Systems-Based Practice

Chapter 6 Systems-Based Practice



Stephen E. Gordon, MBA, John R. Clarke, MD, Stephen K. Klasko, MD, MBA, Linnea S. Hauge, PhD, Barry D. Mann, MD


The Accreditation Council on Graduate Medical Education has defined competency in systems-based practice (SBP) as follows: “Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.”1


Each case in this textbook includes a component of how provision of surgical care intersects with the larger health-care system. These SBP ideas have been organized into three broad categories: The System, Improving System Function, and Health-Care Policy and Business (see Table 6.1).


Table 6.1 Systems-Based Practice and Cases










































Systems-Based Concept Cases
The System
Provider operations and coordination 2, 4, 16, 17, 21, 27, 28, 31, 36, 37, 42, 49
Costs and cost drivers 1, 9, 14, 19, 26, 30
Reimbursement and insurance 7, 23, 26, 41, 43, 44, 52
Improving System Function
Systematization of practices 10, 11, 13, 32, 35, 38, 40, 51
Utilization of information technology 6, 15
Process improvement 5, 25, 27, 30, 45, 47, 48
Patient safety 17, 21, 22, 24, 27, 29, 37, 38, 46, 47, 53
Health-Care Policy and Business
Public health 12, 39
Health-care law 8, 18
Business of medicine 2, 14, 20, 30, 33, 44, 50, 52


COMPONENT I: THE SYSTEM


This category includes examples of how health-care providers—physicians, nurses, technicians, hospitals, and health systems—coordinate and deliver care at many different levels. The surgical cases provide the backdrop for examining a variety of systems issues in surgery, such as operating room dynamics, interdisciplinary team collaboration, and the prioritization system for transplant recipients.


Health-care costs and the costs of surgical procedures are addressed, including the way in which these costs are assigned and managed. Cost drivers are the actual resource-intensive activities that drive up overall health-care costs, not just the price charged for a specific service. The largest cost drivers of health care are length of stay, drugs, supplies, and staffing.


By the year 2007, national health-care expenditures reached $2.1 trillion, and 16 cents of every dollar spent in the United States went toward health care. The cost of the system has made it impossible for the clinical provider to ignore the enormous costs of providing care to patients. An appropriate awareness of costs can help physicians contribute to the overall efficiency of the health-care system and may ultimately improve access. Accordingly, the prices of services appear throughout this book to raise awareness of costs typically associated with certain tests and procedures and incurred by patients, insurers, and health-care organizations. Prices may be inconsistent, as they are indeed inconsistent throughout the country.


Basic ideas behind cost are included: the difference between direct and indirect, and variable and fixed costs; the extraordinarily high fixed cost nature of a hospital; the importance of understanding the reality of “opportunity” costs with regard to infrastructure; and the difference between reimbursement and cost.

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Mar 20, 2017 | Posted by in GENERAL SURGERY | Comments Off on Systems-Based Practice

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