In the first of this two-part series, the ‘House of Healthcare Tour’ covered the Administrative, Academic/Education, and Research areas. Below, we’ll get into the patient care realm.
The Clinical Enterprise Room
Walking from the Research Enterprise to the Clinical Enterprise, you’ll notice some sudden, palpable cultural changes:
- The Clinical Enterprise is largely open-for-business 24/7, so many of the staff are used to working in shifts and on holidays.
- Patient safety is a constant focus of the workers here.
- The fault tolerance is suddenly a lot lower, requiring higher standards for hiring, budgeting, training, and implementing new tools.
- Because it never gets to shut down for maintenance, and because of the low fault-tolerance, both change management and project management are higher-caliber and noticeably different.
- The staff are often highly-educated, many with large amounts of student debt, and so the salaries are suddenly higher.
- The language and culture change may sometimes overlap or be different than the culture and language of the Academic/Educational or Research enterprises.
- Navigating the ‘quasi-military’ style clinical roles can be very complicated.
In the top Clinical Enterprise box, we can see the many Clinical Enterprise Departments that support patient care activities of all the areas below them, including: Credentialing, Medical Staff Office, Nursing Department, Pharmacy & Therapeutics Department, Laboratory & Pathology Department, Diagnostic Radiology, Interventional Radiology, Non-Invasive Cardiology, Interventional Cardiology, Dietary/Nutrition, Physical Therapy, Occupational Therapy, Speech Therapy, Case Management / Social Work, Health Information Management, Registration, Access Management, Revenue (Billing/Coding), Call Center, Scheduling, Clinical IT/Informatics, and Biomedical Engineering.
While many of these Departments above might be physically located inside the Hospital, it’s important to note that the majority of them serve the needs of the following:
- Hospital-based care areas
- Clinic-based care areas
- Nursing Home/Patient Home care areas.
Let’s now take a walk through the first of our patient care areas.
Hospital-based Patient Care Locations
Walking through here, we can see a number of departments, including:
- Emergency Department (technically an outpatient area!)
- Inpatient Units (including Med/Surg, ICU, Labor and Delivery, Nursery, Pediatrics and Psychiatry)
- Perioperative Services (Pre-Op, OR, PACU) (technically all outpatient areas!)
- Ambulatory Procedural Suites (e.g. Endoscopy, Bronchoscopy, Interventional Cardiology, Interventional Radiology, sleep labs, EKG/Echos, etc. — technically all outpatient areas!)
- Chemotherapy and Infusion Suites (note: in some organizations these are not hospital-based areas)
A lot of care is delivered in these hospital-based patient care areas! And keep in mind, it’s a common mistake to either under- or over-estimate the acuity, complexity, or importance of these hospital-based areas. Remember:
- The clinic-based areas can be every bit as acute, complex, and important!
- Many workflows start in the ambulatory clinic-based areas, and end in the Inpatient/ED (hospital)-based areas — and vice-versa!
So understanding these many hospital-based patient care areas is only a part of the story.
Ambulatory (Clinic) Based Locations
In the Ambulatory (Clinic) based locations, you can find a lot of ambulatory clinics, along with sometimes some remote radiology services, blood draw services, and even some procedural and infusion services. For example, you’ll commonly see Primary Care and clinics including:
- Neonatology/Maternal Fetal Medicine
- General Pediatrics
- Medicine – includes General Internal Medicine, Geriatrics, Cardiology (General non-invasive and invasive/interventional), Endocrinology, Gastroenterology, Pulmonary/Sleep Medicine, and Rheumatology.
- Neurology – General and Movement Disorders
- Surgery – General, Neurosurgery, Ophthalmology, Plastics, Otolaryngology (Ear, Nose, & Throat), and Orthopedics (Bone & Joint)
- Maternal Fetal Medicine
- Psychiatry – General Adult and Pediatric/Adolescent
- Dermatology – General Dermatology and Mohs Surgery
- Hematology and Oncology (often divides up into several specialty subdivisions of care)
- Radiation Oncology
- Genetics Counseling
- Physical Therapy
- Occupational Therapy
- Speech Therapy
- Anesthesiology / Perioperative Medicine
- Urgent Care
And more! Although they are generally only open during business hours, these ambulatory clinics provide a tremendous amount of care to a tremendous number of patients, and often have acuity, complexity, and safety issues on par with the hospital-based areas.
Offsite (Nursing Home) or Home Care Locations
For our final stop in our tour of the ‘House of Healthcare,’ we’ll be stopping at the nursing-home and patient-home-based care. Yes, house visits still exist! These are growing areas for many healthcare institutions, and especially since COVID, this segment is only expected to grow in the near future. It often requires providers with unique documentation/billing practices, but this is an important source of care for hospice, homebound, and nursing home patients.
Before we wrap up our walking tour, it’s important to note that Population Health is a growing trend, which ties reimbursement strategies to improved health and improved patient outcomes. While much of the focus is on outpatient/ambulatory clinics, it can also impact a number of hospital-based workflows, and so it’s important for everyone to understand the role that Population Health plays.
And for the particular segment that I work in (IT/Informatics), it’s important to note that there are essentially four IT/Informatics domains that cover the spectrum of a typical healthcare organization:
- Administrative (Enterprise) IT/Informatics (often includes Analytics/Data Governance, and infrastructure like servers, network architecture, security, interface management, hardware/software procurement, life cycle management, desktop/application management, etc.)
- Academic/Educational IT/Informatics
- Research IT/Informatics
- Clinical IT/Informatics
Each, of course, has its own unique language, culture, regulations, needs, and stakeholders.
I hope this has been a quick, helpful virtual tour of a typical healthcare organization. Remember, many organizations will vary slightly, based on mission and local financial, legal, or regulatory needs.