Final Assignment Part II Essay
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages To Order 5-10 Pages Description/Paper Instructions
Final Assignment: Part II
Last Name: Please respond to the following questions by referring back to your completed Part I of this assignment. Be sure to use APA format to cite your sources and include in-text citation and quotations where appropriate. Refer to the tool templates provided in the online course for assistance.
NOTE: The Final Assignment consists of two parts—Part I and Part II. This is Part II of the Final Assignment. The attached Case Study and the responses you provided in Part I will guide you in completing Part II.
Read this case study and then:
1. Prioritize opportunities to improve by doing the following:
· Complete an RCA using a fishbone diagram based on the problem you identified in Part I with the following categories: people (patients), people (staff/employees), policies and procedures, and plant (facilities/equipment); (8 points)
· Describe how you would collect data about how often the root causes contribute to the problem to determine where your greatest opportunity for improvement would be (in other words, identify where the data will to come from and how you will collect it); (4 points)
· Design a Pareto chart from the data given above. You may use hypothetical data to design your Pareto chart. (8 points)
You may submit the diagram and chart as separate files.
2. Review each of the following change concepts (Langley et al. 1996). Identify whether each one may apply to your process. If they do apply, explain how; if they do not apply, explain why. (1 point each, 5 points total)
· Eliminate waste (e.g., things that are not used, intermediaries, unnecessary duplication)
· Improve workflow (e.g., minimize hand offs, move steps in the process closer together, find and remove bottlenecks, do tasks in parallel, adjust to high and low volumes)
· Manage time (e.g., reduce set-up time and waiting time)
· Manage variation (create standard processes where appropriate)
· Design systems to avoid mistakes (use reminders)
3. Improve the process and document the improved process with a Process Flowchart. (4 points)
4. You have completed the “Plan” phase of the Shewhart cycle. Now describe briefly how you would complete the rest of the PDCA cycle. (1 point)
Type your name in the upper-right corner of this page next to Last Name
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Points Possible: 30 Exercise 1
Objective: To practice quality improvement tools by applying them to an improvement effort in an ambulatory care setting.
Instructions
- Read the following case study.
- Follow the instructions at the end of the case.
Case Study
Background You have just been brought in to manage a portfolio of several specialty clinics in a large multiphysician group practice in an academic medical center. The clinics reside in a multiclinic facility that houses primary care and specialty practices as well as a satellite laboratory and radiology and phar-macy services. The practice provides the following centralized services for each of its clinics: registration, payer interface (e.g., authorization), and billing. The CEO of the practice has asked you to initially devote your attention to Clinic X to improve its efficiency and patient satisfaction.
Access Process
A primary care physician (or member of the office staff), patient, or family member calls the receptionist at Clinic X to request an appointment. If the receptionist is in the middle of helping a patient in person, the caller is asked to hold. The receptionist then asks the caller, “How may I help you?” If the caller is requesting an appointment within the next month, the appointment date and time is made and given verbally to the caller. If the caller asks addi-tional questions, the receptionist provides answers. The caller is then given
the toll-free preregistration phone number and asked to preregister before the date of the scheduled appointment. If the requested appointment is beyond a 30-day period, the caller’s name and address are put in a “future file” because physician availability is given only one month in advance. Every month, the receptionist reviews the future file and schedules an appointment for each per-son on the list, and a confirmation is automatically mailed to the caller.
When a patient preregisters, the financial office is automatically noti-fied and performs the necessary insurance checks and authorizations for the appropriate insurance plan. If the patient does not preregister, when the patient arrives in the clinic on the day of the appointment and checks in with the spe-cialty clinic receptionist, he or she is asked to first go to the central registra-tion area to register. If there is an obvious problem with authorization, it is corrected before the patient returns to the specialty clinic waiting room.
The receptionist has determined that the best way to not inconven-ience the caller is to keep him or her on the phone for as short an amount of time as possible. The receptionist also expresses frustration with the fact that there are too many things to do at once.
The physician thinks too much of his or her time is spent on paperwork and chasing down authorizations. The physician senses that appointments are always running behind and that patients are frustrated, no matter how nice he or she is to them.
Physician’s Point of View
Patients are frustrated when asked to wait in a long line to register, which makes them late for their appointment, and when future file appointments are scheduled without their input. As a result of this latter factor, and work or childcare conflicts, patients often do not show up for these scheduled appointments.
Patients’ Point of View
The office nurse feels that he or she is playing catch up all day long and explain-ing delays. The office nurse also wishes there was more time for teaching.
The billing office thinks some care is given that is not reimbursed because of inaccurate or incomplete insurance or demographic information or that care is denied authorization after the fact.
On the NRC+Picker website you find the following patient expecta-tions/dimensions of care for adults and children in their outpatient expe-riences with a hospital or clinic outpatient appointment:
- Respect for patients’ values, preferences, and expressed needs
- Coordination and integration of care
- Information and education
- Physical comfort
Office Nurse’s Point of View
Billing Office’s Point of View
Data
- Emotional support and alleviation of fear and anxiety
- Involvement of family and friends
- Transition and continuity
- Access to care
The clinics have just begun to monitor performance data, and you have one quarter’s worth of data for the clinic:
Overall satisfaction with visit 82% Staff is courteous and helpful 90% Waiting room time is less than 15 minutes 64% Examination room waiting time is less than 15 minutes 63% Patient no-show rate 20% Patient cancellation rate 11% Provider cancellation rate 10% Preregistration rate 16% Average number of patient visits per day 16 Range of patient visits per day 10–23 Instructions
- Completely read all of the instructions.
- Decide which problem you want to focus on as your first priority— the goal for your improvement team.
- Identify the team members that you would want to participate in this effort and what fundamental knowledge they should bring to the process.
- Document the current process using a process flowchart.
- Identify your customers and their expectations.
- Prioritize opportunities to improve by doing the following:
- Complete an RCA using a fishbone diagram with the following categories: people (patients), people (staff/employees), policies and procedures, and plant (facilities/equipment);
- Describe how you would collect data about how often the root causes contribute to the problem to determine where your greatest opportunity for improvement would be; and
- Design a Pareto chart from the data given in the table above (you may also use hypothetical data to design your Pareto chart).
- Review the following change concepts (Langley et al. 1996), and identify the ones that may apply to your process:
- Eliminate waste (e.g., things that are not used, intermediaries, unnecessary duplication)
- Improve workflow (e.g., minimize handoffs, move steps in the process closer together, find and remove bottlenecks, do tasks in parallel, adjust to high and low volumes)
- Manage time (e.g., reduce set-up time and waiting time)
- Manage variation (create standard processes where appropriate)
- Design systems to avoid mistakes (use reminders)
- Improve the process and document the improved process with a process flowchart or workflow diagram.
- Decide what you will measure and briefly describe how you would collect the data.
- You have completed the “Plan” phase of the Shewhart cycle. Describe briefly how you would complete the rest of the PDCA cycle.
- Save your answers to each part of this exercise. This will become the documentation of your improvement effort.
Exercise 2
Objective: To practice an RCA.
Instructions
- Read the following case study.
- Follow the instructions at the end of the case.
Case Study
The letter in this case study is adapted with permission from Trina Bingham, master’s in nursing student at Duke University School of Nursing.
You are the risk manager of a tertiary-care hospital and have just received the following letter from a patient who was recently discharged from your facility.
Dear Risk Manager,
Last month, I had surgery at your hospital. I was supposed to have a short, laparoscopic surgery with a discharge by lunch, but it turned into an open surgery with complications. This led to a 4-day hospital stay and discharge with a Foley catheter. Overall, my hospital stay was OK, but I had a situation when the call bell was broken. It was during the night, and I was alone. I needed pain meds. I kept ringing the call bell and no one answered. I used my phone to call the switchboard and no one answered. I didn’t want to yell. My IV began beeping (to be honest I kinked the tubing to make it beep), but no one came with that noise either. Eventually the certified nursing assistant (CNA) came to routinely check my vitals and she got a nurse for me. They switched call bells, but apparently there was an electrical problem, and the call bell couldn’t be fixed until the next day when main-tenance was working. The CNA told me to “holler if I needed
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. The can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
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