Wexner Medical Center

When organizations discuss ways they can improve internal processes, much of their initial focus centers on revamping existing protocols. 

While short-term results of these changes can lead to positive results, the true measure of success is whether the new processes yield positives in the long term and whether these improvements can be replicated and sustained over time. 

A new paper from Professor of Operations Aravind Chandrasekaran and his colleagues Gopesh Anand and Luv Sharma, illustrates that both objectives of process improvement (PI) are attainable. Their findings were recently published by the Journal of Operations Management. 

The study 

As part of an ongoing examination of how better processes can lead to the delivery of better health care, Chandrasekaran and his colleagues helped redesign and then studied The Ohio State University Wexner Medical Center’s process for educating kidney transplant patients on instructions for post-surgical care. The complexity of the surgery, along with the greater potential for variability and uncertainty, was a determining factor in evaluating what medical procedure to redesign and study, Chandrasekaran said. 

From 2013-2016, the research team worked with 32 caregivers, including frontline care providers such as nurses, physicians and social workers, as well as support staff and administrators to revamp the hospital’s post-surgical care procedures. 

“Our research team focused on understanding how patients are discharged after life-altering surgeries such as transplants,” Chandrasekaran said. “We found that there are several important elements of care, including how to take the right medications, signs and symptoms of rejections, when to call the doctor, how to measure weight, etc. that must be followed after discharge. Our study found that variations exist when these instructions are delivered; these variations can affect compliance. Failure to adhere to these instructions can result in complications leading to unnecessary readmissions.” 

"We worked closely with the transplant unit team of physicians, nurses, social workers and IT specialists to design a discharge process that combines the principles of standardization while giving the opportunity to customize them to individual patient needs.”   

In all, the redesigned process was utilized in 702 transplant patients during the three-year study and included a control group. Using that data, the researchers assessed the impact of the redesign according to two industry standard measures of patient outcomes: 30-day readmission rates and patient satisfaction (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys. 

The results 

Data from the study revealed the following: 

  • the likelihood of 30-day readmission under the redesigned process was 0.25 times lower than the readmission rate of the control group, and 

  • the patient satisfaction scores were about 8 percent higher for the group with the redesigned process.  

But PI is more than just short-term fixes, Chandrasekaran said. Looking at the three-year data, the researchers saw evidence that the processes implemented in 2013 were still in use in 2016. 

“Four years after the redesign, we’re still seeing continuing evidence of the hospital sustaining PI in the form of daily problem solving through huddles,” Chandrasekaran said. “These huddles involve and engage frontline employees and middle management in maintaining the patient education process and lead to ideas that further improve this and other processes.” 

The importance of those redesigning, implementing and then sustaining these new processes, however, cannot be understated. 

“Trusting frontline employees and middle managers with these responsibilities and giving them a combination of direction and autonomy, in turn, increases their engagement — not only in executing day-to-day processes but also in systematically seeking further improvements to the processes," Chandrasekaran said. 

Aravind Chandrasekaran Professor of Operations, Associate Dean for Executive Education, Academic Director, MBOE
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