Innovation in Healthcare Practice - Essay Example

Innovation in Healthcare Practice Part I_- The Maintenance and Care of ERSD Patients In the absence of federal or man d changes, determining the need for change should need to be a group mandated. After a target process is identified and acknowledged the process improvement team work to identify difficulties and adapt a change with measurable outcomes. The change should be based on best practice and evidence based guidelines. The implementation then takes place in accordance to the revised process; this is then evaluated. Cost containment and consistent innovative improvement are of paramount importance in the maintenance and care of ERSD patients. Chronic kidney disease (CKD) is regulated by agencies and guidelines. These agencies recognize the benefit of structure and standardization of treatment and the quality and safety these innovative measures bring. Treatment is governed by the adequacy and mode of dialysis. Haemodialysis requires an access that will sustain a blood flow of 300 to 500 millilitres per minute per treatment. The blood must be able to pass the through the dialyser for a prescribed amount of time in order to guarantee dialysis adequacy. This is usually expressed as a Kt/V value which is a standard measurement of clearances of urea during a specified time. The NHS reforms, which came into effect in 1991, aimed to give patients, wherever they lived in Britain, better health care and greater choice of service. Therefore the concept of the internal market was introduced, according to which, the 'providers' of healthcare were to be separated from the ' purchasers ' of healthcare. The idea was that by giving the purchasers the freedom to choose where to buy the best care, including the private sector, the system would place competitive pressure on the providers to offer greater quality, efficiency and value for money. Healthcare at one time considered itself insulated from market forces until the early nineties. Changes in the form of Medicare reimbursements and a move towards managed care drove healthcare to analyze and adapt innovative efforts in a quantitative method rather than descriptive and prescriptive modalities. Integration and implementation of innovative control and management theories have resulted in a less than homogeneous consensus on innovative management system. Rather, a succession of philosophies, systems, and tools have been embraced and subsequently discarded. Due in large part to the diverse nature of the healthcare services rendered, codification of a single, total innovative entity is a virtual impossibility. Innovative improvement and assurance programs are imperative for healthcare facilities to maintain standards of care. The complexity of treatment and equipment has increased dramatically in the last several decades necessitating continuous education and retraining for healthcare professionals. Innovation works on both prevention and improvement of existing systems. The capability to determine and meet the needs of the patient also impacts the resources allotted and required. Deming stressed that collaboration of multidisciplinary teams improves the channels of communication. Solutions to potential and ongoing problems are consequently more solvable and preventable. These benefits inure to all areas of the organization including assisting in cost containment. Efforts to increase improved performance by healthcare organizations are, as Deming pointed out, a necessity and not an option. End stage renal disease and dialysis lend themselves to an innovation philosophy immersed in numerical data. Six Sigma and dialysis were made for each other and are probably the best example of a perfect fit of innovative management and healthcare. Six Sigma’s focus on poka-yoke and standardizing has resulted in standardized machines, charting and dialyser use worldwide. In an ideal dialysis facility establishment of estimates for innovative standards should be set at the beginning of each year. One such example marker for patient health is the haemoglobin level. A Facility should be expected to maintain patients’ levels at or around 11 gm/dl to 12 gm/dl. To achieve this attention must be paid to many aspects of patient care including medications and haemodialysis techniques. Low haemoglobin levels can be traced back to several controllable factors. One staff member needs to be assigned to follow medications, compliance, treatments and haemoglobin levels. Software is able to track number of complaints and asses patient and family satisfaction. All change processes rely on a change agent. The change agent is given the authority to initiate, formally and informally, those processes that will assist in change. Change agents can be members of the team working towards change by informal or formally appointed positions. Theories differ on the part the change agent assumes. Some focus on the process of change itself and how the environment resists or accepts it. Others incorporate change agents as catalysts and prime facilitators. In the dialysis unit the official change agent would be the educator. Introduction to dialysis treatment will have a profound effect on patient acceptance and compliance. The methods involved in initiating treatment can be allocated to a clinical pathway process starting with establishing the timing and placement of an access. A surgical clinical pathway should be in place to ensure the access, preferably a fistula, has had time to mature and become an effectual access by the time the GFR reaches a critical level. Access maturity may take from two to six months with an average of three. Initiation of dialysis will end a clinical path for new patients, but start a case management mode of care as the patient moves into a chronic disease status. Chronic dialysis patients are then assessed monthly through Kt/V values measuring effective dialysis, in addition to other salient markers, such as haemoglobin, weight gain and dietary compliance. Goals are set for each patient in each facility and a plan is drawn to correct variances. These plans follow a lean Six Sigma format with a collaborative multidisciplinary effort. Dialysis facilities maintain standardization through medication standing orders and treatment procedures. Sodium modelling and ultra filtration conductivity values are all quantitative modes of tailoring dialysis to individual needs while acceptable treatment adequacies are mensurated within a standardized range. Haemodialysis access and the initial treatment course can be measured and managed through clinical pathways. Barriers are present in the complexity and comorbidity of end stage renal disease and the inherent individuality of each patient. Clinical pathways loose their effectiveness when the dialysis patient reaches maintenance and the continuum of health narrows substantially. Case management becomes a mode of treatment management that dialysis patients evolve into as their disease progresses. Part II - How Continuous Patient Satisfaction Improvement Is Important. A clinical value compass is responsible for consolidating the aim of the healthcare provider and client into a succinct framework. This framework is then used to determine the value of the delivered healthcare. Value is defined by cost containment while keeping innovative healthcare at a premium level. Four types of descriptors are employed to assess the cost, satisfaction, function and clinical aspects of the clients’ progression through the healthcare process. Placed in a schematic the descriptors are consistent with the four cardinal points of the compass. The value compass is also represented as a circle with points paired by the by opposite points. The circular design also designates the continuous and connected nature of the flow of the health delivery process. In order to assess the effectiveness of the healthcare, cost and patient satisfaction, some type of measurement of outcomes is necessary. In the example of the application of a value compass above, end stage renal disease resulting in dialysis is assessed. Outcomes are established which are measurable and are used as determinates of dialysis adequacy, cost and patient satisfaction. Each cardinal point is connected with the other. Without adequate dialysis patients are unable to participate in activities of daily living, healthcare costs increase as doctor visits and hospitalizations become more frequent. Outcomes can then be analyzed to establish strengths and weakness in services and the innovative quality of healthcare delivered. Many hospitals and healthcare facilities are now employing scorecards which employ much of the information obtained and evaluated through use of the value compass. A healthcare organization has a responsibility to guarantee the most effective and efficient healthcare, safety for patients and staff and reaffirming its mission, vision and values. After using all the tools and processes most applicable for innovation and care management the outcomes will show their effectiveness. Haemoglobin levels will achieve high levels, access complications and hospitalizations will decrease. The effectual use of a planned and well executed total innovative management will result in a well managed facility that will be used as an example of best practices. Read More