A multi-level approach for identifying process change in cancer pathways

An understudied challenge within process mining is the area of process change over time. This is a particular concern in healthcare, where patterns of care emerge and evolve in response to individual patient needs and through complex interactions between people, process, technology and changing organisational structure. We propose a structured approach to analyse process change over time suitable for the complex domain of healthcare. Our approach applies a qualitative process comparison at three levels of abstraction: a holistic perspective summarizing patient pathways (process model level), a middle level perspective based on activity sequences for individuals (trace level), and a fine-grained detail focus on activities (activity level). Our aim is to identify points in time where a process changed (detection), to localise and characterise the change (localisation and characterisation), and to understand process evolution (unravelling). We illustrate the approach using a case study of cancer pathways in Leeds Cancer Centre where we found evidence of agreement in process change identified at the process model and activity levels, but not at the trace level. In the experiment we show that this qualitative approach provides a useful understanding of process change over time. Examining change at the three levels provides confirmatory evidence of process change where perspectives agree, while contradictory evidence can lead to focused discussions with domain experts. The approach should be of interest to others dealing with processes that undergo complex change over time.