I’m not quite sure where to begin, but I’ve got a meeting in an hour where I’m expected to have answers to some tricky questions.

The speaker was Susanna Vila, M.D., a primary care physician, who, earlier in the day, had been given responsibility to develop a clinical guideline for urinary-tract infections (UTIs). The goal was to design an approach that would streamline the diagnosis and treatment of UTI.

Park Nicollet’s Medical Director explained why Dr. Vila had been selected to develop the medical center’s first clinical guideline.

We chose Susanna for a number of reasons: First, although she’s only a few years out of her residency, she has strong clinical credentials, and, as a primary care physician, she has a great deal of familiarity with UTI. She also has some knowledge of TQM [Total Quality Management] and has been part of some TQM efforts in the past. Of course, she has never been involved with the development of a clinical guideline, but no one in the organization has. Finally, she has proven skills as a facilitator and negotiator, and it’s particularly important that the process be both smooth and effective as we hope to develop a full range of guidelines during the next few years.

BACKGROUND

Park Nicollet operated in a highly competitive, managed care environment. In the prior year it had treated over 11,000 urinary-tract infection (UTI) cases. The costs were difficult to assess, but the accountants had indicated that the average cost per patient treated was approximately $67.

Early this year, Park Nicollet had embarked on an ambitious plan to develop a broad range of guidelines. It chose UTIs for several reasons: (1) the disease was relatively uncomplicated, (2) the problem surfaced at every level of practice, (3) an initial assessment suggested that a wide range of treatment patterns were in use, and (4) the large number of UTI cases each year meant that even a small change would have a large impact.

The Park Nicollet organization included the Institute for Clinical Systems Integration, a research institute, with a $2 million annual budget. Consequently, the organization could offer trained facilitators who could work with pilot sites on an ongoing basis, providing advice and consulting help on all phases of the implementation effort. In addition, the CEO, was a strong advocate of clinical guidelines and saw them as a way of providing what he called the “central nervous system” and the “backbone” of the organization. By this he meant that the ability to make decisions (the central nervous system) and actually implement them (the backbone) seldom existed in an organization. He believed that clinical guidelines, when effectively implemented, represented a way to instill these two critical capabilities within the same organization.

Dr. Vila’s earlier comment was in relation to her scheduled meeting with Park Nicollet’s Medical Director to discuss her answers to the following questions:

1. What should be the formal mandate for the team?
2. How many and what kinds of providers should be on the team? How many and what kinds of non-providers? What time commitments will each member need to make? Will different members need to make different time commitments? . . .

Assignment

1. Prepare answers to the above questions.