Massachusetts General Hospita Case

Massachusetts General Hospital is one of the largest hospitals in the United States and one of the main hospitals serving the greater Boston area in the North East. They are a world-renowned care and research center with numerous Nobel Prize winners on staff and one of the most heavily praised cardiac units in the world. Recently due to changes in the health care insurance sector Mass. General's operating costs have skyrocketed, forcing them to devise a solution to lower costs overall.

Dr. David Torchiana and Dr. Richard Bohmer were faced with the issue of reducing costs by lowering the length of time patients spent in the hospital during a coronary artery bypass graft or CABG via a care path method. The care path method is based off of the management principle known as the critical path, which project managers use to find and identify the shortest path of time between point a and point b, typically start to finish. Dr. Torchiana and Dr. Bohmer were attempting to find the critical path between when a patient checks in for pre surgery and when they are discharged.

A committee was formed to identify where extra costs were coming from and they were able to derive that patients were receiving more tests, attention, procedures and medication than necessary. Thus, the goal of Mass. General care path method was to standardize the CABG procedures as much as possible in order to lower the length of time a patient spends in the hospital and remove any waste that was associated with the overall procedure, such as unnecessary testing. With this care path Mass. General also hoped to increase the quality of care without sacrificing the patients experience.

The care path process aimed to increase standardization to move patients through the procedure at a quicker pace, which would in turn reduce costs. This system however had some potential challenges ahead of it. For one, it had to get physicians to shift from their typical case-by-case way of approaching tasks to a more standardized path. It also requires more communication and coordination between departments and staff. To address these potential issues Mass. General implemented a care path manager, who would be responsible for overseeing where patients are in the path and identify any issues or bottlenecks. Furthermore they also changed the way patient charts were handled, they morphed into a charting by exception approach where nurses and other staff would check off procedures in a systematic manner and would only take further notes if there was a special case or complications. This patient chart change would help everyone see where the patient was on the path and would significantly reduce the amount of time devoted to charting.

Luckily for Mass. General, a care unit within the hospital had already attempted to introduce a critical path method. The knee replacement care unit had a doctor define and implement a care path with his patients and was able to reduce costs and the length of time spent in the hospital by 30%, this led to other physicians

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