By Patrick Flaherty and Joe Haduch
Since W. Edwards Deming stunned the manufacturing world with his industrial engineering insights, global manufacturing has embraced the need for highly replicable work-processes as a precursor for a sustainable level of quality; where extreme quality and low deviation is required, successful businesses have elevated the management, measurement and implementation of highly defined work processes even further. Quality expectations for health care, in manufacturing and care delivery, far exceeds even the automotive and airline markets. The need for health care to incorporate progressive approaches to sustainable quality is self-evident.
Health care has accepted the concept of clinical standards and practices as tools to address practice variation, the presence of which directly correlates to increased costs and variable clinical quality. Clinical pathways (the sequencing of care based on a common diagnosis) and protocolized medicine (the highly defined use of tests and technology to assess a common diagnosis) are the primary vectors used to translate Deming’s ideas into direct care delivery but, for many, protocolized medicine is not perceived as a universal good. For the naysayer, protocolized medicine is a restrictive and obtrusive care delivery model that threatens personal care and is akin to assembly line medicine. For proponents, it is a standard delivery of care derived from terabytes of patient data that minimizes clinical errors and precisely defines patient treatment without individual bias. The current cost pressures driving programmatic change in health care are highlighting this disparity in thought as protocolized medicine offers a structured means to define and control what are currently highly-variable internal costs at a time that value-based care demands cost-effective solutions across the entire health care continuum.
While most of us know intuitively that standardizing our equipment fleet will directly lead to fewer clinical-user errors, lower service and application training costs, and materially lower capital and operational expenses, few of us are familiar with the importance of standardizing medical care and the effect it has on our organizations. Much like standardizing a fleet of equipment, standardizing care through protocolized medicine affords many of the same opportunities, lower clinical errors as a result of predefined standardization of care through the continuous analysis and consolidation of normalized patient data. This needs to be done across a wide spectrum of like-cases that objectifies and integrates diagnosis and clinical decision support resulting in improved patient outcomes. While this may seem straightforward, it is anything but simple. Entire articles could be written about the challenges associated with normalizing patient populations and acquiring the standardized data required to effectively manage this activity. For this discussion, the focus is on clinical equipment and the role it plays in the success or failure of this critical quality improvement effort, as well as the essential role HTM professionals occupy in ensuring success in this initiative.
What will be required of HTM in this type of delivery model and how can we better prepare our organizations to contribute to this environment? Some of you may recall from our previous column how we talked about the need for HTM departments to collaborate in “defining the clinical business language” and “assess value appropriately” using unbiased and objective data. Nowhere is that more important than in defining and supporting a dynamic protocolized medicine program. Matching equipment capabilities, both existing and future, to clinical outcomes at the modality level will be instrumental in protocolized care. Once again, our HTM departments will be called upon to help define the existing equipment’s use and capabilities, both hardware and software, at increasingly granular levels of diagnosis while developing a robust research and analytical capacity capable of organizing current market offerings and product capabilities against real-world clinical need. For example, while the integrated use and implementation of protocol management software for imaging will monitor, restore and normalize imaging protocols across your entire imaging fleet it still requires a commitment by the imaging physicians and clinicians to connect protocols consistently with common patient diagnoses. This connective effort further increases the burden both in data acquisition and in contracting for a definition of the variable aspects of the technology (slice count, primary resolution, software) specific to a measurable clinical outcome.
HTM is essential in the collection of critical data elements which will form the basis of the first baseline assessment and connection of diagnostic equipment to variable outcome quality and expense. Cloud-based software applications, available to every facility within your organization, will offer the same clinical solutions to every patient whether at a small community hospital or a major academic medical center. These are just two examples of the role medical equipment will play in protocolized medicine and the important role HTM will have in supporting and identifying these types of solutions.
Part of the HTM’s function in this process will be to influence and require manufacturers to design and engineer products that support a protocolized care model. Manufacturers need to adopt better value engineering practices that advance clinical efficacy and support new care practices within an economic model reflective of the financial reality of patients and providers. In addition, it is difficult to standardize care without a standardized fleet of equipment and associated diagnostic software. Protocolized care is one of the definitive operational outputs of implementing a standardized fleet strategy centered around total cost and value of ownership.
While clinical teams will need to lead the conversion to protocolized medicine, HTM departments need to start positioning themselves as a capable support mechanism that can provide expertise for the evaluation and assessment of their medical equipment fleet as well as unbiased appraisers of new technology and equipment functions. Protocolized care will require HTM organizations to develop and deploy sophisticated data collection and analytic capabilities in order to catalyze and manage the supplier change needed to successfully move in this direction.
Patrick Flaherty is the vice president of operations for UPMC BioTronics.
Joseph Haduch, MBA, MS, is the senior director of clinical engineering for UPMC BioTronics.
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