Health Care : Current Reviews

Beyond the barriers of healthcare management tools: An integrated approach in lean management, clinical pathways and clinical risk management

5^th International Congress on Healthcare & Hospital Management

December 03-04, 2018 | Rome, Italy

Claudio Beltramello, Franco Pezzato and Jacopo Guercini

Padova University Medical School, Italy
VISION non-profit organization, Italy
University Hospital of Genova, Italy

Scientific Tracks Abstracts: Health Care Current Reviews

Abstract:

In health care management a few approaches and tools exist: ISO certification, international accreditations, total quality management, lean management, clinical risk management, process management, project management, clinical pathways; health technology assessment, clinical audit and others. The choice of one or another ??? the operation of matching the problem at stake to a particular tool according to its suitability for that class of issues ??? is rarely based on evidence. Instead, it usually depends on the manager???s personal attitudes (1). Moreover, literature shows that once a particular tool is picked up, it is then applied with a kind of ???all or nothing??? attitude, with its promoters aiming at demonstrating that the one applied is the only really effective (2, 3). As a matter of fact, commonalities and complementarities among different healthcare management tools/approaches are numerous, and a wider view is therefore pivotal for quality improvement purposes (4, 5). In an effort to adopt such a wider view (6), this work proposes an integration of three relevant tools: Lean management, clinical risk management and clinical pathways. Their main goals are respectively: To reduce waste and improve value and efficiency; to reduce adverse events to patients and improve safety; to increase appropriateness linking clinical choices to the best available evidence and improve effectiveness. All relevant documentation on the three tools stresses the importance of four similar steps: a) An analysis of the actual process the patients go through and of the concrete activities performed by health personnel in wards/departments that need improvement. b) A further examination of the processes involving patients and personnel through a specific lens: - Lean management focuses on increasing value through the elimination of wastes (muda) with the application of dedicated tools (value stream map, visual management, 5S, pull system, kanban and others). (7) - Proactive clinical risk management focuses on the identi-fication of the potentially dangerous steps applying the FMEA (Faiure Mode and Effect Analysis) in order to ???close the holes in the cheese??? before an adverse event might occur to a patient. (8) - Clinical pathways focus on the reduction of variability among health professionals by means of an alignment of diagnostic and therapeutic decisions with the recommendations of the reference clinical guideline. (9) c) An overhaul of the process according to the optimal model worked out. d) The actual implementation of the changes followed by monitoring and evaluation of the results using SMART indicators. The times are ripe in healthcare management for removing barriers and integrating different approaches -getting the best out of each of them (10). Depending on the context and the problems under scrutiny, value stream mapping (lean) or FMEA or clinical pathways can be more appropriate. What may result in critical advancement, however, is that, when it comes to the common step of process re-engineering, an integration of the three approaches is conducive to the improvement of several quality dimensions at once. Recent Publications 1. Walshe K. (2009) Pseudoinnovation: the development and spread of healthcare quality improvement methodologies International Journal for Quality in Health Care, Vol. 21, Issue 3, Pag. 153???159 2. G. H. et al. (2014) Health Care Quality Improvement Publication Trends. American Journal of Medical Quality 2014, Vol. 29(5) 403???407 3. Guo R. et al. (2016) Study on Hospital Administrators' Beliefs and Attitudes toward the Practice of Evidence-Based Management. Hosp Top. 2016 Jul-Dec;94(3-4):62-66. 4. Roberts J. P. et al. (2016) A design thinking framework for health-care management and innovation. Healthc (Amst). Mar;4(1):11-4 5. Pannick S, et al. (2016) Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities. BMJ Qual Saf 2016; 25:716-725 6. Paul E Plsek, et al. (2001) Complexity, leadership, and management in healthcare organisations. BMJ 2001;323:746???9 7. Mazzocato P. et al. Lean thinking in healthcare: a realist review of the literature BMJ Quality & Safety 2010;19:376-382 8. Rah JE et al. (2016) A comparison of two prospective risk analysis methods: Traditional FMEA and a modified healthcare FMEA Med Phys 2016 Dec;43(12):6347. 9. Buchert AR et al. (2016) Clinical Pathways: Driving High-Reliability and High-Value Care. Pediatr Clin North Am. 2016 Apr;63(2):317-28. doi: 10.1016/j.pcl.2015.12.005. Review. 10. Braithwaite J. (2018) Changing how we think about healthcare improvement. BMJ 2018;361:k2014 |doi:10.1136/bmj. k2014

Biography :

Claudio Beltramello is a MD, specialized in Public Health with Diplomas in Healthcare Management and in Business Administration, has a deep knowledge and wide experience in health care quality management. He has being working in the past 12 years as senior consultant and educator for several Italian hospitals and local health trusts. He also teaches hospital management at the Padova University Faculty of Medicine. Previously he operated as a healthcare manager at international level for the World Health Organization for 3 years and for a non-profit organization running health projects in poor Countries for 4 years. He speaks English, French and Portuguese as foreign languages.

E-mail: cla.beltramello@gmail.com