Mass General Case Study

1. The primary challenges in improving operating processes in a health care environment, particularly Mass General Hospital, include maintaining quality care, finding ways to reduce costs without compromising patient services, maintaining quality of conformance, and creating an environment where all departments are working in conjunction of one another. Improving operating processes in a healthcare environment is an important objective and one which can bring many challenges. Hospitals need to assurance their patients that their care is the top priority and corners are not being cut in an effort to reduce costs. The challenge arises when finding ways to maintain the standard but reduce costs. Another challenge, once a process has been established, is making sure this product/service is being delivered according to the design specifications. This may be because of difficulties with inter-department communications, resistance to change, or support from employees. Without every stakeholder on the same page, improving an operating process is a challenge.

2. In the case of Mass General Hospital, a care path can be described as an application of process management with optimal sequencing and timing of interventions by physicians, nurses, and other staff involved in a particular procedure. Its design is meant to minimize delays in processes and manage the quality with regards to standardizations of care processes. It is also used to minimize the variance from procedure to procedure and improve the outcomes of surgeries. Specific features that it provides is the ability to manage costs, create more efficient processes, improve communication between departments and staff, provides a reliable service for patients, and creates on average a quicker cycle time. With the many features and improvements it does create, there are a few things that it does not do. It does not always apply to all procedures and all patients. Some patients require more attention than others which may make them fall off the path. Also, there are no guarantees that the care path will be successful. This needs to be tested and have the flexibility to adapt to changes as needed.

3. Some common causes of extended stay for CABG patients at Mass General Hospital include lack of staff in the intensive care unit, the number of medical tests needed on patients that day before the surgery, and limited availability of beds at the recovery level in Ellison 8. Other causes are method of payment, level of complications from the procedure, amount of therapy needed, and social issues such as a patient not having someone to help them once they leave the hospital. A lack of weekend admissions to rehab facilities may also lead to increased hospital stays.

4. The first step the team took to develop the care path, and maybe the most critical, was to create a cross functional team. They assembled a diverse team from multiple departments including a cardiologist, a surgeon, and anesthesiologist, various residents, staff members from the intensive care and recovery unit, and other members of the hospital staff. While not all members of the team had as big a role, it was important to obtain information and feedback from all as they did not want to alienate any single department. It was also essential to include numerous departments because the success of this process required complete cooperation and understanding from everyone involved.

Once a team has been formed, they would display a flow diagram of the current CABG surgery process and generate a list of problem areas where improvement was needed. They would also examine records of past patients to see why they had stayed in the hospital for the amount of time they had and look for ways to decrease it in future patients.

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