Care Plans, standard work for healthcare

Hi Lean Nation;

The subject of the blog this week is care plans. We must begin with the definition of a care plan. There are other terms floating around as well including pathways and care maps. An attempt at a reasonable definition of care planning would be a road map, to guide all who are involved with a patients care.

The purpose of the care plan is to provide evidence based, comprehensive, inter disciplinary care. Using my lean hat, a care plan provides standard work for assessment, treatment, diagnostics, education, and discharge activities. The road map prevents critical and timely activities from being missed in the care, or unnecessary, extra steps being added into the care.

To build an effective care plan, I suggest the following process be followed;
1) Identify Goals for the Care map that benefit the patient, the staff, and the organization(s)
2) Research the latest evidence for the diagnosis (search all sources and the Internet is full of material)
3)Have an interdisciplinary team identify the outcomes for the pathway
4)Determine the content necessary to achieve the outcomes
5)Create the timeline for execution from initial assessment to discharge (I find swim lanes helpful here either by discipline or by body system)
6)Create a format for the care plan
7)Convert the draft to an electronic format
8)Run mock simulations to clarify content and identify excessive questions or gaps in the care
9)Gather feedback from experts (Professional Practice, other team members, IP&C, health records, legal, etc.
10)Make a final edit
11)Trial the plans on a controlled group of patients
12)Validate their effectiveness
13)Spread the plans

Some helpful hints for the process include:
1) Physician lead pathways are best. Without physician buy-in these plans go no where.
2) Have representation from the entire interdisciplinary team
3) Create a work flow once the plan is created to make the tool operational.
4) Think collaboration and interprofessionally. Try to build the plan as a team, not as a collection of individual disciplines.
5) Build in room for variation and plan deviation. Not every patient is the same.
6) Create a process to update the plans periodically. The evidence does change.

Remember, the ultimate purpose of the care plan is to create a standard approach to who are involved in the care of the patient to provide the appropriate treatment, at the right time, in order to ensure the optimal outcome for those curable, or to slow down or stop symptoms on a chronic patient.

Lean Blessings,

Ron

Ron Bercaw
www.breakthroughhorizons.com