Some benefits of managed care techniques
A good illustration of how industrial principles have been applied to clinical medicine is in the use of critical pathways. Critical pathways are blueprints for delivering standardized care to patients with specific medical problems. Consider a critical pathway for hip replacement surgery. This is a blueprint of what services the surgeon is to provide for the patient, from the date of hospital admission until the date of discharge (which is, of course, predetermined).
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.
