Olika modellering av vårdprocesser utifrån metaforiska perspektiv : – Skapar det nya drivkrafter för processutveckling?

Sammanfattning: The study was conducted in Jönköping County Chamber of fibrillation and is about change and improvement of process modeling technology. The process for treating patients with fibrillation is in the need to evolve and improve. In order to develop the care they needed a current state description which usually is made with the traditional process modeling tool. Many scientists and health professionals is in the opinion that this technology gives a too rigid image to describe the care processes. It also does not sufficiently take into account the human aspects. This reasoning suggests that the process modeling technology in healthcare is in the need to develop multiple perspectives. We have therefore studied Morgan’s organizational metaphors to find such perspectives. These have provided an input to the two approaches by which, if they are used for process modeling, could respond to the health care needs. The purpose of this paper is to examine the modeling of flows in health care, if based on Morgan's organizational metaphors, can describe and convey new approaches to the care process. By this we hope to develop a new technique to model health care processes, which in addition will contribute to make visible improvement in the organization. We have conducted a qualitative study where we from Gareth Morgan's organizational metaphors have created three models to be equal for each metaphor: Machine, Organism and the Brain. Based on a specific patient in the fibrillation process, we created different stories of the events. The stories visualized the characteristics important to describe in each model. We later on made a symbol corresponding list of these important components. The symbols were merged which then created the final model. To collect qualitative empirical data, we then tested the models in the organization that are in the process, Jönköping County Council. We held a workshop because we felt that this gave the best room for participants to have open discussions about how they perceive the models. They also pointed out the strengths and weaknesses. The participants consisted of various health care actors with mixed skills. One in every discipline; physicians, care developers, nurses and medical secretaries. The result was three models. One describes the process according to the machine metaphor, another to the organism metaphor and the third according to the brain metaphor. These were presented at the workshop and resulted in discussions and reflections which mirrored the intended metaphor. The discussions also led to that various problems and solutions related to the different metaphors became visible. All models have achieved its objective to produce the picture of organizational complexity in health care. We can therefore conclude that they also made a contribution, not only for those who work with the modeling tool, but also to those that will receive them. Least suited for modeling the process of care enforcement is the brain model. But it does fill a purpose as a tool for modeling the learning process in health care. This study demonstrates the importance of developing technology for process modeling in health care. The new approaches reflected on new problems and proposals for standardizations. Standardization is not only in need to focus on internal communication structure but also on the placement of functions and knowledge.