IMPROVING HEALTH-CARE .2. A CLINICAL IMPROVEMENT WORKSHEET AND USERS MANUAL

Background: Small tests of change can be conducted in everyday clinica l practice, thereby turning the health care delivery team into reflect ive practitioners who can learn from, and improve on, their work. Clin ical Improvement Worksheet and Users' Manual-Case Study: The worksheet has been designed as a simple tool for applying clinical improvement to the core clinical delivery process. A carpal tunnel surgery (CTS) t eam was formed to improve outcomes and reduce costs for patients and t o promote improvements in quality and value. The Team wanted to determ ine if surgical patients treated with local anesthesia in an ambulator y setting have superior satisfaction with care, comparable clinical an d functional outcomes, and lower medical (and social) costs. For the f irst time, standardized assessments of patient case mix, treatment pro cesses, and health outcomes were designed into the delivery process by gathering data from the patient and from the surgeon presurgery and 4 weeks and 12 weeks postsurgery. Results for the first 49 of 50 to 100 consecutive patients show improved outcomes and reductions in costs, from $937 to $405 per patient. Lessons learned: Even though CTS was se lected to be a quick and noncontroversial opportunity, considerable ef fort had to be expended to ensure that all clinicians and other affect ed staff would understand and support ''the new way.'' Recommendations : ''Ramp up'' improvements-as time passes, more and more change trials are conducted and their complexity increases. To ease implementation of changes, teams can diagram core process ''components'' and attach m easures, use flowcharts to plan and monitor implementation, and use ch ange management thinking to help sharpen the plan and anticipate probl ems.