Business process in health care - How surgery became a business process.

If I say 'Business process in health care" I would presume a lot of you would think I was referring to its application within Health Insurance. Right?

But what if I told you an organisation in the US is looking seriously at implementing business process management.. for surgery. That's right, they are looking at how following fixed surgical checklist procedures can eliminate or at least decrease complications and increase recovery rates. This will have a corresponding positive effect on health care payments and therefore reduce premiums.

Geisinger Health Systems in Pennsylvania runs 3 hospitals with a fixed (i.e fairly predictable and constant) patient base. This made it possible to look at this sort of process.

The premise was very simple: Statistically it is known that different surgeons perform different operations in different ways. If operations could be standardised this would remove variations and herefore eliminate unknowns as a result of this.

The hospital chose coronary-artery bypass graft (CABG, pronounced cabbage) surgery as a test-bed. It appears that there are 40 different steps that need to be aken to make this a succesful operation and in 55% of cases the New England Medical Journal found that all necessary steps were not being taken in surgeries. Putting these two figures together the cardiothorasic surgeons at Geisinger formulated a list (process) of steps that needed to always be performed. Surgeons were bonused on their ability to stick with the list (unless they could identify and document why a step was not necessary in a particular case) As a result costs are down 5% and - more importantly - there has been a 45% decrease in re-admission rates and a 60% decrease in neurologic complications. Both of these figures has resulted in lower costs for the insurer.

What's important to note here is the approach that was taken. It is key to ensure all busines process work follows the same typical path.

  • The initiative was started by the key upper management - in this case the Geisinger CEO Glenn Steele. Thus there was good upper management buy-in
  • The process was defined by people who knew what they were doing. They didn't produce some arbitrary figure of 40 steps, they had their cardiothorasic surgeons analyse and define what the steps were - thus they had acceptance from the users
  • They had an incentive: Bonuses were based on following the process.
  • They had an exception process: Providing things are appropriately known and documented the surgeons had the option of ommitting a step from the process (In this case surgeons opted to skip a step in only three cases out of 181)
  • They measured the process. One of the surgeons involved in the process ended up having the cabbage surgey himself. The surgeon says the case opened his eyes to how complex a routine operation really is: "Two weeks after, the head of our IT group called
    me and said, 'Al, I just looked through [Steele's] chart, and I want to
    send you a list of everybody that accessed the medical record from the
    time he was seen in the clinic to two weeks post-op.' There were 113
    people listed -- and every one had an appropriate reason to be in that
    chart. It shocked all of us. We all knew this was a team sport, but to
    recognize it was that big a team, every one of whom is empowered to
    screw it up -- that makes me toss and turn in my sleep.
    " This is true measurement
As you work through your day-to-day business, are there any sections of your work which, traditionally, wouldn't have come under a BP pervue? Do you now think that this might be something you could look at? After all if open-heart surgery can be improved with business process management, surely something a little less life threatening can....

For more information and detail behind this read the Fast Company article Geisinger Health System's Plan to Fix America's Health Care

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