ABSTRACT
Introduction: In the current healthcare climate, the financial strain created by COVID-19, limited resources, and case backlogs highlight the need to optimize operating and procedure room efficiency and maximize capacity. At Seattle Children's, a clinical multidisciplinary team developed and implemented a data-driven protocol to improve efficiency in a high-volume gastrointestinal (GI) suite. Methods: Key process measures, including all case on-time starts and postanesthesia care unit length of stay, were extracted from the electronic medical record and presented as Statistical Process Control (SPC) charts. Clinicians' performance was stratified by rational subgrouping to better understand variation in the system. We defined an expert clinician as one who performs beyond 3-sigma limits on funnel plot analyses. We developed clinical protocols based on expert clinician clinical practices. We gave clinicians dynamic, daily feedback on this family of measures through continuously updated SPC charts. This real-world data drove system and individual-level plan-do-check-act improvement cycles. Results: Despite significant external challenges over 2 years, procedure volume increased by approximately 25%, on-time starts improved by 36%, turnover time decreased by 34%, and postanesthesia care unit length of stay decreased by 15%. GI laboratory revenue increased by approximately 25% (independent of increased charges per procedure), representing the potential for a $2 million increase in annual revenue. Conclusions: A multidisciplinary clinical team improved efficiency metrics in a busy pediatric GI suite. Access to real-world data through continuously updated SPC charts enabled plan-do-check-act cycles that led to measurable improvement. This data access also served to sustain team motivation and engagement.
ABSTRACT
This article examines the Breslover Hasidim who attempted their annual pilgrimage to Uman during the COVID-19 pandemic. Following the Ukrainian border closure in August 2020, which was supported by the State of Israel, thousands of Breslovers were stranded in airports, land borders, and even imprisoned in the weeks leading up to the Jewish New Year. This research contributes to an emerging scholarly literature on religion and COVID-19, challenging the religion and science “conflict thesis,” as interviews revealed that the choice of Breslovers to ignore public health directives stemmed less from a disbelief in science than from a conflict between state and religious authority. Pious mobilities emerge, I argue, when secular logics fail to contain and properly modify religious actors. The choice to travel to Uman was made according to a Breslover moral universe as informants turned to the spiritual tools and teachings of Rebbe Nachman to guide their decisions, especially his notion of ratzon [willpower], engaging in a form of pious mobility that attempted to transcend nation-state borders. Pious mobilities not only challenged public health initiatives in 2020, but as I demonstrate in the ethnography, Breslovers’ insistence on reaching Uman simultaneously threatened the cooptation of Breslov Hasidim within a Zionist narrative, reigniting a debate over the relocation of Rebbe Nachman’s remains to Israel. By ethnographically examining moments of conflict between religious groups and state officials managing the pandemic, we might better inform future public health policies and the messaging aimed at religious populations including ultra-Orthodox Jews. © 2022, Purdue University Press. All rights reserved.