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Table of Contents
Intro
Foreword I
Foreword II
Preface
Part I
Part II
Part III
Part IV
Summary
Acknowledgments
Contents
List of Contributors
1: Introduction to the New Science of Medicine
Difficulty Involving Physicians in Health Care Performance Improvements
Quality as Ambiguous Versus the Value Revolution in Health Care
The Importance of Training Physicians in Management
The Science of Medicine and Management
The Clinical Side of Medical Organizations Are Led by Medical Practitioners Trained in the Bio-Medical Sciences
Impact of Physician Leadership on Health Care Performance
The Difficult Transition from Clinical Staff Member to Clinical Manager
The Early Frontiers of Medicine and Management
Organizational Learning and the Case of Minimally Invasive Cardiac Surgery
Lesson
Explaining Variations in Risk-Standardized Mortality
Lesson
In-Hospital Cardiac Arrest
Lesson
Adoption of LEAN Management Is Not Implementation
Lesson
Managing for Medical Results at Intermountain Healthcare: Putting Medicine and Management Science to Work
A Few More Lessons about Medicine and Management
The Way Forward
References
Part I: The Well-Managed Health Care Organization: Building Implementation into Strategic Thinking
2: Shouldice Hospital from Interviews and Observations: The Well Managed Organization
Introduction: The Well-Managed Health Care Organization
Literature Review
The First Stream: The Evolution of Hernia Surgery & the Search for an Optimal Hernia Repair
The Second Stream: Comparing Shouldice with Other Techniques
The Third Stream: Focused Factories and Well-Managed Organizations
Research Methodology
The Current Hernia Repair Landscape: How Attractive Is this Service Line?
Shouldice Hospital: Analysis from Interviews and Observations
History: The Early Years of Shouldice
The Care Program: A Vision that Reconstructed the Boundaries for Hernia Surgery
Anesthesia and Conscious Sedation
Post-Operative Care: Immediate and Continuous Ambulation
Hyper-Focused Clinic and a Very High Volume of Cases
The Front Stage and the Key Clinical Activities
An Admission in Two Visits: Pre-Admission and Investigation
Day One: Admission and Investigation Prior to Surgery
Day Two: Surgery and Therapy
Days Three and Four: Post-Surgery Recovery, Follow-Up, and Discharge
Patient Echoes and Frontstage Voices: The Patient Value Proposition
The Back Stage at Shouldice
Targeted Patient Segments
Shouldice Service Concept
Operating Strategy: Focused on Productive Efficiency and Quality
The Method and the Operating Rooms: Focused on Quality and Efficiency
A System and Culture of Patient-Centered Accountability
Well-Designed Service Delivery System
Organization Structure and People Management
People and Job Design
Foreword I
Foreword II
Preface
Part I
Part II
Part III
Part IV
Summary
Acknowledgments
Contents
List of Contributors
1: Introduction to the New Science of Medicine
Difficulty Involving Physicians in Health Care Performance Improvements
Quality as Ambiguous Versus the Value Revolution in Health Care
The Importance of Training Physicians in Management
The Science of Medicine and Management
The Clinical Side of Medical Organizations Are Led by Medical Practitioners Trained in the Bio-Medical Sciences
Impact of Physician Leadership on Health Care Performance
The Difficult Transition from Clinical Staff Member to Clinical Manager
The Early Frontiers of Medicine and Management
Organizational Learning and the Case of Minimally Invasive Cardiac Surgery
Lesson
Explaining Variations in Risk-Standardized Mortality
Lesson
In-Hospital Cardiac Arrest
Lesson
Adoption of LEAN Management Is Not Implementation
Lesson
Managing for Medical Results at Intermountain Healthcare: Putting Medicine and Management Science to Work
A Few More Lessons about Medicine and Management
The Way Forward
References
Part I: The Well-Managed Health Care Organization: Building Implementation into Strategic Thinking
2: Shouldice Hospital from Interviews and Observations: The Well Managed Organization
Introduction: The Well-Managed Health Care Organization
Literature Review
The First Stream: The Evolution of Hernia Surgery & the Search for an Optimal Hernia Repair
The Second Stream: Comparing Shouldice with Other Techniques
The Third Stream: Focused Factories and Well-Managed Organizations
Research Methodology
The Current Hernia Repair Landscape: How Attractive Is this Service Line?
Shouldice Hospital: Analysis from Interviews and Observations
History: The Early Years of Shouldice
The Care Program: A Vision that Reconstructed the Boundaries for Hernia Surgery
Anesthesia and Conscious Sedation
Post-Operative Care: Immediate and Continuous Ambulation
Hyper-Focused Clinic and a Very High Volume of Cases
The Front Stage and the Key Clinical Activities
An Admission in Two Visits: Pre-Admission and Investigation
Day One: Admission and Investigation Prior to Surgery
Day Two: Surgery and Therapy
Days Three and Four: Post-Surgery Recovery, Follow-Up, and Discharge
Patient Echoes and Frontstage Voices: The Patient Value Proposition
The Back Stage at Shouldice
Targeted Patient Segments
Shouldice Service Concept
Operating Strategy: Focused on Productive Efficiency and Quality
The Method and the Operating Rooms: Focused on Quality and Efficiency
A System and Culture of Patient-Centered Accountability
Well-Designed Service Delivery System
Organization Structure and People Management
People and Job Design