Patient-focused care from the ground up

When it opens in April 1997, Genesys Health Park (Grand Blanc Township, MI) will be one of the first US hospitals to offer patient-focused care from the ground up. Located on a 480-acre wooded site, south of Flint and northwest of Detroit, this new hospital will take a holistic, personal approach to treating patients while attempting to keep area residents healthy during their life span. The personal touch afforded by Genesys is evident from a patient's first contact. During a typical 4-day hospital stay, most patients see up to 60 caregivers. At Genesys, through hospital design, technological innovation, and cross-trained employees, a patient will see only 12 caregivers, improving patient care by 60% while cutting personnel costs 30%. This is just one facet of putting the patient first that will be used at this hospital of the future.     

Patient-focused care from a materials manager perspective

In one year, Cedars-Sinai Medical Center (Los Angeles, CA) implemented patient-focused care on 32 nursing units. Through utilizing a continuous quality improvement (CQI) model of which patient-focused care was one operative, successful implementation was completed. The key concept was teamwork, and Materials Management Services proved to be a valuable member at all levels in the process whether at the oversight, design, or specialty task force level. Materials Management Services provided a consistent, efficient, streamlined service while following the guiding principles of patient-focused care: managed demand, redesigned work, and empowered employees.     

Patient-focused care and its implications for nutrition practice

Patient-focused care is a central element in work redesign and restructuring of health-care delivery systems. It affects all levels of dietetics practice. Patient-focused care poses potential benefits and challenges for nutrition professionals, including opportunities to expand the scope of practice and to share traditional nutrition duties with others. This article provides a brief overview of the basic components and terms of patient-focused care and reviews a case study that illustrates how implementation of patient-focused care in a community hospital has influenced the hospital's organizational structure and delivery of nutrition care and services. A review of the initial goals of patient-focused care in relation to long-term outcomes provides perspective for those beginning or in the midst of the reengineering process.     

Patient-focused care boosts patient satisfaction while enhancing safety

Bringing treatment to patients lessens their pain and suffering. Services delivered at point of care include monitoring and testing. New technology helps avoid handoffs of patients and information.     

Immunization: a key to primary health care

Focus of this discussion is on some of the problems enountered by national immunization programs and on the technology that is available now or that will be in the near future to help solve these problems. 4 basic aspects of immunization services are examined: the safety, effectiveness, and stability of vaccines; the cold chain, i.e., the transportation, storage, and handling of heat-sensitives vaccines from manufacturer to health worker in the field; vaccination equipment and sterilization for correct administration of immunization; and program management--schedules, records, training, resource allocation. The section devoted to vaccines focuses on immunization against 6 of (diphtheria, whooping cough, tetanus, measles, polio, and tuberculosis) against 6 of the major killers of children in developing countries: BCG, DPT (diphtheria-pertussis-tetanus), measles and poli vaccines, and tetanus toxiod. The bacillus of Calmette and Guerline (BCG) is considered a very safe vaccine. Questions about the effectiveness of BCG in preventing tuberculosis have been raised throughout its 60-year history. Different studies have produced conflicting results, some showing BCG to be highly effective and others showing no positive effect. Diphtheria toxioid, a very safe and relatively stable vaccine, is very effective in protecting against the development of diphtheria. Live attenuated measles virus vaccine is a safe, highly effective vaccine, but it requires careful handling and storage to prevent damage due to excessive heat or light exposure. The vaccine used for pertussis (whooping cough) is a saline suspension of killed Bordetella pertussis bacteria. The vaccine usually is administered as part of the triple DPT vaccine. Concerns about its safety have led to greatly reduced levels of use in some European countries in recent years. Its effectiveness also has been questioned. 2 types of polio vaccine are available: a live, attenuated vaccine given orally (Sabin) and a killed or inactivated vaccine injected intramuscularly (Salk). Both vaccines are trivalent, i.e., they contain all 3 major strains of polio virus. Both types of vaccine are quite safe. Effectiveness of the vaccines seems to vary in different places. Tetanus toxoid is safe and relatively stable. The 3 doses of DPT given to infants provide long-lasting protection against tetanus. To combine the components of vaccine and equipment into an effective immunizaton service, a program manager must consider several issues: program goals and the development of an appropriate and feasible immunization schedule; systems for keeping records and for training health and cold chain personnel; analysis of the costs of each option; and the development of a method of evaluation.     

Applying economic principles to health care

Applying economic thinking to an understanding of resource use in patient care is challenging given the complexities of delivering health care in a hospital. Health-care markets lack the characteristics needed to determine a "market" price that reflects the economic value of resources used. However, resource allocation in a hospital can be analyzed by using production theory to determine efficient resource use. The information provided by hospital epidemiologists is critical to understanding health-care production processes used by a hospital and developing economic incentives to promote antibiotic effectiveness and infection control.     

Transferring managed care principles to VA

The Under Secretary for Health asked the Health Services Research and Development (HSR&D) service to identify the managed care principles that would enable The Department of Veterans Affairs (VA) to most improve its efficiency and effectiveness while retaining its unique mission. In response to this request, HSR&D's Management Decision & Research Center (MDRC) prepared this article. This article represents the initial work done by the MDRC to determine the extent to which readily available published evidence on implementing managed care principles meets the Under Secretary's information needs and to outline potential areas for further work. It provides an overview and synthesis of existing literature. The document was prepared by the MDRC Technology Assessment Program, which took responsibility because of its expertise in systematic reviews and syntheses of the literature, with contributions from the MDRC's programs in information dissemination and management research.     

Women's health services: restructuring for Medicaid managed care

New Jersey health care providers face the need to change dramatically the way health care is delivered as it enters a new era of managed care. This year, more than 24% of New Jersey's total population is enrolled in commercial managed care plans (New Jersey Department of Insurance, 1996). In addition, the state's Medicaid agency took steps to improve the delivery of health services to recipients by initiating implementation activities to transition from the traditional Medicaid program to a managed care model. Eighty-two percent of New Jersey's Aid to Families with Dependent Children (AFDC) and related populations have already been enrolled in managed care. The state plans to expand enrollment in managed care to the remaining 400,000 Medicaid beneficiaries. Communities with high Medicaid populations are challenged with the need to move through the managed care evolution at an accelerated rate.     

E-health: restructuring care delivery in the Internet age

The authors advocate using the Internet to support clinical care teams dedicated to monitoring patients who can most benefit. Care teams will provide such services as home monitoring for vital signs and supplying patient information. They will work with physicians in managing care. The result should be a stronger provider-patient relationship.     

Home health care in supplementary care: a device for a productive restructuring

This study discusses the role the Brazilian Home Health Care Program (Programa de Aten??o Domiciliar - PAD) plays in supplementary care using the example of a Group Care provider headquartered in Rio de Janeiro. The purpose of the study was to understand how home health care is produced by verifying the interaction between the medical team, beneficiaries and family members considering that the service in this care model is delivered in the micro-political scenery of the process, in the client's own home. The assessment of this program must consider: infrastructure and logistics, beneficiary eligibility criteria, the care-network formed in support of the PAD and above all the work process. Especially the latter is a strong indicator, in the present case characterized by an eminently multi-professional team operating in networks with integrated therapeutic projects. For the professionals, Home Health Care has the meaning of an innovative and highly valuable approach to care delivery. The article concludes considering the PAD an important device for a fruitful restructuring of supplementary care through different ways of care delivery.     

Restructuring care: patient focus is key to innovation

Hospitals across the country are busy reconfiguring their delivery systems to improve patient care delivery. In the process, they are overhauling their organizational structures, reaching out to other institutions for input and participation, and embracing local communities. Many hospital executives are also finding that the path itself is at least as interesting and valuable as the end result.     

Towards a new health care paradigm. Patient-focused care. The case of Kingston Hospital Trust

Patient-focused care (PFC) and business process re-engineering (BPR) have been advocated in the academic literature as techniques to improve both quality of service and reduce costs. Seeks to separate and delineate the components of PFC and BPR and, using the case study method, describe the adoption and implementation process of PFC in medicine and maternity by one London NHS Trust Hospital. Reports the impact of this innovation on service delivery, staff reconfiguration and multi-skilling. Identifies preconditions and key success factors and indicates lessons for the future.