11. Innovating the Patient Care Operating Model: Integrated Value Care

The healthcare industry and hospitals in general have been providing care from an operating model perspective in much the same way since hospitals began. Yes, the medical technology has become much more advanced: imaging technology providing an ever-advancing and amazing view inside the body without a single incision; surgical techniques with cameras and robots enabling surgeons to perform surgeries with smaller incisions and quicker recoveries are just two examples. But the basic operating model has not changed. We are still managing the flow of patients through the healthcare system with a focus on the processes and care providers within a department providing care to each patient, but largely ignoring the flow and progression of a patient to the next step in their care. Patients sit in emergency rooms, with long delays, because the model doesn’t incorporate pulling the patient through their emergency care by understanding where the patient needs to be in their next step of care in a proactive manner. The patient arrives in the emergency room, signs in, and sits down to wait. The triage nurse triages the patient and returns them to the lobby to wait with a vague priority rating of the rough order that they will be called to an emergency room. The patient is finally placed in a room, and waits for the next care provider to pick them out of a list of their other patients, in an unknown priority to assess their medical status, and push them to the next step of the process. Each care step is provided in a somewhat random order, not based on the series of activities that must be performed to make the patient well, but on them sitting in multiple queues for separate departments such as imaging, transportation, registration, scheduling, admitting, emergency physician, nurse, admitting physician, consulting physician, etc. Another example is in the inpatient operating model. The patient comes to the hospital in one of several input channels, being admitted through the emergency room, being a direct admit to registration based on a physician’s orders, being admitted based on either a planned or emergency surgery. Once the patient is admitted to an inpatient floor, which could be after a long wait in one of the input channels, the patient sits and waits again for their initial assessment. “Normal” service level requirements, typically based upon a regulatory requirement from the government, require a patient’s initial inpatient assessment to be performed within 24 hours of admission. This seems like a long time to identify an initial diagnosis, let alone design a potential path of care for the patient. The patient then waits to be “roughly” scheduled for diagnostic tests that provide more insight into their maladies. The “roughly” term is used because a diagnostic test is ordered, but there is really no inpatient schedule. The patient is put on a list for the required department, but has little or no insight into when the test will be run, other than within a rough 24 hours period time-frame. Wouldn’t it be patient-centered to provide the patient with a schedule each morning of the care, and tests that will be provided and performed for that day? In this way the family members can easily be a part of the patient’s care, without waiting for days not knowing when the patient will get their tests. Wouldn’t it also be novel to know when the patient is expected to be discharged based on standardized patient care protocols and inpatient schedules of patient care activities? The existing operating model in a hospital is inefficient and causes immense delays in patient care, when what could be minutes and hours of delays become days and weeks of delays. Is there a better way? The author believes there is a better way to manage the flow of care for a patient through the myriad activities, tests, transports, and hand-offs in a hospital, based on the principles of Lean, Six Sigma, Systems Engineering, and Business Architecture. This chapter will provide a proposal for a new and innovative value care operating model for providing patient care in a hospital setting. It is a proposal for future research and application for those brave care providers, in particular management engineering pioneers who seek to provide a better way.