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Case Management

Case management is among the most essential aspects and topics in business process management in improving business performance, through adoption of a more dynamic approach to business process management. Case management programs have been introduced in different business processes and health care institutions to provide more satisfying outcomes. In addition, case management programs have been introduced in ensuring adoption of more effective technologies that improve delivery of quality services to the customers improving their satisfaction. Case management in a health institution facilitates adoption of comprehensive technology that integrates all information on all processes of the institution (Rosenberg & Sajdak, 2006). It helps identification of the trends in the industry and integrates them in the institutional process before they become obvious.

Case management programs in health care institutions have also been essential in ensuring implementation of the best practices that meet the ever-changing demands. The complexity of the business environment has also increased, as well as the regulatory environment, hence requiring businesses to improve their systems as well as their processes. Therefore, case management involves the adoption of a comprehensive approach to medication and provision of health and medical care. Case management has prominently been used when describing management of complex medical care. It has been defined as collaborative processes that evaluate plans, implement, coordinate, monitor and assess various options and services that meet the individual needs on health, through the use of available community resources and provide quality and cost effective outcomes.

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Therefore, case management is a multidisciplinary, comprehensive and complex process that involves the input from different diverse players in the health care system. For example, all health care providers, vendors, suppliers of the health care system’s patients, family and friends need to be engaged in comprehensive approach of the system.

Hospital University of Pennsylvania (HUP) Case Management Program

Case management program’s adoption in the health care industry has increased in the recent past, with a majority of health care institutions adopting different systems. As among the topmost health care provider in the United States and the world at large, Hospital University of Pennsylvania has adopted a comprehensive approach to case management. For example, the institution has adopted the case management system in the management and use of inpatient resources. The case management process provides clinical pathways, which give a description of services and activities appropriate for diagnosis guiding the treatment of inpatients (URAC & CARF, 2009). The guidelines provided ensure compliance with the best practices that guarantee improvement of patient’s satisfaction ensuring the use of services efficiently.

Health system of the Hospital University of Pennsylvania offers comprehensive medical care services as well as occupational medical care for area businesses. For example, the occupational aspect of the case management process ensures address of the health issues affecting the workers emanating from the work environment. The process involves assessment of the environment ensuring promotion of health, analysis of the hazards surrounding the institution and surveillance of the environment.

Previously, as in most of the health care institutions, case management at HUP was seen and addressed as an aspect in the nursing practice. However, even though the majority of the people involved in case management processes are nurses, there is a need to ensure a comprehensive approach in case management. Case management should have wider approach incorporating the executive team, health care providers, contracting office, specialists involved in decision making processes and staff involved in the medical records’ maintenance ensuring a comprehensive engagement in pursuit of the organization’s objectives. The process is wholly meant to improve provision of quality services to the patients in the institution ensuring their satisfaction (HUP, 2013). The institution operates as case management department, which deals with issues and challenges involved in the planning, designing and sustaining of a comprehensive system.

It has been essential in ensuring exploration of the premises in the institution endeavors in providing health care. It has also been essential in ensuring that the present health care crisis in demand is dealt with in a modern radical approach. The case management department has also been instrumental in ensuring allocation of resources that ensure plan and implementation of innovative clinical solutions in the institution. It also provides an oversight of practical staffing practices as well as the duties and assignments given to different staff (Goldfarb et al. 2000). This ensures provision of the best practices in the provision of health care services that provide real life solutions.

Disease management programs have also been essential in ensuring improvement of patient’s quality of life. It facilitates customization of health care needs for each patient, reducing complications which involve chronic medical conditions. It also enables the health care providers to teach the patients different skills that enable them to take control of their lives. Disease management program at HUP has been introduced for various conditions, and each condition has its management program. Therefore, the organization case management program complies with the generally recognized case management system, as well as disease management programs (Gold, Jacobson & Garfield, 2012).

Quality Assurance Program at HUP

Quality assurance in the health care is based on continuous and sustainable improvement throughout the health system. The institution recognizes the importance of quality assurance in ensuring continuous improvement of quality of the services provided in the institution. The institution has adopted a cross-departmental approach, which has been essential in identification of the causes of inefficiencies in quality assurance program and improvement of performance. The continuous improvement programs adopted by the institution are based on the fact that there is a need to improve the quality of services provided to patients as a result of ever-changing needs of the clients. The program should also focus on ensuring the quality of medical operations and procedures. In addition, it should focus on providing real solutions that ensure that the needs of the patients are met in a customized manner (Rosenberg & Sajdak, 2006). This will enable the response to each patient in accordance to such a patient’s needs and conditions.

The quality assurance program at HUP also includes evaluation of the equipment and facilities utilization in ensuring optimal utilization. This ensures reduction in wastage of capacity in the institution through adoption of health care solutions that enable patients to maximize benefits from the use of the facility. Quality assurance of the institution is also based on optimal staff utilization and staff scheduling, which ensure that patients are attended to in an efficient and timely manner (Saunier, 2011). The institution integrates its quality assurance programs in all programs such that even laboratory tests are also included in the quality assurance program to reduce test errors.

The quality assurance program based on the continuous improvement in the institution also includes the cost perspectives in the organization, since the institution should ensure maximization of the benefits at the least possible cost. Improvement of efficiency facilitates cost reduction while maximizing the benefits is accruing from the services. The disease management programs in the institution have also been essential in improving the quality of services provided by the institution. They have facilitated the customized approach to the services offered to the patients, focusing on the specific needs of each patient (Rosenberg & Sajdak 2006).

Although the institution case management program involves a comprehensive approach, there are various recommendations that the institution should consider for further improvement of quality of the services delivered, for example, the involvement of community health care providers in ensuring comprehensive approach to both inpatient and outpatient. This would facilitate the management of patients released from the hospital, reducing complexities and emergency cases. The disease management programs should also be based on an elaborate and diverse program that ensures comprehensive approach to all conditions.  

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