Hospitals and Health Systems Value Streams: AI-Ready Edition | Capstera

The Hospitals and Health Systems Value Streams: AI-Ready Edition is for business and enterprise architects who need to see how hospital and health system work runs from trigger to value, and where AI belongs in it. It covers 24 value streams in 120 stages. Each stage is shown as it runs today and as it could run with AI, with the target AI mode, the agents involved and the human checkpoint that stays with a person. It holds the 14 value streams shared across healthcare and life sciences and the 10 specific to hospitals and health systems, from Business Architecture for Healthcare and Life Sciences: AI Transformation Blueprint.

What's Inside

The same 24 value streams come in three files: a deck to present, a workbook to work in and a guide to read, plus an import file for the Capstera platform. The workbook holds every field; the deck shows each stage as it runs today and AI-native, with its AI mode and human checkpoint.

• 24 hospital and health system value streams and their 120 stages, each with its steps, stakeholders, entry and exit criteria, and the capabilities that enable it
• For every stage: today's pain points, the AI-native future state, the agents involved, the target AI mode, the human checkpoint and KPIs
• 47 standard healthcare and life sciences value streams with their steps, as a reference process view
• The Value Streams deck (PowerPoint): every value stream as a flow, then stage by stage
• The workbook (Excel): the value streams and every stage, in sheets you can filter and extend
• The guide (Word): the scales used at each stage (AI mode, human oversight, risk tier and work pattern), every value stream in prose, and the license
• An import file that loads the value streams and their stages into the Capstera platform
• Free corrections, and new versions free for 180 days

Every file names your organization and carries your license ID.

The 24 Value Streams

Each value stream runs from a trigger to the value it delivers. The list gives that value and the number of stages.

• Program Proposal to Phase Decision (5 stages): A start, advance, change or stop decision taken by the Chief Research and Development Officer (enterprise) on a plan, a cost forecast and a portfolio comparison every function has checked.
• Study Concept to First Participant Enrolled (5 stages): A study whose clinical study protocol, partners, supplies and sites are approved and ready, so the first participant is enrolled on schedule by a Study Investigator under a protocol the Head of Clinical Development approved.
• Study Start to Locked Study Data (5 stages): A study run as its clinical study protocol says, with participants protected, sites paid correctly and a clean database locked by the Head of Clinical Development.
• Evidence Package to Regulatory Decision (5 stages): A complete, consistent dossier approved by the Head of Regulatory Affairs, questions answered on time, and the regulator's authorization recorded with every condition and commitment.
• Authorization to Launched Product (5 stages): A product available to patients in each market, with labeling, supply, access, medical support and risk minimization in place before the first sale.
• Proposed Change to Implemented Product Change (5 stages): A change approved by the Quality Assurance Manager, notified to regulators where required, validated and confirmed to have done what it was for, with every registration still valid.
• Production Start to Released Product (5 stages): Product made under the current master production record in a controlled environment, tested, reviewed and released by the Quality Release Manager on evidence that would satisfy an inspector.
• Deviation Detected to Effective Corrective Action (5 stages): A deviation contained, investigated to its root cause and closed by the Quality Assurance Manager, with a corrective action shown to work.
• Complaint Received to Closed Product Complaint (5 stages): Every product complaint checked for reportability, investigated to its cause, answered and closed by the Product Complaint Manager, with trends acted on.
• Adverse Event Received to Submitted Safety Report (5 stages): Every adverse event report received, processed, medically assessed and, where the Head of Product Safety and Vigilance decides it is reportable, reported to regulators on time.
• Safety Signal to Benefit-Risk Decision (5 stages): A signal validated, evaluated and concluded on evidence, with the Chief Medical Officer's benefit-risk conclusion and the measures that follow in place and measured.
• Product Problem to Completed Recall (5 stages): A recall or field safety corrective action decided by the Head of Quality (enterprise), executed to every affected customer and closed only when shown effective.
• Medical Inquiry to Answered Inquiry (5 stages): An accurate, balanced answer approved for use, sent and recorded, with any adverse event or product complaint passed on the same day.
• Evidence Need to Agreed Access Contract (5 stages): An access contract on terms inside the pricing guidelines, or approved outside them by the Chief Financial Officer (enterprise), with rebates paid correctly and outcomes tracked.
• Referral to Scheduled Visit (5 stages): A visit booked at the urgency the referral calls for, with the patient registered, coverage verified, any prior authorization requested and the clinic ready.
• Emergency Arrival to Admission or Discharge (5 stages): Patients seen in order of clinical need, treated, and admitted, transferred or discharged without avoidable waits, with emergency capacity that holds under pressure.
• Admission to Discharge (5 stages): A patient placed in the right bed, cared for under a care plan they helped make, and discharged when ready with post-acute care, transport and follow-up arranged.
• Procedure Request to Completed Procedure (5 stages): A procedure on the planned day with the team, room, equipment, implants, consent and authorization in place, and the patient handed safely to recovery.
• Medication Order to Administered Dose (5 stages): The right medicine and dose given to the right patient, verified by a Pharmacist, within the administration limits, and errors caught before they reach the patient.
• Test Order to Reported Result (5 stages): A correct result, tested in control and reported in time, that reaches the clinician responsible and is acknowledged when it is critical.
• Patient Encounter to Paid Claim (5 stages): A charge for every billable service, coded from the signed record, a clean health plan claim paid at the contracted rate, and a correct bill the patient understands.
• Denied Claim to Recovered Payment (5 stages): Every denial corrected, appealed or written off by the Head of Revenue Cycle, payment recovered, the patient kept out of the dispute and the cause removed upstream.
• Patient Safety Event to Closed Review (5 stages): Every patient safety event reported and classified, serious events reviewed to their causes and disclosed to the patient, and actions that make care safer.
• Clinician Application to Granted Privileges (5 stages): Privileges granted, restricted or declined by the Chief Medical Officer on verified credentials, and practice reviewed from then on.

Who Uses It

Process owners and the teams who redesign hospital and health system work, transformation leads who need a future-state process view to plan from, and business architects who map value streams to capabilities.

How It Fits With the Other Products

Each stage names the capabilities that enable it; they are defined in the Healthcare and Life Sciences Capability Model: AI-Ready Edition. The agents each stage involves are specified in Business Architecture for Healthcare and Life Sciences: AI Transformation Blueprint, which also holds the business data model, use cases, controls, an operating model and a roadmap. The Hospitals and Health Systems Business Data Model is sold on its own too.

Target AI modes describe a typical large enterprise and are a starting point for your own.