The surgeon has a checklist of which laboratory tests to order and when, what medications to administer at which times, and what complications to watch for. The nurse and other healthcare workers involved in the patient’s care have their own checklists. They know from the moment of a patient’s hospital admission when to take vital signs, when to get the patient out of bed, when to begin physical therapy, and when to provide standardized instructions to the patient before discharge. All this is pre-determined by the critical pathway.

You can find best health insurance quotes for your state easily. All the while, the care each patient receives under the critical pathway is monitored by a case manager. The job of the case manager (usually a nurse), is to track how well the doctors, nurses, and other healthcare workers involved in the patient’s care are sticking to the prescribed pathway. Every deviation from the pathway (for instance, the patient with a hip replacement might begin physical therapy on Day 3 instead of Day 2) is tabulated as a “variance.”

The idea of tracking variances is not to mete out punishment but to identify areas of the process that need improvement. If too many instances of a particular variance are seen in a critical pathway, then either medical personnel need to be retrained on following the pathway appropriately or the pathway itself should be changed to reflect more realistic expectations.

The case manager is also responsible for tracking the medical outcomes of patients cared for under the critical pathway. If a pathway leads to suboptimal outcomes of care, it needs to be revised. Therefore, a critical pathway is never static. It is a living document that is monitored and revised to produce an ever-improving process of care.
Critical pathways provide at least three benefits that improve the delivery of healthcare.

♦ Developing a pathway requires that you understand the care process being managed. Before managed care, such insights were rare. Often, when first studying the process, one or more routine clinical practices are identified as being obviously wasteful. So just creating a critical pathway often leads to a rapid improvement in the efficiency of medical care.

♦ Critical pathways provide a means of standardizing the processes of care. To the extent that healthcare is like other industries, the Axiom of Industry tells us that such standardization ought to be effective in improving outcomes and reducing cost - mainly by assuring that all patients enrolled in a critical pathway receive necessary items of care at the right time and do not receive any unnecessary ones.

♦ Critical pathways provide an organized means of defining, acquiring, and tracking data related to care. Collection and analysis of data are the keys to improving any repeatable process.

Critical pathways have helped hospitals and physicians achieve the twin goals of managed care - improving outcomes and reducing costs. While critical pathways are only a small part of managed care, they embody the main principles by which managed care aims to tame the healthcare system. People who develop managed care procedures quickly see the benefits of applying these principles. The success of critical pathways has led many in the healthcare field to embrace managed care. Systematically reducing the cost of care while improving the quality of care is an attractive proposition.

A managed care organization is the bureaucratic entity that applies the techniques of managed care to a population of actual patients. Health maintenance organizations (HMOs) and preferred provider organizations (PPOs) are two types of managed care organizations. To keep things simple, in this post I will arbitrarily use the term HMO as shorthand for all species of managed care organizations.

Since it is only an administrative philosophy - a technique, a tool - managed care is value-neutral. It is neither good nor bad, any more than any other tool is good or bad. What is important is how the tool is used. Buy cheap health insurance today!

Pure managed care

Managed care is a concept that has been around for decades, developed in academic and intellectual circles by healthcare policy experts, economists, governmental commissions, and industrial management experts. In its purest form the idea behind managed care is a simple and useful one - it is to apply management principles that have been used successfully in other industries to the healthcare system, thereby injecting logic, organization, and accountability to what was a bastion of disorganization and inefficiency.

There are many industry-derived principles that could be applied to healthcare, but the unifying idea behind most of them boils down to one word: standardization.
Standardization is virtually a synonym for industry. In industry, standardization is the primary means of optimizing the two essential factors in any industrial process: quality and cost.

Let’s state this formally as the Axiom of Industry:

The standardization of any industrial process will improve the outcome and reduce the cost of that process.

If you had a widget-making factory, you would break your manufac