This book is dedicated to improving healthcare through reducing
delays experienced by patients. With an interdisciplinary approach,
this new edition, divided into five sections, begins by examining
healthcare as an integrated system. Chapter 1 provides a
hierarchical model of healthcare, rising from departments, to
centers, regions and the "macro system." A new chapter demonstrates
how to use simulation to assess the interaction of system
components to achieve performance goals, and Chapter 3 provides
hands-on methods for developing process models to identify and
remove bottlenecks, and for developing facility plans.
Section 2 addresses crowding and the consequences of delay. Two
new chapters (4 and 5) focus on delays in emergency departments,
and Chapter 6 then examines medical outcomes that result from waits
for surgeries. Section 3 concentrates on management of demand.
Chapter 7 presents breakthrough strategies that use real-time
monitoring systems for continuous improvement. Chapter 8 looks at
the patient appointment system, particularly through the approach
of advanced access. Chapter 9 concentrates on managing waiting
lists for surgeries, and Chapter 10 examines triage outside of
emergency departments, with a focus on allied health programs
Section 4 offers analytical tools and models to support analysis
of patient flows. Chapter 11 offers techniques for scheduling staff
to match patterns in patient demand. Chapter 12 surveys the
literature on simulation modeling, which is widely used for both
healthcare design and process improvement. Chapter 13 is new and
demonstrates the use of process mapping to represent a complex
regional trauma system. Chapter 14 provides methods for forecasting
demand for healthcare on a region-wide basis. Chapter 15 presents
queueing theory as a method for modeling waits in healthcare, and
Chapter 16 focuses on rapid delivery of medication in the event of
a catastrophic event.
Section 5 focuses on achieving change. Chapter 17 provides a
diagnostic for assessing the state of a hospital and using the
state assessment to select improvement strategies. Chapter 18
demonstrates the importance of optimizing care as patients
transition from one care setting to the next. Chapter 19 is new and
shows how to implement programs that improve patient satisfaction
while also improving flow. Chapter 20 illustrates how to evaluate
the overall portfolio of patient diagnostic groups to guide system
changes, and Chapter 21 provides project management tools to guide
the execution of patient flow projects.
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