Care after Hours Program- Case Analysis

Care after Hours Program- Case Analysis

Due to the soaring trend in new sicknesses and economic constraints, redesigning future health services should be a necessity to reform health care sector (Center for American Progress and Institute on Medicine as a Profession, 2008). In this case, keys of reformation are new models of care and modern, sustainable ways of building efficiencies into health care processes. A ‘model care’ aims to guarantee people get the right care, at the right time, by the right team and in the right place. The health care providers include medical professionals, associates, other communities, accountants, support staff, craft, and trade workers (The World Health Report, 2006). Redesign the Health Service Delivery prepares health providers for the substantive provision of medical services in future to enhance health care quality. One of the most appropriate reformist programs is Care after Hours (CAH) Program. To ensure the effectiveness of CAH, there must be overseers such as the Director of Nursing and managers to deputise him. However, quality service delivery must be their core principles. As such, the provision of better health services is evident by the quality and availability of care to patients in time, as enforced by a well-organised work plan to guide clinicians. This case study dealt with the ‘care after hour program’ that is in its evolutionary pathway. The study discusses several practical and statemental studies that have been conducted to substantiate the purpose of the Care after-hours program.

Scope

The CAH Program was agreed as improving the model of care after hours to make care safer and to provide a safe, satisfying and sustainable working environment for clinicians who do the bulk work. The World Health Organization recommends that a doctor to patient ratio 1:1,000, and a nurse to patient ratio 1:483. The global profile shows a deficit of 4.3 million workers overall the World (Health workers: a global profile, 2006). Due to the uneven ration illustrated above, with increasing demands for healthcare services, clinicians are facing a challenge of bulk work. Junior doctors, nurses, and other staff worked long hours, up to 100 hours per week, or longer. Despite working within the scope of the profession, babies come to the hospital both day and night, seeking medical assistance (Taylor and Francis, n. d). uneven distributions of workloads between medical staffs and after-hours are too cumbersome on clinicians. Accordingly, problems of communication between nurses and doctors after hours, caused by work overload delays patient reviews.

Redesign Processes that were used in CAH

Safer Care after Hours- the program reached so many areas that a more generic label is appropriate.  The program is described as the Care after Hours (CAH) Program. The basic scope of work for CAH was agreed as “the organisation of all patient-care work after hours (6 p.m.–8 a.m.), from patient arrival through to discharge, with the focus on medical and surgical work in the adult medical-surgical wards (Taylor and Francis, n. d). There following are the redesign processes for the CAH.

• The demand for 24X7 care for each patient by medical staffs following the proportional admission of patients in the emergency department and medical-surgical wards has done in this case study, which depicts the necessity of care after-hour programs.
• CAH aims to promote medical professionalism by redesigning work pattern and practices to provide 100% 24X7 care for each patient, which lets them to self-track.
• CAH Governed group scheduled working and analysis based on the redesigning structures as planned, all the medical staff in different categories how they spent their duty hours per day. The results attained are, after hours, to a much greater extent than during the day, the nursing and medical staff lived in parallel universes, inefficiently linked by a paging system.
• The tracking also made it clear that for medical staff, the hospital at night was a different work environment from the hospital during the day.
• These analyses justify that the after-hours program is a new model of care. Following this program, the individual daytime medical teams merged into larger divisional groupings.
• The work divided between small teams of “front-of-house” staff in Emergency Departments and “back-of-house” staff working in the wards where most patients were trying to sleep. The “front-of-house” staff were up from small numbers of medical and surgical registrars and RMOs, operationally based in the hospital’s Emergency Department seeing new patients.
• The “back-of-house” staffs were medical and surgical interns and other more junior medical staff. They were responsible for the ongoing care required by medical and surgical patients inwards spread throughout the hospital. When interns had a problem, they could call for assistance from their seniors, but otherwise, each group got on with its work in a reasonably autonomous fashion.
• The tracking information was informative, but it needed a more discriminating inner structure if it was to serve as a basis for the focused redesign.
• Process Redesign work assessing case study revealed the need for a separate doctor and nursing work. It considers the doctor’s work in quite different ways to form function-related workstreams. It divides up the medical work into four discrete functions: new patients, ongoing care, patient +maintenance, and responding to instability.
• Each category serves with accurate and high-quality assessment through medical, health care and diagnostics. It also provides specialists’ consultation and opinion as to the patient’s health demands.
• The CAH program put forward the stream “maintenance work” for the utmost service of nurses, interns, and medical trainees by providing a mental and physically healthy environment.
• It supports the care progression and everyday care by the significant interventions in the task list for the maintenance workgroup generated by the rapid improvement event. Implement visual management to quickly identify the ward Shift Coordinator (Ged, 2012), develops rounding across areas/patients, formalises and support the role of Shift Coordinator as primary liaison with the doctor, visualises intern work make it visible to all on-ward team, and standardise ordering of diagnostics by accredited ward nurses were the significant interventions.
• Shift coordinator functions as an interface between the ward and the various people that come to award to provide a service to any one of the patients.
• Harvard University describes the interoperability of health information technology as a method of facilitation health information exchange (HIE). Integration, coordination across providers, and information and information technology are the central elements of care coordination. Widespread health information exchange can simultaneously reduce the annual health care spending to 80 billion $ annually (Jha, 2009).
• The Electronic Medical Task Board (EMTB) was a remarkable example of what a collaborative Process Redesign program can achieve concerning a more technically sophisticated intervention. The EMTB turned out to be a kind of “self-help” kanban that was rapidly accepted. Because it used generic programs that the hospital already had access to, there was no cost.

challenges and opportunities in the redesign process were managed

In this case, the primary challenge is bulky work experienced by clinicians. According to Taylor and Francis,  hospitals remain functional. Both days and nights, patients are moving to hospitals, seeking medical assistance. Such instances have become burdensome on clinicians since they have to provide medical services to these patients. The long-drawn duties of junior doctors, nurses, and other medical staff have imposed over their shoulders; it resulted in their loss of consecration.

However, various opportunities were used to endure that clinicians conform with such cumbersome clinical roles. For instance, there was a salary increment for medical personnel. Besides, managers persuaded nurses on the ground of their professional code of conduct. Nurses need to provide medical assistance to patients regardless of the time they access the hospital.

Summary of Outcomes

• After the CAH program, the percentage dropped from 60% to around 20%, and this was confirmed by an analysis of tasks posted on the after-hours task board.
• But CAH had been prompted by a concern over safety. The CAH program did not change the number of staff available after hours, the hypothesis being that work reorganisation would increase the time available for activities such as managing unstable patients.
• Reassuringly, as the overall activity increased, the percentage of people dying after hours decreased, but the decrease in deaths was a trend that was already established when the CAH Program began.
• Gross mortality is a complicated measure to change because many different factors will impact on the exact time of death in a hospital. However, the number of MET calls (calls from nurses to doctors to provide urgent assistance for a patient who has suddenly deteriorated) after hours fell as the CAH program progressed, indicating that the time-released for more systematic care was decreasing crises.
• CAH had been launched after an analysis of a series of hospital adverse events.
• Fortunately, severe hospital adverse events are relatively rare data, and confidentiality concerns related to linking the death to a time of day means that it is not possible to show the actual numbers involved.