Question

I have this study case about

Conserving Blood During Cardiac Surgery at Huntington University Hospital (A)

Abeel A. Mangi, Cate Reavis, and Roberto Fernandez

and I want some help with these questions

1-Dr. Young realized that “the organizational culture was such that there were far easier cost-saving efforts to take on”. Please answer the following (1) what was the “key ingredient” that was able to alter the status quo and achieve the goal of the whole project? (2) why this “ingredient” was so important for the whole project?

2-If you were in Dr Young’s shoes what kind of immediate actions would you implemented towards the Supporters and the Sceptics? (in your answer suggest and explain one action for each group)

3-How the lack of chain of command affected the decision making in heart surgeries? Please explain if you personally agree or disagree with this practice and the reason for it

4-Explain your personal opinion (agree or disagree) about the existing organizational environment with regard to structure and salaries compared to the one Dr. Young experienced in his previous job

5-What were the two major restraining factors that Dr. Young needs to consider seriously on the change he is about to initiate in HUH?

Patients who underwent cardiac surgery often required a blood transfusion or other blood products. In order for surgeons to work upon or inside the heart, certain parts of the heart or great vessels surrounding it needed to be opened and then repaired with suture material. Opening a chamber of the heart disrupted its hermetic seal and permitted blood to spill out and into the surrounding space. While bleeding was undesirable for obvious reasons, restoring blood via transfusions was not a panacea. According to a 2006 study published in the Annals of Thoracic Surgery, a cardiac patient who received a blood transfusion after an aortic valve replacement (AVR) or a coronary artery bypass grafting (CABG) had a 30% lower chance of survival at six months and a 50% lower chance at 10 years.1 The 10-year survival rate without a transfusion was 90%.2

On average, 48.9% of patients in the United States who underwent an AVR or a CABG required a blood transfusion.3 At Huntington University Hospital (HUH), where 500 patients underwent an AVR or CABG annually, the percentage of patients who received blood transfusions in 2011, 2012, and 2013 was around 71%. This was happening at a time when the Affordable Care Act of 2010 was forcing hospitals to provide quality care in a cost efficient way.

Dr. Frank Young, who joined HUH’s for Cardiac Medicine in 2011 and whose patients were among the hospital’s sickest, wanted to help bring down the Center’s transfusion rate by leading a blood

conservation project involving the medical teams that worked together during the intra- and post- operative phases. The goal was to reduce the hospital’s blood product4 utilization during cardiac surgery and after by two-thirds within one year, by the end of 2014, thereby bringing transfusion rates down to the national average and resulting in annual cost savings of $2.5 million. More importantly, it would save the lives of an additional 125 people per year over 10 years.

Young knew he faced an uphill battle in convincing his fellow surgeons and the medical teams that accompanied them during surgeries to make changes to their surgical routines. Autonomy was critically important to physicians and he was attempting a professional intervention of sorts. Furthermore, he was a new arrival to HUH, especially considering some of his senior colleagues had spent their entire careers there. Then there was the challenge posed by the complex organizational structure inherent in most teaching hospitals: fellow cardiac surgeons aside, few, if any, members of the medical teams Young worked with during and after surgery reported to him. He would have to convince colleagues, over whom he had no formal influence, that one, there was a problem and, two, that it could be solved as long as they were willing to change their ways.

Answer 1

Answer 1
The key ingredient as discussed in the case study is doctor young wanted to bring down the centers transfusion. This could be achieved by leading a blood conservation project which involve the medical teams, that work together during the inter and post operative faces. The aim of which was to reduce the hospitals blood product for utilization during the cardiac surgery. This would bring down the transfusion rate to the national average and result in annual cost saving of dollar 2.5. It also would save the additional life of 125 people over a period.of 10 years.
Answer 2A.
This key ingredient was important because it would not only reduce the cost of of operation of the heart surgery, but it also would help in saving the lives of additional 125 estimated people over a time duration of 10 years
Answer 2B.
If I were in doctor young shoes I would take immediate action for the blood conservation project. The reason for the same is a blood conservation project would not only improve the quality of operation in the hospital but also help the hospital to provide quality care in a cost effective.
Also I would convince the fellows surgeons and the medical teams to change the surgical routines during the the heart surgery. Although it was difficult two physician attempting a professional intervention but once the result was seen the process would be continued and adopted by doctors.
Answer 3.
The lack of chain of command state the decision making in the heart surgery according patient who received the blood transfusion after an valve replacement or a by pass grafting had 30% low chances of survival in 6 months and 50% low chance at 10 years. 10 year survival rate with transfusion was 90%. The entire process of lack of command cost life of people. I totally disagree with this ,the reason for this is explained before.
Answer for I personally agree with the organization structure with regard to the salary compare to one doctor young experienced in his previous job. Doctor young had visit to the hospital sickest patient. Dr.Young knew how to bring down the hospital's transfusion rate by leading a blood conservation project. He also attempt to make changes to the surgical routine adopted by other doctors.
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