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BPM 2024 International Workshops, Krakow, Poland, September 1–6, 2024, Revised Selected Papers 

We use evidence from a disruption of clinical documentation routines to propose a novel, predictive mechanism for routine dynamics based on path coherence. Path coherence refers to the continuity of situational attributes from one event to the next along a path, for example, a set of activities conducted by the same person has high actor coherence. Situational attributes include classic descriptors such as who, what, when, where, and why. To be recognized as a path, a minimal level of coherence is required, but path coherence can vary along a path. For example, in a medical clinic, typical paths flow from place to place (e.g., reception, waiting room, exam room) and involve different clinical staff (e.g., receptionist, nurse, physician). Using latent factor network models, we compare clinical documentation routines in five outpatient clinics before and after a technological disruption (an upgrade to the electronic health record system). We show that coherent paths are up to 14 times more likely to persist and up to 40 times more likely to form than less coherent paths. We use these findings to theorize about the role of path coherence in routine dynamics. Path coherence in narrative networks is like homophily in social networks, but with a completely different underlying mechanism. We discuss the implications of our findings for organizational path dependence, resilience, and inertia. Funding: This research was supported by the National Science Foundation [Grants SES-1734237 and BCS-2120530]. This research was also supported in part by the University of Rochester CTSA [Grant UL1 TR002001] from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). 

We use Kremser and Blagoev’s [1] role-routine ecology to theorize about the effects of concurrency in complex service organizations, such as outpatient medical clinics. In a typical clinic, teams of specialized individuals serve multiple clients at the same time. There can be concurrency within a patient visit (a technician may be preparing for a procedure while the doctor talks to the patient) and concurrency between patient visits (multiple patients being treated in the clinic). Using data from electronic health records, we estimate the effects of concurrency within and between patient visits on the duration of patient visits in a set of dermatology clinics. As expected, we find that concurrency within patient visits is associated with reduced duration, while concurrency between visits is associated with increased duration. We discuss the implication of these findings for process mining and discovery of process models in organizations where process instances are not independent.