Task Overlap Among Primary Care Team Members: An Opportunity for System Redesign? Richard G. Best, Sylvia J. Hysong, Jacqueline A. Pugh, Suvro Ghosh, and Frank I. Moore
This article presents the results of research on a systematic approach to the assignment of primary care work in the Veterans Health Administration. Based on a functional job analysis protocol, the study identified overlap in the performance of primary care tasks among multiple occupational groups as prima facie evidence of opportunities to reallocate work responsibilities. Results show that registered nurses, physicians, advanced practitioners, and licensed vocational nurses reported performing 60 percent to 97 percent of the same tasks, while clerks and health technicians appeared to be underutilized. The frequency and duration with which occupational groups performed each task were also examined, providing additional evidence to be used in improving clinic efficiency.
The management of healthcare personnel can be improved through systematic analysis of the work, the worker, and the work organization and more informed decisions about the appropriateness of task assignment (or reassignment). This article presents an evidence-based approach to personnel management with important implications for clinic efficiency. The approach can be used to guide strategic planning and staffing decisions by identifying not only who currently does the work but, more importantly, who should be doing the work given the full array of data.
Managing Variation in Demand: Lessons from the UK National Health Service, Paul Walley, Kate Silvester, and Richard Steyn
Managers within the U.S. healthcare system are becoming more aware of the impact of variation in demand on healthcare processes. The UK National Health Service provides a prime example of the consequences when the issue is not dealt with satisfactorily, because it has suffered from excessive queues for a prolonged period. These delays are mostly caused by a lack of attention to variation and inappropriate responses to the queues, rather than a capacity shortage.
A number of collaborative programs recently have come to grips with many of the causes of the queues in both elective and emergency care. Although there are still areas that need large-scale improvement, some good progress has been made, especially within emergency care. The authors of this article have acted as technical advisors to a number of the improvement programs and have been able to document many of the practices that have helped to reduce or eliminate unnecessary queues and delays across the 200 sites in England that have 24-hour emergency care facilities. Local program managers at these sites continuously reported progress for a period of 18 months. There are a number of important lessons for both the design and control of healthcare processes that have emerged from the collaborative work. These lessons focus on the understanding and measurement of demand, capacity planning, the reduction of introduced variation, the segmentation and streaming of work, process design, capacity yield management, and measurement of variation.
The Roles of Senior Management in Improving Hospital Experiences for Frail Older Adults, Elizabeth H. Bradley, Tashonna R. Webster, Mark Schlesinger, Dorothy Baker, and Sharon K. Inouye
With the aging of the population, healthcare executives are paying increased attention to fostering safe and high-quality care for older adults who become hospitalized. The Hospital Elder Life Program (HELP) is an evidence-based program that has been shown to be cost-effective in reducing episodes of delirium, functional decline, and long-term nursing home placement for older hospitalized adults. Senior administrators are known to play a role in quality improvement, but little is known about their roles in adopting clinical improvement programs such as HELP. Therefore, we conducted a mixed-methods study of 63 hospitals at different stages of adopting HELP to identify key roles and motivations of senior management to adopt HELP and the perceived impact of HELP on patient and staff outcomes. Our findings can be used by hospital management teams as they identify ways to influence and benefit from efforts to improve clinical quality, safety, and the experiences of older adults treated in their hospitals.