The purpose of this paper is to present a process architecture pattern for designing particular components of a complex service. The proposal emphasizes the design of the service production flow component, following modularity ideas, which determines the sequence of actions needed to generate a high quality and efficient service. The authors report its applications to the design of the flow in a single emergency department (ED) case.,In complex services, production design is usually lacking because production activities are not clearly defined and, in many cases, they are dynamically determined as the service is produced according a client’s particular needs. In health services, for example ED, this generates a chaotic production flow that uses resources very inefficiently. The methodology uses a reference architecture, integrating it with disciplines – modularity, analytics and evaluation methods – that provide ideas for formally designing these complex services. This is mainly justified by the fact that, in many such services, no formal design exits and their production processes are the result of practice evolution.,Methodology was applied to the ED of a large public hospital. The authors first analyzed ED’s production and performance data. The authors found two patients’ groups that used more than 90 percent of resources. Therefore, design focused on these groups, defining specialized production lines for them and with physical space remodeled by an architecture project, resulting in well-defined separated workflows for each production line. Design also includes coordination with complementary shared services, including specialists consultations’ requests and execution, and request, processing and reception of laboratory and radiology examinations. The authors implemented new workflows producing a decrease of 26 percent in patients’ delays. More detailed results based on three months of observations also showed, for example, a reduction in examinations waiting times of 80 percent and an increase in the consultation resolution for cardiological patients from 24 to 80 percent in the same day, which means a significant quality increment.,Thus, the authors conclude the plausibility of the idea they proposed that an important design problem in health services, in terms of potential improvements in capacity utilization, is production design. This provides the opportunity to reduce investing large amounts of resources in new hospitals and to instead use the alternative to generate large amounts of capacity by production performance improvements.,The authors are replicating the approach in other hospitals with extensions to inpatient and ambulatory services.,Approach produces better service in public hospitals, which is a problem in emergencies in the world.,Formal design approach in health production services is proposed that provides great value by generating capacity, due to better use of resources, that reduces investment needs in new facilities.

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流程架构模式及其在医疗服务设计中的应用：紧急情况

本文的目的是提出一种用于设计复杂服务的特定组件的流程体系结构模式。该提案强调了服务生产流程组件的设计，遵循模块化思想，该思想确定了生成高质量和高效服务所需的操作顺序。作者报告了其在单个紧急部门（ED）案例中的流程设计中的应用。在复杂的服务中，通常缺少生产设计，因为生产活动没有明确定义，并且在许多情况下，它们是动态确定的。服务是根据客户的特定需求生产的。在医疗服务（例如ED）中，这会产生混乱的生产流程，从而非常低效地利用资源。该方法使用参考架构，将其与模块化，分析和评估方法等学科进行集成，从而为正式设计这些复杂服务提供思路。这主要是因为在许多此类服务中，没有正式的设计出口，其生产过程是实践演变的结果，这是有道理的。方法论已应用于大型公立医院的急诊室。作者首先分析了ED的生产和性能数据。作者发现两个患者小组使用了90％以上的资源。因此，设计专注于这些小组，为他们定义专门的生产线，并通过建筑项目对物理空间进行建模，从而为每个生产线定义明确的分离工作流程。设计还包括与补充共享服务的协调，包括专家咨询的请求和执行，以及实验室和放射学检查的请求，处理和接收。作者实施了新的工作流程，使患者的延误减少了26％。根据三个月的观察得出的更详细的结果还显示，例如，同一天心脏病患者的检查等待时间减少了80％，心脏病的咨询分辨率从24％增加到了80％，这意味着质量显着提高因此，作者得出结论认为，他们提出的想法是，就生产能力设计而言，就卫生服务的潜在设计问题而言，就产能利用率的潜在提高而言，这是一个重要的问题。