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How to Develop a Care Model — and Leverage It in Multiple Ways

Contributing Lab Leader: Diana L. Kremistke, MHA, MS, MT(ASCP)

How to Develop a Care Model — and Leverage It in Multiple Ways
LEADERSHIP

Article highlights:

  • Care models help remove variability and optimize quality in care

  • They need to be designed with key evidence, specialized input and a big-picture perspective of care

  • Learn how to develop a care model from an expert—and how to create efficiencies by leveraging it in further areas of care

Diana Kremitske’s team at Geisinger Medical Laboratories sees the value in a proven care model. But more so, they see the value in leveraging one care model in multiple ways. This creates quality and efficiencies that your patients and entire institution will feel. Let’s take a deeper look.

Better blood management. Better patient management.

 

Kremitske and her team developed a very successful patient blood management program born from a single philosophy: certain things must happen in a certain order, in a certain way, to ensure quality outcomes. This patient blood management program was carefully crafted based on evidence, best practices and key integration needs.

The results? See for yourself.

  • Better blood utilization

    Kremitske’s team was able to pinpoint the right amount of blood needed, when it’s most needed and how to make the most of it.

  • Better care

    As this program is based on volumes of clinical evidence, it is tailor-made for quality outcomes. And Kremitske’s team realized nothing less.

  • Better financial performance

    Due to reduced blood utilization and higher-quality care, it should be no surprise that Kremitske’s team streamlined spending immediately.

It is actually improving length of stay, reducing the chance of getting a disease from transfusion, and significantly helping us avoid other complications.

 

Diana L. Kremistke, MHA, MS, MT(ASCP)

Vice President

Diagnostic Medicine Institute at Geisinger

To care model or not to care model?

Diana Kremitske always prefers to leverage proven care models, as "Care shouldn’t be treated lightly; patients deserve the best."

Can you operate in the absence of care models? Of course. But what impact does this have?

  • Variations in care

  • Risk of suboptimal outcomes

  • Reduced patient loyalty

  • Cost-ineffective resourcing

Developing a Care Model

 

Ready to start creating your own care model? Follow Diana Kremitske's proven five-step process.

 

Step 1: Identify leadership

As care models are highly specialized, they need highly specialized oversight. Leaders of key areas (such as surgery) are integral to architecting them.

Carve out your role

No matter how ambitious you are, care models are generally not designed solely by the lab. However, the lab can play a vital role in designing them. Identify areas where the lab fits into key clinical processes, bring your expertise and inform quality on a deeper level.

  • Be proactive: If you feel a new care model should be crafted—and envision the lab as a key stakeholder—engage leadership from different departments and get the ball rolling

  • Be supportive: If a new care model is currently being designed, step up and insert yourself in the process. No other department leader knows laboratory medicine like you do, which puts you in an invaluable position

Step 2: Determine appropriate criteria

Rely on leadership to frame out what’s needed and when. These can include such things as:

  • Quality standards
  • Sequence of steps
  • Key clinical evidence
  • Care team members
  • Cautions

Form your care committee

Kremitske recommends forming a health system-wide care model committee. These are generally made of hospitalists throughout the system who see the big picture and can help inform best practices.

Step 3: Interface with key contributors

While leadership may own the design process, they’ll always depend on a robust team. Engage physicians, nurses, pharmacists, etc., to collaborate and realize the vision.

In Kremitske’s patient blood management program, she relies heavily on a nursing team. She explains, "RNs are integral to this blood management program. They're able to have a conversation with the patient and surgeon prior to surgery to work out a care plan. Among other things, this dramatically lowers the risk of post-op anemia."

Modeling integration and collaboration

One of the beautiful things about developing a care model is that it promotes clinical integration. This occurs within departments, between departments and even across institutions.

 

The heavy lifting is the clinical integration. You have different cultures, different physician needs, different patient needs."

 

Diana L. Kremistke, MHA, MS, MT(ASCP)

Vice President

Diagnostic Medicine Institute at Geisinger

 

But developing a care model is not a “check the box” act. Even after it has been implemented, do your part to ensure that partnerships and clinical care continue to strengthen. Leverage new evidence, new education on best practices, new data and more.

Step 4: Lead with quality

Kremitske offers this recommendation based on volumes of evidence. Don’t lead with a financial argument. Don’t lead with an operational argument. Always lead with quality. Keep patients at the heart of everything you do.

Designing a care model can have a range of benefits across criteria. But after all, it is primarily about meeting the highest evidence-based standard of care.

Our patient blood management program saves a lot of costs. But it’s not about that. We always need to remember why we’re here.

 

Diana L. Kremistke, MHA, MS, MT(ASCP)

Vice President

Diagnostic Medicine Institute at Geisinger

Modeling integration and collaboration

One of the beautiful things about developing a care model is that it promotes clinical integration. This occurs within departments, between departments and even across institutions.

But developing a care model is not a “check the box” act. Even after it has been implemented, do your part to ensure that partnerships and clinical care continue to strengthen. Leverage new evidence, new education on best practices, new data and more.

Step 5: Ensure a robust EMR

A care model can help ensure that all care team members are focusing on best practices. But decision support is vital to supporting optimal care.

Make sure you have a robust EMR system to help physicians, nurses and other care team members make proper decisions. Key features and benefits include:

  • Feature: Visibility into historical patient data
    Benefit: Ability to see any patient’s full picture of health

  • Feature: Rules writing
    Benefit: Streamline and operationalize activities

  • Feature: Widespread access to information
    Benefit: Fuels partnership across locations

One care model. Diverse applications.

 

Creating a care model can take a lot of work. But the benefits are immense—especially when you can leverage it in different areas. Taking the skeleton of your model and adapting it saves time and money, while maintaining your standard of care.

Here’s how:

  • Determine what’s the same
    Regardless of service line and specific area of care, certain things are constant. Consider Kremitske’s five-step process and compare your findings. See what is unchanged and identify opportunities to leverage proven elements of your existing care model.

  • Determine what’s different
    Clearly, every area of care has its own unique criteria, care team contributors and other mandatories. As you consider Kremitske’s five-step process, identify what is unique to this area of care. Take all measures to craft your care model to address these key considerations.

 

Get more out of care

Care models are vital to optimal care. They remove variability and ensure quality at every step. This helps yield incredible benefits—clinical, operational and financial—and strengthens partnerships on multiple levels of your organization.

In your constant efforts to create value for your institution, be sure to thoughtfully design your care models and uncover strategic ways to leverage them further.

Contributing Lab Leader

Diana L. Kremistke, MHA, MS, MT(ASCP)

Vice President

Diagnostic Medicine Institute at Geisinger

 

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