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1、9-696-063REV:JUNE6,2001GARYPISANOPartnersHealthCareSystem,Inc.(B):CardiacCareImprovementInthefallof1995,JeffreyOtten,CEOofBoston,Massachusetts’BrighamandWomen’sHospital(BWH),wasreconsideringhisinstitution’scareimprovementstrategies.InDecember1993,respondingtoarapidlychangingheal
2、thcareenvironment,BWHagreedtoan“affiliation”withMassachusettsGeneralHospital(MGH),itsbiggestcompetitor;thetwoformedanewparentorganization,PartnersHealthCareSystem,Inc.(Partners),todevelopanintegrated,coordinatedhealthcareprovidernetworktoprovidequalityserviceatthelowestpossiblep
3、rices.Inthepastseveralyears,BWHhadembarkedonseveraleffortstoexamineitshealthcaredelivery“processes”withtheaimofloweringcostsandincreasingefficiencies.ThefirstwaslaunchedinCardiacSurgeryin-patientservices,reengineeringtheentirecareprocess.Sub-sequently,13othercareimprovementteams
4、beganeffortstoreviewselectedproceduresandtoimplementnewapproachestoreducecostsandimprovequality.Overall,theseeffortshadledtoenhancedteamwork,amethodologyforsystematicdatacollectionandanalysisofdataonthecareprocess,costsandoutcomes,plussomereductionincostsandlengthofstayforasubse
5、tofBWHpatients.Nevertheless,noneofthecostreductiontargetsconsideredtherapidlychanginghealthcareenvironment;targetsforcostreductionswerebasedsolelyonidentifiedinternalinefficienciesandredundancies—theywerenotcomparedtoanticipatedfixedpricecontractswithpayers(primarilyhealthmainte
6、nanceorganizations[HMOs]andinsurers).Whilethehospitalstillworkedunderthefee-for-servicepaymentsystem,Ottenhadtodecideonhowtopreparethephysiciansandstafftomanagethefinancialrisksassociatedwithcapitatedcontracts,underwhichthehospitalwouldbepaidafixedfeeperpatient.Heexplainedthedil
7、emma:Veryfocusedcareimprovementeffortsareexcellentexamplesofquasi-scientificmethodstoimprovecarebystartingtosystematicallylookattheprocessesandoutcomes.Forthefirsttimewehavedetailedrecordsofcosts.However,Iamnotyetconvincedthatthecareimprovementeffortshaveledtothenecessarychangei
8、nthebehaviorandattitudeofourphysiciansandnurses
