title: [Modeling a clinical process for differentiated thyroid cancer health care in Hospital Base Valdivia, Chile].
abstract: OBJECTIVE
  To design a clinical process model in the management of differentiated thyroid cancer in order to improve accessibility to this treatment.
  
  
  METHODS
  Based on modified Participatory Action Research, a model design process was conducted using a literature review and meetings with organisations committed to the redesigning process, and to agree an improved and feasible process.
  
  
  RESULTS
  The process map was constructed by participatory action including, characterisation of the value chain, fault detection in the flow of the process, relevant documents and process for proposing modifications and approvals necessary for this purpose. Links were established between the main process and the support and strategic processes. The participatory model helped to cut the waiting times for diagnosis and treatment of this disease from 12 to 4 months.
  
  
  CONCLUSIONS
  For each unit to be able to fully visualise the map of the process and understand their contribution as a set of integrated contributions and not fragmented, helps in the comprehensive management of patients and operation processes based on the hierarchical and dominant organisational model in Chilean hospitals. To analyse and remodel clinical processes by participatory action helps to limit failures in the fluidity of care of the patients, by presenting each participating unit with a general view of the process, the problems, and the possible solutions. Furthermore, this approach helps to clarify the process in order to make it more efficient, to harmonise relationships, and to improve coordination in order to optimise patient care.
authors.affiliation: Subdepartamento de Medicina Nuclear, Hospital Base Valdivia, Chile. Electronic address: carolina.avila@redsalud.gov.cl.
authors.forename: C
authors.initials: C
authors.lastname: Ávila-Schwerter
authors.affiliation: Instituto de Salud Pública, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.
authors.forename: M C
authors.initials: MC
authors.lastname: Torres-Andrade
authors.affiliation: Instituto de Salud Pública, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.
authors.forename: C A
authors.initials: CA
authors.lastname: Méndez
authors.affiliation: Instituto de Salud Sexual y Reproductiva, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.
authors.forename: M
authors.initials: M
authors.lastname: Márquez-Manzano
mesh_terms: D002677:Chile; D003663:Decision Trees; D003695:Delivery of Health Care; D006302:Health Services Research; D006761:Hospitals; D006801:Humans; D010347:Patient Care Planning; D013964:Thyroid Neoplasms / Q000601:surgery*
keywords: Atención integral de salud; Carcinoma in situ; Comprehensive health care; Disease management; Manejo de la enfermedad; Neoplasias de la tiroides; Neoplasms; Thyroid neoplasms