California's restrictions on ownership of medical practices and systems allow the medical foundation model for "greater alignment and shared efficiencies," Manker says. The MemorialCare Health System also includes the Long Beach Memorial Medical Center, Miller Children's Hospital, and the Saddleback Memorial Medical Centers in Laguna Hills and San Clemente.
As hospital officials evaluated changes in care, orthopedics was identified as an appropriate service line for Lean approaches due to the complexity of patient flow, as well as the high cost and significant volume, whether it was hip, knee, bilateral, or other focus, says Pamela Chevreaux, vice president, ambulatory services, for the Long Beach Memorial Medical Center.
Moreover, while there was a dedicated staff for orthopedic surgery, it was not specifically for joint replacement, Chevreaux says.
A major change involved revising focus to patient-centered care, says Douglas Garland, MD, medical director of the MemorialCare Joint Replacement Center and co-chair of the orthopedics, neuroscience and rehabilitation units at Long Beach Memorial Medical Center. The hospital system's previous approach was not considered patient-centered, and the care team was not united under a common philosophy of care, says Garland. As a result, it lacked focus and effort on defined outcomes. For instance, post-operative goals, he says, were considered "clinician-centric, not patient-centric."
Making a swath of changes, including implementing a Lean system, Chevreaux says they were able to improve procedures for patients prior to surgery by expanding education programs, streamline patient interactions, while establishing a family and patient selected "coach" used throughout the process. Patients also were assigned a joint center coordinator to review their procedures.
Developing a total joint center, says Garland, "is not as easy as you think. It's very difficult. First you have to have identifiable goals and you have to select the proper leaders."
As far as Garland is concerned, partnership with orthopedic surgeons became a key element in the overall changes, beginning with sharing data. Changes within the system resulted in direct improvement in patient care, he says.