The cost of the health care industry has always been rising since the early 1980s. It has been a growing concern in both the industry and society. Massachusetts General Hospital (MGH) is no exception. Even though the average length of stay (LOS) for the patients in MGH has been declining (Exhibit 10), it is still the highest compared to their competitors (Exhibit 6). Besides the cost, there is no uniformity of process and standardization across different facilities and departments of the hospital. MGH lacks communication and coordination between the facilities.
Dr. David Torchiana (Cardiac Surgeon) and Dr. Richard Bohmer (Quality Improvement Administrator) want to improve the process in the hospital by implementing a newly created care path across all the departments in the MGH without affecting the patients. Some of the key issues that MGH is facing are: Operating expenses are very high. The overall bottom-line profit compared to their operating revenues are very low. Exhibit 1 indicates that it is lower than 2%. This is mainly due to their high operating expense. Average length of stay in MGH for DRG is highest (Exhibit 7) compared to the other hospitals in the area. One of the reason is due to the operational inefficiencies. Lack of data to improve outcomes.
No standard procedures or uniformity to improve coordination and communication between various medical disciplines and to improve overall quality. Standardizing the process is expected to reduce the length of stay for the patients by 20 to 30%. Expected resistance to accept change in process by personal in different areas or departments such as cardiologists, surgeons, physicians, nurses, anthologists, physical therapists, residents, non-medical staff etc., Capacity planning does not meet expectations especially such as floor needed for patient overflow, bed availability in Ellison 8 rooms, lack of staff in SICU, handling medical complications that requires longer stay in the hospital causing bottlenecks in Ellison room etc., (Exhibit 9)
To address most of the above issues, the care path committee was formed and it first picked the CABG surgery to implement the care path as the cardiac area is the highest utilizers of the resources in terms of cost and also number of days the beds are utilized (Exhibit 5). Moreover, implementing the care path in CABG surgery by Dr. Torchiana can act as a model for the rest of the groups and departments to follow.
Process Focus: This is one of the process strategies that will improve the process and address the operational issues by reducing the cost and length of stay. Implementing the care path is focused on the process improvement. However, this would take intermediate to long term to implement and does not address the planning of capacity when there are overflow of patients, lack of beds in Ellison rooms or short of staff in SICU. Process Redesign: MGH can rethink the business processes to bring dramatic changes in the process and improve performance by focusing on cost, time, and customer value. The process can be hospital layout, payment methods, patient tracking system, outsourcing radiology (X-ray, CT-Scan, MRI) etc. These changes could help address individual areas of improvement. However, there is a heavy cost involved in radically changing the process and could make many staff unhappy. Changing the layout for example could also affect patients. Improve technology: This will increase the productivity especially in the surgery room where the cost is highest overall for the patient’s. There are several areas of technology where MGH could research on buying. Some of them are process control through information technology, robots to perform surgery, automated guided vehicles (AGVs) to transport clean linens in hospital. Technology can be used to educate patients, surgeons, nurses and all personnel involved in the hospital. It can also monitor patients and nurses using RFID....
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