The processes

1. The processes Clinical process refinement object: patient condition including health issues as peceived by healthcare professionals Decision process refinement object: mandate based on demand for care and healthcare commitment, planning, decisions Communication process refinement object: information on resources, documents, messages

2. receive demand for care Demand for care Management process decide on assessment decision not to assess demand for care Communication process demand for care received demand for care refer referred demand

3. receive demand for care Demand for care Clinical process – health condition assess condition perceived condition Management process – mandate decision to assess demand for care decision on assessment Communication process – information demand for care received demand for care

4. Healthcare mandate Clinical process – health condition condition not possible to handle match against service repository Management process – mandate decide on care mandate no mandate Communication process – information refer referred demand

5. Healthcare mandate healthcare commitment Clinical process – health condition condition possible to handle identify health issues match against service repository Management process – mandate decide on care mandate healthcare mandate no mandate Communication process – information

6. Health issue thread, hc objective Clinical process – health condition supplemented perceived condition condition asses- sed regarding need for care assess need for care get supplementary information health issues Management process – mandate health issue complex delineate health issue complex to be handled assess priority, define healthcare objective healthcare objective Communication process – information match objective against available activities

7. Program of care Clinical process – health condition conditions in care plans pick activities Management process – mandate establish programme of care planning decision decide care planning programme of care decide usage of planned activities Communication process – information resource- provided activity list book resources activity list

8. Activities Clinical process – health condition perform investigation assess condition investigated condition assessed condition Management process – mandate redefine health- care objective decision to perform healthcare objective Communication process – information match objective against available services

9. Activities Clinical process – health condition perform treatment treated condition Management process – mandate programme of care decision to perform revise prog- ramme of care decide usage of planned activities Communication process – information resource- provided activity list book resources, record program of care activity list

10. Quality check Clinical process – health condition match condition against objective evaluate result remaining need for care assessed condition Management process – mandate quality result check quality redefine health- care objective Communication process – information

11. End of process Clinical process – health condition assess healthcare objective as fulfilled perceived condition decide discharge message healthcare objective discharge decision Management process – mandate Communication process – information issue discharge message discharge message

12. Healthcare mandate renewed healthcare commitment Clinical process – health condition review health problems, identify additional health problems healthcare objective assessed as not fulfilled perceived condition renew health- care mandate healthcare objective healthcare mandate no mandate Management process – mandate Communication process – information

13. Health issue thread, hc objective Clinical process – health condition get supplementary information health issues refined health issue collection Management process – mandate delineate health issue thread to be treated, define healthcare objective healthcare objective Communication process – information match objective against available services

14. Referral to other healthcare provider assess health is- sues to be referred health issues in referral Clinical process – health condition decision on health issue complex in referral decide referral referral decision delineate health issue complex in referral Management process – mandate Communication process – information issue referral = demand for care no service available demand for care

15. receive demand for care Other healthcare provider’s start Clinical process – health condition Management process – mandate demand for care to be assessed decision on assessment d_f_c not to be assessed Communication process – information demand for care received demand for care