Process-Centered Health Care Organizations

by Smith, Suzanne P.

• ISBN13: 9780834212497
• ISBN10: 0834212498
• Edition: 1st
• Format: Hardcover
• Copyright: 1999-05-01
• Publisher: Jones & Bartlett

Summary

Smith and Flarey bring the hottest new management strategy of the 90's -"reengineering" -- into the new millennium with Process-Centered Health Care Organizations. While reengineering has transformed health care organizations and allowed huge performance improvements, leaders and managers now need new skills and tools to successfully lead the process-centered organization. This book provides comprehensive theories, methodologies and cutting edge strategies for managing the process-centered organization. It provides nurse executives and managers with a comprehensive reference for approaching, implementing and evaluating their own processes.

Author Biography

Rella Adams, PhD, RN, CNAA: Senior Vice President, Nursing Services, Valley Baptist Medical Center, Harlingen, Texas Maia Baker, MSN, RN: Administrative Director, Nursing Services, Valley Baptist Medical Center, Harlingen, Texas Sherry D. Baker, MSN, RN: Director, Women's and Children's Services, Hillcrest Baptist Medical Center, Waco, Texas Edward L. Beard, Jr., MSN, RN, CNAA: Vice President, Patient Services, Catawba Memorial Hospital, Hickory, North Carolina Marjorie Beyers, PhD, RN, FAAN: Executive Director, American Organization of Nurse Executives, Chicago, Illinois Janice K. Bultema, MSN, RN, CNAA, NHA: Executive Director, Transition Planning, Northwestern Memorial Hospital, Chicago, Illinois; Clinical Assistant Professor, Marcella Niehoff School of Nursing, Loyola University, Chicago, Illinois Jo Anne Carrick, MSN, RN: Instructor, The Pennsylvania State University, Shenango Campus, Sharon Marcia A. Colone, PhD, LCSW: Director, Case Management, Northwestern Memorial Hospital, Chicago, Illinois Margret Comack, MEd, BN: Director, Professional Practice, Toronto East General Hospital, Toronto, Ontario Dorothy Counts, MA, RN, CPHQ: Clinical Resource Manager, Performance Improvement, Pennsylvania Hospital, Philadelphia Markie Cowley, MSN, RN, CHE: Vice President, Patient Care and Nursing Services, Mission Hospital Regional Medical Center, Mission Viejo, California Jill Donaldson, MSN, RN, CCRN: Surgical Outcomes Manager, Mission Hospital Regional Medical Center, Mission Viejo, California Cyndy B. Dunlap, MPA, RN: Senior Vice President/Chief Nursing Officer, Hillcrest Baptist Medical Center, Waco, Texas Dominick L. Flarey, PhD, MBA, RN,CS, CNAA, FACHE: President, Dominick L. Flarey and Associates, Inc., Niles, Ohio Paula S. Forte, PhD, MSN, RN, CNAA: Director of Patient Services, Methodist Hospital, HealthSystem, Minnesota; Adjunct Assistant Professor, University of Minnesota School of Nursing, Minneapolis Lisa Freed, MSHA, RN: Administrative Director, Nursing Services, Valley Baptist Medical Center, Harlingen, Texas Anita Gottlieb, MA, RNP, CPHQ: Quality Improvement Coordinator, Arkansas Children's Hospital, Little Rock Patti Higginbotham, RN, CPHQ, FNAHQ: Vice President, Quality Management, Arkansas Children's Hospital, Little Rock Mary Lou Helfrich Jones, PhD, RN, CNAA: Assistant Operating Officer, Women's Services, Duke University Health System, Durham, North Carolina Bette Keeling, MSN, RN, CNAA: Nursing Coordinator, Hillcrest Baptist Medical Center, Waco, Texas Curt Kretzinger, BSN, RN: Vice President, Patient Care Services, Heartland Health System, St. Joseph, Missouri Maura MacPhee, MS, RN: Clinical Specialist, The Children's Hospital, Denver, Colorado Jo Manion, MA, RN, CNAA, FAAN: Founder and Senior Consultant, Manion and Associates, Oviedo, Florida Magdalena A. Mateo, PhD, RN, FAAN: Consultant, Boston, Massachusetts Myra Mengwasser, MHA, RN: Partner, Ernst and Young, LLP, St. Louis, Missouri Mae Taylor Moss, MS, MSN, RN, FAAN: President, Moss Management Inc., International, Houston, Texas Gail Paech, MScN, BScN: Former President and CEO, Toronto East General Hospital, Ontario Celine Peters, MN, RN: Director of Outcomes Management, Mission Hospital Regional Medical Center, Mission Viejo, California Lana S. Peters, MHA, MBA, RN: Senior Consultant, Ernst and Young, LLP, St. Louis, Missouri Tim Porter-O'Grady, PhD, EdD, FAAN: President, Tim Porter-O'Grady Associates, Inc.; Assistant Professor, Emory University, Atlanta, Georgia Mary Pubentz, PharmD, RPh: Clinical Coordinator, Anticoagulation Clinic, Lutheran General Hospital-Advocate Health Care, Park Ridge, Illinois Julie Schaffner, MSN, RN: Vice President of Operations, Lutheran General Hospital-Advocate Health Care, Park Ridge, Illinois Kerry K. Seely, RN: Director, Acute Care Services, Hillcrest Baptist Medical Center, Waco, Texas Suzanne P. Smith, EdD, RN, FAAN: Editor-in-Chief, Journal of Nursing Administration, Philadelphia, Pennsylvania Hussein A. Tahan, MS, RN, CNA: Manager, Clinical Pathway Program, Mount Sinai Hospital, New York; Adjunct Faculty Case Management Programs, Pace University, Pleasantville, New York; College of Mount St. Vincent, Riverdale, New York Janet Teeters, MS, RPh: Director of Operations, Pharmacy and Rehab Services, Lutheran General Hospital-- Advocate Health Care, Park Ridge, Illinois Karen Terry, MS, RN: Nurse Clinical Specialist, The Children's Hospital, Denver, Colorado Linda D. Thompson, BSN, RN: Director, Medical-Surgical Services, Hillcrest Baptist Medical Center, Waco, Texas Karen Vest, BSN, RN: Special Projects Coordinator, Valley Baptist Home Health, Harlingen, Texas Katherine W. Vestal, PhD, RN, FAAN, FACHE: Partner, Ernst and Young, LLP, Dallas, Texas Phyllis M. Watson, PhD, MEd, RN: Senior Vice President, Lakeland Regional Medical Center, Lakeland, Florida

Table of Contents

Contributors	xi
Foreword	xv
Preface	xvii
PART I---THE PROCESS-CENTERED ORGANIZATION	1	(208)
The New World of Health Care: Seeking Change and Improvement	3	(14)
Suzanne P. Smith
Dominick L. Flarey
The Current Environment	4	(4)
The Future	8	(6)
Executive Perceptions	14	(1)
Conclusion	15	(2)
Reengineering: The Journey to a Process-Centered Organization	17	(28)
Dominick L. Flarey
Suzanne P. Smith
The Reengineering Revolution	18	(2)
What Reengineering Is Not	20	(2)
The Need To Reengineer	22	(2)
The Need To Reengineer Health Care	24	(1)
A Methodology for Reengineering	25	(11)
Case Studies	36	(2)
Life after Reengineering	38	(1)
The Process-Centered Organization	39	(3)
Conclusion	42	(3)
From Structure to Culture: A Journey of Transformation	45	(24)
Margret Comack
Gail Paech
Tim Porter-O'Grady
Background	46	(4)
System Transformation	50	(3)
System Integration	53	(1)
Accountability Framework	53	(1)
Patient-Focused Care	54	(1)
Professional Practice Model	55	(4)
Partnership	59	(3)
Evaluation	62	(2)
Conclusion	64	(5)
Process Reengineering: Strategies for Analysis, Redesign, and Refinement	69	(12)
Jo Anne Carrick
Business Processes in Health Care	69	(1)
Core Business Processes in Health Care	70	(2)
Management Structure	72	(3)
Identifying Reengineering Opportunities	75	(1)
Understanding Process Requirements	76	(2)
Conclusion	78	(3)
Chaos or Transformation? Managing the Process of Innovation	81	(14)
Jo Manion
The Five Phases of Innovation	82	(12)
Conclusion	94	(1)
Process Redesign: Beyond TQM and Reengineering	95	(8)
Bette Keeling
Sherry D. Baker
Linda D. Thompson
Cyndy B. Dunlap
Kerry K. Seely
What Is TQM?	95	(1)
What Is Reengineering?	96	(1)
What Is Process Redesign?	97	(1)
What Is Organizational Infrastructure?	98	(1)
Scope of the Changes	98	(1)
Preparing Management	99	(1)
Preparing the Work Force	100	(1)
Conclusion	101	(2)
Leading People through Organizational Transformation: The Human Side of Radical Change and Transformation	103	(10)
Edward L. Beard Jr.
The People Side	104	(1)
Employee Needs	104	(1)
Management's Responsibility	105	(1)
Planning for the Behavioral and Cultural Side of Change	106	(5)
Conclusion	111	(2)
Teams: The Essential Work Unit	113	(6)
Patti Higginbotham
Process Teams	113	(1)
Success Factors for Teams	114	(1)
Team Roles	115	(1)
The Next Challenges	116	(1)
Conclusion	117	(2)
Leading Upstream: Implementing Process-Centered Leadership Skills	119	(22)
Janice K. Bultema
Marcia A. Colone
Responding to Today's Upstream Environment	120	(3)
Creating Processes	123	(6)
Sustaining Processes	129	(5)
Renewing and Redesigning Processes	134	(4)
Conclusion	138	(3)
Management and Organizational Restructuring: Reforming the Corporate System	141	(12)
Dominick L. Flarey
Suzanne P. Smith
Re-Creating Management Roles	141	(3)
The New Nurse Manager	144	(2)
The Matrix Structure	146	(3)
Rethinking the Organization	149	(3)
Conclusion	152	(1)
Management in the Process-Centered Environment	153	(8)
Anita Gottlieb
Management Roles in the Process-Centered Organization	154	(2)
Process Centering in the Health Care Environment	156	(2)
Stuctures Supporting the Key Processes	158	(1)
Conclusion	158	(3)
Reengineering Patient Care in a Multi-Institutional System	161	(16)
Marjorie Beyers
Reengineering: The Importance of Language	162	(1)
Reengineering in a Corporate Structure	162	(3)
Initiating Reengineering Efforts	165	(1)
Building on Strengths	166	(1)
The Critical Element in Reengineering: The Worker	166	(1)
A Corporate Approach to Change	167	(5)
Special Considerations for Reengineering Clinical Services	172	(1)
Managing the Issues	172	(3)
Conclusion	175	(2)
Managing Diversity	177	(10)
Magdalena A. Mateo
Promoting Cultural Cohesion	177	(1)
Elements of Diversity Management	178	(3)
Strategies for Promoting Diversity Efforts	181	(4)
Conclusion	185	(2)
The Learning Team	187	(22)
Hussein A. Tahan
Teaching, Educating, or Learning	187	(2)
Health Care Reengineering and Learning	189	(1)
Relating the Four Key Elements of Reengineering to Learning	190	(3)
The Learning Work Team	193	(10)
Strategies for Successful Work Team Learning	203	(1)
Important Aspects for Health Care Work Team Learning	204	(2)
Conclusion	206	(3)
PART II---CASE STUDIES	209	(160)
Team 2000: One Hospital's Initiative in Reengineering	211	(12)
Mary Lou Helfrich Jones
Dorothy Counts
Environmental and Historical Perspectives	211	(1)
Reengineering Initiative	212	(1)
Design Phase	213	(2)
Implementation	215	(2)
Evaluation	217	(2)
Human Resource Considerations	219	(1)
Communication	220	(1)
Monitoring Quality and Outcomes	220	(1)
Conclusion	221	(2)
Creating a Process-Centered Organization	223	(20)
Mae Taylor Moss
The Need To Reengineer	225	(1)
Employee Culling as a Byproduct of Reengineering	225	(14)
Phase 1: Analysis and Measurement of Existing Processes	227	(1)
Phase 2: Redesign of Core Processes	228	(6)
Phase 3: Implementation and Measurement with Continuous Monitoring and Improvement	234	(5)
Conclusion	239	(4)
The Patient Care Documentation Process: The Infrastructure to Support Outcome-Based Standards of Care	243	(18)
Lana S. Peters
Myra Mengwasser
Curt Kretzinger
Establishment of Foundation for Interdisciplinary Standards	246	(4)
Understanding the Current Process	250	(1)
Creation of the Ideal Process	251	(4)
Pilot Implementation	255	(3)
Conclusion	258	(3)
The Outcomes Management Process: A Three-Year Experience	261	(18)
Celine Peters
Markie Cowley
Jill Donaldson
Historical Perspective	261	(5)
Implementation of Outcomes Management Process	266	(5)
Case Example	271	(5)
Outcomes Management, 1998	276	(2)
Conclusion	278	(1)
Home Health Care Documentation: Process Reengineering through Information Systems	279	(18)
Rella Adams
Maia Baker
Lisa Freed
Karen Vest
The Home Health Environment	280	(1)
Home Health Information System Requirements	281	(1)
Background: VBMC Home Health	282	(2)
Process Centering at VBMC Home Health	284	(1)
The Reengineering Experience	285	(8)
Conclusion	293	(4)
Developing and Maintaining a Team-Based Organization as Processes Evolve	297	(24)
Jo Manion
Phyllis M. Watson
History	297	(3)
Team Structural Design	300	(5)
Assignment of Patients to Teams	305	(1)
Developing ``Teamness''---The Cultural Change	306	(4)
Additional Key Issues	310	(3)
Barriers to Team-Based Structure	313	(3)
Moving Beyond Patient Care Teams	316	(1)
Conclusion	316	(5)
Pediatric Intravenous Medication Delivery: An Innovation Project	321	(14)
Maura MacPhee
Karen Terry
The Beginning	322	(1)
Theory to Practice	322	(1)
The New Paradigm	323	(1)
Essential Innovators	324	(2)
Innovation at Work	326	(3)
Clinical Care Process Innovation---Intravenous Medication Administration	329	(3)
Conclusion	332	(3)
Warfarin Management in an Ambulatory Clinic	335	(22)
Janet Teeters
Julie Schaffner
Mary Pubentz
Anticoagulation Therapy Initiative	335	(2)
Warfarin Protocol Development	337	(1)
Developing and Implementing the Ambulatory Anticoagulation Clinic	338	(15)
Challenges	353	(1)
Reproducibility	353	(1)
Conclusion	354	(3)
Information Management: Supporting Process-Centered Work	357	(12)
Paula S. Forte
Information Management	357	(1)
Nursing and Information	357	(1)
Determining Information Management Needs	358	(8)
Conclusion	366	(3)
Index	369	(16)
About the Authors	385