Revising the Business Process

The initial design of the Treatment Approval process has raised a number of questions and concerns, and some revisions are required. The functional changes that are to be applied are as follows:

• The business rule that performs the initial check whether a formal approval is required contains logic that refers to the estimated cost level of the treatment. Initially, any treatment in cost categories 1, 2, and 3 was automatically approved, while categories 4 and 5 required the formal approval of at least the financial department. This level is to be adapted: Category 3 is no longer automatically approved, but will also require the financial department to consent.

• It is concluded that although the financial department definitely has a say in whether a treatment can be performed, there is a need for a different type of evaluation as well. Medical treatment can be controversial for purely medical and ethical reasons, not necessarily directly connected with money issues. The business process should explicitly cater to this fact by introducing two new steps that can be performed in parallel with the financial validation. The first step is the peer review, where a fellow doctor needs to indicate whether the proposed treatment is the regular approach or whether it is something that is out of the ordinary that requires the stamp of approval from St. Matthews ethics committee, which is the (optional) second new step. This committee is composed of legal, medical, and public relational experts who together decide whether treatments deemed controversial in any way should be performed. Any decision by the committee needs to be carefully monitored and recorded.