Mass General

1, What are the primary challenges in improving operating processes in a health care environment? – The primary challenges is creating a process of care of patients that is accepted and practiced by every doctor and staff member that will interact with the patient during their service experience in the hospital Currently there is no uniformity or standardization of care. All subgroups have to buy-into this new flow of operations process in order for it to be effective This cannot be done by force or the fear of loosing hospital beds.

In addition, operations are expensive and cost reduction is a major concern and one of the founding reasons for a CABG care path process. Time management of hospital staff such as nurses and physical therapist; post operative care received by patients and patient length of stay all ties into the cost reduction efforts of improving the operations process. Each department has its own set of TQM.

(Total Management Quality Techniques) Lastly and equally as important, health care environment has to maintain their reputation for excellence service, reduce bottlenecking and give patients the feeling of trust by educating them about the new processes. ” Charting by expectation” They cannot feel abandoned in regards to information about the service they will receive and what should expect through out the entire process from admission to discharge to healing. 2. What is a care path? What are its specific features? What does it not do?

A care path describes expected goals and events before, during and after CABG surgery until the patient is discharged. It is also described as “an optional sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to minimize delay and resource utilization and at the same time maximize the quality of care” (Massachusetts General Hospital CABG Surgery (A) ) – The specific features of a care path is a paper checklist of what should happen to a patient on day 1 through day 5 and on the day before surgery, the day of surgery and on the post-surgical days.

The care path cannot predict or have control over the “off path” activities of a patient. These off path happenings fall into 3 categories; systematic, medical and social. 3. What are the most common causes of extended stay for CABG patients? A systematic problem may occur the hospital does not have available beds. A medical problem may occur medical complications that require a longer stay in the hospital. A social problem, a patient may not have someone to pick them up or be home with them until day 6.

They are forced to stay in the hospital longer. In addition a physician may order physical therapy for a patient and that may not be a necessary step in patient care and the patient stays in the hospital longer. Eliminating something like this is one of the benefits of having a care path in place (cost reduction). 4. What are some of the important steps the team took develop the care path to make it acceptable to everyone involved?

Every department came to meetings and even held meetings on line and contributed what was important to them in the care path they give to patients. These meeting were open to everyone. This made every team member feel a part of the process and defused resistance. Team members /sub groups in the hospital went back to their department and discussed the issues under consideration at a meeting. Then, presented in writing a flow diagram of their processes and a problem list was developed and it identified communication, coordination and patient flow issues.

The care path attempt to address these issues. In order to make the changes that MGH seeks everyone participation in identifying and defining the process they were trying to change. This is an excellent as it builds a framework for continuous improvement in the future and efficiency is on top of mind in all departments and the hospital will operate as one unit and the process buy-in is greater. 5. What are the hazards of standardizing the process too rigorously?

People are in tune with each other, if hospital staff members are forced to take on a mandated care path without considering what they bring to the job, they will be disgruntle and that will have an effect in their job performance and patients level of comfort and trust in the hospital staff will lead to empty beds and complaints. Word of mouth is a serious and viral for of advertising. In addition, staff members may choose to work elsewhere, where they feel that they have the freedom to express their concerns and they are appreciated.

Now the hospital is short staffed for a while or experience constant turnover. 6. What are the dangers of allowing too much freedom to customize the process? There has to be a balance. Too much freedom may have this large group of departments reps (25) not staying on target and the care path initiative will be delayed or not happen at all because is not understood or it is misunderstood. 7. Does every care path patient have to go through all the steps in the care path? What happens to patients who do not follow the path fully? Every patient should definitely go through all the steps unless they are experiencing a medical problem that puts them off path.

If they are not on path for any reason other then medical complications; them bottleneck will occur and other patients will be left unattended to and now there is at least 2 patients who will stay overnight at the hospital until going through the final steps for discharge. In addition if the care path is skipped and patients not thoroughly examined or checked off as move forward on the chart; if something happens to them and it is an over-site by the hospital – the hospital may face medical malpractice suites.

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