Change Comes to a University Clinic
 
Aiming to sustainably improve in-house processes, the managers of Tübingen Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, the university’s otolaryngology clinic, are looking to follow other industries’ example.

In a joint effort underway since the beginning of the year, we have been reviewing the recipes for success used in other sectors, for example, the automotive industry, to learn which may be applied to the clinic’s patient management processes and flow of consumable materials.

The otolaryngology clinic is part of Tübingen’s university clinic. As a full-service healthcare institution, it is able to diagnose and treat nearly all diseases of the throat, nose, and ears. A staff of some 300 provides inpatient treatment in four departments comprising intensive care, a day clinic, a polyclinic, a diagnostic center, and a surgical tract with five operating rooms and a post anesthesia and recovery room. The clinic’s workforce treats some 4,700 inpatients and performs 4,000 surgical procedures every year. In addition, its doctors see 10,000 outpatients, providing nearly 30,000 consultations. The university otolaryngology clinic is also an academic teaching and research facility of Eberhard-Karls-Universität Tübingen.

“Every patient deserves the best possible treatment,” notes the senior physician and assistant medical director at the otolaryngology clinic, Dr. Paul-Stefan Mauz M.D. This requires excellent equipment, advanced methods, and the best-trained and dedicated personnel of the sort Tübingen otolaryngology clinic offers its patients today. “Nonetheless,” adds Dr. Mauz, “we must drive on with the rationalization measures we have already applied in other areas of the hospital. To this end, we can learn from other industries: We are striving to apply the flow principle proven in industrial manufacturing to the hospital’s organization. That is, we’re removing bottlenecks, avoiding duplication of work, shortening distances, and creating logistically coordinated processes. This has nothing to do with cheap medicine. It is how we are improving the quality of our efforts, ultimately to the patient’s benefit!”

Teaming up with clinic staff, we selected one example surgical procedure as our object of investigation - the elective tonsillectomy*. We are auditing the entire workflow, including associated patient management processes. In a joint effort with the administrative workforce, nursing staff, and doctors, we are assessing the tasks and processes of admission, diagnosis, therapy, care, and discharge, benchmarking them, and aligning each cost factor with its source. Even at this early stage, a comparison with diagnosis-related groups (DRG) – that is, the lump-sum price given for major procedure categories - will show if the specific case is over- or under-funded. Then we will analyze and optimize individual steps of the workflow

Dr. Mauz notes, “On the path through the clinic, the patient comes into contact with many interfaces that so far have received little attention.”

A clinical pathway developed especially for the surgical procedure of an elective tonsillectomy provides the template for the indication and treatment process. The goal is to ensure the DRG lump-sum covers the costs of treating the patient and, if possible, leaves some surplus to fund future investments. Dr. Mauz notes, “As a full-service healthcare provider, we have no strategic leeway for decisions on whether we must continue to offer certain medical treatments or may strike them from the list of services. Lacking this freedom of choice, improving the processes practiced so far is our top priority.”

We expect this project to yield concrete results by the end of June.

Andreas Bahr, Agamus Consult

  *Chronically or frequently afflicted palatine tonsils are a constant source of infection that weakens the body or may cause other diseases. Barring acute tonsillitis, these tonsils may be removed in a scheduled surgical procedure called an elective tonsillectomy. The hospital stay is five to seven days. Despite every precaution in surgery, the patient may experience secondary bleeding upon discharge from the hospital, prompting a renewed consultation at the clinic.