A growing number of rehabilitation centers in Europe structure their patient rehabilitation program along “critical pathways” (also known as “patient pathways” or “clinical pathways”) and use process management techniques to improve the quality and outcome of rehabilitation efforts in the most efficient way possible. Business processes are defined as a sequence of activities necessary to complete an operational task, such as the rehabilitation of patients with a certain diagnosis and specific participation goals. Therefore, the treatment program of a patient with SCI would be different from the one for a patient with an orthopedic problem. This means that a program is organized according to its key processes (e.g., rehabilitation of SCI patients) and not primarily based on its functional structure (e.g., OT department, PT department). Overall a process organization can be understood as the permanent structuring and continuous optimization of processes. Patient pathways (or clinical pathways) describe the key business processes or the workflow of a rehabilitation clinic.

By developing the concept “Rehabilitation at the SPZ” in 2012, the SPZ initiated a process-based organizational structure. The concept refers to a fundamental reorganization in which employees are brought together in ways that enable them to fully focus on the patient and thereby improve the effectiveness and efficiency of the rehabilitation process. Studies show that structured patient management with coordinated processes improves goal attainment and patient satisfaction, reduces the length of patients’ stay at the hospital, and prevents organizational bottlenecks as well as resource underutilization [14].

The implementation of patient-centered treatment procedures holds great promise for achieving significant improvements in patient outcomes [23]. Patient pathways have proved a useful concept for the management of various health conditions [24]. However, a uniform definition for clinical pathways or patient pathways is not yet available. Definitions vary depending on the main focus of a particular rehabilitation context [25]. For the purpose of this chapter, we refer to Roeder and Küttner who understand patient pathways as a multidisciplinary plan that defines the treatment stages between admission to and discharge from a rehabilitation clinic [24].

The patient pathways at the SPZ (see Fig. 17.1) rely on a comprehensive and integrative ICF-based rehabilitation concept that includes the criteria of effectiveness, sustainability, practicability, and economic efficiency. The pathways encompass the entire range of inpatient and outpatient services and define the processes from admission to discharge. The regulation of interdisciplinary measures and processes is essential to ensure an optimal treatment process with an efficient allocation of resources. The pathways are incorporated into a process management system with indicators and defined responsibilities and are structured into key processes, processes (i.e., paths), subprocesses, and sub-subprocesses. Each process includes process goals, definitions of possible key goals, inputs, outputs, and performance metrics. This structure provides the basis for a transparent quality management system. Patient pathways represent key elements for control and documentation in a clinical information system and allow for structured and patient-centered transdisciplinary communication. Moreover, they facilitate standardized rehabilitation services and serve as a basis for quality improvement and financial control with a process cost analysis.

Figure 17.1 illustrates the five patient pathways at the SPZ and their three “subprocesses”:

These subprocesses are further divided into “sub-subprocesses” such as “housing assessment”, “ergonomic counseling”, or “vocational measures”. For each sub-subprocess, a specific “patient management cockpit” is available defining the different stages of the goal attainment process, appropriate assessments and interventions for the different stages, and the disciplines in charge.

Interdisciplinary communication plays a key role in the rehabilitation process at the SPZ. In this regard the current coexistence of various information technology (IT) application systems, which work perfectly for their original particular purpose, represents a big challenge for the members of the rehabilitation team. Currently, team members have to seek essential information in unconnected IT application systems, which is extremely time consuming. In addition, these unconnected systems reduce the team’s ability to share interdisciplinary knowledge of specific interventions, and a common thread is not always apparent. Documenting specific treatment measures and their progress is important for an interdisciplinary team approach, as it facilitates the structuring of work processes and the clarification of interfaces between the various professional disciplines involved in the rehabilitation process.

The patient management cockpit provides the basis for an overarching clinic information system and visualizes the workflow in all medical, nursing, and therapeutic measures. It consists of a basic module which works up and digitally illustrates the structure of the work processes in a set of rules. The tool fulfills the function of a parent layer with access to all applications. It serves as a navigation tool as well as a working tool in clinical practice. Furthermore, the tool provides users with immediate access to all information defined in the workflow and allows for bidirectional documentation of treatment results.

A survey of the different disciplines involved in the rehabilitation process at the SPZ showed that the team members expect the patient management cockpit to provide information on the current status of the patients in their own as well as in other disciplines. This information includes current findings (e.g., consultation reports), medical prescriptions (e.g., pre- or postoperative), courses of treatment (e.g., general or discipline specific), and patient status (e.g., treatment status or insurance status). In addition, the respective intermediate goals and their status should be made available.

In this section, we briefly describe the nature of the patient management cockpits as they are being applied in the SPZ, using the treatment process “vocational measures” as a specific example. Figure 17.2 presents a flowchart that provides a detailed overview of the treatment process “vocational measures” as it currently takes place at the IBF of the SPZ. The horizontal axis represents the time course, whereas the vertical axis illustrates the different actors involved in the VR process. The process starts with the decision by the medical doctors and the persons involved in the interdisciplinary ICF meetings that vocational measures are needed.