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Editor's Note: This introduction to our three-part package describes how BPM is changing healthcare in areas ranging from billing to communication to patient education. Part II focuses on BPM's growing role in the industry's long-time push to eliminate paper records. And Part III examines how BPM is helping healthcare organizations with ever-tougher regulatory compliance.

Even as milestone breakthroughs and new diagnostic tools continue to advance American medical care, the healthcare industry frequently lags behind other fields in adopting new, more efficient management processes—even those with the potential to improve patient care.

But change is coming rapidly. An aging population, strict federal regulations and a climate of economic uncertainty have combined to force healthcare facilities to adopt different processes for managing patients and generating revenues. Hospitals, doctor offices, nursing homes, clinics and other facilities have begun to apply BPM to record-keeping, billing, collaboration and even patient education.

Health professionals have begun to recognize that business processes should be viewed as resources, just as important as facilities, people and technology. And, like all assets, processes must be carefully managed from inception to archive, says Sandra Nunn, a veteran director of health information management and author of "Enterprise Content Management and the Electronic Health Record" (AHIMA Press, 2012).

"Healthcare was behind manufacturing; it's now catching up pretty rapidly," Nunn says. "The [earlier] thinking was that healthcare was not like manufacturing, it's not like a car; it involves human beings. But now we are finding there's a lot you can standardize and there are a lot of processes that can be made more efficient."


First—and most important, experts say—healthcare must end its traditional reliance on "silo" environments, in which every medical department in a facility operated as its own kingdom. In that approach, staff and physicians in various departments sometimes didn't communicate with each other even when they were treating the same patient. Departments often adopted their own IT platforms and, far too often, the various systems couldn't communicate with each other, either.

"Healthcare was always very 'silo-ed,'" Nunn says. "Radiology was in one area; lab in another. We are now looking at processes that run all the way across the organization. People are having to collaborate rather than just thinking about their little piece."

That's partly because American healthcare has been largely based on a hospital-based, acute-care model, says Steven J. Spear, a senior fellow at the Institute for Healthcare Improvement and a senior lecturer at the MIT Sloan School of Management.

If you broke a leg, you went to the emergency room for a diagnosis, then to radiology for an X-ray, then to another department for a cast. Then, finally, you were sent home. Now you may get any of a number of imaging procedures, receive a variety of immobilization devices and be referred to specialized services as physical therapy for after-care. BPM can help hospitals cope with these new realities of healthcare, which is now "more complex than it ever has been," Spear says.

"Back in the old day of very simple systems, it was enough for the doctor to say what he – and it was typically a 'he' – wanted and then go from there," says Spear, whose most recent book is "The High Velocity Edge: How Market Leaders Leverage Operational Excellence to Beat the Competition" (McGraw-Hill, 2010). "Now we have to get all these pieces to mesh. It's critical to get the input of nurses and technicians. You have to get everyone involved."

New systems also must account for the shift from acute care to chronic care, Nunn says. Americans are living longer, but need more care in managing chronic conditions such as diabetes. "Chronic disease is the name of the game," she says.

Thus, she says, "The latest concept in terms of billing and healthcare is billing along the continuum." Healthcare providers would get a lump sum for managing a patient along this continuum of care as a patient moves from clinic to hospital to rehabilitation.

On the IT side, you must be looking at how you capture all that information through all those entities and levels of care," she says. "You must identify the patient throughout and capture all the information correctly."

To accomplish that goal, facilities must ensure that IT systems work among a range of departments. Different systems must "talk" to each other, and patient information must be updated rapidly.

Spear emphasizes that senior leadership should thoroughly understand the actual ways by which patients are currently diagnosed and treated, examining both formal and informal processes. He suggests three checkpoints by which facilities "capture, store and convey" information:

1. Address a key question. Ask: What's the targeted outcome?

2. Identify the needed work. Determine what work has to be done in what order, by whom and for whom. ("That critical question 'for whom, by whom' is not often asked," Spear adds.)

3. Determine content and format. That is, figure out how one person can record information so it can be successfully used by the next person in the process.

Addressing those steps will save time and money in the long run. "When you come up with a well-targeted problem, then the solution is typically much simpler," Spear says.


Many facilities are moving toward the use of electronic health records (EHRs), but such records represent only one aspect of how BPM can be applied to healthcare. On an institutional level, new IT systems can help hospitals more effectively plan staffing levels or provide forums for staff to share information or even determine weak points along the continuum of care.

For example, Nunn says, one facility used BPM to reduce the number of patient falls—a common problem among elderly people and those recovering from surgery. After analyzing data, the facility changed the layout of its beds so nurses could better keep an eye on patients when they got up at night to use the bathroom, which was when most falls were recorded.

In another case, Nunn worked with a hospital trying to pinpoint why many of its heart-surgery patients were getting infections. By examining the entire process of surgery from admittance to discharge, Nunn's team was able to determine that an autoclave, a machine for sterilizing instruments, was not working properly, even though its gauges indicated that it was reaching the proper temperatures. After the hospital replaced the machine, infection rates plummeted.

Nunn says collaboration tools such as intranets, online forums, chat programs and similar options can help providers voluntarily share ideas and best-practices and information over long distances and outside of normal business hours. ("It's like Facebook, but it's clinical," she says.) The approach not only generates innovation, but helps recognize staffers for their contributions—which can be a morale booster in an era of limited financial incentives. "People love to have their ideas acknowledged," Nunn says.

Even automation has a role. Spear serves on the board of directors for a company targeting the problem of re-admissions. New software allows a healthcare facility to create an interactive care program for newly discharged patients, which can be accessed via cable TV both at the facility and from patient homes. That process upgrades the traditional process, in which nurses educated about-to-be-discharged patients about their continuing care needs. "The problem there was that the nurse may not have all the information that’s needed. Or he or she may be a good nurse, but not be a good educator," Spear says. The new system allows the patients to repeatedly access the post-discharge information from their own TVs.

Such BPM innovations, both Nunn and Spear believe, will lead to major changes in how health services are delivered.

About the Author

Based in the Boston area, Stephanie Schorow is a freelance journalist and book author. Contact her [at] sschorow@comcast.net.

More by Stephanie Schorow, ebizQ Contributor



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