Managing clinical processes is a key strategy in achieving organisational objectives that relate to improving quality, conserving resources and managing risk. Identify the types of clinical processes that need to be managed in meeting these organisational objectives.
Students can answer this question in a general sense, or they can take a specific clinical case type on which they can base a discussion of the key processes involved. Examples from students' own workplaces can be used so long as the examples used are support by the literature. Students should try to be specific in identifying the key processes involved, and indicate how these processes meet organisational objectives, where they fail to do so, and why this might be the case.
Healthcare organizations are termed as complex organization keeping in mind the complexities involved in its operations (WHO, 2000). Its structure, processes and the outcomes are the key aspects which are involved in achieving the highest possible quality at a given cost and minimum occurrence of any risk or adverse event. The major challenge for the healthcare organization is to fulfil the increasing demand of providing quality service along with the pressure of budget constraints which in turn makes it more difficult to manage. Managing clinical processes is an ongoing approach to identify the key factors involved in a process and designing them in a most effective manner to ensure a consistent deliverance of quality service with a maximum utilisation of resources and minimum cost involved. In doing so both the customer and the service provider attains their objective. This report will discuss the importance of managing clinical processes and how they are helpful in attainment of organizations objectives.
Intro
Intense competition and unexpected as well as unexplained variations in medical outcomes are the few hurdles in front of healthcare organizations (Brook et al, 1986). Therefore, organizations are trying to identify processes that are cost - effective and involve minimum risk. Managing clinical process is thus the fundamental factor included in the key strategy of the healthcare organizations in order to have a positive impact on the patient outcomes. As a result, organizations are trying to determine a more comprehensive study of these processes in order to overcome these hurdles and thus attain their goals and objectives.
Managing Clinical Processes to Deliver Quality Service
The healthcare industry around the world had a major impact after the Institute of Medicine released its report, "To Err is Human: Building a safer Health System", in November 1999. The report exposed a series of medical blunders which occurred even in the best hospitals in America whose services were perceived to be "gold standard of the world" (Kohn, Corrigan and Donaldson, 1999). Thus the healthcare organizations were under a huge pressure of providing safe and effective care to the patients along with escalating financial constraints. McGrath et al (2008) underlines that a traditional way to overcome these hurdles is to acknowledge departmental problems in an organization. However, it's not the department but an overall connection between these departments which is the root cause of the problems been faced by these organizations. McQuillan et al (1998) suggests that a lack of structured processes between different units, in terms of patient care is a major obstacle in providing effective services.
One of the methods to manage clinical processes is the use of critical pathways which determines the flow of patients and ideal timing of staff actions to perform a job in the most effective manner (Coffey RJ et al, 1992). Clinical pathways include selecting the best practice and standardization of the process. Thus any variations in the process can be recorded and then analysed to make the process even better (Schriefer J, 1995). For instance I was working with Apollo Hospitals, India in the room division section and was a part of a team looking at the LOS for patients having elective surgeries like CABG, Hip or Knee replacements etc and had to keep a track on the patient flow from one unit to another. For instance a patient who had undergone a CABG was supposed to stay in an ICU for a maximum of 4 days and thereafter in the ward for the next four days, now any variations in his stay in a particular unit were recorded with adequate reasons and then analysed for further improvements in the quality of services been offered. Various benefits in context of patient satisfaction, reduced LOS and waiting time were achieved by adopting this method.
However, Falconer et al (1993) argues that clinical pathway had no effect on the LOS or patient outcomes. Also it has been suggested that the benefits that some people have attributed to clinical pathways may be achieved in simplistic ways like instructing a clinician to manage his patient within a specified LOS (Yandell B, 1995 Pg: 55-64). Considerable research is required to identify the best method to develop a pathway and thereafter implement it so as to get maximum benefits. On one hand the use of clinical pathways in order to manage clinical processes can significantly contribute in achieving organizations objectives of high quality, low risk and minimum cost while on the other hand it may just remain a value judgement for healthcare organizations (Pearson et al, 1995, Pg, 941-948). It may be so because not always the vectors like quality, satisfaction and the cost head in the same direction. Therefore the organization has to place values to these parameters in accordance with the clinicians.
Managing Clinical Process to Minimise Risk & Cost
Managing Clinical Processes also play a pivotal role in minimising clinical risk involved in the organization. While developing a pathway the current process is reviewed and the most recent incidents are taken into consideration. The variations are recorded and analysed so as to figure out potential risk factors. Another advantage is that it prevents reoccurrence of adverse events since a pathway includes guidelines for all involved, communicating them the potential risk and actions to prevent them from recurring (Kitchiner D J and Bundred P E, 1999, Pg, 54-55). Garnick et al,(1991, Pg,2856-2859) identifies that guidelines can have a major impact on the reduction of cost associated with malpractice litigations.
Another approach used in managing clinical process is to redesign the process. As said by Baker et al (2004: 1678) "The greatest gains in improving patient safety will come from modifying the work environment of healthcare professionals, creating better defences for averting adverse events and mitigating their effects" It involves analysis of the problems from the perspective of patient's flow from one unit to another (McGrath et al, 2008). Thus it identifies events of miscommunication, poor decision making and disconnection of care (Littleford, 2006).McGrath et al (2008) identified that by eliminating unnecessary steps of the patient care in Emergency Department followed by increasing the role of nurses, the process became more efficient yielding higher patient satisfaction and a risk free environment. Latest example of process redesigning was the introduction of (CSRP) Clinical Services Redesign Program by NSW health, who by its initial success in 2002 implemented 75 separate redesign projects in 60 hospitals(McGrath et al, 2008).
Jhonson et al (2000, Pg.640-643.) evaluated that use of integrated care pathways actually resulted in reduced LOS, elimination of practices with no benefits and a more simplified process. Also, the staffs involved in the care process were satisfied and the working relationships improved significantly. As a result continuity of care improved and with a decrease in the LOS, patients were relatively less exposed to hospital acquired infections and the clinical risk. Sorensen & Iedema (2008) suggests that the right care provided the first time is less expensive than the poor care which results in unexpected outcomes because it involves repeation of work.
In spite of all these benefits clinical process management is obstructed by a number of factors. For instance the physicians resistance towards standardization of care because it puts their independence at stake (Degeling et al 2001). Another factor is the exposure of physicians towards malpractice suits in case they fail to work within the pathway and a patient experience some complications (Pearson et al 1995, Pg. 941-948). An active involvement of clinicians is required so that organizations as a whole work collectively in managing clinical processes thus making them more effective in achieving the desired goals and objectives.
Current site-
http://www.annals.org/cgi/content/full/123/12/941
http://www.mja.com.au/public/issues/188_06_170308/ben11040_fm.html
http://www.mja.com.au/cgi-bin/s.cgi?q=the+case+for+clinical+process+redesign&o=1
http://www.annals.edu.sg/pdf/tscheah.pdf
Conclusion
In conclusion it can be said that managing clinical process plays a significant role in deliverance of quality service, minimising the clinical risk and at the same time controlling the cost involved. However, all the processes cannot be standardized and systemised keeping in mind the variations of care for different patients (Lillrank and Liukko 2004). Managing clinical process thus means to identify those processes which can undergo systemisation and standardization along with those that do not and thus designing a flexible system for delivery of patient care (Sorensen and Iedema, 2008)
References
Brook RH,Chassin MR, Park RE, Keesey J, Fink A, Kosecoff J, et al. Variations in the use of medical and surgical services by the Medicare population N Engl J Med. 1986;314:285-90.[Abstract]).
Baker G R, Norton P G, Flintoft V et al 2004 The Canadian Adverse Events Study: The incidence of adverseevents among hospital patients in Canada. CMAJ, 170(11): 1678-1686
Lillrank P, Liukko M 2004 Standard routine and non-routine processes in healhcare. International journal of Healthcare Quality Assurance 17: 39-46
Sorensen R, Iedema Rick Managing Clinical Processesin Health Services 2008
WHO 2002
Brook RH,Chassin MR, Park RE, Keesey J, Fink A, Kosecoff J, et al. Variations in the use of medical and surgical services by the Medicare population N Engl J Med. 1986;314:285-90.[Abstract]
Kohn, Corrigan and Donaldson, 1999 cited in Quality pays: A case for improving clinical care and reducing medical errors by Russell C Coile jr, Journal of healthcare management; May/June 2001; 46, 3; Porquest health and medical complete Pg. 156).
Coffey RJ, Richards JS, Remmert CS, LeRoy SS, Schoville RR, Baldwin PJ. An introduction to critical paths Qual Manag Health Care. 1992;1:45-54.[Medline])
Schriefer J. Managing critical pathway variances Qual Manage Health Care. 1995;3:30-42.cited in The Critical pathways as strategyfor improving care: problems and potential by pearson; goulart- Fisher;Lee,1995, volume123, issue 12, pg 941-948.
Falconer JA, Roth EJ, Sutin JA, Strasser DC, Chang RW. The critical path method in stroke rehabilitation: lessons from an experiment in cost containment and outcome improvement QRB Qual Rev Bull. 1993;19:8-16.[Medline]
Yandell B. Critical paths at Alliant Health System Qual Manage Health Care. 1995;3:55-64
Pearson, Goulart-Fisher, lee; Critical Pathways as a strategy for improving care: problems and potentials, 1995, vol 123, issue 12, pg, 941-948
Kitchiner D J, Bundred P E Clinical pathways A practical tool for specifying , evaluating and improving the quality of clinical practice MJA 1999; 170: 54-55
Garnick D W, Hendricks A M, Brennan T A. Can practice guidelines reducethe number and costs of malpractice claims? JAMA 1991; 266:2856-9.
Littleford, 2006- Improving the older person's journey: Clinical Services Redesign Program. Viewed on 14th August 2009 at http://www.achse.org.au/nsw/seminars/31oct06_littleford.pdf.
Johnson, S., Dracass, M., Vartan, J., Summers, S., Edington, J. (2000), "Setting standards using integrated care pathways", Professional Nurse, Vol. 15 No.10, pp.640-3.)
McGrath, K.Ben-Tomvin, D., M., O'Connell, T., & Dougherty (2008) Patient journeys: the process of clinical redesign eMJA viewed on 11th August 2009 at www.mja.com.au
McQuillan P, Pilkinton S, Allan A, Taylor B, Short A, Mortan G, Nielsen M, Barrett D, Smith G 1998 Confidential inquiry into quality of care before admission to intensive care. British Medical Journal 316: 1853-1858)
