Public defence in Industrial Engineering and Management, M.Sc. (Tech) Märt Vesinurm

Title of the thesis: Managing Complex Patient Journeys: A Healthcare Operations Management Perspective

Doctoral student: Märt Vesinurm
Opponent: Professor Axel Kaehne, Edge Hill University, United Kingdom
Custos: Prof. Emeritus Paul Lillrank, Aalto University School of Science, Department of Industrial Engineering and Management

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. Despite ongoing efforts to address this issue, it remains a persistent and pressing problem that many healthcare systems are unable to keep up with. 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, 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. 

This thesis employed a mixed methods approach within the Finnish healthcare system. 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 multiple sclerosis 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.

Key words: health care operations, health systems engineering, integrated care, health systems science, care pathway, patient journey analysis, resource management, value co-creation

Thesis available for public display 10 days prior to the defence at: https://aaltodoc.aalto.fi/doc_public/eonly/riiputus/ 

Contact information:

Doctoral theses of the School of Science: https://aaltodoc.aalto.fi/handle/123456789/52