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The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

Clinical pathways (CPs) are multidisciplinary care plans with essential care steps for patients with specific clinical problems. CPs were introduced in China in 2009 to assure quality, reduce risks, increase resource efficiency and control costs. The purpose of this paper is to present a Chinese public hospital case study where a CP pilot was undertaken to evaluate two main outcomes: length of stay and hospitalization costs for a tertiary hospital from 2010 to 2012 using a mixed-methods approach.

Data were drawn from hospital records and in-depth interviews with hospital staff in a Shanxi Province tertiary hospital, northern China.

The authors found that the main objectives: to standardize treatment procedures by reducing length of stay and containing costs, were not fully achieved. Staff implementing CPs clearly encountered several barriers; i.e., managers did not see the pilot as a useful managerial instrument but were still driven by revenue generation. Physicians, too, lacked incentive to follow the guidelines due to income concerns.

The authors point to the daunting challenges brought about by perverse incentives embedded in the country’s health system. The authors argue that concerted efforts are needed to undertake difficult health policy reforms in China.

The authors present the first empirical study in the English-language literature that examines China’s ongoing CP pilots from a micro perspective. The authors combine qualitative and quantitative methods and reveal the hospital-level dynamics in its implementation.

The aim of the article is to propose BPMN extensions that facilitate the modeling of Clinical Pathways in a way that enables for various groups of users, the transfer of a much wider range of information in the form of process models without compromising their readability and usefulness.

The paper uses the design science research methodology (DSRM) and covers phases of a design-oriented research project extending BPMN notation for clinical pathway modeling.

The article proposes extensions of BPMN in 5 areas, enabling standardization of the description of business processes of different natures and complexity and in turn meeting the needs and requirements of modeling clinical pathways and, more broadly speaking, knowledge-intensive business processes (kiBPs) in general. As shown by the evaluation carried out among medical personnel, the proposed extensions allow for the readable transfer of a considerably larger body of information relevant to the planned, conducted and assessed therapy (kiBPs) than the current BPMN 2.0 standard.

The BPMN extensions proposed in the article fill the gaps in this notation and do not require users to know many notations, which in practice is unrealistic. Defined extensions to the BPMN specification makes it possible to standardise the description of processes of different natures and levels of complexity. In this way, both simplified models (and views of models) dedicated to users unfamiliar with BPMN and models (or views) using advanced possibilities provided by BPMN can be based on one standard, even if they use only a small part of its possibilities.

The article discusses how care programmes and integrated care pathways can be linked, finding ways to improve healthcare process professional and logistical quality from a supply chain and a network point‐of‐view.

The authors argue that owing to cost containment goals and increasing healthcare demand, healthcare services systems are challenged to improve service quality, whilst at the same time finding ways to improve delivery processes. It explores if the combination of two instruments, care programmes and integrated care pathways, can meet both goals. This combination is illustrated by an example from the Institute of Mental Health Care Eindhoven en de Kempen.

Analysis suggests that care programmes can be combined with integrated care pathways, leading to a situation where both quality and process improvement can be reached. These instruments are complementary.

The article is largely conceptual; ideas are presented to stimulate thinking rather than to prove an argument.

Combining care programmes and integrated care pathways has implications for the way we think about and organise healthcare processes.

There have been few publications on instruments combining both a network and a supply chain approach to describe and understand healthcare processes.

Process management approaches all pursue standardization, of which evidence-based medicine (EBM) is the most common form in healthcare. While EBM addresses improvement in clinical performance, it is unclear whether EBM also enhances operational performance. Conversely, operational process standardization (OPS) does not necessarily yield better clinical performance. The authors have therefore looked at the relationship between clinical practise standardization (CPS) and OPS and the way in which they jointly affect operational performance. The paper aims to discuss this issue.

The authors conducted a comparative case study analysis of a cataract surgery treatment at five Belgium hospital sites. Data collection involved 218 h of observations of 274 cataract surgeries. Both qualitative and quantitative methods were used.

Findings suggest that CPS does not automatically lead to improved resource or throughput efficiency. This can be explained by the low level of OPS across the five units, notwithstanding CPS. The results indicate that a wide range of variables on different levels (patient, physician and organization) affect OPS.

Considering one type of care treatment in which clinical outcome variations are small complicates translating the findings to unstructured and complex care treatments.

With the introduction of OPS as a complementary view of CPS, the study clearly shows the potential of OPS to support CPS in practice. Operations matters in healthcare standardization, but only when it is managed in a deliberate way on a hospital and policy level.

Health care has come to a turning point. Particularly due to aging societies and economic pressure placed on health care system, health is rapidly becoming one's own responsibility. This fundamental paradigm shift does not only affect the way health care services that will be provided in the near future but it also places enormous health information management demands on the laypeople. The purpose of this paper is to look into this emerging phenomenon, its current challenges and available solutions.

In order to identify different kinds of solutions used for personal health information management (PHIM) and related challenges, a bibliographical review is conducted using five online databases. The review focuses on articles that emphasize personal nature of the health information management. The bibliographical review is also extended to some of the articles cited in the original review. To support discoveries from the bibliographical review, the results are compared to free electronic personal health records of different types.

The paper identifies some of the most current challenges in the field of PHIM and provides an outline for overcoming them. Proposed guidelines include a concept of citizen pathways (CPs) that can be used for complementing the currently available solutions from a citizen‐centric perspective.

The paper points out near‐future development directions for the PHIM solutions in the form of identified and relevant challenges and characterized CPs. However, the forward‐looking conclusions are based on a bibliographical review and analysis of existing systems, and therefore their functionality and applicability are not tested in practice.

The findings of this paper can be used in shaping PHIM solutions of the near future. The described challenges can also be used to identify potential problems of the internet and new media on a larger scale in the context of health and medical informatics.

As part of a nationwide research about knowledge, attitude, experiences and educational needs towards complementary and alternative medicine (CAM) among Indonesian clinical psychologists (CPs), the purpose of this paper is to explore CPs’ perceptions of CAM research and their interest in learning CAM.

A link to an online survey was e-mailed to all 1,045 CPs across Indonesia. At the end of the survey, two open-ended questions were asked: “What do you think about CAM research in Indonesia?” and “Why are you interested in learning about CAM?”, which were responded to by 127 participants (87 per cent of females; M_age=36.67, SD=9.02). Participants’ responses were analysed using inductive qualitative content analysis.

It was found that two global themes for CPs’ perceptions of CAM were to improve participants’ professionalism and as part of continuing education and development for mental health professionals. The favourable responses in this study may reflect participants’ willingness to be involved in collaborative CAM research and education. Moreover, CAM was perceived as part of Indonesian culture and participants viewed CAM research and knowledge as a chance to promote Indonesian local wisdom to complement conventional psychotherapy.

These findings might call for stakeholders to integrate CAM knowledge into psychology education, facilitate CAM research in psychology settings and encourage collaborative CAM research. However, self-selection bias may limit the findings of this study.

This study explored perceptions of CAM research and interest in learning CAM that have rarely been investigated among mental health professionals and particularly, until now, have not been investigated in Indonesia.

The purpose of this paper is to highlight the provision of therapy for witnesses who have a learning disability prior to and following a criminal trial. Authors will reflect on clinical practice whilst stressing that this area of work is in its infancy and both continue to learn through continued reflection and each new experience.

The paper broadly describes the nature of pre-trial therapy followed by reflection by a Counsellor and Supervisor on their clinical practice.

Authors describe some of the common themes that arise whilst providing pre-trial therapy.

The authors hope that the paper will encourage professionals involved in Safeguarding cases to fully consider the emotional needs of victims and to seek timely therapeutic support where the need presents. They also hope that it will encourage practitioners from various professions to consider providing this specialist and delicate type of therapy whilst highlighting the need for good supervision.

There is a paucity of written information about this specific subject area. Although safeguarding of vulnerable adults has grown considerably over the last decade and investigations are now more likely to lead to legal action, the availability of emotional support for victims who have learning disabilities needs to be addressed.

Child welfare services (CWSs) globally continue to absorb high rates of children living with or suspected of fetal alcohol spectrum disorder (FASD). Such high prevalence rates render CWS with major ethical and moral dilemmas of meeting complex needs. Currently, many jurisdictions are challenged by diagnostic capacity and cost implications of formal FASD diagnosis. This paper aims to recommend a screening protocol to address management gap between FASD initial presentation and formal diagnosis.

This is a follow-up paper from a grounded-theory study of a sample (N = 18) of child welfare social workers (CWSWs), allied health professionals and foster parents. A stepwise protocol was developed through systematical interpretation of the final data.

The application of a five-step screening protocol would greatly support CWSW in meeting the needs of children with suspected FASD. This CWSWs-led assessment model incorporates a clinical evaluation to exclude neurodevelopmental conditions caused by known genetic disorders, followed by behavioral and neurocognitive psychosocial assessments.

This study had several limitations. Firstly, as a specific social work-based sample, it is not necessarily representative of the wider population of social workers globally due to different cultural responses to FASD in CWSs. The transferability of findings will have to be considered due to cultural variations concerning FASD.

By offering a management and nonlabeling approach, this five-step screening protocol offers a delineated pathway for CWSW and addresses the major professional frustrations while seeking to plan safe care for a child suspected of having FASD.

The research offers a pragmatic low-cost to society to alleviate the mounting social and monetary implications of FASD. A large percentage of children impacted by prenatal alcohol exposure do not qualify under formal clinical diagnostic guidelines. Leaving these children without intervention is problematic. The recommendation of this study addresses this critical gap in services. The primary aim is to alleviate the burden on this cohort of vulnerable children by offering nonlabeling neurodevelopmental screening.

The direct implications of FASD and how it impacts CWS are well documented. However, few studies focus on the critical interface of FASD and the role of CWSW responsible for planning their safe care. This paper offers a novel pragmatic and functional multistep protocol to aid CWSW in this complex area of practice.

Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of security level is minimal and few instruments are available. The DUNDRUM toolkit is a structured clinical judgement instrument that can be used to provide support when determining security level. The purpose of this paper is to investigate the applicability and validity of the DUNDRUM-1 in Flanders.

The DUNDRUM-1 was scored for 50 male patients admitted at the forensic units in the public psychiatric hospital Rekem. Some files were rated by three researchers who were blind to participants’ security status, resulting in 33 double measurements.

Almost all files (96 per cent) contained enough information to score the DUNDRUM-1. Average DUNDRUM-1 final judgement scores were concordant with a medium security profile. No difference was found between the current security levels and the DUNDRUM-1 final judgement scores. Inter-rater reliability was excellent for the DUNDRUM-1 final judgement scores. On item level, all items had excellent to good inter-rater reliability with the exception of one item institutional behaviour which had an average inter-rater reliability.

The DUNDRUM-1 can be a useful tool in Flemish forensic settings. It has good psychometric properties. More research is needed to investigate the relationship between DUNDRUM-1 scores and security level decisions by the courts.

This is the first study that investigated the applicability of the DUNDRUM-1 in a Belgian setting, also a relative large number of repeated measurements were available to investigate the inter-rater reliability of the DUNDRUM-1.