Page 152 - Simplicity is Key in CRT

Figure 2. Lean Six Sigma methodology of Care Pathway development
Flow chart of care pathway development in a stepped approach. The different steps and processes involved in each individual step are indicated. Adapted from Tennant. 2001 [21].
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Results
1. Definition of the “Model care pathway”
Medical specialists and device technologists involved in CRT care from the three participating hospitals were involved in defining the model pathway. Participants had several meetings to discuss current guidelines [7, 13] and literature, and to compare with local experience in CRT care in order to benchmark the CRT care process. To enable an effective sharing and identification of differences in CRT care practices, expert consultants (Medtronic Integrated Health Solutions), on care pathway design and Lean Six Sigma methodology conducted an evaluation (observations, interviews and measurements) of the current practices in each hospital prior to the consensus meetings. Combining the evaluation of current practice and consensus benchmark CRT care resulted in a detailed “Model care pathway” (Chapter 8), including aides (checklists) to use in evaluating current local CRT care and implementation of the consensus CRT care pathway. This exercise required two face to face consensus meetings and 4 conference calls and was completed in 4 months. The preparation of this phase required 10 consulting days per hospital.
2. Translation into an ”Operational pathway” for the Maastricht University Medical Centre.
To customize the model care pathway into a locally applicable operational pathway, the expert consultants first conducted a more detailed evaluation of the baseline processes involved in current CRT care in the Maastricht University Medical Centre (MUMC). First, mapping of the processes (including systems and communications) involved in current CRT care was performed through observations, interviews and a workshop involving all personnel contributing to CRT care. Subsequently, a random measurement survey was conducted in 30 CRT patients implanted between 2010 and 2012 (first 10 new CRT implantations each year, excluding any patient involved in a clinical study). This survey included detailed observations of predefined operational outcomes such as activities, use of resources, personnel and time, as well as patient-based outcomes such as procedure-related complications and hospitalisation