Abstract
Public hospitals currently face an ever increasing demand on their resources, and there are many attempts at streamlining processes and patient flows. However, in many cases, optimizing processes is not enough, as ‘soft’ factors such as the relationships between hospital wards influence how efficiently the resources needed to treat patients are utilized. These factors are often ignored when attempting to improve patient flows. In this chapter, the authors describe a case study investigating the relationships between an acute stroke ward and a specialist stroke rehabilitation ward of a large metropolitan health service. The motivation for this study was the hospital management’s interest in improving communication and collaboration across wards as a means to optimize hospital processes, and thus, patient care. To assess the relationships between the two wards, the authors examined the patient handover process that links the wards’ activities and applied the Trust-Confidence-Distrust (TCD) framework of Gans et al. (2003), which was developed to model trust relationships in social networks, to examine the trust relationships between the wards.
TopBackground
In health informatics, clinical, organizational processes are mainly investigated in regard to how they can be supported or improved by information technology. Even though this is not the focus of our contribution, such analyses presuppose means to describe and model these processes. Due to the focus on information systems, typical process modelling notations such as event-driven process chains (Scheer, 1994), Petri net based workflow notations (van der Aalst and van Hee, 1996), or languages like the business process modelling notation BPMN (www.bpmn.org) are commonly used. In (Framinan et al., 2005) some have been investigated in the context of business process reengineering of clinical processes. They allow capturing the timely relation of activities and the assignment of resources and responsibilities of involved actors. Also Saboor et al. (2007) propose a method, named MedFlow, to support the systematic assessment of clinical processes focusing on the quality of information logistics. They derived relevant quality criteria from literature, developed an extended process modelling notation based on UML activity diagrams, and evaluated the method in a preliminary case study. Their analysis distinguishes four different process aspects, i.e. control flow, data flow, tool usage, and organizational information. For each of them, a rule-set that represents a “pattern of critical cross-points” was used, to detect weak points within these views. A shortcoming of these modelling means is that the human side of the process, the social interaction of the people that carry out these processes and for example, trust issues that are involved, are neglected. When trust is investigated in the context of health informatics, mostly three fields are considered: how to build up trust in online communities or health information on the web (Luo and Najdawi, 2004; Song and Zahedi, 2007), trust issues in the context of electronic health records (Smit et al., 2005), or regarding the physician-patient relationship.
Key Terms in this Chapter
Cooperation: Cooperation denotes the relationships between two or more organizations or parts thereof, which aim at fulfilling some shared goal, are based on written or oral (legal) agreements, and keep the partners legally independent. (Kethers, 2000)
Social Network: An autonomous form of coordination of interactions whose essence is the trusting cooperation of autonomous, but interdependent agents who cooperate for a limited time, considering their partners’ interests, because they can thus fulfil their individual goals better than through non-coordinated activities. (Weyer, 2000)
Process: A process is a set of identifiable, repeatable actions which contribute to the fulfilment of the objective (or goal) for which the process was designed. Actions are in some way ordered, performed by actors, and possibly subject to limitations or constraints. Actions can be activities (tasks), or be related to information flows or communication. (Kethers, 2000)
Process: A process is a set of identifiable, repeatable actions which contribute to the fulfilment of the objective (or goal) for which the process was designed. Actions are in some way ordered, performed by actors, and possibly subject to limitations or constraints. Actions can be activities (tasks), or be related to information flows or communication. (Kethers, 2000)
Social Network: An autonomous form of coordination of interactions whose essence is the trusting cooperation of autonomous, but interdependent agents who cooperate for a limited time, considering their partners’ interests, because they can thus fulfil their individual goals better than through non-coordinated activities. (Weyer, 2000)
Strategic Rationale model: “The Strategic Rationale (SR) model provides an intentional description of processes in terms of process elements and the rationales behind them. […] [It] describes the intentional relationships that are “internal” to actors, such as means-ends relationships that relate process elements, providing explicit representations of “why” and “how” and alternatives.” (Yu, 1995)
Strategic Rationale model: “The Strategic Rationale (SR) model provides an intentional description of processes in terms of process elements and the rationales behind them. […] [It] describes the intentional relationships that are “internal” to actors, such as means-ends relationships that relate process elements, providing explicit representations of “why” and “how” and alternatives.” (Yu, 1995)
Trust: “The willingness of a party to be vulnerable to the actions of another party based on the expectation that the other will perform a particular action important to the trustor, irrespective of the ability to monitor or control that other party.” (Mayer and van der Hoek, 1995)
Distrust: “The expectation of opportunistic behaviour from partners” (Gans et al., 2003)
Confidence (also system trust): Trust in the network/organization as a whole that is due to the mesh of dependencies neither completely visible nor manageable by the trustor. (Luhmann, 1988)
Strategic Dependency model: “The Strategic Dependency (SD) model provides an intentional description of a process in terms of a network of dependency relationships among actors. […] [It] consists of a set of nodes and links. Each node represents an “actor”, and each link between two actors indicates that one actor depends on the other for something in order that the former may attain some goal.” (Yu, 1995)
Distrust: “The expectation of opportunistic behaviour from partners” (Gans et al., 2003)
Strategic Dependency model: “The Strategic Dependency (SD) model provides an intentional description of a process in terms of a network of dependency relationships among actors. […] [It] consists of a set of nodes and links. Each node represents an “actor”, and each link between two actors indicates that one actor depends on the other for something in order that the former may attain some goal.” (Yu, 1995)
Cooperation: Cooperation denotes the relationships between two or more organizations or parts thereof, which aim at fulfilling some shared goal, are based on written or oral (legal) agreements, and keep the partners legally independent. (Kethers, 2000)
Confidence (also system trust): Trust in the network/organization as a whole that is due to the mesh of dependencies neither completely visible nor manageable by the trustor. (Luhmann, 1988)
Trust: “The willingness of a party to be vulnerable to the actions of another party based on the expectation that the other will perform a particular action important to the trustor, irrespective of the ability to monitor or control that other party.” (Mayer and van der Hoek, 1995)