Written Assignment Unit 7 Case Study 3 - The Culture of Quality at Arnold Palmer Hospital
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Written Assignment Unit 7: Case Study 3 - The Culture of Quality at Arnold Palmer Hospital Anonymous University of the People BUS 4406: Quality Management Instructor Mohd Asad Siddiq March 18, 2024
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Case Study 3 - The Culture of Quality at Arnold Palmer Hospital 1.
Would becoming ISO certified benefit more Arnold Hospital than implementing Six Sigma initiatives? Give at least 3 reasons properly explained.
Arnold Palmer Hospital “consistently scores in the top 10% in overall patient satisfaction.” It shows its culture of quality and the commitment to continuous improvements. That said, whatev-
er they are doing now is working perfectly. While the ISO certification can provide standardized processes and enhance credibility, I do not think becoming ISO certified would benefit Arnold Palmer Hospital more than implementing Six Sigma initiatives. Here are the reasons: (i) The number one priority in healthcare is to minimize errors. Simple mistakes may lead to unimaginable consequences and fatalities. “The Institute of Medicine in 1998 estimated that 98 thousand deaths could have been prevented that year due to medical errors” (Rathi, et al., 2021, para. 2). The Six Sigma methodology can be an effective way of decreasing these hurtful pre-
ventable deaths, improving patient results, and optimizing overall efficiency (Rathi, et al., 2021). (ii) Six Sigma focuses on spotting and removing defects or variations in the process, which is vital in the healthcare industry. This feature benefits the hospital in terms of cost savings and pa-
tient care quality improvements (Rathi, et al., 2021). (iii) The DMAIC (Define, Measure, Analyze, Improve, Control) methodology in Six Sigma aligns closely with healthcare improvement objectives by providing a meticulous and systematic approach to problem-solving and data-driven decision-making. Here is how DMAIC works for the hospital:
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Define: The first step is to define the patients and their needs in a transparent and incisive man-
ner and the end purposes and capacities of the process (6sigma, 2021). Measure: This step is to measure the hospital's current healthcare level and sort out areas that need improvements. The hospital can use KPIs, such as staff-to-patient ratio, patient wait time, and patient satisfaction level, to collect the measurement (6sigma, 2021). Analyze: The third step is to use Six Sigma’s tools, such as advanced statistical methods, to ana-
lyze collected data. It helps identify root causes that affect the quality (6sigma, 2021). Improve: The patient care process undergoes some changes to improve in this phase. It is critical to track the progress to ensure data is available. The data helps the team determine if the changes made are effective (6sigma, 2021). Control: The last phase is to standardize improvements made. The team will build standard oper-
ating systems, such as protocols and policies. It provides guidelines for future patient care im-
provements and ensures the improvements made continue to progress over time (6sigma, 2021).
2. Should management at Arnold Hospital control all processes tightly? Why? Give mini-
mum 2 reasons properly explained? Yes, management at Arnold Palmer Hospital should control processes tightly to ensure consistent patient care quality and patient safety. Tight control over processes helps minimize errors, de-
crease inconsistency, and ensure compliance with regulatory standards, leading to significantly better patient outcomes. Besides, there is little room for errors and mistakes in healthcare. Strict process control is vital for building and maintaining trust and confidence among patients, their
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families, and the hospital. In addition, tight process control enables the hospital to identify and address inefficient areas and risks. Continuous improvement is a win-win situation for the hospi-
tal and patients. 3. What in your opinion should be monitored continuously and why?
Arnold Palmer Hospital should continuously monitor several important metrics to ensure patient care quality and operational efficiency. These include: (i) Morbidity: Tracking morbidity rates help identify patient outcome movements. It also allows early interventions to prevent complications and illness recurrences and determine specific healthcare needs (Kenton, 2023). (ii) Infection rates: Monitoring infection rates can prevent infections and ensure a hygienic and safe environment to safeguard patients and medical staff. (iii) Readmission rates: Readmission rates are an important measure of healthcare quality. It in-
dicates problems associated with patient care arrangements or discharge planning. For example, high readmission rates may suggest issues with low quality and high costs (Let’s Get Healthy California, n.d.). (iv) Costs per case: Monitoring costs per case helps discover possibilities for cost reduction and resource optimization without trading off patient care quality. (v) Length of stays: Tracking length of stays can help pinpoint obstacles in the care process and enhance patient flow. It results in shorter hospital stays and more efficient resource utilization. Consistent monitoring of these metrics enables prompt detection of problems, promotes data-dri-
ven decision-making, and enhances efforts toward quality improvement.
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4. How could Arnold Hospital thrive towards Excellence? Explain. (give 5 different means).
Arnold Palmer Hospital can strive towards excellence by executing the actions below: (i) Patient flow
: The process of “how patients move through the hospital system, from admis-
sion to discharge” (Chukhrungfa, 2023, para. 3). is critical in advancing efficiency and outcomes. Adopting digital technologies can help determine triage, facilities admission, and discharge pro-
cesses, and allocate resources based on data and analytics (Chukhrungfa, 2023). (ii) Time management and scheduling
: Time is vital in terms of hospital activity planning and coordination, such as emergency management, surgeries, appointments, examinations, and pro-
cedures. Time management and proper scheduling at crucial hours or life-saving times can min-
imize patient wait times, appointments, cancellations, overbooking, and delays. Digital technolo-
gies can remedies for the hospital (Chukhrungfa, 2023). (iii) Service quality
: Service excellence is one of the priority quality indexes for the hospital and patients. Customer service plays an essential role in operational processes. Leaders’ commit-
ments, service excellence culture, and ongoing employee training are crucial in achieving health-
care service excellence. Having well-designed customer service strategies is necessary to stay a top-notch healthcare provider (Chukhrungfa, 2023). (iv) Cost
: Operational expenses can determine the hospital’s success as to remain profitable, sus-
tainable, and able to bring the hospital development to the next level. The balance between cost control and service standard management and the fine-tuning of expenses and profits can opti-
mize operational efficiency (Chukhrungfa, 2023). (v) Supply chain management
: It refers to “how hospitals’ way of carrying out the activities to procure, store, distribute, and use their materials, equipment, drugs, and other supplies decides
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the contribution to success in service delivery and business” (Chukhrungfa, 2023, para. 8). If the hospital manages its supply chain effectively, it can minimize costs, waste, errors, and shortages. Similarly, digital technologies can help “improve their inventory management, tracking, order-
ing, and delivery, institutionalizing the best practices, and implementing process improvement methodologies” (Chukhrungfa, 2023, para. 8). 5. Develop a fish-bone diagram illustrating the quality variables for the ICU (Intensive Care Unit) at Arnold Hospital. Include causes and sub-causes.
6. At Arnold Hospital, daily tools adopted are Pareto charts, flowcharts and process chart. Give an example of how can they adopt a Pareto chart and illustrate it (draw it). Give as well an example of how they can adopt a flowchart and illustrate it. Explain assumptions as needed. Customer Complaints
Man
Management
Materials
Methods
Maintenance Mother Nature
Staff slow responses
Unclear explanation of patients’ situations
Poor facility navigation
Old bed sheets
Poor admission process instruction
Malfunctions of equipment
Power shortage due to heave rain
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Pareto Chart Arnold Hospital can use a Pareto chart to identify the common medical errors occurring in the ICU. They can categorize errors into different types, such as medication errors, diagnostic errors, surgical errors, infection, delayed diagnosis, and faulty medical devices. By plotting the frequen-
cy of each error type on the chart, they can prioritize areas for improvement. Based on the Pareto 80-20 Principle, which states that 80% of problems are often caused by 20% of the factors, and the data provided above, we can conclude that fixing medication errors and diagnostic errors can reduce the frequency of errors by 80%. The hospital should prioritize solving these issues.
Error
0
100
200
300
400
500
0.00%
25.00%
50.00%
75.00%
100.00%
Medication Errors
Diagnostic Errors
Surgical Errors
Infection
Delayed Diagnosis
Faulty Medical Devices
Frequency
Culmulative %
Frequency and Culmulative %
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Medication Administration Process Flowchart This is a medication administration process flowchart in the ICU. The flowchart is designed to be straightforward to avoid medication errors, ensure medication safety, and minimize medical staff confusion. The seven steps include “Right Person, Right Medication, Right Dose, Right Time, Right Route, Right Reason, and Right Documentation” (CA Department of Developmental Ser-
vices, n.d., para 1). The map allows the staff to visually identify restrictions, sources of error, and areas for improvement. It can also serve as a reference tool for medical staff to ensure consisten-
cy and adherence to these steps. 1. Right Person
2. Right Medication
3. Right Dose
4. Right Time
5. Right Route
6. Right Reason
7. Right Documentation
DONE!
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7. Suggest another tool to be adopted by Arnold Hospital and explain its importance. Give an example of how it could be used and illustrate it. Plan-Do-Study-Act (PDSA) cycle PLAN - Set objectives: Reduce wait times by 20%
•
Pilot test the triage system in one section of ED
•
Train staff on new process
- Develop plan: Implement triage system
- Identify problem: Long ED wait times
DO
STUDY
- Measure impact on wait times, satisfaction, workload - Collect data before and after implementation
ACT
- Analyze results
- Expand triage system if successful
- Make adjustments based on feedback
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Arnold Hospital can consider adopting the Plan-Do-Study-Act (PDSA) cycle. The PDSA cycle is a systematic four-stage problem-solving approach for process improvements and change imple-
mentations. Since customers define quality, it is vital to include internal and external customers in the PDSA cycle as they can provide feedback about the positives and negatives. The PDSA cycle is essential because it offers systematic guidelines for continuous improvements. It allows Arnold Hospital to experiment with little changes, assess their effects, and make adjustments ac-
cordingly. The iterative approach also enables the hospital to implement evidence-based changes quickly, minimize risks, and optimize outcomes (Minnesota Department of Health, n.d.). Here is an example of how the hospital can use the PDSA cycle. Let's say Arnold Hospital wants to reduce patient wait times in the emergency department (ED). They can use the PDSA cycle to test various interventions to improve efficiency. Plan •
Identify the problem: Long wait times in the ED lead to patient dissatisfaction and delays in receiving care on time. •
Establish objectives: Reduce patient wait times by 20% within three months. •
Generate a plan: Implement a triage system. Patients can be quickly assessed upon arrival. Di-
rect patients with non-urgent conditions to a separate waiting area for expedited care. Do •
Implement the triage system in one section of the ED as a pilot test.
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•
Train medical staff about new processes and ensure appropriate communication with patients about the changes. Study •
Measure the triage system's effect on patient wait times, patient satisfaction level, and medical staff workload. •
Collect data on wait times before and after implementation. Gather feedback from patients and staff. Act •
Analyze the results: If the triage system successfully reduces wait times, improves patient sat-
isfaction levels, and maintains the medical staff usual workload, the hospital can consider ex-
panding it to other sections of the ED. •
Adjust the process based on feedback and data during the pilot test. •
Continue to track performance and make fine-tunings as needed.
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References
CA Department of Developmental Services. (n.d.). Medication safety
. LinkedIn. https://
www.linkedin.com/pulse/operational-excellence-hospitals-framework-success-
chukhrungfa Chukhrungfa, T. (2023, June 27). Operational excellence in hospitals - a framework for success
. LinkedIn. https://www.linkedin.com/pulse/operational-excellence-hospitals-framework-
success-chukhrungfa Kenton, W. (2023, August 14). What is the morbidity rate? Investopedia. https://www.investope-
dia.com/terms/m/morbidity-rate.asp
Let’s Get Healthy California. (n.d.). Redesigning the healthy system / reducing hospital readmis-
sions - California’s overall 30-day readmission rate has declined from 14% in 2011 to 13.5% in 2015.
https://letsgethealthy.ca.gov/goals/redesigning-the-health-system/reduc-
ing-hospital-readmissions/
Minnesota Department of Health. (n.d.). PDSA: plan-do-study-act
. https://www.health.state.m-
n.us/communities/practice/resources/phqitoolbox/pdsa.html
Rathi, R., Vakharia, A., & Shadab, M. (2021, June 7). Lean six sigma in the healthcare sector: a systematic literature review. Mater Today Proc., 2022
(50), 773-781. https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC8820448/
6sigma. (2021, February 8). How DMAIC helps hospitals improve patient care
. https://6sigma.-
com/how-dmaic-helps-hospitals-improve-patient-care/
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