Clinical management in public health care: Implementation and results

Clinical Management Units (CMU) are organizational structures conceived to provide health care services to a reference population restricted to global budget and to quality and efficiency standards. The objective of this work is to describe the implementation process and results of an Internal Medicine CMU in a Spanish public hospital.

A group of improvement and value analysis was created to design the reengineering process previous to CMU implementation. A wide range of quality tools were used, including analysis of root causes and modal analysis of failures and effects (AMFE). Group meetings were planned to Monitoring and evaluation of changes and to implement new measures.

The Internal Medicine CMU was established in 2007 with 119 beds, 160 professionals and an annual budget of nearly 9 million euro. Special effort was made to improve clinic safety through recording and tracking of the falls, phlebitis catheter, decubitus ulcer, DVT, nosocomial infections and adverse drug reactions index. An advanced electronic device to deliver drugs in unit dose was implemented. Patient satisfaction with the service was 89%, with <0.20% of patients filed a claim. Official External certificate of advanced quality was obtained.

The CMU of Internal Medicine in a public hospital has collaborated to accomplish health policy objectives considering available resources and to achieve adequate levels of quality and safety. The implementation of management tools such as clinical management units is also an adequate strategy to harmonize the relationship between clinicians and managers.