BUS303: Strategic Information Technology

The quality control tradition has had, and continues to have, an important impact on the development and implementation of BPM. As was outlined previously, the historical underpinnings of BPM find themselves routed in a long tradition going as far back as the 1970s with a focus on quality management and quality improvement. This relationship of efficiency and quality is of specific relevance to the health care field, which seems itself continuously pushed to maximize resource use and reduction in waste while maintaining quality of care and patient outcomes. This section therefore aims at highlighting the relevance of focusing on quality when discussing the application of BPM in health care delivery.

In the context of health care, the Institute of Medicine's six dimensions in defining quality of care require well-designed, integrated, monitored, and controlled processes and therefore should form the basis for the application of BPM in health care. These are efficiency (maximizing resource use while avoiding waste), accessibility (providing timely, geographically reasonable care), patient centeredness (taking into account the preferences of individual service users and the cultures of their communities), equity (delivering health care that does not vary in quality because of personal characteristics of the patient), safety (minimizing risk and harm to service users), and effectiveness (delivering health care that is adherent to an evidence base and results in improved health outcomes for individuals and communities, based on need).

The definition of quality of care brings forth the complexity of the concept and therefore of its evaluation. Holistic care, integrated care, patient pathways, clinical audit, patient logistic flow, patient empowerment, and teamwork are some of the popular keywords in health care literature related to the quality and they reflect wide perspectives and the complex dynamics of health care delivery. McGlynn identified six challenges which are encountered when addressing this complexity. These challenges center on the conflict between competing stakeholders with respect to health care delivery objectives and the need for adequate information systems to enable the collection and monitoring of indicators of quality of care.

These challenges focus on quality assessment, measurement, and inhibitors/enablers of improving performance.

All processes have a system perspective and therefore processes have to be understood as part of the whole. In a report published in 2006, the World Health Organization addresses quality from a health systems perspective. This is because even well-developed and well-resourced health systems suffer from wide variations in standards of health care delivery and that expected outcomes are not always achieved. Indeed, over the past few years, scandals in the delivery of basic health care have surfaced in health systems considered as world leaders. A public inquiry into the goings on of the Mid Staffordshire NHS Foundation Trust from 2005 to 2008 highlighted that even in a developed system such as the British NHS, serious failings led to a catastrophic reduction in performance. This in-depth inquiry highlighted a number of factors that led to a breakdown in the health system. It is clear that a negative culture is developed, which led to the system failing to react to all the information and warnings signs. This inevitably led to an acceptance of poor standards for all targets. Once processes and targets were no longer being managed, governance of the system faltered, professionals became disengaged, and patient standard of care diminished.

On the end of the spectrum, developing countries are faced with the challenge of optimizing the use of scarce resources, while still striving to supply universal population coverage. The root of the problems worldwide can be traced to the process of improvement and scaling up, which need to be based on sound local strategies for quality so that the best possible results are achieved for whatever investment.

The discussion on achieving optimal quality of care in any health system would be incomplete if the current challenges facing health care today are not understood and included in this paper. Additionally, against the background of emphasizing BPM as a means to put in place processes for performance improvement in health systems and organizations, it is pertinent to ask whether or not BPM helps in addressing some of these current challenges that are deemed to threaten the sustainability of health systems.