specific mark in their charts. The system also shows the provider all
of the next steps in the pathway. So, a PACU nurse can go into the
system, confirm that the patient is still meeting the criteria and see
protocols like when the patient can eat or the medications he should
receive in recovery, which can be ordered from our pharmacy with
the push of a button.
4. Let staff move through the pathway without physician input, when appropri-
ate. In a focused factory, staff is empowered to move through the care
protocol without gaining a doctor's approval before each step, since
the protocol uses physician-agreed-to standards. For example, a col-
orectal patient recovering from surgery wants something to drink.
Previously, the nurse may have had to track down the doctor to
approve of this first, which could be frustrating for everyone involved.
Now, the nurse can check the patient's chart and see that he can
have a drink as long as he is meeting pathway standards. If he isn't
meeting the criteria, the nurse knows she must revert back to the tra-
ditional individualized care model and find the physician before mov-
ing forward.
5. Group patients with similar care together. We found that locating both
our pathway and individualized, complex cases together slowed down
workflow and made implementing the pathways more difficult.
Consider assigning your focused-factory cases in designated pre-op,
OR and PACU areas, while grouping those who don't meet the stan-
dards in a separate location. This also helps in making sense of met-
rics.
6. Roll it out in phases. Determining the patient criteria and best prac-
tices took us about 3 months per specialty, per care environment.
After that, we spent about 3 months in early implementation, starting
with the OR protocols and expanding them throughout patients' entire
length of stay. During this early phase, we studied our outcomes and
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