Quality Management and Performance Improvement

Scenario Directions:
Review the case study example related to a quality management/process improvement scenario.
Respond to the questions using the same writing standards as your papers. Responses should
reflect expertise, the text, research, and online learnings. Responses should be in APA format. It
can’t be plagiarized.
**Book used*** Advanced Performance improvement in Health Care (principles and methods).
By Donald E. Lighter. **if needed for reference**
All answers should be thorough, answered in complete sentences and with well-formed
responses.
Case Study – Quality Management and Process Improvement
A 26-year-old women developed gradual onset of shortness of breath over the past three
days, she had no cough, fever, wheezing, or other symptoms. Because the sensation of shortness
of breath increased in intensity, she went to her local hospital’s emergency department (ED). At
the ED, she waited in the busy reception area until her name was called to registration. After
providing her general and insurance information, she was told to wait. Twenty minutes later, a
triage nurse obtained a brief history and took vital signs. She returned to the waiting room, where
she waited for two and a half hours. During this time, she witnessed a steady flow of patients
with various degrees of injury and distress pass through the emergency area; most appeared
much sicker than she was. She was eventually led to a stretcher, where another nurse took a
detailed history. A physician entered the room, took a more detailed history, performed a physical
examination and ordered blood tests, a chest X-ray, lung scan, and electrocardiogram. Over the
next three hours the tests were evaluated, after which time the physician told her that he thought
that she might have asthma, but no serious disease. She was instructed to follow up with her
primary physician and was given a prescription for an inhaled bronchodilator.
The afternoon previous to the patient’s visit a hospital administrator, the physician director
of the emergency department, and the director of hospital improvement met to review several
disturbing trends. Patient satisfaction with the emergency department was falling, the proportion
of “elopements” (patients leaving the emergency department without being fully evaluated) was
increasing, and there had been at least one instance of a patient falling in the crowded waited
room. The administrator wanted the physician director to organize the department more
efficiently to address the fundamental problem of excess wait time; the physician director
believed that the wait time was to be expected given the severity of illnesses of the patient
population, and the existing resources. The performance improvement director suggested that the
wait times first be measured and benchmarked before embarking on a performance improvement
plan that focused on wait time. Using the techniques described, with enthusiastic and substantive support from hospital
administration and the medical staff, the emergency department embarked on a nine-month effort
to measure, analyze, and improve the quality of care. They chose to focus on wait times; patient
satisfaction with services delivered; timeliness of initiation of care for patients with timesensitive diagnoses for cases such as stroke and chest pain; and return visits to the departments
for the same complaint within 72 hours. Using tools from performance improvement
organizations and ideas from staff within the hospital, they developed new policies and
procedures, re-organized the functions of staff, hired additional staff, and instituted performancebased incentives. Some of the changes they initiated included: Hiring a “greeter” to establish contact with every patient form the time they entered the
ED
Moving triage out into the waiting area to better and more quickly identify seriously ill
patients
Completing registration in the examination areas, with the aid of wireless computers, to
begin diagnosis and treatment more quickly
Posting an electronic sign that reads, “Patients registering now may have an average wait
time of . . . .” In addition, the greeter, registration, nursing, and other staff were trained in the recognition
of and appropriate action for time-sensitive conditions. Each person was then empowered to
initiate an appropriate care process (e.g., the greeter knew to escort any patient complaining of
chest pain to a wheelchair and then immediately to the triage nurse, bypassing registration).
Other improvements were made to decrease wait times and improve the quality of care.
Please answer these questions as the new hospital administrator, joining the hospital three
months after the incident:
1: What would you do to join the improvement effort?
2. What are the top five attributes of quality you are seeking to foster?
3. What four other suggestions would you offer for improvement and why?