Humanitas is a Clinical Research Hospital with a strong culture of quality and safety.
After some successful experiences in clinical pathways redesign through Value Based Healthcare approach, i.e. in the bariatric (winning VBHC prize for the outcomes in 2018), esophagus, breast and orthopedic surgeries, because of the hospital complex environment, with different clinical behaviors, cross-functional activities and shared assets, an integrated and systematic approach was needed in order to improve value in care delivery within the overall hospital. Therefore, a Value Based Care Model was developed, reaching a wide success in delivering high value to patients, including the following steps.
Value definition is the starting point. Clinicians discuss about relevant outcomes for patients and how each patient can obtain them through the best quality of care. Patients are interviewed and their needs are included in the clinical pathway. Then, clinicians through the support of the staff translate it into the organizational pathway and the outcomes and costs are continuously monitored and discussed. This model was reported in a Harvard Business Review Italia white paper in order to spread the culture of care and validated through some hospital Value Based Healthcare projects as “Value Based Breast Cancer Care”.
Value Based Care Model was applied to pre-operative admissions, a transversal process that touches all the units involved in surgical activities, thus standing out as one of the first initiatives reported addressing this issue.
Pre-operative assessment is characterized by some specificities compared to a single clinical pathway, due to the fact that the clinical condition involved is the one of patients undergoing a surgery. This initiative suggests a new way of organizing pre-operative assessment in the healthcare organizations worldwide, solving some typical issues i.e., staging and pre-operative tests/visits overlapping, burdened anesthesiologists, waste and inefficiencies as multiple accesses and tests/visits expired, thus improving clinical outcomes and costs.
Pre-operative assessment improvement in Humanitas from 2019 to 2021 took advantages for more than 64,163 patients. The project aimed at reducing the surgical complications, thus decreasing the risk for patients. Consistently, patients’ safety was improved. Firstly, a clinical revision was performed and it was followed by the review of the organizational pathway.
IPUs were involved. 15 multidisciplinary groups were identified and currently participate to periodical discussions around real data results. The project was guided by a core team composed by the Anesthesiology Department Director, the Quality Management and the Operations Management.
A digital governance system was implemented and allowed outcomes indicators measurement and results monitoring at different levels (i.e., the managerial, units, client service, anesthesiologists levels), thus promoting continuous improvement.
Innovations and technology allowed to improve accessibility and safety (i.e., telepre-operative assessments), to increase data availability and patients’ involvement (i.e., APP, videos, web sites)
Additionally, networking was favored sharing the model with other hospitals of the group as Catania’s hospital and Bergamo’s hospital that validated it.
After 2 years, the results of patients’ health outcomes demonstrate that personalized pathways are able to reduce risk, mortality and complications; the new pre-operative assessment represents a sustainable care with lower new hospitalization and medical advices requested after pre-operative assessment; this can be translated in an increased Value Time for patients, improving their experience.
Better outcomes drag lower costs. This is due to the elimination of unnecessary tests for a specific clinical condition and type of surgery (i.e. -71% chest-x rays). Additionally, costs’ reduction in the overall pathway was reported due to the lower length of stay, ICU admissions and new hospitalizations.
These patients’ outcomes became an additional and unexpected Value in sars-Cov-2 pandemic as long as safety was increased and continuity of care was granted for more patients.