How to implement process-oriented care: A case study on the implementation of process-oriented in-hospital stroke care

Dutch hospitals are in the midst of a transition towards process-oriented organisation to realise optimal and undisturbed care processes. Between 2004 and 2007, the University Hospital of Maastricht conducted a case study implementing process-oriented in-hospital stroke unit care. The case study consisted of four steps: (1) process analysis; (2) identification of bottlenecks; (3) setting goals for process-oriented care, and selection of coordination measures; and (4) implementation and evaluation. Implementation of process-orientation via the coordination measures chosen streamlined the process and led to a better performance of in-hospital stroke unit care; the length of stay was reduced from 12 to 7 days, and the percentage of patients who could not be admitted to the stroke unit was reduced from 31% to 2%. The implementation of coordination measures is a useful means of controlling the activities of the stroke care process from a process point of view. The coordination measures used will not automatically be applicable to other care processes because of the specific nature of each care process. Nevertheless, the general principles of visual representation, bottleneck reduction, and elimination of waste and uncertainty would be applicable in many settings.