LIUC Corso di Gestione della Produzione e della Logistica.
Docente : Prof. Claudio Sella
Un caso di gestione delle operazioni in un centro ospedaliero
Suppose you are 5 years old again and you’re very sick or badly injured. Your mother rushes you to the hospital and now you’re
scared. Meeting the healthcare needs of children and their families is no small challenge.
Christine Johns is Paediatric centre of excellence executive for the Alexian Brothers hospital network. She’s a leader in the effort to
try to create a hospital in a hospital at St. Alexius medical centre. By redesigning faculties and processes to improve the service,
treatment and effectiveness of care for children and their families.
Christine Johns- Executive Director, Paediatric Center of Excellence
“Its very important to treat children and adults differently we like to have unique paediatric areas at our faculties. At both the acute
care hospitals we have a separate paediatric unit, we also have a separate paedritic emergency area which is called EmergiKids at
St. Alexius. And we also have a separate paediatric intensive care unit, where the children are separate of course, from the adults.”
Katie Hammerberg, Certified Child Life Specialist
“Being on a paediatric unit we have to think small, things need to be at the level of a child. So when we designed the playroom we
wanted to be able to have sinks that are small enough that the kids can wash their hands without having to get on a step -stool or
chairs; make it safe for them. The designs of the shelves and cupboards are at the level of a child so that that can reach a toy or a
game safety. The decorations are important, we want it to be soothing and inviting, not scary and sterile looking.”
Special care is taken to design to design the look and feel of the rooms to lower the child’s anxiety level. St. Alexius even has a
child specialist on staff to help co-ordinate everything from facility layout to staff development. This progressive approach is part of
a holistic healthcare philosophy that is fostered by the Alexian brothers. The Alexian brothers are a 700-year-old catholic order
devoted to the care of the sick, the poor, the elderly and the neglected. They are planning an ambitious $352million investment in
the physical restructuring of the exiting hospital campuses to create the finest healthcare network in the region. In order to deliver
the finest healthcare with the best quality treatment and service, they will need the best operations management. The Alexian
brothers first examined the healthcare needs of the community and did a competitive analysis. Downtown Chicago teaching
hospitals have excellent reputations, but commuting into the city is often difficult for families. Smaller suburban hospitals generally
lack subspecialties like neurology, rehabilitation paediatric oncology, and a cardiac catheter lab. This analysis led Alexian brothers
hospital network to create 8 centres of excellence. To ensure that the community would have access to the latest medical, surgical
and diagnostic advances close to home. Paediatrics is considered a most important centre, because it’s often the gateway for
families as they establish a relationship with the hospital. An operating plan was developed for paediatrics. They analysed the
current procedures and visited other new hospitals to see the latest designs in use.
Gerardo Reyes, M.D.- medical director of paediatric I.C.U
“What we found out, is that patients, of course would rather have private rooms, we found out that expanding the admission and
discharge procedures was very important, when a sick patient arrives in the hospital it is very important that they get admitted to the
floor or bed as soon as possible. And when the patients ready to be discharged home we found that accommodating those needs
was very important. Not only, the patient wants to go home, the family wants to go home, but it also frees up the bed they are
leaving early in the day for the next patient. This is especially important during the winter when we have a fair amount of paediatric
patients that are admitted everyday. It is very important to maintain the flow of patients, going very smoothly and efficiently.”
New facility designs emerged from this through analysis. The new paediatric floor will include an upgrade from semi-private, to
private rooms, which enables better infection control and better privacy, especially when parents spend the night with their child.
The paediatrics floor will again feature a circular layout, which gives a clear view of all rooms from the nursing station. It also makes
for easier communication between staffers. But the circular layout is a bit loud so noise control features are being considered. A
medication room will be added so nurses can prepare medications away from the distractions surrounding the nursing station and
minimise the potential for error. Infection control supplies currently stared on a cart outside each room, along with safety and
emergency supplies will be stated in wall cabinets alongside each patient room. The design of the new paediatric emergency
department will also have separate exam rooms and advanced viewing for future electronic equipment and wireless technology. A
new central monitoring system will show vital sign for all patients in one control room, thus reducing the need for frequent nurse
visits to check patient vital sign monitors. A separate paediatric triage or check-in area is also in the plans, this will provide children
more security and protection from potential dangers. Each department is equipped with a special paediatric crash cart.
Lisa Potts, R.N –Assistant Director of Paediatric ICU
“This is the crash cart; it is used for an emergent need for resuscitation. It is stocked with paediatric supplies and the draws are
labelled accordingly. The computer on tap measures vital signs during the emergency and the cart is kept locked at all times we
open the cart during emergencies and within an within an have after the emergency the cart is restocked by the nurse and then
relocked with the nurse and the pharmacist. Hospitals must face the challenge of matching current and future patient needs with
new equipment and to implement new procedures is a whole other challenge. Monthly unit meetings include training on the newes t
techniques.”
‘”This is the central monitor, it allows us to see all the vital signs of the patients in the ICU rooms”.
The new facility will use more advanced systems to monitor vital signs. Many staffers will need to be trained to use this imp ortant
new technology. Before the new monitors are put into critical situations.
Emi Datuin-Pal, R.N- Paediatric Clinical Educator
“We work as a team in the education department, so what actually happens is we attend.............. ourselves then we in turn will be
updating the staff with the new monitors that are coming. I think we’re going to do it house wide and we’re planning to choose a
date like a month before when the monitors come out and do it hands on.”
Charles Nozicka. D.O- Medical Director of Paediatric Emergency Services
“One of the things that we are also excited about with the build out in the new facilities in the development in bringing in more
sophisticated monitoring equipment in the paediatric emergency department. There are two phases to that. There’s increasing
better monitoring for the patient at the bed side which includes bed side monitoring for oxygen and even Co2 monitoring, heart
monitors. The other things that we’re also excited is a patient tracking system, that we’re going to be developing or actually not so
much developing but we are going to be purchasing in the next several years. It’s a patient tracking system in that, the patient, as
soon as they arrive in the paediatric emergency department. From the time they register, when they go to the x-ray, when that have
different testing done they will be monitored electronically and each provider will, almost like swiping a key card when they have a
patient encounter will know exactly where the patient is within the department we’ll be able to study how efficient we’re treating the
patient, we’ll be able to follow them from the time they enter the door of the emergency department to the time that they leave the
paediatric emergency department. So we are very excited about that. It will make us much more effective processes with the
patient and it really is the model for the emergency department of the future.”
There’s a long list of quality improvements, that have been or will be implement and in some cases quality is critical to the survival
of patients. Computer technology is driving many qualities improvements. St Alexius uses the Meditech and Pyxis computer
systems for checking patient records and for prescribing and administrating drugs. This reduces paperwork and minimises the room
for error.
Laurie Miller R.N- Assistant Director of Paediatric Services
“This is our mobile Meditech computer system. We usually bring these in when we have an admission to take care of on the floor.
We ask the patient or the family history questions. We also do our physical assessment as we’re examining the patient we enter the
data in here so that its right up to date, up to the minute. Then we can also take them into the rooms for shift assessments and
enter the data as we examine the patient in between shifts. Before we had the mobile computer system we had to ask the patients
all the questions and document everything on paper and then go out to the stationary terminals and enter it manually from out
there. So it was like double the work: you come in here and ask the questions then go and enter it into the computer system. These
are a lot more time efficient.”
The Pyxis system controls the distribution of patients. Doctors hand written prescriptions are scanned and sent to the pharmacy
department where they are entered into the Pyxis system and profiled: or checked for dangerous drug interactions, the Pyxis
control the dispensing of the drug by the hospital staff via computer controlled draws at the nursing stations.
Dauca Nay: R.N nurse of paediatric services
“To get the medications of cut of the Pyxis, first of all I would obtain the patients M.A.R; which is a sheet telling me what
medications the patient needs to be taking. Then I’d come over here to the Pyxis machine, where I can just push the scan with my
finger and type my initials, then we have a high-tech system where it actually reads my finger print, to make sure the right nurse is
taking out the appropriate medications. I select my patient; it has a list of all my patients’ medications right now. I pick the
appropriate medication according to my sheet. Unisen: and I just want one of those. I hit one; remove now and the drawer will
open up. It tells me that this is the appropriate drawer and I will have to look into pocket 10 and pull out the medication. And once
again I’m going to check and see that I’m pulling out the appropriate vial. That the correct one; and I shut the drawer and I need to
exit myself out so that no other nurse can get in there right now.”
Prior to installing Pyxis medications would sometimes be shared among patients. This was more convenient for nurses
administrating the medications. But, it was venerable to mix up and inaccurate for billing records. A variety of quality measures are
regularly tracked like infection rates and security breaches. Patients are surveyed to measure satisfaction. Paediatrics generally
leads all other departments in the hospital in patient satisfaction. Once the basic design was in place, capacity management
decisions were needed. Hospital planning specialists assisted with democratic studies and analysis to estimate patient demand.
Rick Hustedler- Corporate Director of facility Development
“We generally planned capacities based on the volumes of the various clinical areas. If volumes are growing in an area such as out
patient then we certainly design facilities to create efficiencies, flows and processes in that area. That when we are doing now, we’d
like to go to a more medical mall approach where we get most of our out patients to come through that medical mall entrance, and
then can easily go through pharmacy and the various areas of service that they require. I think the tendency is to get away from
inpatient beds as much, towards shorter lengths of stay and higher tech driver services that get people home much quicker, and get
them well quicker.”
Some factors just can’t be predicted. Scheduling staff for the 3 paediatrics areas at St. Alexius is not an exact science.
Christine Johns- Executive Director, Paediatric Center of Excellence
“The paediatric intensive care unit has of course a much higher acuity of patients. So they are usually stopped one nurse per two
patients, sometimes even one nurse per one patient. On the paediatric floor it depends again on their acuity, but usually, its about
one nurse per four patients. And a change nurse who doesn’t take any patients or takes a few patients, when we look at the
EmergiKids area we look at traditionally how many children, how many visits we’ve had in the E.R and then gage our staff by that.
It’s hard to predict how many children you’re going to get in a night. Sometimes its 20, sometime its 50 so that’s the challenge
there.”
It will take some time to measure the effects of the improvements at Alexian brothers hospital network and in Paediatric at St
Alexius. Yes its clear that competitive advantages have been gained. Well-trained paediatricians are always on site and physicians
with 60 paediatric sub specialists are on staff.
Charles Nozicka. D.O- Medical Director of Paediatric Emergency Services
“The physicians that are on staff, staffing our paediatric emergency section, are paediatricians who are either double boarded in
emergency medicine and paediatrics, or they are paediatrics that have paediatric emergency fellowship, which is an additional 3
years of training after becoming a paediatrician. These are physicians who dedicate their entire professional careers to just the
treatment of the acutely ill and injured child. They take care of paediatric emergencies only. They don’t have office practic es, they
are not general predications so its a very high level of care and its a very deep commitment to caring for injured children.”
Efficient operations are as important in the hospital as they are in any business you can imagine. And the operations must be
customised within each department and run like a hospital within a hospital from process analysis to facility design, to quality
management. Modern hospital operations techniques are vital to the health of a community. Now suppose you are 5 years old
again and you’re feeling better and you’re so comfortable in the hospital that you don’t want to leave.