From 'solution shop' model to 'focused factory' in hospital surgery: increasing care value and predictability

David Cook, Jeffrey E. Thompson, Elizabeth B Habermann, Sue L. Visscher, Joseph A. Dearani, Veronique Lee Roger, Bijan J Borah

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

The full-service US hospital has been described organizationally as a "solution shop," in which medical problems are assumed to be unstructured and to require expert physicians to determine each course of care. If universally applied, this model contributes to unwarranted variation in care, which leads to lower quality and higher costs. We purposely disrupted the adult cardiac surgical practice that we led at Mayo Clinic, in Rochester, Minnesota, by creating a "focused factory" model (characterized by a uniform approach to delivering a limited set of high-quality products) within the practice's solution shop. Key elements of implementing the new model were mapping the care process, segmenting the patient population, using information technology to communicate clearly defined expectations, and empowering nonphysician providers at the bedside. Using a set of criteria, we determined that the focused-factory model was appropriate for 67 percent of cardiac surgical patients. We found that implementation of the model reduced resource use, length-of-stay, and cost. Variation was markedly reduced, and outcomes were improved. Assigning patients to different care models increases care value and the predictability of care process, outcomes, and costs while preserving (in a lesser clinical footprint) the strengths of the solution shop. We conclude that creating a focused-factory model within a solution shop, by applying industrial engineering principles and health information technology tools and changing the model of work, is very effective in both improving quality and reducing costs.

Original languageEnglish (US)
Pages (from-to)746-755
Number of pages10
JournalHealth Affairs
Volume33
Issue number5
DOIs
StatePublished - May 1 2014

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Costs and Cost Analysis
Medical Informatics
Length of Stay
Technology
Physicians
Population

Keywords

  • Cost of Health Care
  • Health Economics
  • Information Technology
  • Organization and Delivery of Care
  • Quality Of Care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

From 'solution shop' model to 'focused factory' in hospital surgery : increasing care value and predictability. / Cook, David; Thompson, Jeffrey E.; Habermann, Elizabeth B; Visscher, Sue L.; Dearani, Joseph A.; Roger, Veronique Lee; Borah, Bijan J.

In: Health Affairs, Vol. 33, No. 5, 01.05.2014, p. 746-755.

Research output: Contribution to journalArticle

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