A Six Sigma green belt who tracked and blogged about her medical treatment for two rare diseases made a startling discovery — in 20 emergency room visits, 56 outpatient visits and 54 inpatient days across nine admissions, she found just 0.08 percent of that time was spent treating her conditions.
"[The patient] felt her providers were delivering very little quality of care when defined by the one metric that mattered most to her: time," according to an article in Harvard Business Review.
The article, written by three physicians and one managing director at Oakland, Calif.-based Kaiser Permanente, suggested the best way to improve value for patients is to change how healthcare manages time. Specifically, the authors pointed to team-based care as a way to reduce the amount of time patients spend at the hospital and enhance the value of the time they spend with caregivers.
The patient who blogged about her experiences was not treated at Kaiser. However, the article explored how the health system has redesigned its care model for hip- and knee-replacement patients to make better use of patients' time.
Here's how it works.
- Before surgery, a care coordinator educates the patient and his or her family about what to expect. A physical therapist visits the home to reinforce their education. A pharmacist goes over medications. Other care team members deliver walkers to the home and ensure the patient's bed is on the ground floor.
- The day of surgery, orthopedic surgeons perform the procedure from an anterior approach, which can reduce the pain of surgery and speed up recovery.
- After surgery, the patient eats a meal in the recovery room, demonstrates he or she can get dressed and walk at least 30 feet and is sent home, and is typically sent home that day. A physical therapist visits the patient's home for six PT sessions, the care coordinator checks in via phone calls and the patient returns to the surgeon's office two weeks later.
- Results: Kaiser physicians perform about 8,000 elective hip surgeries and 15,000 elective knee surgeries annually. So far this year, 11 percent of those patients have recovered at home with no hospital stay. The readmission rate for both at-home patients and hospitalized patients is 2 percent.
Editor's note: The patient who blogged about her medical experiences tragically passed away August 2016 at the age of 29.