In medical situations, people typically look to doctors and nurses — not a business professor who studies process management and improvement.
But it turns out that Luv Sharma’s experience and expertise were the perfect combination for creating an intervention for kidney transplant patients at a major U.S. hospital. The key goals of the project were to create a self-improving and sustainable process that would improve outcomes for the patients.
“We not only successfully redesigned the patient education process, but the redesigned process also showed a reduction in readmissions and improvement in patient satisfaction for the treatment group,” says Sharma, an associate professor of management science in the Darla Moore School of Business. “Further, we demonstrated sustainment of this modified process over time.”
Before their intervention began, Sharma’s team looked at kidney transplants over a four-year period (2001-05) and found that almost a third of transplant recipients returned to the hospital because of post-surgical complications.
The kidney is the most transplanted organ in the U.S. with more than 20,000 transplants each year, according to the National Kidney Foundation. It’s also the organ with the longest transplant waiting list of more than 100,000 potential recipients.
To reach more of those on the waiting list, transplant teams are more aggressively using less-healthy organs and accepting more complicated transplant cases. At the same time, there is a push to reduce the length of hospital stays following surgery. These factors add to the importance of strict adherence to post-surgical self-care such as taking medication properly, follow-up physician visits, changing unhealthy diets and preventing infection.
“This process requires high patient-caregiver interaction and active patient participation, thus presenting greater potential for variability, uncertainty and complexity,” Sharma says. “Lapses in following instructions can result in added complications leading to readmissions, emergency visits and loss of life.
“Such settings require a process that combines standardization with the ability to adapt certain features based on the patient needs and preferences.”
The final piece of the research focused on creating a system where the caregivers could evaluate the processes over time and make adjustments as needed — what Sharma calls organizational learning. Sharma’s team identified the areas where the process they created could face challenges such as when outcomes stop improving or get worse. The process improvement outline calls on the organization to use input and feedback from frontline workers and patients to redesign the system as needed.
Sharma says the process could easily be used for other post-surgical scenarios.
“A large percentage of hospital readmissions in complex surgeries that require lengthy recovery periods and/or changes to lifestyles are due to patient anxiety or failure to adhere to instructions for post-surgical care,” he says. “Improving a patient’s understanding of these discharge instructions through process redesign should impact readmissions. The kidney transplant project outlines the approach that can be used to make such process changes and ensure that such changes can be sustained over time.”