Reengineering a cardiovascular surgery service.
BACKGROUND
Reengineering, involving the radical redesign of business processes, has been used successfully in a variety of health care settings. In 1994 New York University (NYU) Medical Center (MC) launched its first reengineering team, whose purpose was to redesign the entire process of caring for patients-from referral to discharge-on the cardiovascular (CV) surgery service. REENIGINEERING TEAM: The multidisciplinary CV Surgery Reengineering Team was charged with two goals: improving customer (patient, family, and referring physician) satisfaction and improving profitability. The methodology to be used was based on a reengineering philosophy-discarding basic assumptions and designing the patient care process from the ground up. THE TRANSFER-IN INITIATIVE: A survey of NYU cardiologists, distributed in April 1994, suggested that the organization was considered a difficult place to transfer patients. The team's recommendations led to a new, streamlined transfer-in policy. The average waiting time from when a referring physician requested a patient transfer and the time when an NYUMC physician accepted the transfer decreased from an average of 9 hours under the old system to immediate acceptance.
Three customer satisfaction task forces implemented multiple programs to make the service more user friendly. In addition, referrals increased and length of stay decreased, without an adverse impact on the mortality rate.


CONCLUSIONS
For the first time at NYUMC, a multidisciplinary team was given the mandate to achieve major changes in an entire patient care process. Similar projects are now underway.
Tunick
P A
PA
Non-Invasive Cardiology Laboratory, New York University Medical Center, New York 10016, USA. paul.tunick@ccmail.med.nyu.edu
Etkin
S
S
Horrocks
A
A
Jeglinski
G
G
Kelly
J
J
Sutton
P
P
D016507:Cardiology Service, Hospital / Q000458:organization & administration*; D002318:Cardiovascular Diseases / Q000601:surgery; D003365:Costs and Cost Analysis; D003659:Decision Making, Organizational; D017598:Efficiency, Organizational; D005568:Forms and Records Control / Q000458:organization & administration; D006754:Hospital Restructuring / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008332:Management Quality Circles; D009519:New York City; D016134:Organizational Policy; D010343:Patient Admission; D017060:Patient Satisfaction; D010360:Patient Transfer / Q000458:organization & administration; D011367:Professional Staff Committees; D012985:Software Design; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D017749:Total Quality Management / Q000379:methods*