Sunday, November 09, 2008

What Was Management Doing?

We seem to have a hard time accepting that if our system of providing health services was managed, it might cost less and outcomes might be better.

The Beth Israel Deaconess Medical Center in Boston has a program called BIDMC Spirit. Employees are invited to “callout” any situation that they believe might put patients at risk or is unnecessarily costly. The “callout” is reviewed and, if it is accepted, a team is formed to work on improvement. Many hospitals are doing something similar.

The CEO of BIDMC is Paul Levy, in my mind one of the stars of health care management. He is an enthusiastic supporter of BIDMC Spirit. Paul operates his own blog (www.runningahospital.blogspot.com) in which he periodically reports successful BIDMC Spirit projects.

The most recent one had to do with the process of getting specimens from a GI procedure room to the lab. The “callout” was made by one of the persons who transported the specimens and a team was put together to work on improvement..

The results of the team’s efforts as reported in Levy’s blog were as follows:

-- A reduction of 57% in the amount of time between when a specimen was ready for transport and when transport arrived to pick the specimen up.
-- A reduction of 61% in the time it took to transport specimens to Pathology.
-- Freeing up of hours of transport time/day without sacrificing the safety associated with this task.
-- Much improved workflow for the pathology techs.
-- Improved communication between nursing and physician staff, further reducing instances of mismatched information between the specimen label and requisition.

All of that is great and everyone involved is to be congratulated.

But one might ask what management was doing during the goodness knows how many years the cumbersome and wasteful process was in the making, and why nothing was done about it until a lowly transporter pointed it out.

The answer is found in the way hospitals are organized and operated. Most likely the GI procedure room is part of the Department of Medicine and the lab part of the Department of Pathology. The process of requisitioning, labeling, recording and moving specimens overlaps the two. Medicine and Pathology are clinical departments in which management does not ordinarily interfere. The only person with executive jurisdiction over both is somewhere high in the clinical hierarchy. The practical effect is that nobody takes day-to-day responsibility for these interdepartmental processes which accrete inefficiency until something like BIDMC Spirit comes along.

That is an example of the sort of thing that has to change if we are to have meaningful reform in health care.

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