Adaptive Process Control

Wireless communication devices, context-aware applications, and adaptive workflow engines can help overcome problems identified by Operating Room of the Future experts. Health care processes require coordinating not only many concurrent administra

Fig. 8.1 Postoperative deep wound and organ space infection rates per 1,000 elective surgical cases [19]

tive processes, but also clinical events and the patient scenario within a health care enterprise that can span many departments and extended periods. In addition, health care workflows are notably dynamic because of regular upgrade of treatment protocols and unexpected changes in patient status or response to treatment [3].

It is important to note that workflow systems implemented in most industrial settings are inappropriate for health care. For example, ERP systems are increasingly adopting standards-based workflow engines to control process flow. These systems are typically designed to control "predictive processes". implying that the steps of the process are highly predictable in advance.

Health care workflows can be highly unpredictable due to organizational or medical complexity. What is most interesting and important is what goes wrong and how the quickly the system can adapt to unexpected events [10]. At UMMC, for example, a third of the surgeries are unanticipated and enter the process at unpredictable times during the day. These unexpected behaviors have unpredictable implications for the well-understood and planned activities. A highly adaptive system is needed to help control this "empirical process." In the chemical industry where process research is a core competency, applying a "predictive process" system to control an "empirical process" has caused many plant explosions [26]. In health care, this same mistake will also increase morbidity and mortality.

Complex adaptive system theory has been applied to analysis of information systems in health care and other industries [33]. All that follows should be interpreted with the understanding that a health care enterprise is viewed as a complex adaptive system [23, 39].

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