However, there is currently no evidence of improved health outcomes from implementing generic self-management support processes 160 162; though further trials of self-management support are currently underway.
The model focuses on a single core process with multiple related capability areas, which include management and support processes.
But based on a consistent process architecture that considers key processes as well as management and support processes, the strategy of excellent health service provision including quality, safety and transparency can be realised in daily operative work.
In line with previous research, we found that the nonconformities identified in external inspections addressed deficiencies in the management system, support processes, and clinical processes, but not clinical outcomes [ 11, 25– 27].
The ED and the Department of Internal Medicine initiated the project, and the hospital management supported the process.
Subsequently, we extend a service-based PLM architecture to support the holistic management model to continuously support processes.
We found that many of the observations addressed deficiencies in the management system and the support processes.
The core activity of health-care organizations is to deliver high-quality health-care services in accordance with the legal requirements, and the main purpose of the organization's management system and corresponding support processes is to ensure that the organization's clinical processes are in accordance with sound professional standards.
In line with Power [ 28] and Benson et al. [ 11], we suggest that observations that clearly demonstrate how deficiencies in the management system and its corresponding support processes affect the clinical processes are more likely to be understandable for clinicians.
Management support is an important ingredient in the planning process.
35 36 Crucial elements in this model are support of self management, support of informed consent, and organising the healthcare process.
