Managing Complex Patient Journeys: A Healthcare Operations Management Perspective

The single most important challenge of modern healthcare operations management is that of the complex patient journey. Modern healthcare systems observe an increasing trend of healthcare use and costs being accumulated from a small group of multimorbid, long-term – complex patients, whose patient journeys are riddled with discontinuities, disruptions, and a maze of service providers who do not communicate with each other. With the development of new technologies, it is possible to treat more conditions with better outcomes, with a subsequent higher price tag. Despite ongoing efforts to address this issue, it remains a persistent and pressing problem that many healthcare systems are unable to keep up with. Framing this challenge through the lens of healthcare operations management raises the question, "How can we deliver personalized healthcare services with the efficiency of mass production?" Theories in healthcare operations management suggest that addressing complex patient journeys involves segmenting demand, standardizing modular service components, reducing or streamlining non-value-adding activities such as handovers and setups, and maximizing the use of repeatable processes. It also calls for delegating decision-making and judgment to the lowest hierarchical level where the necessary information and expertise are available. However, there are still many unanswered questions in the current literature, such as how to understand variation and its causes in the high-variability context of complex patients, how existing tools like patient pathways can be used to reduce variation while allowing flexibility where appropriate, and how these tools can promote value co-creation and bring decision-making and judgment closer to the patient. This thesis employed a mixed methods approach within the Finnish healthcare system to address patient journey disruptions. Causes of discontinuities were explored through focus groups with private-sector healthcare professionals and a survey of abdominal patients. Conceptual analysis, supported by expert input and interviews with healthcare professionals and home care patients, led to the development of a generalizable patient journey disruption framework. Guidelines for patient pathway use were derived from an exploratory survey of public-sector healthcare professionals, while the impact of a digital care pathway on value co-creation for people with multiplesclerosis was assessed via statistical analysis of electronic health records. The results of this thesis highlight various ways to structure management problems in healthcare. Key findings include insights into healthcare professionals' experiences with patient pathway use, guidelines for optimizing these pathways, and evidence that digital care pathways can enhance co-creation for people with multiple sclerosis. The primary theoretical contribution is the conceptualization of patient journey disruption as an agency-based event linked to negative outcomes in care pathways relative to reasonable expectations. This concept emphasizes identifying, analyzing, and addressing PJDs to optimize complex patient journeys.