Redesigning care delivery in British Columbia

Phase 1 of this initiative was designed to examine the current state of practice in acute care and to provide administrators with research evidence for identifying areas for improvement. Data were collected through observational research using function analysis augmented by a staff survey and interviews. Data were collected from 17 acute care sites across Vancouver Island and the Mainland of British Columbia involving four health authorities.     

Redesigning ambulatory care business processes supporting clinical care delivery

The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care.     

Redesigning pharmacy delivery processes of a health care complex

This paper addresses a pharmacy delivery design problem with two types of human resources: pharmacy assistants and transporters within a hospital. Each medical unit of the hospital has a mobile medicine closet which is conveyed each week by transporters to the central pharmacy for inventory assessment and refill by assistants. Transportation is carried out by foot, by tractor or by truck depending on the location. The problem consists in creating a transportation and supply planning for each day of the week in order to balance workloads for both transporters and assistants while ensuring the availability of medicine to each medical service. A two-step approach using mixed-integer linear programming formulation is proposed to determine a near optimal schedule. Numerical results are given to assess its efficiency. The proposed approach is then combined with a simulation model to redesign the delivery process of the pharmacy department of a French university teaching hospital. Methodology of this real-life reengineering study is presented and discussed. Submitted to ORAHS’2007 special issue in HCMS.     

Redesigning the pre-anesthesia clinic at Providence Hospital & Medical Center

Using the critical incident technique, a team at Providence Hospital & Medical Center found that patients' greatest source of dissatisfaction with out-patient surgical services was the waiting they experienced in the pre-anesthesia clinic. After analyzing the process, the team discovered that patients spent an average of 32 minutes waiting. The team reconceptualized the process so that individual patient appointments are now made, and anesthesiologists scrutinize each preoperative test ordered. Results: Average patient throughput time dropped from 58 minutes to 36.5 minutes. Routine preoperative tests dramatically decreased (eg, 35 percent drop in complete blood counts and urinalyses). Patient waiting time was completely eliminated unless appointment and arrival times differed significantly. Patient satisfaction with the entire outpatient surgical experience rose from 85 percent to 96 percent.     

The health care delivery system in the year 2000: nursing care for the societal client

The health care delivery system is defined as a societal entity consisting of all persons in the country capable of acting responsibly, and is seen as a client requiring nursing care. Using the nursing process (assessment, diagnosis, planning, intervention, and evaluation), the author determines a NANDA-approved diagnosis of body image disturbance and offers a care plan with the year 2000 as a time limit for short-term goals.     

Inova Fairfax Hospital goes wireless to improve services

The advent of the wireless technology has brought new communications opportunities to healthcare facilities. A wireless phone system has allowed key employees to stay in touch at Inova Fairfax Hospital in Virginia, saving countless hours compared to traditional beeper systems, as well as saving money in reduced costs and improved efficiency.     

Redesigning care delivery in response to a high-performance network: the Virginia Mason Medical Center

We examine how an integrated delivery system responded to threatened exclusion from an insurer's high-performance network by attempting to reduce costs through fundamental redesign of care processes. Some factors facilitating this transformation, such as its structure as a large salaried medical group exclusively affiliated with a hospital, might be specific to the organization and its market. Other essential elements could be replicated. But in a fee-for-service payment system, cost reduction from reducing the number of services or changing their mix can reduce profitability. Making the business case for sustaining desirable provider behavior may require that purchasers and plans make equally fundamental changes in payment policy.     

Restructuring the health care delivery system

Enormous changes continue to occur in how Americans receive their health care. Hospitals are redesigning their institutions to accommodate their changing delivery patterns. The result: costs are down, inpatient stays are shorter, patients are satisfied, staffs are very, very nervous.     

心理护理在剖宫产手术中的应用效果观察

手术是一种强烈的应激源,常导致产妇产生以焦虑为代表的心理应激反应。行剖宫产手术产妇不仅担心自己及胎儿的安全或健全,更担心手术影响其以后生活等。手术室护士将心理护理模式应用于剖宫产手术中,可以解除手术产妇的焦虑恐惧心理,使之愉快配合手术,收到满意效果。     

妇产科手术医院感染分析与护理

目的 结合临床实践经验开展妇产科手术医院感染分析,并探讨护理措施.方法 2009年1-12月医院妇产科共做手术1210例,以此为研究对象,采用总结回顾分析法,将患者的病例资料、临床治疗资料等搜集整理,并与经治医师、责任护士共同探讨,分析妇产科手术医院感染与护理措施.结果 医院妇产科共做手术1210例,发生感染43例,感染率3.55％;手术后感染类型主要有泌尿道、呼吸道、手术切口感染,感染率分别为0.91％、1.40％、0,66％;对于不同的手术后感染,采取不同的护理对策.结论 相关人员应采取积极措施确保医疗质量和医疗安全,预防和控制医院感染的发生,以有效降低医院感染率,促进患者早日康复.     

HIV: challenging the health care delivery system

HIV offers a lens through which the underlying problems of the US health care system can be examined. New treatments offer the potential of prolonged quality of life for people living with HIV if they have adequate access to health care. However, increasing numbers of new cases of HIV occur among individuals with poor access to health care. Restrictions on eligibility for Medicaid (and state-by-state variability) contribute to uneven access to the most important safety net source of HIV care financing, while relatively modest discretionary programs attempt to fill in the gap with an ever-increasing caseload. Many poor people with HIV are going without care, even though aggregate public spending on HIV-related care will total $7.7 billion in fiscal year 2000, an amount sufficient to cover the care costs of one half of those living with HIV. But inefficiencies and inequities in the system (both structural and geographic) require assessment of the steps that can be taken to create a more rational model of care financing for people living with HIV that could become a model for all chronic diseases.     

Project health care at Bellevue Hospital

Project Health Care is a program which uses college students considering careers in health care, as summer volunteers in the Emergency Department of a large, municipal hospital. It began with a small group in 1981, and was expanded the following year to include 16 students. The program was designed to provide opportunities for service and observation in various out-patient settings, seminars, lectures and individual and group projects. The project benefitted all participants. For the Emergency Department staff it stimulated better communication with non-professionals; for the hospital it provided intelligent, enthusiastic volunteer help while aiding community relations, and for the volunteers it provided an opportunity to make educated career decisions.