identifying of the health issues.
Communication process – information

6. Health issue thread, hc objective
Clinical process – health condition
get
supplementary
information
supplemented
perceived
condition
condition asses-
sed regarding
need for care
health issues
assess need
for care
Management process – mandate
delineate health issue
complex to be handled
health issue
complex
assess priority,
define healthcare
objective
healthcare
objective
By supplementing the clinical information, the appropriate health issue collection can be identified and a health issue thread delineated. Such information can be collected by questioning the patient or from older healthcare records. This is the basis for a helathcare objective.
In order to achieve the health care objective, it should be matched against available services.
Communication process – information
match objective
against available
activities

7. Program of care Clinical process – health condition
pick
activities
conditions in
care plans
Management process – mandate
establish
programme
of care
decide
care planning
planning
decision
programme
of care
decide usage of
planned activities
The result of this match is a list of the activities. This list is a resource for decision of care planning. From the activity list certain activities will be chosen to solve specific health issues concerning the subject of care.
This will make it possible to establish a program of care.
When the program of care has been established you have to book resources of different kinds, for example staff, equipment, room for consultation. The program of care shall be recorded.
It is then possible to decide every single activity or service that is to be performed.
The first service in a line of activities will be an investigating one.
Communication process – information
book resources
resource-
provided
activity list
activity
list

8. Activities Clinical process – health condition
perform
investigation
investigated
condition
assess
condition
assessed
condition
Management process – mandate
decision
to perform
redefine health-
care objective
healthcare
objective
The condition, which has been perceived by investigation must be assessed before treatment.
The assessed condition is an input to an update of the healthcare objective, which once more must be matched against services available for the moment.
Communication process – information
match objective
against available
services

9. Activities Clinical process – health condition
perform
treatment
treated
condition
Management process – mandate
revise prog-
ramme of care
programme
of care
decide usage of
planned activities
decision
to perform
When an updated list of activities has been established, the program of care will also be updated, resources booked and next decision to perform activities made.
This activity is supposed to be a treating one giving a treated condition as output.
Communication process – information
activity
list
book resources,
record program
of care
resource-
provided
activity list

10. Quality check Clinical process – health condition
evaluate
result
assessed
condition
match condition
against objective
remaining
need for care
Management process – mandate
check quality
quality
result
redefine health-
care objective
Now the result of the activities must be evaluated.
This assessed condition is the basis for quality evaluation and
an update of the healthcare record. This action illustrates the communication with another process package, the healthcare record.
The assessed condition is also subject to comparison with the healthcare objective. Hopefully, a part of this objective has been fulfilled, and the objective can be redefined to encompass goals just for activities against remaining health issues.
The process steps in the last three slides can be repeated as long as there is a healthcare objective present which can be treated with available services.
Communication process – information

11. End of process Clinical process – health condition
assess healthcare
objective
as fulfilled
perceived
condition
healthcare
objective
decide discharge
message
discharge
decision
Management process – mandate
There is however now a possibility that we find that the healthcare objective has been fulfilled. This is assessed in the Clinical process.
This satisfactory condition is the basis for a decision to terminate the process and issue a discharge message. This means that the Clinical process ends, and with the discharge decision the decision process will also end. The discharge message can be a reply to a referral, a part of the healthcare record or active information to the subjekt of care and her possible supporting other carers. Probably, the discharge message consists of two or more kinds of information. As the discharge message is the final output from the process package and is produced in the communication process, it is evidently the final state of the refinement object, which was originally input as a demand for care.
Communication process – information
issue discharge
message
discharge
message

12. review health problems,
Healthcare mandate
renewed healthcare commitment
Clinical process – health condition
healthcare objective
assessed as
not fulfilled
perceived
condition
review health problems,
identify additional
health problems
healthcare
objective
renew health-
care mandate no
mandate
healthcare
mandate
Management process – mandate
The condition described in the demand for care is matched against the service repository of the healthcare provider. If there is no match, for instance the patient calls at the department for orthopedics with an eye problem, it is possible to decide that the demand for care is no matter for the provider, and the subject of care is referred, either to another health care provider or to take care of herself.
If there seems to be a possibility to help the patient, a health care mandate has been established and the process goes on with identifying of the health issues.
Communication process – information

13. Health issue thread, hc objective
Clinical process – health condition
health issues
get
supplementary
information
refined health
issue collection
Management process – mandate
delineate health issue
thread to be treated,
define healthcare objective
healthcare
objective
It will call for a new match against available services.
Communication process – information
match objective
against available
services

14. Referral to other healthcare provider
assess health is-
sues to be referred
health issues
in referral
Clinical process – health condition
decision on
health issue
complex in
referral
decide
referral
referral
decision
delineate health
issue complex
in referral
Management process –
mandate
There is now a possibility is that the remaining health issues are not subject to any available services, and in that case we must decide to make a referral to another healthcare provider who, according to our knowledge, has got the adequate resources.
This will yield a demand for care as input in the other provider’s process. This means, that the Clinical process and the decision process are finished, which means that there is no longer any responsability tied to the first provider. But the communication process yields an object which starts the next communication process. You can establish rules saying that the communication process is the process that creates seamless care.
Communication process – information
no service
available
issue referral =
demand for care
demand
for care

15. Other healthcare provider’s start
Clinical process – health condition
Management process – mandate
decision on
assessment
demand for care
to be assessed
d_f_c not to
be assessed
So, that leads us to the start, but this is the process of another healthcare provider. I won’t show the next steps which of course are the same as you have already seen.
So, now you have seen two ways to end the process. One way of handling it is that the entire process is accomplished by only one healthcare provider. The other way is to refer tha subject of care to another healthcare provider when the first provider has no adequate services available.
Communication process – information
receive
demand
for care
demand
for care
received
demand for care