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Process Modeling and public Value: Performance Measurement for Emergency Assistance Services?

Conférence Annuelle EGPA 2012. Process Modeling and public Value: Performance Measurement for Emergency Assistance Services?. Claude ROCHET, Bruno TIBERGHIEN, Anaïs SAINT, Aix-Marseille Université, CERGAM, IMPGT Philippe AGOPIAN, Catherine PARIS-LAPORTE, Valery SOULLEIHET, SDIS 13.

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Process Modeling and public Value: Performance Measurement for Emergency Assistance Services?

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  1. Conférence Annuelle EGPA 2012 Process Modeling and public Value: Performance Measurement for Emergency Assistance Services? Claude ROCHET, Bruno TIBERGHIEN, Anaïs SAINT, Aix-Marseille Université, CERGAM, IMPGT Philippe AGOPIAN, Catherine PARIS-LAPORTE, Valery SOULLEIHET, SDIS 13

  2. Introduction • The framework: Streamlining and monitoring the processes using BPMN approach, applied to an emergency service • The case: : optimizing the cerebrovascular accident (CVA) channel services’ coordination in the Bouches du Rhône • The actors: the Fire department (SDIS) and the medical emergency service (SAMU) coordinate their processes with hospitals

  3. Introduction • Three operational steps : • We first have to produce the global modelling of the channel (processes, sub processes and procedures) according to the BPMN rules. • Then we will choose and drag out the relevant indicators • These indicators will permit us to build up the balanced scorecard

  4. Introduction • Then three vision levels of the process : • COST: • What is the cost of this rescue channel compared to a classical one? • MANAGEMENT: • What are the impacts of this process on the Fire department budget? What kind of organizational change is required? How to join up public services that have been split in silos? • IMPACT & EXTERNALITIES: • What are the costs saved for the health care system? What are the quality of life of the relieved patient? How to evaluate the pertinence of such an approach?

  5. Introduction • WHY A PROCESS MODELING? • To save people of paralysis for life (20% of CVA are eligible to a thrombolysis) • To highlight the benefits of the channel for society (costs/benefits) • To understand the role of the information system in organizational innovation in this public service

  6. Explanations: Whatis a stroke? • Averageageis 73 • Third cause of adultdeath • Around150.000 strokes per year in France • Weexpectthisnumber to raisebecause of the ageing of the population • Alsocalled stroke, a cerebrovascular accident (CVA) is a disturbance in the bloodsupply to the brain. Withouttreatment, the patient willsuffer non-reversiblediseases as severeparalysis. -> It is a public health issue

  7. The Thrombolysis • The lack of an appropriate treatment has for years made room for a « contemplative and wait-and-see attitude » (Canault et al., 2005) • Nowadays, we have discovered a treatment: a thrombolysis can dissolve a blood clot (detected by MRI) in the brain if it is applied in the four hours following the first symptoms: • Paralysis on one side of the body, aphasia, legs which steal/fall, paralysis on one side of the face, headaches.

  8. The CVA Channel • Because of thisparticular and frequentpathology, health care system actorsneed to coordinate in a waythatanyone on the territorycanreach a thrombolysis within four hours if necessary. • Eachuniversitaryhospital center issupposed to have a stroke center. In the Bouches du Rhône, itislocated in Marseille (la Timone)… • In this stroke center, an MRI and a neurologistwillalwaysbeavailable to practice a thrombolysis

  9. The CVA Channel • … But severalactors: SAMU, the firemen and their first responders, the hospital and the stroke center. • So thereis a need to coordinate all the actorsand monitor the wholechannel in real time: that’swhyweneed the processmodeling and the BSC!

  10. Creation, organization and inventory of Stroke Channels in France • According to the French Neurovascular Society (2001): • the organization of stroke unitsavoids1 death or disability for 20 patients treated(120 deaths or disabilitiesavoided per year). • The benefits due to suchunitsis not based on the action of a drug, but on the effectiveness of an interactive multidisciplinary team. • The economic aspect of stroke management canbemeasuredthrough the averagelength of hospital : • The specializedunitsenable a reduction in length of stay of almost 8% (0,3 days) (Hommelet al., 1999). • A Cochrane meta-analysisrevealedthat for every 100 patients treated in a stroke unit, thereis a reduction of 26 days(Bowen & Yaste, 1994).

  11. Creation, organization and inventory of Stroke Channels in France • But the expectedeconomic impact of the development of stroke unitsisinsufficientlystudied in the literature. • The public health challenge is to implement a rational therapeutic strategy as early as possible coordinating the different actors of the chain. If there is an added cost, it appears justified by the clinical benefits observed (Launoiset al., 2002). • Despite a significant increase in the implementation of stroke units in France, we observe a lag between the recommendations adopted by the government and the reality.

  12. Role of the Information SYStem and BPM Approach • The prime functions of an information system: • Toprovide a unique standard of data for all the actors involved in the channel (Rochetet al., 2011): that way every process could be standardized and useable by every actor • To inform people with reliable data (required for our BSC). (Elidrissi & Elidrissi, 2010) • The Business Process Modeling(BPM) approach: represents the processes of an organization to be able to analyze the global system, which allows us to work on different levels of granularity (Rochet, 2010).

  13. Role of the Information SYStem and BPM Approach • Whatis a process? With WHAT? • Material • Information system With WHO? What abilities are required ?required? Availability What do I need? Costs, quality, deadline New orders Process What have I got to supply with? Costs, quality, deadline • New orders Requirements Requirements How much? Efficiency measurement Optimization of the means’ use Operating delay Material availability… How? Procedures and control plans Information systems Purchases Recruitment, training Insurance…

  14. Role of the Information SYStem and BPM Approach • So a business process is a set of activities assembled to produce specific outputs for specific customers. • Humans start to draw the processes without using any hardware… • … and then we use technology in order to get digitalized processes which will reflect what the humans initially drew.

  15. A Word about Methodology • Drawing a status report: a preliminarysearchthrough the literature • Information system in public organization, BPM approach and performance measurementthroughout BSC in the public sector. • An important phase of observation and an abductive work: • Back and forthsbetweentheory and fieldwork… (Avenier & Gavard-Perret, 2007) • … to producesensethanks to comparisons (Charreire Petit & Durieux, 2007)

  16. A Word about Methodology • A research-action approach: • Immersion of the researcher who will directly work on the problem’s resolution (Allard-Poesi & Maréchal, 2007)… • … but non-separability of the researcher and the object of study (Giordano & Jolibert, 2008)… • … and, therefore, an amplification of the bias effect due to behaviour of the actors in relation to the problem (Journé, 2008).

  17. Modeling the pre-hospital Phase

  18. This lag is critical and may be reduced only by the patient and his “natural helpers” thanks to basic and generalized education to recognize the symptoms and to have the appropriate reflexes

  19. FromProcessModeling to a roadmap for CVA Channels • This method has made it possible to obtaindifferentindicators to beginwith an evaluation of the channelsbenefits:

  20. FromProcessModeling to a roadmap for CVA Channels • Because of our conviction of the reproducibility of this channel, we can conclude with a roadmap to build up and conduct such an undertaking: • The crucial point in the functioning of this channel was the coordination needed between the different actors: it led to an organizational change. • The information quality and the training also played an important role. • It will be necessary to inform the institutions to obtain the support of higher organizations, and to inform the public by awareness campaigns. • At the edge, technical aspects may have their importance.

  21. How could a bsc help monitoring the process? Benefits of extra stroke centers costs Short term output Lon term outcome hospital phase Prehospital phase Calling the rescue The number of stokes is a constant in an homogeneous set of population. If the number fails, it means that patients have escape the process Deciding an education campaign Socio economic impact

  22. CONclusion • Weproposed an overview of a real stroke channel. • A BSC isrequired to pursuethiswork. • The channelisreproducible… • Without modifications, in anyhospital for strokes • With modifications, to beapplied to other pathologies as heartattack.

  23. Thankyou for your attention.

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