Clinical Management

1. Clinical Management Nutr 564: Management Summer 2007

2. Clinical Management • Objectives: • • Contrast the functions of management as presented previously to the functions of clinical management • • Analyze tools available for clinical management • Review the Nutrition Care Plan • Review Care Pathways

3. Concept Discussion • Review the major topics we have covered this quarter and be prepared to discuss examples from clinical management.

4. Functions of Management • Leadership / Management • Information Management • Time Management • Systems Management

5. Why? Puckett ‘04

6. Management Activities 1) Planning Strategic Planning: Setting Goals Operational Planning Defining Objectives Designing the organization to achieve the goals and objectives Assigning responsibilities Allocating resources Designing organizational controls

7. Planning • Examples from the reading • Policies, Procedures and Standards (Also see p. 251 Puckett) • Planning for facility goals and objectives • Planning for program goals and objectives • Personnel needs (education, travel) • Planning for services – patient care • Marketing Opportunities

8. Policies and Procedures Purpose: Documentation Internal purposes JCAHO requirements Standardization Consistency between personnel / Communication Establishes plan for revision and evaluation

9. Polices • Examples

10. Procedures • Examples

13. Management Activities 2) ControllingManagement control Designing project controls Motivating/ Monitoring Reviewing Progress Solving Problems Leadership, coaching and counseling Performance appraisal Measuring productivity

14. Measuring Productivity Puckett ‘04

15. Measuring Productivity • Determine the estimated variability in the time spent on each task. • Evaluate patient acuity relative to staff services

16. Measuring Productivity • Acuity: • Decisions about acuity are based on sensitivity and specificity models not on universal principles. • May be determined by: • • Diagnosis • • Screening • • Clinical Status

17. Measuring Productivity • Match staffing to appropriate skill level • Include estimates of cost-effectiveness/ quality assurance • Avoid the pitfall of only monitoring processes and not outcomes

18. Measuring Productivity • Controlling • Operational control • Scheduling • Establishing procedures

19. Screening Puckett ‘04

20. Clinical Management • Objectives: • • Contrast the functions of management as presented previously to the functions of clinical management • • Analyze tools available for clinical management • Review the Nutrition Care Plan • Review Care Pathways

21. Definition The ADA Nutrition Care Process is…. A systematic problem solving method tha dietetics professionals use to critically think and make decisions to address nutrition related problems and provide safe, effective, high quality nutrition care.

23. Nutrition Care Plan • A means of communication among all members of the treatment team • A resource to be used in treating the patient’s illness • A means of providing continuing patient care in different health care settings. • An important tool in utilization management and quality assessment programs. • A constant and valuable source of information for research and educational and statistical studies • Proof of services provided (for reimbursement documentation) • A document that can afford legal protection to the health care facility, its employees and its patients. Puckett ‘04

24. Nutrition Care Plan • What are the advantages to using the pathway? • Standardized language • Link to EBM • Focus is on delivery of quality care • Systematic documentation for reimbursement

25. Clinical Management • Objectives: • • Contrast the functions of management as presented previously to the functions of clinical management • • Analyze tools available for clinical management • Review the Nutrition Care Plan • Review Care Pathways

26. Clinical Pathways

27. Clinical Pathways Also known as: Critical paths Critical pathways Care paths

28. Clinical Pathways “Management plans that display goals for patients and provide the sequence and timing of actions necessary to achieve these goals with optimal efficiency” Every NR et al. Circulation 2000;101:461-5.

29. Clinical Pathways • Select the best practice when practice varies unnecessarily • Defining the standards for the expected duration of hospital stay and for the use of tests and treatment • Examining the interrelations among the different steps in the care process to find ways to coordinate or decrease the time in the rate-limiting step

30. Clinical Pathways • Giving all hospital staff a common game planfrom which to view and understand their various roles in the overall care process • Providing a framework for collecting data on the care process so that providers can learn how often and why patients do not follow an expected course during their hospitalization • Decreasing documentation burdens • Improving patient satisfaction with care by educating patients and their families about the plan of care

31. Clinical Pathways Care delivery tool similar diagnoses Identify level of care Members of Health Care Team Specifies time of intervention Incorporates discharge planning & education

32. Clinical Pathways Benefits Uniform care / reduces variation in care Improves communication Facilitates documentation Supports quality assurance efforts

33. Clinical Pathways Limitations Only useful if properly used in a timely fashion Flexibility Often many of the processes have not been tested Not all variation is negative Not an end in itself Allow for identification of problems

34. Clinical Pathways • Examples: Information on patient’s nutritional care • Admission: • Screening - • Baseline data - Ht, Wt, IBW, • Nutritional Assessment - at risk statement • During hospitalization: • Interactions • * Diet Instruction • * Nutrition Support

35. Clinical Pathways Examples: Information on patient’s nutritional care Discharge Planning: Education Plan for follow-up

36. Clinical Pathways Sabo ‘05

37. Clinical Pathways Sabo ‘05

38. Clinical Pathways Steps in developing a care pathway Select a topic Select a team Evaluate the current process of care Evaluate medical evidence and current practice Determine the critical pathway format Develop the algorithm Include documentation on the pathway Document and analyze variance Pathway implementation Continuous Quality Improvement

39. Fuss: J Trauma Nursing; ‘98

40. Clinical Management Examples McMahon ‘06

41. Clinical Management Challenges Organizational Structure Health Care Ancillary service