I have this study case about
Conserving Blood During Cardiac Surgery at Huntington UniversityHospital (A)
Abeel A. Mangi, Cate Reavis, and Roberto Fernandez
and I want some help with these questions
1-Dr. Young realized that “the organizational culture was suchthat there were far easier cost-saving efforts to take on”. Pleaseanswer the following (1) what was the “key ingredient” that wasable to alter the status quo and achieve the goal of the wholeproject? (2) why this “ingredient” was so important for the wholeproject?
2-If you were in Dr Young’s shoes what kind of immediate actionswould you implemented towards the Supporters and the Sceptics? (inyour answer suggest and explain one action for each group)
3-How the lack of chain of command affected the decision makingin heart surgeries? Please explain if you personally agree ordisagree with this practice and the reason for it
4-Explain your personal opinion (agree or disagree) about theexisting organizational environment with regard to structure andsalaries compared to the one Dr. Young experienced in his previousjob
5-What were the two major restraining factors that Dr. Youngneeds to consider seriously on the change he is about to initiatein HUH?
Patients who underwent cardiac surgery often required 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 was 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 (AVR) or a coronary artery bypassgrafting (CABG) had a 30% lower chance of survival at six monthsand a 50% lower chance at 10 years.1 The 10-year survival ratewithout a transfusion was 90%.2
On average, 48.9% of patients in the United States who underwentan AVR or a CABG required a blood transfusion.3 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, who joined HUH’s for Cardiac Medicine in 2011and whose patients were among the hospital’s sickest, wanted tohelp bring down the Center’s transfusion rate by leading ablood
conservation project involving the medical teams that workedtogether during the intra- and post- operative phases. The goal wasto reduce the hospital’s blood product4 utilization during cardiacsurgery and after by two-thirds within one year, by the end of2014, thereby bringing transfusion rates down to the nationalaverage and resulting in annual cost savings of $2.5 million. Moreimportantly, it would save the lives of an additional 125 peopleper year over 10 years.
Young knew he faced an uphill battle in convincing his fellowsurgeons 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 his seniorcolleagues had spent their entire careers there. Then there was thechallenge posed by the complex organizational structure inherent inmost teaching hospitals: fellow cardiac surgeons aside, few, ifany, members of the medical teams Young worked with during andafter surgery reported to him. He would have to convincecolleagues, over whom he had no formal influence, that one, therewas a problem and, two, that it could be solved as long as theywere willing to change their ways.
