Management science assistant professor Luv Sharma and his fellow researchers worked with hospital staff to better assist kidney transplant patients in their post-discharge recovery.

Sharma and his colleagues recently published their research analyzing process improvements to a kidney transplant team’s post-operating instructions and procedures that greatly reduced complications and re-admission rates for patients.

Sharma’s research team included Gopesh Anand, an associate professor of business administration and the academic director for operations management for the University of Illinois Urbana-Champaign, and Aravind Chandrasekaran, a professor of operations and associate dean for graduate programs and executive education for Ohio State University.

The research team recently received the Illinois Strategic Organizations Initiative Research Award, which recognizes high-quality scholarship at the intersection of strategy and organization. The paper was selected from a pool of research papers published over the past 5 years.

As part of their research on kidney transplant discharge processes, they examined a study that looked at kidney transplants from 2001-2005 and found of the transplant recipients, more than 30 percent were readmitted to the hospital due to post-surgical complications.

Adhering to medication protocols, follow-up doctor visits, dietary modifications and infection prevention are all critical for post-op self care, according to Sharma and his colleagues.

The research team decided to create a methodology for making process improvements for post-op kidney transplant variables.

They worked with caregivers at a large U.S. hospital over a 3-year span to redesign a process for educating kidney transplant patients post-surgical care.

Read below as Sharma explains their research and their findings.

What were your findings in this research?
In this research, we work with caregivers at a large U.S. hospital over 3 years to improve their post-discharge education and care process for kidney transplant recipients. This process requires high patient-caregiver interaction and active patient participation, thus presenting greater potential for variability, uncertainty and complexity. Patients' needs and requirements differ based not only on medical conditions and treatment plans but also on patients' attention levels and ability to understand caregiver instructions. Lapses in following instructions can result in added complications leading to readmissions, emergency visits and even loss of life. Such settings require a process which combines standardization with the ability to adapt certain features based on the patient needs and preferences.

Our intervention for the process redesign consisted of working with 32 caregivers, including frontline care providers (nurses, physicians and social workers), support staff and administrators at a large teaching hospital in the United States from 2013–2016. We participated in, observed and analyzed the execution of the process redesign while applying insights from organizational learning theory, which informs how knowledge is created and used within organizations. Our specific focus was to redesign a process to include standardization and adaptation in patient education for post-surgical care and to ensure sustainment of these changes over time.

Why are these findings important?
In 2014, over 17,000 patients received kidney transplants in the United States. The wait list for such transplants is longer than 100,000 with more than 3000 patients being added to the list every month. Post-transplant, kidney recipients have high occurrence of readmissions. A study covering kidney transplants from 2001 to 2005 found the readmission rate to be 31 percent. Proper self-care by patients after discharge, including adherence to medication protocols, doctor visits, dietary modifications, and infection prevention, plays an important role in preventing readmissions.

The instructions for such post-discharge care are given to the patients during their transplant-related stay at the hospital. However, these instructions for kidney transplant recipients are becoming more complex with the aggressive use of marginal organs and with increasingly complicated transplant cases being accepted. In addition, with early discharges stemming from added pressures for reducing patient lengths of stay, the scope of patient responsibilities for self-care is also increasing.

Why is this research valuable/critical from a big picture perspective?
We not only successfully redesign the patient education process – the redesigned process showed a reduction in readmissions and improvement in patient satisfaction for the treatment group (patients that were part of the intervention) when compared to the control group (patients that were not part of the intervention). 

Further, we demonstrated sustainment of this modified process over time. While process improvement has been extensively studied in related research, sustaining changes can be challenging, and existing research provides limited guidance in this regard. This research develops a methodology for making process improvements that can be sustained over time. Working in conjunction with caregivers and patients, we developed and incorporated specific directions, which we call countermeasures, on how teams working on process improvements can overcome the challenges in sustaining changes. Thus, our research offers preliminary evidence on ways to overcome these challenges and sustain the overall process improvement. The evidence presented in our research suggests that using these countermeasures not only help sustain process improvements but also result in greater patient satisfaction and better medical outcomes.