Adapted and shortened version of \"Conserving Blood DuringCardiac Surgery at Huntington University Hospital\" Case Study fromMIT Sloan School of Management
Key Question: Which approach from the Hershey & BlanchardSituational Leadership model would you recommend Surgical DirectorYoung utilize and why? Second, let's pretend Surgical DirectorYoung has the characteristics to be a transformational leader.Which aspect of transformational leadership should Dr. Youngespecially focus on in this situation?
Case Study:
Patients who undergo cardiac surgery often require a bloodtransfusion or other blood products. In order for surgeons to workupon or inside the heart, certain parts of the heart or greatvessels surrounding it needed to be opened and then repaired withsuture material. Opening a chamber of the heart disrupted itshermetic seal and permitted blood to spill out and into thesurrounding space. While bleeding was undesirable for obviousreasons, restoring blood via transfusions is not a panacea.According to a 2006 study published in the Annals of ThoracicSurgery, a cardiac patient who received a blood transfusion afteran aortic valve replacement or a coronary artery bypass graftinghad a 30% lower chance of survival at six months and a 50% lowerchance at 10 years. The 10-year survival rate without a transfusionwas 90%.
On average, 49% of patients in the United States who underwentan AVR or a CABG required a blood transfusion. At HuntingtonUniversity Hospital (HUH), where 500 patients underwent an AVR orCABG annually, the percentage of patients who received bloodtransfusions in 2011, 2012, and 2013 was around 71%. This washappening at a time when the Affordable Care Act of 2010 wasforcing hospitals to provide quality care in a cost efficientway.
Dr. Frank Young became HUH's Surgical Director in 2011. Priorto joining HUH, he spent two years as a cardiac surgeon at one ofthe world’s top cardiac care hospitals where medical teams carriedout over 4,000 open heart operations a year. Huntington Universityhired Young to rejuvenate the hospital's heart transplantationprogram where the number of patients coming in was on the declineand outcomes were unsatisfactory. One medical survey conducted in2013 ranked HUH #39 for cardiology and heart surgery, giving itvery low scores when it came to patient safety and success inpreventing major postsurgical bleeding. Despite the poor score,patient safety was a critically important value at HUH. Everymonth, an email was sent out to the entire hospital staffrecognizing specific employees for making a meaningful contributionto patient safety.
Director Young wanted to help bring down the hospital'stransfusion rate by leading a blood conservation project involvingthe medical teams that worked together during the intra- andpostoperative phases. The goal was to reduce the hospital’s bloodproduct utilization during cardiac surgery and after by two-thirdswithin one year, by the end of 2014, thereby bringing transfusionrates down to the national average and resulting in annual costsavings of $2.5 million. More importantly, it would save the livesof an additional 125 people per year over 10 years.
Young knew he faced an uphill battle in convincing his thesurgeons and the medical teams that accompanied them duringsurgeries to make changes to their surgical routines. Autonomy wascritically important to physicians and he was attempting aprofessional intervention of sorts. Furthermore, he was a newarrival to HUH, especially considering some of the surgical teamhad spent their entire careers there. In addition, every cardiacoperation involved a 20-person functional team, which included thecardiac anesthesiologist, perfusionist, cardiac surgeon, operatingroom (OR) nurses, intensive care unit (ICU) physicians, physicianassistants, and fellows and residents.
Could you please include an analysis of the case study?
