Variations in Care, Part 2: Limiting Operational Variation to Improve Efficiency and Outcome

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An area of variation noted in many cardiovascular programs is the processes in which we deliver care to our patients. This variation could include schedule management, call management, test result follow-up, patient rooming and many others.

There has been significant work in this area with many health care organizations working towards being a high reliability organization, lean hospital or high performing program.

One of the foundations of all these frameworks is identifying appropriate roles and responsibilities of each team member along with standard work.

As an administrator, it is very challenging to lead a team, maintain efficiency and control costs when the processes are varied. A great example is rooming processes for the outpatient clinic.

If the medical assistant team must remember multiple ways to room a patient such as what information to enter, what questions to ask and which vitals to take, the reliability of the outcomes will be severely diminished.

In addition, it challenges the ability to cross cover and make nimble scheduling changes. The team members are often discouraged as it is almost impossible to be successful when the processes change based on who they are assigned to work with.

If the process is highly variable and the roles or responsibilities are not clear, success will not be reliable.

Another common example is cath lab processes such as patient prep, IV antibiotic administration for device implants and pre-procedure fluids. If the protocol is variable, there is more opportunity for mistakes or fall-outs.

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Some programs develop a separate level of pre-procedure review to identify any misses which require the addition of an entire clinical FTE. A streamline of the processes and alignment of protocols allowed for that FTE to be reallocated to another area of the program.

Inefficiency and variation can be costly.

A similar approach to clinical pathway development is needed for process management. Developing a deliberate process or protocol that only varies based on patient needs can be challenging without strong leadership.

Even developing a single rooming process can take months as each provider may have preferences.

The goal is to take those preferences and identify those that are necessary at the patient level and develop a standard approach. Once a standard approach has been developed, the operational roll out is much easier, more reliable and efficient.

Staff can be trained, performance management can be put into place to hold the team accountable, and staffing can be scheduled in a quantitatively based on time studies and volumes.

Stay tuned for part 3 of this article in the coming weeks. Miss part 1? Check it out here.

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This article is authored by Ginger Biesbrock, PA-C, MPH, MPAS, AACC, senior vice president of Consulting at MedAxiom, and Talal T. Attar, MD, MBA, FACC, director of the Heart and Vascular Center and Cardiac Catheterization Laboratories, University Hospital East.