Developing Clinical Pathway - Essay Example

Organizational Management and Healthcare Process Study: Developing Clinical Pathway Developing a Clinical Pathway Healthcare today has many problems, including short staffed, cost, and reductions in recent sources. It is a service industry in this world that cannot be done without and is highly debatable as to whether it is a privilege or right. Either way those of us that work in the healthcare industry are immensely responsible to assure that the industry is not only safe but well-organized. We must find a way to continually update and reduce risk in todays healthcare system. The profitability of the system comes nowhere close to the increase in quality over the years, however, the average healthcare user could not afford an increase in profitability on the hospital side. Therefore is the healthcare industry did find a more efficient way to conduct the processes needed within the system. We will look at just one of those processes, that being the clinical pathway. The clinical pathway was meant to streamline the process of patient care. Unfortunately, it is now not always turned out that way. We will discuss some of those reasons including lack of inclusion of stakeholders as well as review of the process. In 1996, the national Library of medicine in the United States introduced the term critical pathway defining it according to Mosbys Medical Nursing and Allied health dictionary, entitled schedules of medical and nursing procedures, including diagnostic tests, medications, and consultations designed to effect efficient, coordinated program of treatment. (Anderson, 2004). Critical pathways or clinical pathways are now used throughout the world (Zander, 2002). There have been many issues over the years related to clinical pathways, many of those are related to the fact that clinical pathways have a tendency to get into the system and then sit there without a process change. Other issues include the fact that terminology used in pathways throughout the world differs. One can I go from one set of clinical pathways on congestive heart failure in Australia for example and expect to see the same on in clinical pathway on congestive heart failure in United States. Secondly, on average the impact of clinical pathways wherever there used are unclear. There are many studies that show the clinical pathways are related to clinical outcomes, however, it does not appear for many of those studies, then using the clinical pathway will give you a specific outcome. Further, it appears that if clinical pathways were updated on a regular basis they may be more effective. This happens because of expected outcomes change, as well as treatment measures. Many hospitals have begun to do away with the clinical pathways in use clinical protocols. One of the reasons for that is because developing a clinical pathway takes a lot of time. (Vanhaecht,Wuttem Deoreuterem 2006). In reviewing the process of clinical management through clinical pathway, we must look at the tools needed for process improvement. Measuring and assessing outcomes is not necessarily an option in todays healthcare market. An organization must know how to systematically assess, measure, and evaluate their processes to improve the outcomes that are expected. CQI methods and tools provide the foundation for this type of work. Is important to use the correct CQI tool for the job; an example of that is that you would not use a crowbar to open your house you would use a key, the always well use the right tool for the right work. A bar chart for example will not elicit the information needed when you want to take apart and examine a process (Bandolier, 2003) The first thing we have to do is decide what needs improving, then decide whats the current process versus the best process, and thirdly make changes in the direction of the improvement. So in changing a clinical pathway what is it were trying to change? (Powell, 2007). Once it is determined what it is that we want to do with the clinical pathway, what kind of change needs to happen, research must be done first. It is imperative in todays healthcare, to know what the evidence says about a practice before we redesign the pathway. Research of the most recent studies related to that process is very important. For example, youd not want to look it CHF data from 10 years ago is youre trying to design a CHF pathway for now. Once we have reviewed the research that we can go about building a new pathway. The data that we collected from the research can be used here to determine the best method to use in meeting our clinical outcomes. In this part of the process we can use flowcharts, run charts, statistical process control charts, pie charts, Pareto charts, cause-and-effect diagrams, and scatter grams. Flowcharts display the process and probably are the best to use in this circumstance(Bower & Sander, 2007). They increase the understanding of the problem, analyze the process, identify gaps between current and desired situations, identify opportunities to improve, and plan for the change. Once we determine what the research says, we must decide how the research affects our particular facility. Understanding the relationship between the outcomes gained from other studies and our own facility is very important. Team meetings have been held with all the stakeholders that are related to the particular pathway that is being built. This involves several departments, all pathways do. Team roles and responsibilities are defined and the process begins with storming in which the team attempts to determine the needs for the hospital. Of course we know what the effective characteristics of a team arm in that those include team members were clear about the role and responsibility, are able to communicate, are one the stakeholders, and knows the rules of teamwork. During this time the team a lot to determine which is best among some choices. Using a force field analysis may be a possibility at that stage (Zander, 2007). Although there are vast amounts of literature that exists on how to build a clinical pathway as well as how to use a clinical pathway, is astounding the lack of research on auditing of pathways that have been in place. The very first audit tool came 10 years after the development of the first pathway (Panella, 2003). The only validated tool for use today is called IC PAT (Whittle, 2004). The IC PAT covers 15/17 characteristics that are needed in a clinical pathway it was too developed in 2004. This flow chart indicates the process that must be followed to implement a clinical pathway, with one of the most important steps being the last two. These are often not done, which is the reason, that there are so many today that no longer function. Critical pathways detail the anticipated flow of care for a typical patient with a specific diagnosis. Care is detailed throughout the patient stay. Generally when a patient is admitted to the hospital with a specific diagnosis each profession has an expectation of the sequence of events that occur with that patient during that stay. The anticipation of what is to happen helps in educating the patient in their disease. Its a multidisciplinary approach to assessing, planning, implementing, monitoring, and evaluating care. Is usually designed around a length of stay. The average clinical path enables providers of care to use resources more efficiently and can have an impact on the quality of care by measuring specific patient outcomes, that is if they are continually evaluated and brought up to date (Tobin, 1998). Documentation is usually preprinted and follows a specific guideline, however there often variances in care due to the fact that patients very. In deviation from the prescribed pathway is usually recorded on a variance tracking sheet. That variance usually falls into four categories, that would be a patient variance, which is a change in patient condition or complications, a clinical, nurse, paramedic variance, a systems variance or community variance. In the case of the clinician variance it usually is a process in which a nurse or paramedic or some other healthcare worker as forgone and did not perform a task. System variance includes such things as laboratory results of social worker not available, in the community variance of course includes ambulance delay is occupational therapy assessment delays things that are not always preventable. He recently publicized example of a problem with a critical pathway is an example of what can go wrong. At St. Thomas Hospital trust the department of orthopedics noted that there was a high average length of stay for their patients. This was particularly high with trauma patients. Compared with other hospitals they were over a day above the average. He was important to get a handle on this because the hospital had just gone to a pay performance plan which certainly showed reduce performance in the orthopedic apartment. Data on length of stay as well as recent literature was collected and analyzed. The data showed that there needed to be a change in the departments way of caring for these patients. However, to save time they chose to purchase a critical pathway. The pathway was a perfectly good one, however he did not work with their patients. In fact there it length of stay increased. In the end, they hit it up having to develop their own critical path after all (Wigfield, 2009). Organizational reality today is that efficiency is more important than most things with the exception of quality. Every healthcare organization in the world must assure that they are as efficient and have the best quality care that they could possibly have. This is presently a very difficult task. Not only does it take time, but it requires personnel. Help take care all over the world is so short of nursing staff as well as other healthcare staff that is difficult to allow the Kind of work that must be done in order to be efficient. Process determination is extremely important (Jones, 2003), but even more important is the reevaluation of those processes on a regular basis. We have discussed the clinical pathway as a method of process change. However there are other methods used more often today in healthcare. These are specialty teams, and are called Kaison, Six Sigma, and throughput. Each of these are specialized teams that conduct their process improvement in a different way. Different facilities have selected different kinds of teams. The process of the teamwork itself is very much the same, however, the process thats being improved will always be much different (Kwon, 2004). The team function is very much the same as what weve been discussing, however, the way in which the team functions may be different. For example Six Sigma is a team function similar to throughput, designed in such a way that those who function very well in this process gain belt access. One starts early with a green belt in which they are trained through a process change by a black belt, assuring that the process is done correctly. When that process change has occurred and the benefits to the hospital have been seen is likely that the Greenbelt will change to a black belt. Is very important in every hospital today that wants to use Six Sigma that they hire a black belt for their facility that is able to lead. In summation, there are many methods to organize good process improvement in todays facilities. Each and every one of them involves the team structure, as we cannot make improvements on our own. Wilma stay aware of the fact that stakeholders have a right to be involved in a process change. Therefore, it becomes very important to educate more than just the team on what process program improvement is about it may very well and be important along the way to pull someone other than management into one of these teams due to the fact that they are stakeholders. (Darer, 2002). Therefore we leave this discussion realizing that healthcare workers today must have a significant amount of training in teamwork and process improvement if we are going to see our facilities become efficient and quality effective. References s Anderson K>, Anderson L, & Glanze W. (2004). Mosbys Medical, Nursing, and Allied Health Dictionary, 4th edn. Mosby, St Louis. Bandolier K, (2003). Independent Evidence-based Health care on care pathways. Available at: http://www.jr2.ox.ac.uk/Bandolier/Extraforbando/Forum2.pdf, accessed on 10/21/2010. Bower K & Zander K. (2000). Clinical path assessment. Implementing strategies for managing care. Center for Case Management, South Nattic, Massachusetts. Darer J, Pronovost P, & Bass E. (2002). Use and evaluation of critical pathways in hospitals. Effective Clinical Practice 5: 114-119. Kwon J & Sandercock P. (2004). In-hospital care pathways for stroke. Cochrane Database of Systematic Review 18 (4). Jones S. (2003). 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