| |
|
X. CONCLUSIONS
Site visits to 15 transplant centers and 34 organ programs revealed six strategies/drivers
and 23 accompanying key change concepts that appear to be
associated with high performance in organ acceptance, transplantation,
and outcomes. Many of these strategies/drivers and key change
concepts are interrelated.
For most of the high-performing transplant centers visited,
a critical success factor has been the vision and commitment
of their hospitals’ leadership to making transplantation an
institutional priority and to assuring the necessary resources
and infrastructure to grow their transplant programs. At some
of the centers, transplant programs have grown directly as
a result of the executive leadership’s decision to seek out
innovative and committed transplant surgeon and physician
leaders and providing them with the necessary resources to
achieve transplant growth. At other centers, transplant program
administrators and clinical leaders have gained institutional
support by first building a case for the value of transplant
services to both the hospital and patients. In either case,
organ transplantation has been established as a strategic
priority at all of these centers, and significant investments
in staffing and other resources have been made to facilitate
growth of the transplant programs.
Another critical success factor of the 15 high-performing
transplant centers is the existence of a collaborative and
rewarding work environment that attracts and retains highly
dynamic, committed, and skilled specialists in transplantation.
Across all of the centers visited, transplant teams are led
by proactive and committed surgeons and physicians who are
aligned with the institution’s vision to build and grow the
transplant program. However, in order to be successful, these
surgeons and physicians need to be supported by a highly specialized
and dedicated multi-disciplinary team of nurses, coordinators,
social workers, financial managers and coordinators, medical
specialists (e.g., infectious disease physicians, anesthesiologists,
etc.), administrative staff, and allied health staff. Each
team member possesses a unique set of skills, expertise, and
knowledge that is needed to effectively manage patients and
to provide high quality patient care.
Given the perpetual shortage of organs, aggressive patient
and organ acceptance practices are critical components for
optimizing transplant growth and volume, while maintaining
expected or higher than expected patient and graft survival
outcomes. Across the centers visited, evidence-based practices
are employed to create a high threshold for rejecting less
than optimal organ offers (including ECD and DCD organs),
as well as higher-risk recipients. This aggressive approach
also applies to patient evaluation and management while on
the waitlist. By actively marketing their high quality transplant
programs among patients, referring physicians in the community,
OPOs, and payers, these centers are able to build and grow
their transplant waitlists to an optimal size that allows
them to effectively identify appropriate donor-recipient matches
for every viable organ offer and to achieve increased transplant
volume and growth, without sacrificing patient and graft outcomes.
In an effort to provide the best possible care to every
patient and family everyday, the high-performing transplant
centers visited have established institution-wide practices,
systems, and mechanisms to organize care around the needs
of patients and families. By looking at the transplant process
through the patient lens, these centers have identified ways
to make the entire transplant process easier and less stressful
for both patients and their families. Centers have accomplished
this by removing patient access barriers and streamlining
staff workflow to provide more efficient care; providing patients
and their families with a high level of education and support
throughout the transplant process so that they have the information
to make informed decisions about their care; and by creating
a family-friendly, “normal” environment in order to make patients
and their families feel at home while at the hospital for
extended periods of time.
Achieving and maintaining transplant program financial strength
has been another critical success factor of the high-performing
transplant centers visited. Centers have employed various
strategies including having a detailed understanding of program
finances, sound financial management, and excellent payer
relations. Financial staff at centers actively track and monitor
their program finances and payer reimbursement mechanisms,
negotiate payer contracts with rates that are based on transplant
program actual costs and patient resource use, develop constructive
and mutually beneficial relationships with payers, and provide
transplant-specific financial counseling and coordination
to patients and their families.
Finally, all of the transplant centers visited optimize their
performance by aggressively monitoring and managing their
program performance outcomes. From pre-, peri-, to post-transplant
care, protocols are used to deliver standardized, efficient,
and high quality care. In addition, all of the centers visited
engage in clinical research both to advance the field of transplantation
and to improve patient outcomes. By being on the cutting edge
of research and innovative practices, these centers are able
to foster transplant volume and growth by attracting patients
and payers. Lastly, all of the centers visited regularly collect
and review data on various transplant program outcome measures
and use the data to identify problem areas and to implement
appropriate process improvement strategies.
|
