An Integrated Predictive Impact–Enhanced Process Mining Framework for Strategic Oncology Workflow Optimization: Case Study in Iran

Process Mining (PM) effectively diagnoses inefficiencies in complex healthcare workflows, such as chemotherapy protocols. However, current methodologies often remain retrospective or rely on loosely coupled simulations, leaving a critical methodological void: the inability to quantify the aggregate, system-wide operational impact of eliminating specific, diagnosed workflow deviations. This gap prevents decision-makers from forming evidence-based strategies for resource allocation. We address this by introducing the PM²-Predictive Impact Model (PIM) framework, a novel, fully embedded process-native methodology that unifies conformance checking, predictive monitoring, and quantitative scenario analysis within a singular, closed-loop structure. Using event logs from an Iranian Radiotherapy and Oncology Center, we modeled a normative seven-step pathway (Fitness = 0.97, Precision = 1.00) and identified high-impact deviations, including skipped approvals and resequencing, enabling a direct causal linkage between deviation categories and system performance. PIM simulation demonstrated that removing these deviations yields statistically significant reductions in managerially relevant KPIs: Cycle Time (8.00%) and Workload (6.00%), which were robust to parameter uncertainty (<i>p</i> < 0.001). The PM²-PIM framework thus transforms retrospective diagnosis into proactive, quantitatively justified strategic planning, providing oncology services with a reproducible, low-cost, and evidence-rich basis for prioritizing interventions and achieving sustained performance gains.