Management of a Patient Process Framework - An Advocacy - A Legacy
I formulated the Management of a Patient Process circa 1989 to rationalize the problem-solving and decision-making of physicians.
I have taught it to medical students, surgical residents and other physicians of various medical schools, departments of surgery, and hospitals.
This was most intensively used in Department of Surgery of Ospital ng Maynila Medical Center (2000-2019); GSI Division of the Philippine General Hospital (which earned me the title of JOSONIC); Department of Surgery of Zamboanga City Medical Center (1991 - 1997); Zamboanga Medical School Foundation and other schools which adopted the Problem-based learning medical curriculum.
This is a legacy I am and will leave behind for the medical students, surgical residents, physicians, and surgeons, and most important of all, to the Filipino patients who will benefit most in terms of rational problem-solving and decision-making of their health problems by the physicians who will use this framework.
My philosophy: There is no such thing as one and only one right way of managing and treating patients.
One, every patient is different or unique. No two people have the exact same genetic makeup, reactions to diseases (biophysical, psychosocial, and mindset) and responses to treatment.
Two, physicians have different ways of managing and treating patients. No two physicians have the exact same methods and skills of managing and treating patients. One, usually they have different mindsets. Two, as human beings, they have different inherent problem-solving and decision-making skills. They do problem-solving and decision-making in the context of the individual patients (individualization) who are not the same as mentioned above. Third, no two physicians and surgeons have exactly the same dexterity in doing procedures. Again, they have to adjust their treatment procedures in the context of in the individual patients (individualization) who are not the same as mentioned above.
One can say there are many “right” ways of managing and treating patients if the targeted outcomes (cured and controlled diseases) are being similarly achieved. The various “right” ways of managing and treating patients will just differ in terms of cost-effectiveness and patient experience.
Question I asked myself: If there is no such thing as one and only one right way of managing and treating patients, is there such a thing as one and only one “process” of managing and treating patients?
There could be.
I am proposing a management of a patient process framework which I find useful in standardizing managing and treating patients. Using the the process framework will bring out the most cost-effective and best patient experience way of managing and treating patients.
See below.
The details can be seen:
Management of a Patient (All Types) – ROJoson from Reynaldo Joson
Another question I asked myself: Is there such a thing as wrong way of managing and treating patients?
Yes, if the way of managing and treating patients is creating and producing more harm than benefit and if it is not promoting cost-effectiveness and patient experience.
ROJ@18apr20
Maxims, Rules, and Guides in the Management of a Patient
Management of a Patient Process and Clinical Practice Guidelines
In medical practice and in hospital administration, we now oftentimes hear of clinical practice guidelines, evidence-based clinical practice guidelines and clinical / care pathways. These are tools to improve quality and safe patient care.
Clinical Practice Guideline (CPG) as defined by the Institute of Medicine, is a “systematically developed statement to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”
Evidence-based Clinical Practice Guideline (EBCPG) is clinical practice guideline supported by the best available evidence in the clinical literature. As Sackett defined it, EBCPG is the “ the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients and integrating clinical expertise with the best available external clinical evidence from systematic research.”
Clinical / Care Pathways (CPath) is an interdisciplinary plan of care that outlines the optimal sequencing and timing of interventions and expected outcomes for patients with a particular diagnosis, procedure or symptom.
Basic among the clinical practice guidelines, evidence-based clinical practice guidelines and clinical / care pathways is a management of a patient process which has not been fully explained to the max in the literature.
The management of a patient process occurs in two settings in medical practice and in hospital administration. The first setting is in the management of the patient health problem itself without the patient getting admitted to the hospital. The second setting is when a patient gets admitted to a hospital. In the second setting, invariably there is the management of the patient health problem process preceded by the admitting and followed by the discharge processes.
In this manuscript, we will be discussing the management of a patient health problem process. We will not discuss the admitting to and discharge from the hospital processes. At the end of the discussion on the management of a patient health problem process, we will integrate or relate it to the clinical practice guidelines and evidence-based clinical practice guidelines.
Management of a patient process is a process. Process as defined by ISO Standards is a “set of interrelated or interacting activities, which transforms inputs into outputs”.
Management of a patient process is therefore, a set of interrelated or interacting activities, which transforms inputs into outputs, the input being the patient health problem or patient with a health problem and the output is the resolution of the patient health problem. The set of interrelated or interacting activities are the throughputs, which essentially consist of problem-solving and decision-making on tasks to be done by the physician or any health care professional.
Again, the input or the starting point of the management of a patient process is the patient health problem or a patient with a health problem or concern. The output is the goals of management which can generically be spelled out as resolution of the health problem in such a way that the patient does not end up dead, with disability or complications and in such a manner that the patient is satisfied and there is no medicolegal suit.
The throughput, as mentioned, consist of the processes of problem-solving and decision-making on the tasks to be done.
Feedback from residents of the Department of Surgery of Ospital ng Maynila Medical Center (in 2012):
JOSONICS
https://www.youtube.com/watch?v=s98oOsKGKco&fbclid=IwAR2_H8SIdbLXMB2M1hVSYN1JHj8paGMIIx4XGS0VsBBh2Flg3WOsflEA-x4
References:
https://sites.google.com/site/patientmanagementprocess/home
https://sites.google.com/site/patientmanagementprocess/management-of-a-surgical-patient-process)
ROJ@18nov26