575012
research-article2015
FAIXXX10.1177/1071100715575012Foot & Ankle InternationalPinzur
FootForum Foot & Ankle International® 2015, Vol. 36(5) 608 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100715575012 fai.sagepub.com
Individualized Care Plans Michael S. Pinzur, MD1 The audio for a radio commercial for a local health care chain highlights the individualized care plans developed for each and every patient. This audio overlies a video of a group of physicians and nurses seriously discussing the care plan of a patient. Obviously, focus groups responded very well to this message of individualized care. How do you think that the same focus group would respond to the following message: We work hard to standardize the care that we provide to our patients. We emulate a factory assembly line and do everything we can to avoid deviations from our one-size-fits-all approach. I suspect that most consumers would favor the touchyfeely message of individualized crafting of the care plan. Taking that one step further, this reasoning would suggest that each surgeon in that institution has a process that differs from the other physicians offering the same service. Taking individualized care to the extreme, each physician would specify his or her specific processes for patient selection, preoperative preparation, surgery, and postoperative rehabilitation. This would allow patients to receive individualized care from the physician of their choice. Contrast that with an organization where that same patient care team develops a common method of evaluation and treatment. Every patient gets the same preoperative evaluation, the same skin prep, the same prophylactic antibiotics, the same venous thromboembolism (VTE) prophylaxis, and the same postoperative care. The surgeons agree to 1 or, at most, 2 vendors to supply implants. The process is as close to an assembly line as possible. One would assume that individualization trumps assembly-line consistency every time. Unfortunately, that assumption would be wrong. Think about the airline industry. When you board an airplane, your pilot may never have met the copilot. Neither the pilot nor the copilot has necessarily met the flight attendants. The pilots certainly do not have a relationship with the maintenance team that readied the plane for flying. Yet, despite this unfamiliarity with each of the key components of the team, flying is safer than driving your car to work. The reason is that everyone has a set responsibility within the system. Before takeoff, the pilot
(or, in our industry, the surgeon) goes through a checklist (timeout) to make certain that everything is set for a safe flight (error-free surgery). When everyone understands their roles in the process, items are not missed. The assembly-line method prevents forgetting to perform the correct skin prep and remembers to initiate the VTE prophylaxis, start the prophylactic antibiotics prior to the skin incision, and get the patient out of bed and initiate ambulation the day of surgery. Patients do not remain in bed for 2 days because a resident forgot to order the physical therapy (PT) or the therapy order arrived after the PT supervisor set up the schedule for the next day. The assembly-line method avoids the anesthesia resident asking, 20 minutes into the case, “Do you want antibiotics?” The data are clear: common agreed-upon patient care pathways lead to improved clinical outcomes with fewer complications and less near misses. Teamwork among both surgeons and supporting staff improves health care. Are you a better surgeon than your colleagues? Do you have fewer complications? If yes, your colleagues need to learn from you and come up to your standards. If the answer is no, then you need to learn from your colleagues and come up to their standards. Teamwork leads to better outcomes and fewer complications. The FootForum is interested in your opinions. Contact us at [email protected]. Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author received no financial support for the research, authorship, and/or publication of this article.
1
Loyola University Health System, Maywood, IL, USA
Corresponding Author: Michael S. Pinzur, MD, Loyola University Health System, Orthopaedic Surgery, 2160 S First Ave, Maywood, IL 60153, USA. Email: [email protected]
Downloaded from fai.sagepub.com at East Tennessee State University on May 26, 2015
research-article2015
FAIXXX10.1177/1071100715575012Foot & Ankle InternationalPinzur
FootForum Foot & Ankle International® 2015, Vol. 36(5) 608 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100715575012 fai.sagepub.com
Individualized Care Plans Michael S. Pinzur, MD1 The audio for a radio commercial for a local health care chain highlights the individualized care plans developed for each and every patient. This audio overlies a video of a group of physicians and nurses seriously discussing the care plan of a patient. Obviously, focus groups responded very well to this message of individualized care. How do you think that the same focus group would respond to the following message: We work hard to standardize the care that we provide to our patients. We emulate a factory assembly line and do everything we can to avoid deviations from our one-size-fits-all approach. I suspect that most consumers would favor the touchyfeely message of individualized crafting of the care plan. Taking that one step further, this reasoning would suggest that each surgeon in that institution has a process that differs from the other physicians offering the same service. Taking individualized care to the extreme, each physician would specify his or her specific processes for patient selection, preoperative preparation, surgery, and postoperative rehabilitation. This would allow patients to receive individualized care from the physician of their choice. Contrast that with an organization where that same patient care team develops a common method of evaluation and treatment. Every patient gets the same preoperative evaluation, the same skin prep, the same prophylactic antibiotics, the same venous thromboembolism (VTE) prophylaxis, and the same postoperative care. The surgeons agree to 1 or, at most, 2 vendors to supply implants. The process is as close to an assembly line as possible. One would assume that individualization trumps assembly-line consistency every time. Unfortunately, that assumption would be wrong. Think about the airline industry. When you board an airplane, your pilot may never have met the copilot. Neither the pilot nor the copilot has necessarily met the flight attendants. The pilots certainly do not have a relationship with the maintenance team that readied the plane for flying. Yet, despite this unfamiliarity with each of the key components of the team, flying is safer than driving your car to work. The reason is that everyone has a set responsibility within the system. Before takeoff, the pilot
(or, in our industry, the surgeon) goes through a checklist (timeout) to make certain that everything is set for a safe flight (error-free surgery). When everyone understands their roles in the process, items are not missed. The assembly-line method prevents forgetting to perform the correct skin prep and remembers to initiate the VTE prophylaxis, start the prophylactic antibiotics prior to the skin incision, and get the patient out of bed and initiate ambulation the day of surgery. Patients do not remain in bed for 2 days because a resident forgot to order the physical therapy (PT) or the therapy order arrived after the PT supervisor set up the schedule for the next day. The assembly-line method avoids the anesthesia resident asking, 20 minutes into the case, “Do you want antibiotics?” The data are clear: common agreed-upon patient care pathways lead to improved clinical outcomes with fewer complications and less near misses. Teamwork among both surgeons and supporting staff improves health care. Are you a better surgeon than your colleagues? Do you have fewer complications? If yes, your colleagues need to learn from you and come up to your standards. If the answer is no, then you need to learn from your colleagues and come up to their standards. Teamwork leads to better outcomes and fewer complications. The FootForum is interested in your opinions. Contact us at [email protected]. Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author received no financial support for the research, authorship, and/or publication of this article.
1
Loyola University Health System, Maywood, IL, USA
Corresponding Author: Michael S. Pinzur, MD, Loyola University Health System, Orthopaedic Surgery, 2160 S First Ave, Maywood, IL 60153, USA. Email: [email protected]
Downloaded from fai.sagepub.com at East Tennessee State University on May 26, 2015
