What we know
Friction exists across approvals, authorisations, claims, and referrals.
Healthcare Interoperability Working Group · Nigeria
Mapping the space between request and decision.
We’re documenting how hospitals and HMOs coordinate approvals, claims, referrals, and healthcare data—before writing a practical specification for improvement.
- 01
Request
A hospital asks for an approval or authorisation.
- 02
Review
The HMO checks the request against its process.
- 03
Follow-up
Staff—and sometimes the patient—chase a response.
- 04
Decision
Care proceeds after a response is communicated.
01 — What we have observed
The delay is visible. The cause isn’t.
A treatment request can require a hospital to contact an HMO, wait, follow up repeatedly, and sometimes ask the patient to intervene before a decision is communicated.
What we don’t know
Whether the root cause is process, policy, operations, technology—or something else.
Why it matters
Patients should not become the follow-up system.
02 — How we work
Listen.
Map.
Specify.
Meaningful improvement starts with the people who work inside the system—not with a predetermined product or technical answer.
- 01
Listen
Interview the people handling care, claims, operations, policy, and technology every day.
- 02
Map
Document the real workflows, decisions, constraints, delays, and systems already in place.
- 03
Specify
Turn what we learn into practical recommendations that others can evaluate and implement.
03 — Research map
Four lenses.
Seven questions.
Each lens helps us move from an observed delay to a clearer picture of the full system. Open one to see the questions guiding our work.
01Workflow & decisions
How requests move between hospitals and HMOs.
Workflow & decisions
How requests move between hospitals and HMOs.
- How do hospitals and HMOs interact today?
- What steps and decisions shape approvals and authorisations?
02Delay & friction
Where requests slow down and who feels the impact.
Delay & friction
Where requests slow down and who feels the impact.
- What are the major causes of delay?
- Which hand-offs require repeated follow-up or patient intervention?
03Systems & data
The tools, records, and channels supporting the work.
Systems & data
The tools, records, and channels supporting the work.
- Which software and operational systems are already in use?
- How are patient records and supporting information exchanged?
04Policy & prior learning
The constraints and earlier attempts we should understand.
Policy & prior learning
The constraints and earlier attempts we should understand.
- Which regulatory and compliance considerations shape the process?
- What has already been tried, and what can those efforts teach us?
What this could inform
- Standards
- Specifications
- Process improvements
- Policy recommendations
04 — Add your experience
The system already has experts. We want to listen.
Join an interview, share a workflow or document, point us to previous efforts, or introduce us to someone we should learn from.
Care delivery
Doctors, medical directors, hospital administrators, and operations teams
Coverage & claims
HMO leaders, health insurance professionals, and claims officers
Systems & data
Health informatics teams, hospital IT teams, and technology operators
Policy & public interest
Regulators, policymakers, public advocates, and healthcare leaders
Give 30 minutes. Share a workflow. Make an introduction.
Every useful conversation helps us build a more accurate picture.
Volunteer-led
No funding, contracts, customers, or commercial partnerships.
Solution-agnostic
The answer may be operational, regulatory, financial, or technical.
Evidence before answers
If our assumptions are wrong, learning that is a valuable outcome.
Privacy
Useful insight, with your choice.
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