Abstract:
A healthcare organization/enterprise (HCO) process definition framework is provided that holistically defines processes and process structures for a generic HCO. The HCO framework addresses clinical, operational and financial performance excellence and maximization. This model may be utilized by consultants and HCO representatives working together to integrate the HCO framework into an existing model of a specific HCO to create a customized process model for a this specific HCO. The models may be developed utilizing a process management tool, a best practice and benchmark database and Siemens HCO reference model. The approach focuses, from the beginning, on implementing change, and thus change management is an integral part of the holistic approach.

Description:
BACKGROUND OF THE INVENTION  
         [0001]    1. Field of the Invention  
           [0002]    The invention relates to the field of healthcare organizations/enterprises (HCOs) and in particular to a comprehensive standardized process change management model (PCMM) framework. The invention also relates to a method for using this framework to provide a customized process model for a particular HCO.  
           [0003]    2. Description of the Related Art  
           [0004]    A major problem in health care delivery systems is the inefficiency of processes that result in low quality and high cost. The need for quality improvement is described in “Crossing the Quality Chasm: A New Health System for the 21st Century Committee on Quality of Health Care in America”, Institute of Medicine, National Academy Press Washington, D.C., 2001 (“the Institute of Medicine Report”), herein incorporated by reference. This report describes the quality problems in the healthcare industry.  
           [0005]    The need for efficient delivery of medical treatment is obvious from all ongoing efforts to achieve operational business improvement within the healthcare market. The current approaches do not use the synergy of applying both efforts (operational and clinical process improvement) in order to reduce cost and improve quality that could create integrated clinical and operational performance excellence, thereby enabling financial performance excellence and maximization. A comprehensive business process framework addressing optimization of clinical, operational, and financial performance has not been applied as the basis for fundamental organizational change in the healthcare industry. The Institute of Medicine Report identifies the need that “the changes needed to realize a substantial improvement in health care involve the health care system as a whole,” but does little to address the concrete mechanisms for accomplishing this.  
           [0006]    Current patents and industry offerings generally involve generic process management approaches for generic business environments, focusing heavily on operational performance aspects. Furthermore, when directed to health care environments, current patents and industry offerings typically address improvement needs at the departmental level and not to the level of the entire HCO; current HCO process and business improvement approaches focus only on individual processes or subprocesses, and do not fine-tune a whole system in a comprehensive manner, but rather parts of the system. These partial solutions in health care settings can result in suboptimized process design and metrics identification that may produce a gain in one area but only by introducing a loss in another, e.g., improving the cost of an HCO on one end may worsen performance at the other end. Often the improvement activities focus on operational efficiency and performance without considering the relevant clinical processes, again leading to optimized operational performance only but often producing difficulties and quality problems with care delivery. The prior art has not provided a holistic workable solution to the needs of clinical, operational and financial performance excellence and maximization addressed above.  
           [0007]    This non-holistic approach can be illustrated in that, for example, HCOs have historically taken a function-oriented approach to addressing problems. Such a function-oriented view of the HCO involves focusing on perspectives such as the employee being a cause of the problem, attempting to measure individuals and change the person, determining who is at fault when a problem occurs, and controlling employees. Ultimately, these approaches tend to be overly bottom-line driven, and operate in a sub-optimal manner. The functional focus tends to lead to sub-optimal organization and creates functional “silos” such that there are communication gaps between functions, leading to unclear responsibilities of those associated with particular functions. These also tend to result in informal decision making that may not take into consideration other relevant factors or properly address different priorities of functions. Furthermore, whatever metrics are utilized may not be tied to the ultimate success of the HCO, and incentives may not be sufficiently tied to those metrics that are relevant.  
           [0008]    Existing relevant prior art patents provide generic methodologies for process improvement and process management. These include: U.S. Pat. No. 6,101,479 directed to a System and Method for Allocating Company Resources to Fulfill Customer Expectations; U.S. Pat. No. 5,467,471 directed to Maintaining Databases by Means of Hierarchical Genealogical table (referenced by the previously mentioned patent); U.S. Pat. No. 6,101,481 directed to a Task Management System; U.S. Pat. No. 6,092,060 directed to Computer-aided Methods and Apparatus for Assessing an Organizational Process or System; U.S. Pat. No. 5,737,494 directed to Assessment Methods and Apparatus for an Organizational Process or System; U.S. Pat. No. 5,930,512 directed to a Method and Apparatus for Building and Running Workflow Process Models using a Hypertext Markup Language; U.S. Pat. No. 6,442,512 directed to an Interactive Process Modeling System; U.S. Pat. No. 6,339,838 directed to a Contol of Commercial Processes; U.S. Pat. No. 5,781,454 directed to a Process Modeling Technique; European Patent Office GB 2370389 directed to a Process for Mapping Change in a Business System; International Patent Application WO 0248935 directed to an Integrated Business Management System; U.S. Patent Publication 2002042731 directed to a Method, System and Tools for Performing Business-related Planning; European Patent EP1 180741 directed to a Flexible System and Method for Standardizing Communications and Decision-making across Multiple Business Processes; and Canadian Patent CA 2337933 directed to a Process Management Graphical User Interface, System and Method.  
         SUMMARY OF THE INVENTION  
         [0009]    The object of the present invention is to provide a comprehensive standardized process change management model (PCMM) framework (the “HCO framework”) that takes a holistic approach to addressing HCO-related issues, where the framework is generic and independent of any specific HCO, that can be used as a reference model to implement a comprehensive approach to healthcare in dealing with education, sales, research and development and to help provide customer-driven products and services by Siemens Medical Solutions or anyone else associated with the healthcare industry. Another object of the invention is to provide a method for updating and maintaining the HCO framework. A further object of the invention is to provide a method for utilizing this HCO framework to create a customized process model for a particular HCO (the “HCO Customized Model”) by focusing on the specific HCO as a whole and the relationship of the processes within the specific HCO as a whole.  
           [0010]    The object of the invention is achieved by a method for creating a customized process model for an HCO using a standardized process change management model comprising pre-defining, by a consultant, a plurality of PCMM patient-centered processes encompassing a plurality of HCO process levels including operations, management and support processes; determining existing processes of an HCO from communications between the consultant and healthcare, management, operations and support personnel at the HCO; identifying, by the consultant and the HCO personnel, a selected group of one or more existing patient processes to re-engineered by the healthcare personnel; and re-engineering the selected group of existing processes with a group of PCMM patient-centered processes. The re-engineering means adapting existing processes and process structures/relationships to conform with the HCO framework.  
           [0011]    The object of the invention is also achieved by a comprehensive healthcare organization (HCO) framework, comprising a pre-defined plurality of HCO-related process change management model (PCMM) processes that are independent of a specific HCO, the PCMM processes collectively comprising operations processes, management processes and support processes, the PCMM processes being collectively organized across and identified according to more than one hierarchical level.  
           [0012]    The object of the invention is also achived by an HCO framework system comprising the HCO framework combined with an idealized reference model that is based on the HCO framework and that further comprises additional HCO specific information that is based on an idealized HCO.  
           [0013]    The object of the invention is also achieved by a method for updating the HCO framework of claim  1 , comprising updating the HCO framework based on a new input of information.  
           [0014]    The object of the invention is also achieved by a method for utilizing the HCO framework comprising predicting future state processes that may be required by HCOs with the HCO framework.  
           [0015]    The HCO framework supports creating health care delivery systems to become patient centered, process focused, and outcome oriented by designing around a common framework with metrics partially based on the Institute of Medicine Report&#39;s six specific improvement aims: safety; effectiveness; patient-centeredness; timeliness; efficiency; and equity. Thus this approach generally focuses on improvement of clinical outcomes. The presented unique approach ties this effort into efforts to improve enterprise operations by commonly used efficiency metrics for economic outcomes like, among others, ROI (return on investment) utilization rates, and/or economic value added. This allows for achieving integrated performance optimization, through e.g., defined and reliable measurement and evaluation of performance, comparison of performance states of HCOs and establishment of best practices, thus delivering proven clinical and operational outcome improvements.  
           [0016]    Implementing the HCO framework into a specific HCO includes applying the comprehensive methodology, complete processing from the “as is” state to the ideal state or at least some improved state, and utilizing associated metrics to support continuous process improvement to optimize the entire organization. This is done in the context of providing offerings that standardize and optimize the entire system of health care delivery using the pre-defined HCO framework having clinician developed and reviewed content and associated methodologies for comprehensive organizational change (including leadership strategies, process management, and improvement portfolio implementation.) The process model may be designed as an easy to use, web (HTML) based application that enables a navigation through the different process levels. However, other implementations may be considered to be part of the invention as well, including implementations using nothing more sophisticated than paper forms and pencil, standard computer-based applications, etc.  
           [0017]    The inventive solutions utilize systems thinking in the field of HCOs in applying a holistic approach focusing on clinical, operational and financial performance excellence and maximization that results in a highly informed decision and are able to: 1) provide an organization-independent framework of processes; 2) adapt this framework of processes to a specific organization; and/or 3) ultimately adapt the framework processes based on feedback from the specific organization implementations. 
       
    
    
     DESCRIPTION OF THE DRAWINGS  
       [0018]    [0018]FIG. 1 is a block diagram providing an overview of the inventive HCO framework and its potential use in the inventive method;  
         [0019]    [0019]FIG. 2 is a block diagram expanding the HCO framework;  
         [0020]    [0020]FIG. 3 is a tree diagram illustrating an exemplary hierarchy for the operating processes used for detection;  
         [0021]    [0021]FIG. 4 is a tree diagram illustrating an exemplary hierarchy for the operating processes used for treatment; and  
         [0022]    [0022]FIG. 5 is a flowchart illustrating a four-step embodiment of the inventive method. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0023]    [0023]FIG. 1 illustrates the inventive HCO framework and its application to the inventive method for customizing a specific HCO.  
         [0024]    There are two broad aspects of the invention: 1) an HCO framework system  11  dealing with the organization, maintenance, and updating of an HCO framework  12 , which structures generalized processes independent of a specific HCO; and 2) an HCO framework integration and customization  13 , which utilizes the HCO framework  12  and results in an HCO-specific process model  18 . The combination of the HCO framework system  11  and the HCO framework integration and customization  13  comprise the overall model for HCO improvement  10 .  
         [0025]    Although a primary use of the HCO framework system  11  is to provide a standardized model that can be used for HCO framework integration and customization  13  of a particular HCO, the HCO framework system  11  can exist independently of the HCO framework integration and customization  13  and, correspondingly, the HCO framework  12  can exist independently of the specific HCO process models (both the existing processes  16  and the customized processes  18 ). An independent HCO framework  12  can be used as a reference model to implement a comprehensive approach to healthcare in dealing with education, sales, research and development and to help provide customer-driven products and services by Siemens Medical Solutions or anyone else associated with the healthcare industry, including advisors, experts, partners, etc., apart from a focus on a particular HCO. Thus, the HCO framework  12  is not limited to a structure of defining existing processes, but can also be used to define (and possibly predict) future state processes that may be required by HCOs in response to medical developments, changes in legislation, demographic changes, etc. For example, the discovery of a new medical procedure may impact processes beyond the scope of the medical procedure itself, and this impact may suggest a much broader future state change than the new medical procedure itself might suggest in isolation. Such discoveries are not limited to medical procedures, however, but could include, e.g., discoveries related to communications and data networking, computing, administration, accounting, etc.  
         [0026]    In contrast, however, the HCO framework integration and customization  13 , according to the invention, requires the use of the HCO framework  12  and thus cannot exist independently in the invention, even though certain processes are HCO specific (and thus, not directly a part of the generalized HCO framework  12 ).  
         [0027]    HCO Framework—the Standardized Process Change Management Model  
         [0028]    The HCO framework  12  comprises a hierarchically structured database of process-definitions that may be used both to provide value-added solutions to existing specific HCO customers by adapting their existing processes and organization to conform to the HCO framework  12  model as well as provide a tool for use independently of a specific HCO. The initial HCO framework  12  has been developed based on initial consultations with doctors, nurses, other medical personnel, suppliers, patients, administrators, managers, insurance companies, technology companies, HMOs, etc., and based on years of research and consultation in this field and on literature from the general medical community, from the healthcare industry as a whole and all disciplines affiliated with the industry. This HCO framework  12 , however, is not fixed and can be changed over time, based on input from various sources including feedback received during the integration of the HCO framework into a specific HCO (described below), as well as general developments in the field and other newly acquired information. A particularly detailed embodiment of the HCO framework is provided as an example in Appendix B.  
         [0029]    In the HCO framework system  11 , an HCO framework  12  is provided that is organization independent, i.e., contains defined processes and hierarchical process structures that are general in nature and do not have the dependencies of any specific organization built in to them. FIG. 2 illustrates a breakdown of the HCO framework  12  that may utilize industry standards and include management processes  122 , operating processes  124 , and support processes  126 , as well as a hierarchical process structure described in more detail below. See also Appendix B, p. 9 for a more detailed view.  
         [0030]    This process change management model has been inventively adapted to the field of HCOs by the use of a patient-centric model. In this HCO framework model  12 , all work within the operating processes  124  starts with the identification of a patient&#39;s needs and ends with the fulfillment of a patient&#39;s needs (Appendix B, pp. 2, 9). The management processes  122  and support processes  126 , while being somewhat organizationally generic (i.e., not specific to the general field of HCOs), remain a part of the model in that these processes must interface with the highly patient-centric operating processes  124 , and thus their application remains part of the inventive system. The very core of the operating processes  124  are those through which care is delivered to the patient. All aspects of this process model are choreographed and continuously optimized to ensure superior clinical and operational outcomes. See Appendix B, p. 35.  
         [0031]    The patient-oriented operating processes are focused on the patient at a number of stages. For example, in the planning stages, processes may be provided for understanding a patient and relatives&#39; health policy, pre-clinic negotiations, and providing a care guide for relatives post-clinic help. The patent processes can also include processes, e.g., dealing with pharmaceutical materials, operating (surgery), how to admit, treat, and release the patient, readmittance procedures, dealing with expired materials, and addressing new surgery required or clinical treatment. More detail on potential patient processes is provided in Appendix B, pp. 73-111.  
         [0032]    The hierarchical process structure may be used in an embodiment of the invention in which the processes are defined according to some number of hierarchical levels. For example, the number of levels used may be five and be defined in accordance with the Supply Chain Operations Reference Model (SCOR), as discussed in the Overview of SCOR Version 5.0, published by the Supply-Change Council, Inc., 2001, herein incorporated by reference. In this model, the highest level is defined as “Level 0”, and the lowest level is defined as “Level 4” (Appendix B, p. 4). In the SCOR model, these levels are defined in the following manner.  
                             TABLE 1                       SCOR Process Hierarchy Levels                                Level   Process   Process Groups generic- Provides a standardized       0   Framework   systematic overview of core processes and their               interactions       Level   Top Level   Core Processes generic- Provides definitions       1   (Process   of the scope and content of the core management,           Types)   operating and support processes       Level   Configuration   Process Models, Variants generic- Allows one to       2   Level   configure and implement individual variants and           (Process   focus strategy           Categories)       Level   Process   Chain with Process Elements - Allows one to       3   Element   optimize and “fine tune” management, operating           Level   and support processes through the definition of               process elements, addressing information input               and output, using performance metrics, tools,               etc.       Level   Implementation   Detailed Process Chain with Processing Elements       4   Level   generic and specific- Allows one to implement               specific requirements to achieve optimized               performance                  
 
         [0033]    For illustrative purposes, FIG. 3 shows an exemplary organization of the processes according to the operating processes-patient processes  124  (a broader perspective of the patient processes  124  can be seen in Appendix B, pp. 73-111). This exemplary embodiment illustrates a potential hierarchy utilized for the processes. The embodiments shown in FIGS. 3 and 4 are illustrative only and are not intended to provide a comprehensive or complete description of the hierarchy or process at any particular level (see Appendix B, p. 81 and associated description). FIG. 3 shows Level 1 process types  32  that may include plan, admit, detect, treat, discharge, source, and return, e.g. At the Level 2 process categories  34 , (focusing in on a particular Level 1 process type) the “detect” process type may include the process categories laboratory tests, imaging tests, and clinical tests, e.g. The imaging tests may, e.g., be subject to three category variants: a CT-Scan, an MRI-Scan and an Ultrasound (see Appendix B, p. 92). The Level 3 process elements  36  might include, for each of the category variants, the following elements: assess, order, schedule, prepare, perform, document, evaluate, communicate, and store/archive.  
         [0034]    Similarly, for illustrative purposes and as shown in FIG. 4, the Level 1 process type “treat”, can be broken down into the Level 2 process categories  34 ′ invasive procedures and non-invasive procedures. The non-invasive procedures may, e.g., address the variants of medication, physical therapy and radiation (see Appendix B, pp. 92, 105 and associated description). This hierarchical organization of the processes helps to ensure that the system can be viewed in a holistic manner. Similar process breakdowns are described in detail in Appendix B. The illustrative examples provided in FIGS. 3 and 4 are not all-inclusive and can accommodate any number of processes at any of the process levels.  
         [0035]    This embodiment of the invention may support rule-based process definition to at least these five levels of detail of process decomposition. Details included in the process definition may be documented in the process management tool  30  and may include the following: 1) inputs, outputs, and activities; 2) responsible and participating roles; 3) reference models that support practices of the enterprise; 4) information technology tools that are used to enable the processes and links between the tools and processes; 5) metrics that reflect process performance; and 6) points of integration between processes. An exemplary process definition may be seen in Appendix B at p. 15.  
         [0036]    Note that although FIG. 1 only shows access to the process management tool  30  by the consultant  22  and HCO representative  24 , it should be understood that the HCO framework  12 , HCO existing processes  16 , and HCO customized processes  18  may all utilize and/or be implemented with the process management tool  30 . Appendix B provides a much more detailed embodiment of the invention for the HCO framework and illustrates a potential hierarchical structure that may be utilized to organize the process definitions.  
         [0037]    HCO Framework Integration and Customization of a Specific HCO  
         [0038]    As noted above, one of the primary uses of the HCO framework  12  is to be utilized as a tool for creating a customized process model  18  for a particular HCO. This permits use of the HCO framework to provide a unified, structure approach to the customer.  
         [0039]    Although use of a process management tool  30  (described below) permits a great deal of customization and detail per customer, it is important that a particular HCO maintains at least the basics of the HCO framework  12 . These basics include a structure arranged according to management, operating and support processes, and, within operating processes, maintaining Patient and Partnership Relationship Management (PPRM), Product and Service Lifecycle Management (PSLM) and patient processes as standard. These basics also may include the rules for defining process (use of levels of process decomposition; defining inputs, outputs, activities; roles; references, etc).  
         [0040]    This integration of the HCO framework  12  with a particular specific HCO may take place in an embodiment of the invention as follows. The consultant  22  works with a representative of a specific HCO  24  to document existing HCO processes  16 . Although the HCO may already have some documented processes, it is usually the case that many of an HCO&#39;s existing processes are undocumented or perhaps even non-existent. And it is possible that even the documented processes have significant omissions that would not permit their inclusion in the ultimate resulting customized model  18 . Thus, the consultant  22  and HCO representative(s)  24  work together to create documented processes  16  from these undocumented processes  14 , preferably based on the model for the individual process previously defined, having 1) inputs, outputs, and activities; 2) responsible and participating roles; 3) reference models that support practices of the enterprise; 4) information technology tools that are used to enable the processes and links between the tools and processes; 5) metrics that reflect process performance; and/or 6) points of integration between processes.  
         [0041]    Once the documented processes  16  are created, the consultant  22  and HCO representative(s)  24  work together to determine which existing documented processes  16  (or groups of processes) of the HCO would benefit by utilizing processes within the HCO framework  12 . Processes from the HCO framework  12  may be integrated into the existing documented processes  16  for the HCO; one or more of the existing documented processes  16  may be re-engineered or adapted to produce HCO customized processes  18  that fit within a customized model. This integration may be performed according to a four step approach (FIG. 5, 50) presented below.  
         [0042]    Step One—Identification of HCO Overall Strategies and Principles  52   
         [0043]    According to this embodiment, a consultant  22  works with one or more HCO representatives  24  to identify broad overall strategies and principles of the HCO. The consultant  22  obtains HCO strategies and principles  19  information regarding, for example, organizational identity which encompasses vision (e.g., through an existing vision statement and/or discussions with HCO leadership), mission (e.g., through instruments of incorporation), strategic leadership (e.g., from human resource personnel in the form of goals and objectives of various members in the organization), and environmental analysis (e.g., through consultant  22  or HCO representative  24 , through observation, personnel interviews, etc.).  
         [0044]    All of this information  19  may be obtained through formal documentation produced by the HCO, through private discussions with key personnel, through meetings of representative employees, through direct observation of procedures, or any other appropriate source. This information is collected and placed in a centrally accessible database. The word “database” here is used in a general sense and although it is preferably in an electronic format, the database could be nothing more than an index of paper cards. In an embodiment of the invention, this information may be placed in a web-based process management tool  30  (described below). This step includes mapping out the requirements for change in the HCO.  
         [0045]    Step Two—Definition of Existing HCO Process Model  54   
         [0046]    Once the overall strategies and principles  19  of the HCO have been obtained and stored in a database, the consultant  22  works with the representative  24  of the HCO and begins identifying and defining an existing process model  16  for the HCO. This includes using business process management in which process owners are identified for at least each major process or group of processes. Process owners may be identified by a governance level that could include: 1) collective—process owners are groups of departments or groups of individuals; 2) single—process owners are single departments; and 3) individual—process owners are single individuals. A process owner is responsible for the detailed definition, implementation and optimization of a process. Training may be provided to process owners in aspects of process management during this step.  
         [0047]    There are two significant aspects that may be used during the identifying and defining stage of the existing process to produce the HCO existing processes  16 . The first is the use of a business process-management methodology (described below) to improve performance measured through relevant business metrics. The second includes the use of a process model adapted for HCOs as the starting point for analyzing the current state of the HCOs&#39; processes, mapping requirements for change (identified during the previous Step One) to the current situation, comparing these to the HCO framework  12 , and then, in Step Three defining the customized process model  18  for a particular HCO. This information may then be placed in the web-based information management tool  30 , described below in relationship to the process management tool  30 .  
         [0048]    Step Three—Creating a Detailed Customized Process Model  56   
         [0049]    In Step Three, the consultant  22  works with the HCO representative  24  to create a detailed process model for the HCO  18 . During this Step, process metrics are defined that address the customized process model as a whole. These metrics could, for example, be broken down into the broad classifications previously identified: 1) enterprise management, 2) operating processes, and 3) business administration and support. Refer to Appendix A for the identification of metrics that can be considered in the context of the HCO. The metrics in Appendix A reflect a combination of those metrics already known as well as those determined based on extensive consulting experience—Appendix A reflects an inventive combination and holistic view to these metrics.  
         [0050]    The detailed process model goes through a level of validation by comparing it with a Siemens HCO Reference Model (SHCORM)  26 . The SHCORM is an idealized reference model  26  that is similar to an HCO customized process model  18  in that it is based on the HCO framework  12 , but includes additional information that may be HCO specific. However, the HCO specific information relates to a “virtual” or “idealized” HCO that implements the best practice processes in all process levels. The SHCORM  26  comprises a database of worldwide evidence-based medicine guidelines, care paths and best-practice healthcare enterprise processes (qualitative and quantitative data). The SHCORM  26  may be used to identify the gap of the particular HCO that is being assessed with the HCO to a “virtual” worldwide best practice healthcare enterprise. The SHCORM  26  is dynamic as it is the nature of evidence-based medicine and will be permanently developed further based on the information from the worldwide consulting projects and HCO process assessments with the HCO process model. The SHCORM  26  enhances the system-based and holistic approach of utilizing a common language and structure approach to dealing with healthcare industry-related issues.  
         [0051]    Step Four—Implementation of the HCO Customized Process Model  58   
         [0052]    Once the HCO customized process model and processes  18  are defined, implementation and optimization steps of the business process management methodology are performed, creating an implementation strategy.  
         [0053]    In a preferred embodiment, this implementation strategy may address: 1) pilot testing new processes in the organization, i.e., training a limited number of medical care provider, administrative, management personnel, and other relevant participants on the use of the new processes, monitoring the quality of each process, and making any changes necessary before cross-enterprise use of the process occurs; 2) training employees based on the roles they will play in the new process; 3) scheduling mass deployment (e.g., which departments will adopt the new processes and by when); and 4) monitoring the process metrics that have been defined as part of Step Three.  
         [0054]    The process model that is implemented may be provided in the process management tool  30 . The newly implemented processes may be allowed to stabilize for some period of time (this time period being dependent on the complexity and nature of the process). Once some level of stability is achieved, the owners of the processes may begin optimization (continuous improvement) activities. The implemented model  18  becomes the basis for all future process improvement, benchmarking, and knowledge sharing for the specific HCO. The HCO&#39;s ultimate process model then represents a combination of: 1) the best practices delivered in the original version of the HCO framework  12 ; 2) the value-added content; and 3) organization-specific content.  
         [0055]    The relationship between the consultant  22  and the HCO representatives  24  need not end at this stage; rather it can continue on as long as the relationship is mutually beneficial. For example, it may be possible for the consultant  22  to implement some of the value-added content noted above that is independent of the HCO into the HCO framework  12 . Although a specific HCO might initially not want such value-added content to be included in the HCO framework (as it might permit other competing HCOs to benefit), this specific HCO might also be able to benefit from value-added content from another HCO—thus, the inclusion of a specific HCO&#39;s value-added content by the consultant  22  into the HCO framework  12  could be viewed as a beneficial exchange by this HCO for their use of other HCOs&#39; value-added content. Additionally, going the other way, it may be possible over time that the HCO framework  12  has evolved additional beneficial processes that could be again integrated into the HCO customized model  18 .  
         [0056]    Process Management Tool  
         [0057]    The process management tool  30  may serve as a centralized data repository that may be used in an embodiment of the invention for the input, processing, and output of all process-related material, including the HCO framework  12  and the processes defined within, as well as the HCO existing documented processes  16  and the HCO customized process model and processes  18 . In a preferred embodiment, the process management tool  30  utilizes a web-based user input and output and communications architecture, but it is not limited to this approach.  
         [0058]    The process management tool  30  may be implemented according to the following rule-based definitions: 1) processes can be decomposed to at least five levels; 2) process definitions include a description of inputs (including its source), outputs (including its target), and activities associated with the process; 3) interfaces between processes are identified; 4) metrics are defined for monitoring the effectiveness and quality of processes; 5) reference models on which processes are based are identified and linked to the process (i.e., the original reference model and documentation could remain available and accessible along with the customized model); and 6) information technology tools that enable the process are identified and linked to the process activity they support.  
         [0059]    Also, standards, rules and recommendations may be provided, as well as the previously described governance level. The process descriptions may be provided on a process description card and the descriptions on such cards may be provided as input or output to/from the web-based tool. The advantage of utilizing these rule-based definitions is that a process template contained within the process management tool  30  may be used to provide rapid process documentation. Users can learn how to document a process quickly, as the structure of processes are pre-defined and many allowable values for the required fields for documenting a process are contained in e.g., drop-down lists.  
         [0060]    Furthermore, the process management tool  30  may be configured to provide intelligent reporting capabilities that allow users to troubleshoot process definitions. For example, if there is an input without a source or an output without a target, the tool can produce a report to support this and also suggest potential corrections.  
         [0061]    The primary use for the process management tool  30  is during each of the four steps of the HCO framework integration  13 ; however, this tool could also be used to maintain and update the HCO framework  12  itself. Furthermore, HCO representatives  24  can assume ownership and support of the process management tool  30  after qualification training.  
         [0062]    For the purposes of promoting an understanding of the principles of the invention, reference has been made to the preferred embodiments illustrated in the drawings, and specific language has been used to describe these embodiments. However, no limitation of the scope of the invention is intended by this specific language, and the invention should be construed to encompass all embodiments that would normally occur to one of ordinary skill in the art.  
         [0063]    The present invention may be described in terms of functional block components and various processing steps. Such functional blocks may be realized by any number of hardware and/or software components configured to perform the specified functions. For example, the present invention may employ various processing elements, logic elements, look-up tables, and the like, which may carry out a variety of functions under the control of one or more computer systems that may be networked together in some fashion. Similarly, where the elements of the present invention are implemented using software programming or software elements the invention may be implemented with any programming or scripting language such as C, C++, Java, assembler, or the like, with the various algorithms being implemented with any combination of data structures, objects, processes, routines or other programming elements. Furthermore, the present invention could employ any number of conventional techniques for user input, data processing and the like.  
         [0064]    The particular implementations shown and described herein are illustrative examples of the invention and are not intended to otherwise limit the scope of the invention in any way. For the sake of brevity, conventional software development and other functional aspects of the systems (and components of the individual operating components of the systems) may not be described in detail. Furthermore, the connecting lines, or connectors shown in the various figures presented are intended to represent exemplary functional relationships and/or physical or logical couplings between the various elements. It should be noted that many alternative or additional functional relationships, physical connections or logical connections may be present in a practical device. Moreover, no item or component is essential to the practice of the invention unless the element is specifically described as “essential” or “critical”. Numerous modifications and adaptations will be readily apparent to those skilled in this art without departing from the spirit and scope of the present invention.  
       Appendix A  
     Possible Metrics  
       [0065]    Under enterprise management, metrics related to financial performance, outcomes and satisfaction could be considered. These metrics could include, among others:  
                       TABLE 1                                       number of workshops for improvement           of politics and strategy           management dedicated time for quality projects           number of patients according to health insurance           length of stay extension           sales per fte           cash flow per fte           contribution margin per fte           equity rate           profit per fte           cash flow rate           return on capital           return on equity           return on sales           operative profit           contribution margin per drg           case mix index           internal drg base rate           operative revenue           growth rate           cases p.a.           no. of performed services           length of stay           patient census           unit profitability           funds raised for facility improvements           average length of stay           length of stay           sales volume           return on investment           operative profit           asset turnover           return on sales           return on equity           economic value added           shareholder value           profit per fte           market share                      
 
         [0066]    Under operating processes, metrics could be classified under Patient-Partner Relationship Management, Product/Service Lifecycle Management, and Patient Processes.  
         [0067]    The Patient Partner Relationship Management metrics could include:  
                       TABLE 2                                       Safety           Patient-Centeredness           Number of Workshops with referring Physicians           Referring Physicians Satisfaction           Patient Satisfaction           Communication with Referring Physicians           Patient Satisfaction           Patient Referral Rate           Reclamations           Recommendation Rate           Effectiveness           Timeliness           Reclamation Rate           Recommendation Rate           Referring Physicians Satisfaction           Satisfaction of health insurances           Patient Retention           Timeliness Discharge Letter           Patient Satisfaction           Reclamation Rate                      
 
         [0068]    The Product Service Lifecycle Management metrics could include:  
                       TABLE 3                                       Efficiency           Number of Clinical Pathways           Rate of Improvement Suggestions           Growth Rate           Competencies           Training Hours per caregiver           Equity           Sales Contribution of new Services           Rate of successful implemented Improvement suggestions           Knowledge about needs of stakeholders           Improvement suggestions                      
 
         [0069]    The Patient Process metrics could include:  
                       TABLE 4                                       For Acute Myocardial Infarction           Aspirin at Arrival           Aspirin at discharge           Beta Blocker at arrival           Beta blocker at discharge           ACE inhibitor for left ventricular systolic dysfunction           For Heart Failure           left ventrincular function assessment           ACE inhibitor for left ventricular systolic dysfunction           For Pneumonia           Initial antibiotic timing           Pneumococcal vaccination           Oxygenation assessment                      
 
         [0070]    The Patient Processes could also be broken down according to classifications of care indicators, that may include:  
                       TABLE 5                                       Inpatient Acute Care indicators           Device-Associated Infections in Intensive Care Units           Surgical Site Infections           Prophylaxis for Surgical Procedures           Neonatal Mortality           Management of Labor           Unscheduled Admissions Following Ambulatory Procedures           Unscheduled Returns to the Operating Room           Isolated CABG Perioperative Mortality           Documented Falls           Pressure Ulcers in Acute Care           Device Use in Intensive Care Units           Inpatient Mortality           Perioperative Mortality           Unscheduled Readmissions           Unscheduled Returns to Intensive Care Units           Physical Restraint Events           Complications following Sedation           and Analgesia in Intensive Care Units(14a),           Cardiac Catheterization Labs(14b),           Endoscopy Suites(14c),           Emergency Departments(14d),           and Radiology Suites(14e)           Ambulatory Care Indicators           Unscheduled Returns to the Emergency Department           X-Ray Study Discrepancies in the Emergency Department           Requiring a Change in Patient Management           Cancellation of Scheduled Ambulatory Procedures           Length of Stay in the Emergency Department           Patients Leaving the Emergency Department Before           Completion of Treatment           Psychiatric Care Indicators           Injurious Behaviors           Transfers to Inpatient Acute Care           Physical Restraint Events           Partial Hospitalization Programs           Unplanned Departures Resulting in Discharge           Readmissions to Inpatient Psychiatric Care           Seclusion Events           Medication Use (PILOT)           Long Term Care Indicators           Unplanned Weight Gain           Documented Falls           Nosocomial Infections           Pressure Ulcers           Unscheduled Transfers/Discharges to Inpatient           Acute Care           Physical Restraint Events           Home Care Indicators           Unscheduled Transfers to Inpatient Acute Care           Discharge to Nursing Home Care           Use of Emergent Care Services           Acquired Infections                      
 
         [0071]    Additional patient process metrics could include:  
                       TABLE 6                                       Waiting Times Emergency Room           Waiting times Radiology           Rate of postponed admissions to elected surgery           Rate of postponed elected Surgeries           Mortality           Rate of Transfusion incidents           Rate of Patients with multiresistent germs           Postoperative Infections           Unsceduled Re-entries           Team Quality           Management of errors           Rate of Emergency Patient Readmission           Rate of Hospital acquired Infections           Outpatient Waiting times           Tracer Inginual Hernia           Tracer Acute Myocardial Infarction           Tracer Diabetes Mellitus           Tracer Breast Cancer           Tracer Total endoprosthesis for Primary Cox Arthrosis           Unscheduled Rehospitalization           Documented Falls, Injuries           Waiting Times Emergency           Anaesthesiological complications           Pressure Ulcers           Patient Mortality, e.g., 10-day Mortality           Heart Module           Resource utilization           Process Times           Process error rates           Waiting Times Functional diagnostics           Rate of discarded Blood Products           Rate of Patients with high preoperative length of stay           Neonatal Mortality           Unscheduled Readmissions           Readmissions to OR           Nosocomial Infections           OR Utilization           Waiting times for elected OP           Standardization of Processes           Patient Loads           Rate of unplanned Return to OR           Waiting times for elective surgery           Tracer Appendicitis and           Suspected Appendicitis           Tracer Proximal Femoral Fracture           Tracer Cerebrovascular Insultt           Tracer Birth by Cesarian Section           Tracer Benign Prostatic Hyperplasia           Tracer Cataract           Unscheduled Re-Intervention           Waiting Times elected Surgery           Suspension of elective Surgery           Nosocomial Infections           Improvement of individually felt health status           Discharges, e.g., to home, nursing home, rehabilitation           Lung Module           Waiting times           Productivity per fte.                      
 
         [0072]    Note that “tracer” in Table 6 means exemplary representative Diagnosis/Pathway including metrics, which could serve as a template for other Diagnosis/Pathways.  
         [0073]    Finally, under business administration and support, metrics could be classified according to cost/revenue, productivity, and resource utilization.  
         [0074]    These metrics could include:  
                       TABLE 7                                       Training Budget           Staff cost           Effectivity of Personnel Management           Work Overtime           Average Job Tenure           Asset depreciation           Liquidity           Employee Satisfaction           Condition of Capital           Cost per Non-inpatient Occassion of Service           User cost of capital per separation           Liquid assets           Liquidity           Fixed cost           Case Mix Index           Staff efficiency           Staff qualification index           Staff development           Material Cost           Staff Satisfaction           Fluctuation Rate           Capital intensity per Case Mix adjusted treatment           Overhead Cost           Employee Satisfaction           Employee Turnover Rate           Cost of Casemix adjusted separation           Labor Cost per separation           Capital assets           Accounts receivable           Variable costs           Cost of Nonconformance           PCCL           Staff effectiveness                      
 
         [0075]    Under people, metrics could include (note: fte means full time equivalent and is equated to one person working, for example, 1280 hours per year):  
                       TABLE 8                                       cost/revenue per full time equivalent           education budget per fte           staff retention           cases per fte           safety regulation compliance           a staff satisfaction score                      
 
         [0076]    Under resources (that might include materials, equipment, it, and facilities), metrics might include:  
                       TABLE 9                                       procurement cost per case           disposal cost per case           services cost per case           materials and logistics cost per case           maintenance cost per resource