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Summary Literature HSOM week 3
This is a summary of the literature of week 3.
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Literature Week 3 HSOMVanhaecht et al. (2008) Do pathways lead to better organized care
processes? Journal of Evaluation in Clinical Practice
Clinical pathways are used to (re)organize care processes (a method to achieve a result).
Multidisciplinary teams use this to organize their work. Care is standardized through these
pathways, leading to less variation in care and more transparency on how it’s done.
5 elements of well-organised care processes: patient-focused organization, coordination of
the care process, communication with patient and family, collaboration with primary care,
and follow-up. Multidisciplinary teams are daily involved in care processes, so they evaluate
them. Care processes and clinical pathways are not the same. Everyone goes through care
processes, these might be organized in a certain way, and evaluated in retrospect. In
designing a clinical pathway, the multidisciplinary team should endeavour to make a care
process as transparent and standardized as possible. Clinical pathways, however, do not
guarantee that a care process will be perfectly organized. There is room for improvement
and possibility for bottlenecks. Sometimes, clinical pathways support care processes.
Pathways have a significant positive impact on the coordination of care, the follow-up of
care and the overall organization of the care process. Although the relationship between
clinical pathways and well-organized care processes is not perfect, pathways have a
significant impact on the organization of care processes. However, pathway methodology
does not have a significant impact on ‘patient-focused organization’, ‘communication with
patients and family’ and ‘collaboration with primary care’. Meaning that teams might not
pay enough attention to these elements.
Donabedian describes the relationship between the structure of an organization, the way
that
processes are managed and their effect on outcomes. The emphasis on evaluating quality of
care has shifted from structures (having the right things) to processes (doing the right
things) to outcomes (having the right things happen).
Pathways are a part of the structure of the organization, and teams deliver the process.
Pathways are developed by task forces ‘back stage’ but are implemented ‘front stage’
during direct patient contact. Tebouls’ conclusion is that ‘service is front stage’ and that the
perceptions of the team is therefore important. Quality of service is not the same as quality
of product. Service quality can be very subjective, depending on the patient.
Pathways provide a basis for re-establishing ‘responsible autonomy’ as the primary
organizing principle of clinical work. If teams and professionals don’t work together, there
will be distrust and crises of confidence. By implementing pathways, we can assume that the
scores on the organization of care processes will not only increase but also that the scores
of the individual team members will be more similar. If the goal of the clinical pathway
methodology is to build well-organized care processes, they should not only focus on the
‘coordination of the care process’ and ‘follow-up of the care process’ but also on ‘patient-
focused organization’, ‘communication with patients and family’, and on ‘collaboration with
primary care’. This will be one of the main challenges for the pathway community.
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, Lovelle (2001) Mapping the value stream
Value-stream mapping (VMS) lets one understand the proper flow of the product and help
maximize its value through the stream. This can eliminate costly errors. It answers the
question: how de we continuously improve in a capable, sustainable manner?
Fig. 1 The external map
VSM is a map that outlines the current and future state of a production system, allowing
users to understand where they are and what wasteful acts need to be eliminated. The user
than applies lean manufacturing principals to transition into the future state. VSM includes
value-adding and non-value-adding activities that are required to bring a product from raw
material through delivery to the customer. Outline of a product’s manufacturing life cycle
which shows each step of the production process. The ultimate goal is to design and
introduce a lean value stream that optimzaes the flow of the entire system. It improves
quality and efficiency by reducing lead-time, inventory and over-production.
Three different icons:
- Material flow: represent stops in the manufacturing process (machines), outside
sources (factories), inventories, push arrows, shipments etc.
- Information: used to connect material flow icons to form a complete and united
production system. E.g. electronic, manual etc.
- General icons
Drawing a VSM – external mapping (current state)
A VSM always starts with customer demand. The basis of lean manufacturing is product
families. The first task for the mapping team is to define which product family to map (so
which product is being demanded).
- Start of the map is drawing a factory icon (for the customer) and data box in top
right corner. Data box is filled in with customer requirements (might include more
than just the factory because it starts at the raw materials – that’s why start with
customer, bc they can only define the true value of the product).
- Next, outline the basic supplies production process by drawing a suppliers box in the
upper left corner. Select the suppliers of the most vital components or the company
supplying the most components by dollar amount. After, list the production details
of the operation in a data box.
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