Computerisation of Clinical Pathways: Based on a Semiotically Inspired Methodology

1. Introduction

Large numbers of people continue to be successfully cared for and treated in the National Health Service, but a significant number of errors and other forms of harm occur. It is calculated that around 10% of patients admitted to NHS hospitals are subject to a patient safety incident and that up to half of these incidents could have been prevented (Chang, Schyve et al. 2005). Increasing costs of health care, fuelled by demand for high quality, cost-efficient health care has propelled hospitals to restructure their patient care delivery systems. One such systematic approach is the adaptation of an engineering project management methodology, the critical path method (CPM), as a tool to organise, standardise and improve the quality of healthcare delivery and hence patient outcomes (Yang, Liu et al. 2010). Clinical Guidelines (CG) are developed as a standard way to manage medical activities since the 1980’s and are structured multi-disciplinary care plans or medical processes in which diagnostic and therapeutic interventions performed for a particular diagnosis are described.

However, the application and adaptation of CGs in local hospital setting, inevitably has some limitations of process management in practice. Despite the benefits, there are many instances which show that CGs fail to offer a clear description of activities, conditions, sequence and authorities of action of a care process. Therefore current application of CGs cannot very well handle situation where decisions are made solely on human judgement and do not specify a facility for specifying how decision making (exceptions) can be handled. This issue is mostly related to healthcare settings where processes are complex, less structured and are made up of social agents such as physicians, departments with goals that they actively pursue in constant interaction with a network of other social agents (Mould, Bowers et al. 2010). Healthcare settings are dynamic networks of interrelated activities. As a result, current adaptation of CGs becomes a source of patient safety incident (Carthey 2010). Viewing errors as the result of poorly designed systems more so than incompetent or misguided individuals introduces variables that operationalize dynamics seen process management levels. Workflow management has been cited as potentially important in addressing medical errors and patient safety in many publications like the “To Err Is Human” and “Crossing the Quality Chasm” (Corrigan 2005). For example, “To Err Is Human” places at the core of a successful systems-based approach to reducing error the need for a strong patient-safety culture, simplified process design, development of clear work flow of activities and use of patient-centric modelling approaches in adaptation of CGs to local settings (Carthey 2010).