The customer in focus Patient roles in designing and improving care processes
Challenges in today’s healthcare are many. One of them is that a patient focus is missing in
design and improvement of care processes. Traditionally healthcare professionals have done
the improvements of care processes in a way they assumed were best based on their
experiences and professional knowledge. However, it is only the patient that has experiences
of the entire care process. Hence, this way of improving care can contribute to building
barriers between specialist functions, for instance between different outpatient clinics and
Since the late 1980s, principles, practices and tools for quality management have received
increased attention from healthcare organizations. Process orientation with a patient focus has
been spread as an example of a beneficial quality management practice. Patient experiences
are becoming important sources of information, and there are recent examples of
collaboration between patients and healthcare professionals in the actual improvement of care
The purpose of this thesis is to contribute to the knowledge base concerning design of good
care. More specifically, it aims to explore patient’s roles in care processes, and the ways in
which a patient focus can contribute to the design and improvement of care processes.
The thesis is based on three improvement projects in care processes. The three improvement
projects are described in three appended papers. Paper I is about design of a medication
process with a Design for Six Sigma (DFSS) approach. Paper II studies an application of the
Kano model aimed to support development of an understanding of patients as customers in
various roles in children’s and women’s healthcare. Finally, Paper III is based on a project in
a neonatal process, using experience-based co-design – EBCD. The thesis is based on an
action research approach at Skaraborg hospital, Sweden.
One common notion in the appended papers is that there is a need for customer orientation in
healthcare related to care processes, instead of focus on different functions. Moreover, in care
processes the patient is a customer pursuing various roles. When improving care processes,
experiences of both patients and healthcare professionals is needed. However, in each case
considerations has to be made about the importance of involving patients in improvement
work. The result of the studies also highlights various roles that patients can have in
improvement of care processes, including the role for the patient as co-designer of
improvements. Still, the co-designer role asks for a new way of viewing patients in healthcare.
A view based on more equal power between patients and healthcare professionals. Thus could
be viewed as a paradigm shift in healthcare.
Keywords: quality management, customer focus, care processes, patient roles, healthcare