Quality Improvement in Health Care: The Crowded Clinic
Instructions:
Your administration is given this case and you are required to study this using the Lean Six Sigma framework and identify the following –
- What is the VOC? Develop a project charter.
- What types of individuals would you like to have on your team?
- What baseline measures would you use and why?
- What data would you collect? Be specific.
- Assume
you are developing a fish bone diagram.
- What is the effect?
- What would be the categories you would use for the bones?
- How would you display the data?
- How would you know you were successful?
Solution.
Quality Improvement in Health Care: The Crowded Clinic
Voice of Customer
The voice of customer will involve-
Patient segmentation
Patient profiling
Patient value criteria
Patient satisfaction
Patient satisfaction
The Project Charter
OVERVIEW:
Linkage to Mission, Vision, Values, and Promise: To provide efficient, quality, and friendly services- reduce wait times, improve patient experience, eliminate caregivers’ mistakes, to increase the number of patients show ups.
Problem Statement:
Goal/Benefit: Reduce rate of no-show as well as eliminate the existing backlog
Scope: Appointment scheduling improvement starting with patients setting their appointments ending with physicians aligning to the new changes
Improving patients experience starting with reducing doctors mistakes ending with workforce alignment with the customer needs
Core Team: Clinic CEO, Clinic Managers, Physicians, nurses, appointment staff, inpatient caregivers, inpatient auxiliary staff, patient representative if possible, and any other relevant staff
Deliverables: 1) a report of the current situation analysis 2) Recommendations for solutions to the current issues 3) a clear description of the expected challenges in addressing the issues
KEY METRICS:
Reduced no-shows
Improved customer experience
Reduced patient wait time
Increased number of patient served by a single physician
MILESTONES:
Description Date
Define Dec 1-10
Implementation Jan 1-March-31
Measure/analyze April 1-10
Correction April 11-30
The Project Team
Carrying out the task will involve some professionals who will assist in problem analysis and solution formulation. The stakeholders will have to be involved eliminate chances of compromising their interests. The hospital managers will have to be required to identify the amount of resources that will be committed towards the project. The team members will include:
- The Clinic CEO
- The clinic Managers
- The Physicians
- Nurses
- Appointment staff
- Inpatient caregivers
- Inpatient auxiliary staff
- Inpatient representatives
- Staff organizations’ representatives
- Any other relevant member
Baseline Measures
The baseline measurements in this task include the current number of show ups. The number of patients that show up during the scheduled time will be examined to evaluate the magnitude of the current situation. The number of patients a physician attends to in a given duration of time is another baseline measure in this project. The number of the patients a doctor handles in a day will have to be known. The number will be compared to the patients a particular physician can control in a certain duration of time (Black & Revere, 2004).
The measure will help to identify the nature of the current problem and specify the improvement possible. The number of patients showing up for an appointment will be another baseline measure in this project. The number will be critical in assessing the compliance of patients. The number will be helpful in identifying the effects of the language barrier to the patient compliance. Working patients will also be considered to ensure that they are incorporated in the program. The number will be essential in evaluating the necessity of the open access appointment programs (Revere, Black & Huq, 2004).
The patients that own a phone or have working communication channels will also have to be identified. The number will be critical in evaluating non-compliance due to lack of proper communication channels. The amount of patients with no proper communication channels will determine whether non-compliance is caused by improper communication. The factor will be essential in determining whether the same day appointments will work. The patient wait time will also be considered at the beginning of the program (Revere, 2003).
The wait time is a determining factor in the patient satisfaction and will be used in establishing whether it is worthy to modify the program. The number of patients affected by the wait time if so large will force the program modification to incorporate them. The existing resources and their effect on the patient experience will be evaluated to identify whether there is an optimal utilization. Lack of optimum utilization of resources will show a window of improvement opportunity (IOM., 2001).
Data Collection
The program will begin with an extensive collection of data for situation analysis. The number of patients that the clinic attends to in a given duration of time will be identified. The number will assist in quantifying the current problems the hospital is facing. The number of physicians available will also be identified. Quality improvements approaches will rely heavily on this figure. The patient waiting time will also be observed in hours to examine the level of frustration it is causing. The physician waits time will also be calculated in hours to establish the nature of improvement that can be made (Arch Pathol Lab Med., 1990).
The patients and the physician composition will also be another field of interest in this study. The composition will be evaluated regarding language, race, and color. This data about the physician and patients will be necessary for establishing the patients’ representation in the clinic’s workforce. Data about the working patients will also be collected to determine the need for extra measures to improve their experience. Finally, the data about the patient who are satisfied with the services will be gathered to establish the causes of their satisfaction (Revere, 2003).
The Fish Bone Diagram
Effect
The cause-effect diagram will help in the analysis of the problem hence improving understanding. The chart will identify the cause of the problem will be determined by the layout. The knowledge will assist in linking the solution to the existing problem. This knowledge will assist in the formulation of an appropriate solution to improve the customer experience. The improved experience will lead to more customer adhering to the scheduling program (IOM., 2001).
Categories for Bones
The causes of variation will be the bones for the fishbone. The categories for the bones will be people who will include physicians, nurses, and patients. The measurement of the existing efforts to help in approximating the issues. The current resources will also be another category for the bones. The methods that are currently in use and those that will be implemented will be a bone group. The environment and the machines available will also be categories for the bones (IOM., 2001).
Displaying Data
The data will be displayed in many ways for the purpose of understanding. Some of the tools that will be used to display data include tables, graphs, charts and any other relevant tool that will enhance understanding.
Success
Success will be measured by the overall patients’ response. A Gantt chart will be used to schedule implementation and to track the implementation of the process. The Gantt chart will be a good measure of implementation of success (Revere, 2003).
References
Black, K., & Revere, L. (2004). Six Sigma Arises from the Ashes of TQM with a Twist. University of Houston – Clear Lake School of Business and Public Administration.
Revere, L., Black, K., & Huq, A. (2004). Integrating Six Sigma and CQI for improving patient care. The TQM Magazine, 16(2), 105-113. doi:10.1108/09544780410522991
Revere, L. (2003). Integrating six sigma with total quality management a case example for measuring medication errors. Berwick, D. M., Nolan, T. W., & Whittington, J. (2008).
Institute of Medicine (IOM). (2001). Crossing the quality chasm. Institute of medicine. doi:10.17226/10027
Arch Pathol Lab Med. (1990, November). The seven pillars of quality. – Pubmed – ncpb. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2241519
