Systematic design of healthcare processes.

In recent years, healthcare organizations have actively implemented modern approaches to the management of quality adapted from industrial practice.'-5 Most of these efforts to improve quality have focused on incremental improvement of existing processes, or on the measurement and control of quality relative to standards. Relatively less effort has been put into the fundamental redesign of the processes of health care. Juran6 points out that the design of a process sets the limit on what improvement and control is achievable. For example, consider a specialist referral process in a healthcare organisation that, by design, requires many paper forms that must be handled by several people. The inherent complexity that is designed into this process naturally limits achievable performance in time, accuracy, and coordination of care. The purpose of this paper is to show how the modern methods of process design, applied systematically, can further our existing efforts to manage and improve the quality ofprocesses in health care.