HCA 675 Week 5 Discussion Question One

What do you see as the conflicts between customizing patient care to the needs of an individual patient and standardizing care based on research? Efforts to develop customized care must be designed around a deep understanding of what happens at the ground level along the patient pathway and must incorporate patient preferences by focusing on such things as shared decision-making, definition of appointments, delays and self-management, all of which are elements of an organizational approach. Soliciting active feedback also HCA 675 Week 5 Discussion Question One can help to promote necessary adjustments in the organization of work.3 Such efforts foster the ability of patients to incorporate their own priorities while minimizing complexity and the burden of choice, arguably leading to both quality improvement and cost savings. However, all these efforts must be integrated in a delivery system. No one would dispute that the delivery of patient care is complex. But the level of complexity is increasing at a greater rate than the managerial capacity to deal effectively with it. Among the drivers of increasing complexity are intensification of economic pressure, the need to find better ways of managing chronic conditions in aging populations, and efforts to build patient preferences and goals into the delivery process. In the last 10 years, hospitals in industrialized nations around the globe, paid on the basis of some diagnosis-related group (DRG) or DRG-like system, have been incentivized to increase their volume of activity, or the number of patients treated per unit time.4 For better or for worse, its impact on patient care has been huge. To be financially successful, hospitals have to execute faster on all facets of patient care, often creating tension between clinical and administrative goals, and ultimately resulting in lower average lengths of stay for patients. In fact, the average length of stay has fallen in the last ten years in virtually every the Organization for Economic Co-operation and Development (OECD) member country, dropping from 9.2 days in 2000 to 7.3 in 2013.5 In the wake of increasing dissatisfaction with DRG-type payment systems, and the ongoing upward march of healthcare costs, alternative models such as bundled payments and accountable care arrangements have emerged. Now, the driver of complexity is not just pressure to do more in a shorter span of time, but also the need to coordinate care in smarter ways so that high-quality care is delivered at an acceptable cost. These reasons explain the tension that customization can introduce as described by Russell Mannion and Mark Exworthy. Customized care must be applied to more activities that need to be coordinated, more “sites” for care to be taken into account, and all of this under pressure to get it done more quickly and at lower cost that need to standardize whenever possible. In addition, this tension can be amplified by health professionals’ beliefs, values, culture. Some express reluctance to absolve responsibility for treatment decision making, and may not engage in inter-professional collaboration required to customize all aspects of healthcare. The challenge, then, is clear. The process of improving a targeted pathway according to the logic of customization and then spreading the knowledge gained from such an effort within a delivery system can’t be accomplished quickly or easily. Such improvements require well-planned and carefully orchestrated investments of time and energy by leaders, middle managers, trainers, and frontline staff. These investments will help to ensure three preconditions for the successful implementation of customized care.