Health Organization Case Study The mission of Banner Healthcare is to make a difference in the lives of people through excellent patient care. They achieve this by providing leadership for excellence in patient safety and clinical care. Traditionally, healthcare institutions focused on analyzing aggregate performance, questioning causation, monitoring scorecards and identifying gaps. Planning and managing stages at integral to the process of achieving Banner Healthcare's vision. Planning entails the development of standards, rules, and work teams necessary for the work. Concurrent management involves patient-oriented care and coordinated health care. Across the various work teams, care management efforts and the number of people are involved in making clinical improvements across the organization have been gradually increasing.

This occurs regardless of whether they are work groups, system wide teams, strategic initiatives, and special projects. The work is organized under functional teams. Besides the functional teams, initiative work groups and clinical consensus groups guide the work of the manager. To guarantee consistency in the delivery of the evidence-based system, the organization has adopted a three-phased approach. Clinical groups and multi-disciplinary teams comprising of clinicians assist establish clinical practices based on the best evidence available. The organization also has an initiative work team that helps lead the accomplishment of clinical strategic and safety initiatives. These groups focus on clinical areas such as heart failure, pneumonia and skin care.

Care Transformation

Banner Healthcare is committed to clinical automation by using information systems to hard wire care practices. Throughout its operations, the organization has continued to deploy care transformation across its systems. This has laid the foundation for making evidence-based processes and electronic medical records (EMR) a reality for a number of Banner patients. Transformation of care is an organizational priority for which Banner Healthcare has dedicated substantial human resources and capital to support the initiative. The extra resources have helped hasten the implementation of clinical computer frameworks. These have completed the integration of the EMR, improved support at Banner's health facilities, and created a safe working environment with improved clinical results for patients. The objective was to have foundational applications for the EMR implemented (Wickramasinghe & Sharma, 2010). The organization plans to implement more care transformation initiatives; this will safely lay the foundation for the system to help clinicians offer the safest care in a highly reliable fashion.

Care Management Areas of Focus in future

Recommendations for clinical areas of measurement and focus were made by a group comprising of team leaders, staff, members, chief nursing officers, and chief medical officers. Leaders of Banner Healthcare teams participate in system wide initiatives enabling them to meet regularly to review the information and monitor progress towards improvement objectives. The organization holds a collaborative learning session frequently. This is important in offering progressive education to leaders and group members and whilst sharing the challenges and successes in the improvement process.

ED Door-to Doc Program

Researchers have documented the challenges faced by hospital emergency departments across the United States. Various reports describe the overcrowding of rooms, which places emergency patients at risk. Regardless of the relationship between this overcrowding and the rapidly growing patient population, deficiencies in primary caregivers, insufficient health care insurance coverage, it is obvious that emergency departments require improving processes of patient flow with a keen focus on enhancing patient safety. At the national level, the Banner Hospitals take care for one out of every two -- hundred-inpatient admissions.

Banner's emergency departments have over 500,000 visits annually (Wickramasinghe & Sharma, 2010). Evidently, emergency department patients often spend hours in overcrowded waiting rooms before they are assisted. More of these patients decide to leave without treatment; these patients assume the risk of worsening their medical conditions. At some institutions, this rate has risen to more than fifteen percent. Enhancing patient safety in the emergency department patients has become a major priority for Banner Healthcare. From this perspective, Banner created an innovative reform in the process flow known as "Door to Doc" (D2D). This method was effective in reducing the waiting time for patients to be seen by a physician. As a result, it improved patient safety.

Because of its diversity and sheer size, Banner Healthcare provides a peculiar living laboratory for testing the efficiency of D2D. The eight Banner Healthcare facilities involved in this initiative have emergency departments that vary in staff size, business, acuity, patient population, and physical layout. The proportion of emergency department patients who are treated and discharged to those admitted as inpatients also varies with seasonal demand trends within each facility and from hospital to hospital. The organization implemented...

The strategy of implementing the D2D process flow in different emergency departments was based on a reform paradigm, which acknowledges the need for robust technical solutions accompanied by acceptance of the change by individuals affected. It encompassed two vital aspects:
I. Process: process analysis in the adaptation to unique patient volumes and acuities

II. People: supporting acceptance of the change among affected individuals

The aspect of "people" was addressed via the formation of organizational structures supporting the implementation efforts and coordination with related activities that would affect EDs. The design teams and physicians developed the process design using a rapid cycle approach. The intervention consisted of a patient flow in sub-groups based on a quick look instead of a full triage. The advantage of this is that it keeps less sick patients that are the vast majority, flowing during busy times. Since less sick patients are not put to bed, they tend to move between areas of treatment, as is the trend in a clinical setting (Wickramasinghe & Sharma, 2010).

iCare Puts Intensive Care Doctors at the Bedside Day and Night

Banner Healthcare is the first healthcare giver in northern Colorado and metropolitan phoenix areas to use Baltimore-based VISICU Inc.'s technology. This technology enables intensive care physicians to monitor patients in intensive care units remotely. Under its iCare program, intensive care physicians support nurses and other caregivers at the bedside and assist monitor patients in ICU round the clock. With iCare, intensive care physicians are able to be virtually at the bedside of multiple patients in Banner Healthcare's ICUs in Colorado and Arizona (Wickramasinghe & Sharma, 2010). However, the specialists work from a central command located at Banner's medical center in Arizona. A key advantage of iCare is the ability to identify and trend almost imperceptible changes in patient's vital signs and condition. Because patients in intensive care are extremely medically fragile, this system of early warning helps head off life threatening complications.

When intensive care physicians detect a concern or problem with a patient, they are able to speak live immediately with the caregivers at the bedside through video and voice to discuss interventions and treatment. Such a timely response often results in shorter hospital stays and minimal complications for patients. The intensivists are not replacements for any caregivers at the facility but rather additional practitioners who have access to all the patient's medical records, vital signs, test results and X-rays found in the medical records (Wickramasinghe & Sharma, 2010).

Robotic Surgery at Banner Healthcare

Banner Healthcare's facilities support the use of robotics by surgeons when performing complex procedures to improve the healing of patients. The robot offers surgeons with all the advantages of conventional surgery while permitting them to operate across tiny incisions. With smaller incisions, a patient can have faster, easier and better recovery from a surgery. The hospital uses the daVinci Robotic Surgical framework (Wickramasinghe & Sharma, 2010). This is a popular system, consisting of an ergonomically designed high performance vision system, surgeon's console, a patient side cart, and proprietary instruments. The hand movement of the surgeon is scaled, seamlessly translated, and filtered into precise movements of the proprietary instruments. The surgical system cannot make decisions solely nor can it be programmed. Each surgical maneuver must be conducted with direct input from the surgeon.

Through robotic surgeries, patients who once confronted a series of weeks in recovery because of surgery have been able to stand on their feet within days. With an advanced technology, which creates a minimally invasive approach to surgery, a patient might experience:

I. Minimal trauma to the body

II. Less need for blood transfusion and blood loss

III. Reduced post-operative discomfort and pain

IV. Reduced risk of infections

V. Less hospital stays

VI. Speedy recovery and return to normal life

VII. Less scarring (Wickramasinghe & Sharma, 2010)

Conclusion

Banner Healthcare has become an exemplary organization in the healthcare industry. The hospital has launched a benchmark for other institutions to adopt care processes, which can protect millions of patients from incidents of harm. It is the only healthcare facility across the country with systems that support important patient safety practices. Some of the reasons for this success are that Banner's board has been engaged in clinical process improvements. Therefore, this engagement has caused Banner to be categorized as 'on board" with its support for enhanced efforts. This success has been attributed to the dedication and involvement of Banner's health board.

Reference

Wickramasinghe, N. & Sharma, S.K. (2010). Creating knowledge-based healthcare organizations. Hershey Penns: Idea Group Pub.