Vila Health: Patient Flow - Speed Assignments

Create a 5-7 page report that will help the Director of Quality Management at Vila Health to understand the current trend of patient satisfaction numbers, and propose potential solutions to any problems.

Demonstrating the organization’s ability to be respectful of and responsive to the needs of their consumers will in turn improve upon the quality and safety of the care being delivered, decrease costs, and increase provider satisfaction. Organizations that seek to remain relevant in the industry, improve business operations, continue to capture market share, and continue quality improvement efforts, should always be focused on establishing patient safety as an improvement priority. Patient safety should never fall off the improvement radar, as organizations can quickly suffer from the implications of declined satisfaction if they are not monitoring the needs of their consumers. Organizations that fail to prioritize patient satisfaction run the risk of losing business and reimbursements. Given that reimbursements are tied to patient satisfaction, quality, and outcomes, any organization wishing to remain relevant in the industry would make patient satisfaction a priority within their strategy.

The quality improvement team is a diverse group of individuals who are tasked with carrying out improvement efforts. The team should include individuals who will be impacted by the improvement efforts being worked on. With this in mind, several teams may exist and be working on a variety of improvement efforts simultaneously within the organization. Each team is responsible for addressing the improvement initiative and tracking its progress toward achieving the anticipated improvement.

Common tools utilized by the team include lean methodology, six sigma, DMAIC, value stream mapping, and fishbone diagrams. The fishbone diagram (also known as the cause-and-effect diagram) is a visual tool utilized to highlight potential causes of a problem, including delays in care, in order to determine the root causes (Kros & Brown, 2013). Lean methodology focuses on making rapid improvements toward the goals of delivering value, eliminating waste, establishing flow, and pursuing perfection. Reducing unnecessary and wasteful steps is key in creating a dramatic improvement in flow in the value stream resulting in improved efficiency and speedthe main goal of the methodology. DMAIC (define, measure, analyze, improve, and control) is a five-step process utilized in the six sigma method, which is focused on eliminating defects and waste, resulting in improved quality and efficiency (Kros & Brown, 2013). The data-driven strategy requires use of all five steps in order to ensure the best possible results.

Reference
Kros, J. F., & Brown, E. C. (2013). Health care operations and supply chain management: Operations, planning, and control. San Francisco, CA: Jossey-Bass.

Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

Competency 1: Describe when and how the senior leader would directly impact health care operations.
Describe why leaders should select declining patient satisfaction as a performance improvement initiative.
Competency 2: Analyze the impact of the various success factors of a health care organization.
Explain why patient satisfaction is an essential component of health care business.
Competency 3: Analyze the concept of competitive strength by considering efficiency and effectiveness of organizational processes.
Complete a fishbone diagram of the situation presented in this assessment.
Describe the purpose of a performance improvement team.
Competency 4: Apply management concepts to lead an efficient health care system.
Describe lean methodology.
Explain the DMAIC model for a data-driven improvement cycle.
Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals.
Write following APA style for in-text citations, quotes, and references.
Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
Preparation
This assessment is based on the Vila Health: Patient Flow media simulation, which is linked in the Vila Health: Patient Flow section of Assessment 2. Go to that section to complete the scenario at this time. The scenario presented in this media piece will provide you with the baseline information and context to create a report that addresses utilizing process improvement techniques and strategies to improve upon patient flow within and out of Independence Medical Center.

In addition to the information presented on fishbone diagrams and quality improvement strategies within the simulation, you may also want to conduct more in-depth research before create your report. You are encouraged to research topics on patient flow, DMAIC, patient satisfaction, and performance improvement teams.

Vila Health: Patient Flow | TranscVila Health: Patient Flow | Transcriptmedia simulation.
Instructions
Based on the media simulation you completed, the Director of Quality Management has asked you, in your position in the quality assurance department, to create a report on the declining patient satisfaction at Independence Medical Center. In addition to your findings, you have been asked to present potential solutions and rationale for why these solutions are potentially relevant and valuable to pursue at IMC.

Include the following in your report:

Explain why patient satisfaction is an essential component of a health care business.
Identify a competitive advantage of the organization depicted in Vila Health: Patient Flow.
Explain the organizations strategic initiatives.
Explain why patient satisfaction is a strategy for this organization.
Describe why leaders should select declining patient satisfaction as a performance improvement initiative.
Describe potential reasons for patient satisfaction decline.
Define a performance improvement initiative.
Complete a fishbone diagram of the situation presented in the Vila Health: Patient Flow media piece.
Discuss the process to identify the top categories of an issue.
Describe how to organize the subtopics when producing a fishbone diagram.
Describe the purpose of a performance improvement team.
Identify the positions or roles that are necessary to form a performance improvement team.
Describe the stakeholders that should be represented in a performance improvement team.
Describe lean methodology.
Define lean methodology.
Determine what kinds of projects benefit from the use of lean methodology.
Explain the define, measure, analyze, improve, and control (DMAIC) model for a data-driven improvement cycle.
Define the problem or scope that is depicted in Vila Health: Patient Flow.
Discuss what data you have to collect respective to the identified problem.
Define the root causes of the problem.
Determine the possible recommendations the team would offer.
Define possible recommendations and what would affect them.
Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.

Apply the principles of effective composition.
Determine the proper application of the rules of grammar and mechanics.
Write following APA style for in-text citations, quotes, and references.

Determine the proper application of APA formatting requirements and scholarly writing standards.
Assess the relevance and credibility of information sources.
Additional Requirements
Written communication: Writing is clear, precise, scholarly, and free of errors that detract from the overall message. Concepts flow in a logical order.
References: A minimum of three scholarly references.
Length: 57 pages.
APA: Correct use of APA style and formatting. Refer to the APA resources in the NHS Learner Success Lab (located in the courseroom navigation menu) if you have questions about APA style or formatting.

References – VILA FLOW SIMULATION

Introduction
The physical delivery of health care is a complicated process, and one which can have implications for the organizations finances and its patients health. For those reasons, organizations try to make their delivery as efficient as possible. For example, hospitals routinely analyze how patients flow from one department to another such as from the ER to a room in one of the units, or from Surgery to Med-Surg to discharge. The goal is to make sure that patients get treatment in a timely fashion and then discharged or moved to a more appropriate floor as soon as possible.

In this activity, you will observe the flow of patients in an ER.

Email From Quality Assurance
Independence Medical Center is a critical access hospital in Independence, Iowa. You are a recently hired project manager in the hospitals Quality Assurance department, and youve been given an assignment: Find out why patient satisfaction has been going down in recent months.

Email from Chad Williams, Director of Quality Assurance
Subject: Survey Numbers

Hey there! Im in charge of Quality Assurance and I hear from Albert Lynton that youre in charge of the project to figure out our problem with patient satisfaction. Albert (hes our director of operations) asked me to send you the survey numbers so you know what were seeing.

So heres the scoop: In the last 8 months, our patient sat has tanked. Were talking 93 percent satisfaction at the beginning of that time to 79 percent now. Ouch!

Were still at 90 percent satisfaction with treatment outcomes, so at least theres that. And were at 85 percent with the quality of the environment beds, food, that sort of thing.

But heres where were hurting: communication and wait times. Were at 65 percent for communication (by providers, that is, our docs and nurses), and 49 percent for wait times.

Now, heres a breakdown of those who said they were dissatisfied with their wait time:

47 percent of those who completed the survey were treated in the ER.
38 percent were admitted from the ER to the floor (to Med-Surg, the ICU, and other departments).
15 percent of the patients who completed the survey were parents of pediatric patients.
Other facts you might want to keep in mind: 73 percent of the hospitals admissions come through the Emergency Room, and nearly half (46 percent) of these admissions occur between 6 p.m. and 4 a.m.

Good luck, and let me know if you need anything!

Chad

The Emergency Room
You decide to use a common technique for figuring out problems in patient flow: shadowing patients as they come through the ER.

Ruby Martindale, Linda Mueller, and Stephanie Foster
Ruby Martindale: Were going to have to divert all ambulances to Buchanan County. We are at capacity, and by that I mean we are beyond capacity.

Linda Mueller: When can I see a doctor?

Ruby Martindale: Any time now! (to another nurse) Whos attending today? Arent there any doctors we can pull in?

Stephanie Foster: No, theyre still doing rounds.

Ruby Martindale: What? Its 3:00! How many patients do we have still here who could have been moved?

Stephanie Foster: I dont know, but Med-Surg is under capacity. So probably several.

Message over the hospital PA system:
Dr. Fabiola, please call the ER. Dr. Fabiola, please call the ER.

Debra Green and Beverly Mitchell
Debra Green: Thats his third page. I wonder where he is?

Beverly Marshall: I dont know, but Mr. Tensleep, the one with the confusing lab results, isnt going anywhere until we can consult with him.

Winston Sutherland and Heather Taylor
Winston Sutherland: Lets get an EKG on Ms. Mueller.

Heather Taylor: But shes not showing any cardiac risk factors.

Winston Sutherland: Lets get one anyway. Shes driving me nuts and Im not giving her a single excuse to sue us. Besides, the last patient who didnt have any risk factors went home on my okay, and he was back here three hours later.

Heather Taylor: Well, it will have to wait. There are quite a few elective surgeries today, and several of the patients needed a preoperative EKG.

Winston Sutherland: Oh, right. Its Monday. I should have known wed get backed up. Remind me again why they dont spread those out?

Heather Taylor: Dont get me started.

The Fishbone Diagram
Email from Chad Williams, Director of Quality Assurance
Subject: Template for You

How did your observations go? I hope you learned what you needed to. Meanwhile, heres a template for you to use as you pull together your ideas for improving patient satisfaction. I think this is a useful tool, and I use it myself regularly.

Attachement: The Fishbone Diagram.docx

Now, please answer the following questions.
Question 1: Generated from customer feedback on their perceptions of hospital care, this important and regularly utilized indicator for measuring quality in health care produces data relative to patient experiences, allows for benchmarking, and encourages hospitals to work towards improving the quality of care they deliver.

Your response:

This question has not been answered yet.
Incorrect.
Correct Answer: Patient Satisfaction

Demonstrating the organizations ability to be respectful of, and responsive to the needs of their consumers which will in turn improve the quality and safety of the care being delivered, decrease costs and increase provider satisfaction as well. Organizations who seek to remain relevant in the industry, improve business operations, continue to capture market share and continue quality improvement efforts, should always be focused on establishing patient safety as an improvement priority. Patient safety should never fall off the improvement radar as organizations can quickly suffer from the implications of declined satisfaction if they are not monitoring the needs of their consumers.

Incorrect.
Correct Answer: Patient Satisfaction

Correct!
Demonstrating the organizations ability to be respectful of, and responsive to the needs of their consumers which will in turn improve the quality and safety of the care being delivered, decrease costs and increase provider satisfaction as well. Organizations who seek to remain relevant in the industry, improve business operations, continue to capture market share and continue quality improvement efforts, should always be focused on establishing patient safety as an improvement priority. Patient safety should never fall off the improvement radar as organizations can quickly suffer from the implications of declined satisfaction if they are not monitoring the needs of their consumers.

Incorrect.
Correct Answer: Patient Satisfaction

Question 2: Commonly referred to as a cause and effect diagram, this visual tool categorizes potential causes of a problem.

Your response:

This question has not been answered yet.
Incorrect.
Correct Answer: Fishbone

A flow chart is a diagram utilized to depict a workflow or process.

Correct!
The fishbone diagram (or cause and effect diagram) is a visual tool utilized to highlight potential causes of a problem in order to determine its root causes. The tool itself breaks down the problem into causes under each of the following categories: methods, people, materials, equipment, and environment.

Incorrect.
Correct Answer: Fishbone

Venn diagrams are mathematical diagrams used to demonstrate the relationship between sets.

Incorrect.
Correct Answer: Fishbone

Pareto charts are utilized in quality management to identify the most common causes of defects.

Question 3: The front-line staff member is a critical member to the performance improvement (PI) team, as they offer valuable insight into daily operational functions where variation and waste generally occur.

Your response:

This question has not been answered yet.
Correct!
The front-line staff member is generally closest to the process the PI team is seeking to improve. Including them will provide the team with valuable insight into the process and what areas need improvement. In addition, success of the implemented improvement will require buy-in from those who are going to be impacted most by the change. Including them in the improvement process will generate a sense of ownership and buy-in amongst those on the front line.

Incorrect.
Correct Answer: True

The front-line staff member is a critical member of the PI team. Failing to include them in the process may result in unsuccessful improvement attempts, lack of staff engagement and buy-in.

Question 4: This systematic improvement methodology focuses on removing waste from the value stream without forfeiting productivity.

Your response:

This question has not been answered yet.
Incorrect.
Correct Answer: Lean methodology

The lean methodology focuses on making rapid improvements towards the goal of delivering value, eliminating waste, establishing flow and pursuing perfection. Reducing unnecessary and wasteful steps is key towards creating a dramatic improvement in flow in the value stream resulting in improved efficiency and speed – the main goal of the methodology.

Incorrect.
Correct Answer: Lean methodology

Correct!
The lean methodology focuses on making rapid improvements towards the goal of delivering value, eliminating waste, establishing flow and pursuing perfection. Reducing unnecessary and wasteful steps is key towards creating a dramatic improvement in flow in the value stream resulting in improved efficiency and speed – the main goal of the methodology.

Incorrect.
Correct Answer: Lean methodology

Question 5: A plan created by the organization to move from their present operations to a more advantageous point in the future in the face of uncertainty, competition and constant change.

Your response:

This question has not been answered yet.
Correct!
The strategic plan is created by the organization to highlight the desired future state. The plan includes goals, objectives, and tactics necessary to achieve the desired state. This form of planning works from the desired end backwards to the current status.

Incorrect.
Correct Answer: Strategic Plan

The risk management plan is created with the intent to minimize the organizations exposure to risk. At a minimum, the plan should include information related to patient safety, federal regulations, medical errors, and health policy and legislation.

Incorrect.
Correct Answer: Strategic Plan

The marketing plan is created to guide the organization in its efforts towards marketing their products and services. The end goal is to persuade customers to purchase products or seek services from the organization.

Incorrect.
Correct Answer: Strategic Plan

The emergency operations plan describes how the organization will respond and recuperate from hazards.

Question 6: Demonstrating outstanding scores in patient satisfaction distinguishes an organization from its competitors providing for a ________________ advantage.

Your response:

This question has not been answered yet.
Incorrect.
Correct Answer: Competitive

Creating and maintaining a competitive edge in the health care industry is a topic of focus for many organizations as change is constant requiring organizations to be innovative and agile in their operations. Given that reimbursements are tied to patient satisfaction, quality, and outcomes any organization wishing to remain relevant in the industry would make patient satisfaction a priority within their strategy. Demonstrating the organizations ability to be respectful of, and responsive to the needs of their consumers which will in turn improve the quality and safety of the care being delivered, decrease costs and increase provider satisfaction as well. Organizations who seek to remain relevant in the industry, improve business operations, continue to capture market share and continue quality improvement efforts, should always be focused on establishing patient satisfaction as an improvement priority. Patient satisfaction should never fall off of the improvement radar as organizations can quickly suffer from the implications of declined satisfaction if they are not monitoring the needs of their consumers.

Incorrect.
Correct Answer: Competitive

Correct!
Creating and maintaining a competitive edge in the health care industry is a topic of focus for many organizations as change is constant requiring organizations to be innovative and agile in their operations. Given that reimbursements are tied to patient satisfaction, quality, and outcomes any organization wishing to remain relevant in the industry would make patient satisfaction a priority within their strategy. Demonstrating the organizations ability to be respectful of, and responsive to the needs of their consumers which will in turn improve the quality and safety of the care being delivered, decrease costs and increase provider satisfaction as well. Organizations who seek to remain relevant in the industry, improve business operations, continue to capture market share and continue quality improvement efforts, should always be focused on establishing patient satisfaction as an improvement priority. Patient satisfaction should never fall off of the improvement radar as organizations can quickly suffer from the implications of declined satisfaction if they are not monitoring the needs of their consumers.

Question 7: According to the Institute for Healthcare Improvement (IHI), the six major bones included on the fishbone diagram include; measurements, materials, people, machine, methods and ________________.

Your response:

This question has not been answered yet.
Incorrect.
Correct Answer: Environment

The environment bone will highlight key elements that may contribute to an error including patient acuity at the time of the error, staffing ratios, conditions (time, temperature, culture of the unit etc.).

Correct!
The environment bone will highlight key elements that may contribute to an error including patient acuity at the time of the error, staffing ratios, conditions (time, temperature, culture of the unit etc.).

Incorrect.
Correct Answer: Environment

Question 8: The Value Stream Map is a tool utilized in the lean methodology and analyzes the current state for a series of events that takes a product or service from its beginning through to the end.

Your response:

This question has not been answered yet.
Correct!
Value stream mapping is an effective tool utilized in lean six sigma projects to help visualize a patients path to treatment in an effort to improve the service an minimize delays. Delays in care are considered wasted time in health care as time spent with the patient equates to dollars reimbursed. A key component to the value stream map is identifying the ideal state.

Incorrect.
Correct Answer: True

Value stream mapping is an effective tool utilized in lean six sigma projects to help visualize a patients path to treatment in an effort to improve the service an minimize delays. Delays in care are considered wasted time in health care as time spent with the patient equates to dollars reimbursed. A key component to the value stream map is identifying the ideal state.

Question 9: This five-step model is a core tool utilized in Six-Sigma improvement projects:

Your response:

This question has not been answered yet.
Incorrect.
Correct Answer: DMAIC

Correct!
The DMAIC (define, measure, analyze, improve, and control) is a five-step process utilized in the Six Sigma method which is focused on eliminating defects and waste resulting in improved quality and efficiency. The data driven strategy requires use of all five steps in order to ensure the best possible results.

Incorrect.
Correct Answer: DMAIC

A strategic planning tool, the SWOT analysis includes a review of the strengths, weaknesses, opportunities and threats related to business planning.

Incorrect.
Correct Answer: DMAIC

ISO 9000 is a compilation of quality management systems utilized by organizations to meet the needs of various stakeholders while simultaneously meeting regulatory requirements.

Question 10: By improving __________________ organizations can realize monetary savings on staffing, decreased wait times, and increase provider and patient satisfaction as patients are efficiently transferred between.

Your response:

This question has not been answered yet.
Incorrect.
Correct Answer: Patient Flow

Barriers to seamless patient flow may include staffing, limited inpatient bed availability and delays in radiology and laboratory study processing. Failing to address barriers to patient flow result in increased organizational costs, diminished patient & provider satisfaction and delays in rendering care. Barriers to patient flow exist between facilities as well due to lack of collaboration, communication, and established process. Facility to facility transfers in care will continue to rise given the increase of baby boomers entering into retirement and seeking services from the industry. Organizations who are proactive in addressing potential inefficiencies and barriers to patient flow between facilities will reap the benefits of seamless patient throughput.

Incorrect.
Correct Answer: Patient Flow

Correct!
Barriers to seamless patient flow may include staffing, limited inpatient bed availability and delays in radiology and laboratory study processing. Failing to address barriers to patient flow result in increased organizational costs, diminished patient & provider satisfaction and delays in rendering care. Barriers to patient flow exist between facilities as well due to lack of collaboration, communication, and established process. Facility to facility transfers in care will continue to rise given the increase of baby boomers entering into retirement and seeking services from the industry. Organizations who are proactive in addressing potential inefficiencies and barriers to patient flow between facilities will reap the benefits of seamless patient throughput.

Incorrect.
Correct Answer: Patient Flow

Conclusion
Conclusion: Activity complete!

What did you learn about Independence Medical Centers patient flow? What would you do to improve the situation?