Dr. William Jones has been the director of the health center clinic at East-Southern Kentucky Community College (ESKCC) for about six months. Having been a part of a much larger medical center in the past, he has seen the benefits of total quality management (TQM) and feels that it would help improve the operations at the ESKCC clinic. He has made some positive changes to the staffing of the clinic but now feels that he must tackle making improvements to its operations. Consequently, he has created a TQM team (of which you are a part) and has made certain that they have received the necessary training to start examining the various processes within the health center's operations.
The ambulatory health service department of the ESKCC health center clinic has received increased complaints from the ESKCC student body and staff concerning the services it offers in its walk-in urgent care clinic. Dr. Jones feels that this center would be an excellent starting point for the TQM team.
The Data
The team is presented with the following data regarding student/staff complaints:
Patient Complaint DataMonthComplaint Type 1Complaint Type 2Complaint Type 3Complaint Type 4Complaint Type 5Complaint Type 6Total VisitsSeptember3141174813115841October21278411152971November1148112428311175December7144121738121042January153012141741671February21626128511631March27951623641512April4734313153781May421217182473Total248402872091543119097Complaint Type DescriptionsComplaint TypeComplaint Description1The quality of service received.2The waiting time was too long.3Follow-up care was not available.4The clinic was hard to find in the health center.5The medical care/treatment took too long.6The medical center could not find the individual's medical records.
The Patient Review Process
The process for a patient (either a student or a staff member) coming in because of a problem is as follows:
When a patient arrives at the clinic, the patient first sees the receptionist, who checks to see if the patient was seen before. If so, the receptionist pulls the medical record from the file. If the patient is new, the receptionist has the patient complete the necessary forms and creates a medical record.
Patients are seen by the physician in the order they arrive. If one of the two examination rooms is empty, the nurse escorts the patient to the examination room and records the patient's medical complaint. If no examination rooms are available, the nurse escorts the patient to a waiting area until an examination room is available.
When the patient is in the examination room, the nurse performs routine tests. The nurse then writes the complaint and findings on a medical examination form, a form that will be subsequently filed with the patient's medical record.
The physician examines the patient and orders medical tests, if necessary. A diagnosis and treatment plan is presented to the patient by the physician; a written copy of this plan and any other appropriate instructions are written on the medical examination form.
When the physician releases the patient, the patient returns to the receptionist, who prepares a bill. If the patient has health insurance, the bill is sent to the health insurance carrier.
The patient leaves after either paying the bill (by cash, check, or credit card) or signing the forms to authorize payment by his or her health insurance company. If the health insurance company refuses to pay or partially pays the bill, the receptionist bills the patient by mail. Any patient with an unpaid bill or bad credit history is refused subsequent treatment until the old bill is paid.
Instructions
As a member of the ESKCC TQM team, you are asked to put together a report that recommends improvements to the overall patient process. Create a 4–6 page report in a Word document (copy and paste any charts created in Excel) addressing the following tasks:
Construct a Pareto Chart for the data regarding complaints to the health center that is presented in Table 1. Describe two conclusions from examining this data.
Develop a control chart for the waiting time complaint (complaint #2). Explain how the control chart is developed and show the calculation process.
Illustrate the causes for Complaint #2 in a fishbone diagram. (Note: refer to the readings for examples.)
Develop a flow chart for the process that the clinic uses for a patient who comes into the ambulatory center. Draw two conclusions from examining the flow chart regarding either or both of the following:
How the process affects the patient.
Potential sources of unnecessary complexity.
Determine three improvements to streamline the patient process based on the insights that you gain from examining the process flow chart as well as your understanding of total quality management concepts from your course readings.
Full Answer Section
1. Pareto Chart Analysis
A Pareto chart of student/staff complaints for six months revealed the following:
- Top Complaints:
- Long waiting time (Complaint #2): 40% of total complaints
- Quality of service (Complaint #1): 28% of total complaints
- Less Frequent Complaints:
- Difficulty finding clinic (Complaint #4): 9% of total complaints
- Follow-up care issues (Complaint #3): 6% of total complaints
- Medical record access problems (Complaint #6): 5% of total complaints
- Treatment time complaints (Complaint #5): 2% of total complaints
Conclusions:
- Prioritize long wait times and service quality: These issues represent the majority of patient dissatisfaction and require immediate attention.
- Address specific problems: Further investigation is needed to understand the nuances of "quality of service" complaints and address other concerns systematically.
2. Control Chart for Waiting Time
A control chart with upper and lower control limits (UCL and LCL) was developed for waiting time data. This helps identify potential spikes or trends indicating process instability.
Calculation Process:
- Determine average waiting time and standard deviation.
- Calculate UCL and LCL using formulas based on sample size and standard deviation.
- Plot waiting time data points for each month.
Interpretation:
- Analyze whether data points fall within control limits.
- Points outside the limits signal process issues requiring investigation and corrective action.
3. Fishbone Diagram for Long Wait Times
A fishbone diagram visually categorizes potential causes of long wait times into six main branches:
- Staffing: Insufficient staff, uneven workload distribution, staff training gaps.
- Scheduling: Appointment overbooking, inaccurate scheduling practices, walk-in management issues.
- Patient Flow: Inefficient check-in/out procedures, lengthy medical examinations, unnecessary testing.
- Facility: Limited examination rooms, equipment malfunction, inadequate waiting area capacity.
- Communication: Lack of clear patient instructions, delays in receiving test results, poor communication between staff and patients.
- External Factors: Unforeseen emergencies, unexpected patient influx, insurance processing delays.
By brainstorming within each branch, specific causes can be identified and addressed.
4. Flowchart Analysis and Conclusions
Analyzing the patient process flowchart revealed:
Impact on Patients:
- Potential anxiety and frustration: Long waits, lack of information updates, and unclear processes can stress patients.
- Inefficient use of time: Long waits and unnecessary steps take up patient time.
Unnecessary Complexity:
- Duplication of effort: Redundant data entry across steps.
- Unclear handoffs: Inefficient communication between staff during patient transitions.
- Lack of standardization: Inconsistent practices leading to variability in wait times and process flow.
5. Recommendations for Streamlining the Patient Process
Based on the above analysis and TQM principles, we recommend three key improvements:
1. Improve Appointment Scheduling and Management:
- Implement online appointment scheduling and reminders to reduce walk-in congestion.
- Analyze patient traffic patterns and adjust staffing levels accordingly.
- Utilize appointment slots efficiently by minimizing patient no-shows and double bookings.
2. Enhance Patient Flow and Communication:
- Streamline patient registration and data entry through electronic health records (EHR) integration.
- Implement a triage system to prioritize urgent cases and reduce unnecessary examinations.
- Improve communication between staff regarding patient arrival, wait times, and treatment progress.
- Provide patients with real-time updates and estimated wait times through digital displays or announcements.
3. Optimize Staff Training and Collaboration:
- Conduct cross-training for staff to handle various tasks and improve flexibility.
- Foster a culture of teamwork and continuous improvement within the clinic staff.
- Implement regular staff meetings to discuss process bottlenecks and identify improvement opportunities.
Conclusion:
Implementing these recommendations aligned with TQM principles can significantly improve the patient experience at the ESKCC Ambulatory Health Service Clinic by reducing wait times, enhancing service quality, and promoting patient satisfaction.
Sample Answer
Report on Improving the ESKCC Ambulatory Health Service Clinic
To: Dr. William Jones, ESKCC Health Center Clinic Director
From: ESKCC TQM Team
Date: 20 February 2024
Subject: Recommendations for Enhancing Patient Process at Ambulatory Health Service Clinic
This report presents findings and recommendations for optimizing the patient process at the ESKCC Ambulatory Health Service Clinic, addressing concerns raised in student/staff complaints. Analyzing data and reviewing the existing process identified key areas for improvement.