Intensive care unit bedside documentation systems. Realizing cost savings and quality improvements.

Automating intensive care unit (ICU) documentation saves time and assists in interpreting data and planning care. The current economic climate makes the cost of ICU computer systems prohibitive for many institutions. Any expenditure without a measurable return on investment will be scrutinized carefully. The literature describing ICU computer system benefits often is difficult to interpret. No two implementations, hospitals, or benefit study designs have been the same. Each implementation has many unique variables. These variables make study comparison and replication potentially impossible. The authors have concluded that replicating previous studies may not be relevant if the goal is to justify system cost. The objective is met by designing a study that evaluates changes in data management activities as well as issues unique to the study unit or institution. The purpose of this article is to review the findings of previous benefits studies related to ICU documentation systems and to suggest other measures to support cost justification for expensive bedside documentation systems.

Quality and outcomes management in the primary care practice.

In response to the trend away from thinking of health care as a commodity to one in which quality is a differentiating feature among providers, primary care practices must focus on outcomes management. This article reviews the various clinical and office-based processes that influence practice outcomes. These include patient management, chart management, practice guidelines, clinical pathways, case management, and patient information. The key to a quality program and successful outcomes management is a commitment on the part of physicians to managing these processes so that best outcomes are achievable.

Issues of cost and quality: barriers to an informed debate.

Debates over health reform in the United States are hampered by a poorly informed public and misunderstandings about the concepts of quality, cost containment and their relationship to each other. This paper explores the nature and persistence of barriers to an informed public discussion of reform proposals. Those barriers are: (1) multiple definitions of quality, cost and cost containment, (2) the impact of the media on those definitions, (3) a false assumption that cost containment automatically results in diminished quality, and (4) the perceived impact of managed care and for-profit health firms on that assumption. We suggest a framework for building the understanding and knowledge base necessary to a reform of the nation's health care system.

The quality and cost of medical care. The potential for information technology to meet the challenge.

The rising cost of health care has precipitated a variety of cost containment initiatives. With the accelerated transition to managed care, the question of quality has emerged. The feeling of many is that cost reduction alone can have only one effect, a reduction in quality. In response, many have focused on the need to reassess and reengineer the processes involved in the delivery of care and to integrate these processes to ensure better management of the patient through the monitoring of the continuum of care. In this paper, we describe the potential for the application of an information technology, known as workflow management technology, in the design and control of health care delivery processes.

The medical practice as business organization.

Medical practices historically have not been examined in terms of their organizational structures and of the appropriateness of their structures for survival as business entities. In this paper, we propose a model for the typical medical practice and discuss its fit with current organizational theory. It is apparent that the medical practice organization does not fit with the demands of a rapidly changing and complex environment. To survive and grow, the medical practice organization must align itself with others that have an interest and stake in the health care system, develop teamwork among physicians, bridge the gap between physicians and others in the organization, and recognize that the work done in the organization depends on other components of the organization.

Total quality management: lessons learned from the medical practice environment.

Experience in dealing with the application of total quality management (TQM) to the medical practice environment suggests some generic lessons that can be helpful in applying TQM in other health care settings. These lessons focus on the need to address the motivation for TQM and its potential value; understanding the barriers created by the organizational and industry culture; identifying the structural barriers within the organization; clearly stating the guiding principles of the TQM effort; implementing the correct management tools for implementation; and allowing users of TQM to create new ideas for the application of TQM in their organizations.

The organization of the medical practice and implications for delivering quality care.

The attention devoted to quality in health care has focused primarily on hospitals. With the shift in care from hospitals to outpatient clinics and physicians' offices, there has emerged a need to consider how quality should be approached in these settings. This article explores the structural barriers in the typical medical practice that must be removed in order to improve the many dimensions of quality. The typical practice must concentrate on enhancing clinical outcomes, patient satisfaction, and practice productivity. One effective strategy is to form teams of physicians and other staff to work on relevant issues. Another is to focus on how the practice can be defined to better meet the needs of patients.

Introducing teamwork in physician groups: a case study.

Authors Thomas N. Tavantzis, Ed.D., Carla J. Krasnik, M.B.A., M.S.N., and A. Douglas Bender, Ph.D., try team building as a basis for increasing quality and performance in a medical practices. Through the use of the Myers-Briggs Type Inventory, physicians were better able to understand their interrelationships and build more of a team feeling in the practice.

Applying total quality management to the medical practice.

Total quality management (TQM) has the potential to help medical practices in the transition to a healthcare system that is more demanding in terms of both higher quality and lower cost. Incorporation of TQM principles, however, must be based on creating skills in the areas of teamwork, communication, and problem solving. The potential gain will be seen in improved patient satisfaction, increased revenue as a result of more accurate billing, clearer understanding of costs and outcomes, better clinical documentation, and enhanced staff productivity.

Implementing total quality management in the medical practice: managing the transition.

TQM has a place in the medical practice. While it will require that the practice deal with the many barriers to change in the practice, the results can be significant. Increased patient satisfaction, lower costs, improved quality of work life, and increased productivity can enhance the working of a practice at a time when there are significant pressures on the practice and physicians. TQM may indeed be a way for a practice to take more control of this changing environment rather than being controlled by it.

Budget model can aid group practice planning.

A medical practice can enhance its planning by developing a budgetary model to test effects of planning assumptions on its profitability and cash requirements. A model focusing on patient visits, payment mix, patient mix, and fee and payment schedules can help assess effects of proposed decisions. A planning model is not a substitute for planning but should complement a plan that includes mission, goals, values, strategic issues, and different outcomes.

Matrix sorts hospital issues for urgent or long-term plan.

The strategic planning process requires many tools in determining and acting on the issues that will influence a hospital's future. To efficiently and effectively launch a strategic plan, administrators must begin by prioritizing problems and opportunities so that they are proactive rather than reactive. In the following article, the author suggests a matrix system that will aid in that effort.

Managing strategic change.

Strategic business planning is a two-step process--(1) formulation and (2) implementation. While much effort has been placed on how to formulate strategies that are consistent with internal and external environmental pressures, the key lies in making strategies work. Management cannot stop with formulation but must concern itself equally with the implementation process. This means paying attention to the change process and its management.

Strategic plan needs focus, structure to aid vision.

Having a strategic vision for a hospital is of no use unless it is supported by a focused plan and a management ready to make it work. But, there are generic factors that impede the success of strategic change, barriers that can be lessened, if not eliminated, with structure. In the following article, the author describes the ingredients necessary to turn strategic vision into practice.

Primary care referral management: a marketing strategy for hospitals.

With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.