healthcare quality management, writing homework help

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Case Study


You have been brought in to manage a portfolio of several specialty clinics in a large multi-physician group practice in an academic medical center. The clinics reside in a multi-clinic facility that houses primary care and specialty practice as well as a satellite laboratory and radiology and pharmacy services. The practice provides the following centralized services for each of its clinics: registration, payer interface, 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, patient or family member calls the receptionist at Clinic X for 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 additional questions, the receptionist provides answers. The caller is then given the toll free pre-registration 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 person on the list, and a confirmation is automatically mailed to the caller.

When a patient preregisters, the financial office is automatically notified 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 specialty clinic receptionist, she is asked to first go to the central registration area to register. Any obvious problems with authorization are corrected before patient returns to the specialty clinic waiting room.

Receptionist’s Point of View

The receptionist has determined the best way to not inconvenience the caller is to keep her on the phone 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.

Physician’s Point of View

The physician thinks too much of his 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 is to them.

Patient’s Point of View

Patients are frustrated when asked to wait in a long line to register, which makes them late for their appointments, and when future appointments are scheduled without their input. As a result of this later factor, and work of childcare conflicts, patient often do not show up for these scheduled appointments.

Office Nurse’s Point of View

The office nurse feels that he is playing catch up all day long and explaining delays. The office nurse also wishes there was more time for teaching.

Billing Office’s Point of View

The billing office thinks some care is given that is not reimbursed because of inaccurate or incomplete insurance or demographic information or that care id denied authorization after the fact.


On the Picker Institute website (, you will find the following patient expectations and dimensions of care for adults and children in their outpatient experiences with a hospital or clinic outpatient appointment:

  • Respect for patient s’ values, preferences, and expressed needs
  • Coordination and integration of care
  • Information and education
  • Physical comfort
  • Emotional support and alleviation of fear and anxiety
  • Involvement of family and friends
  • Transition and continuity
  • Access to care

Your last quarter’s worth of performance data for clinic is

Overall satisfaction with visit


Staff courteous and helpful


Waiting room time


Examination room wait time is less than 15 minutes


Patient no-show rate


Patient cancellation rate


Provider cancellation rate


Preregistration rate


Average number of patient visits per day


Range of patient visits per day


Instructions –

  1. Decide which problem your group wants to focus on as your first priority. Describe the problem and why you chose this problem
  2. State the goal for this improvement effort
  3. Identify the fundamental knowledge that is required on the team to solve this problem. Define the people you will invite to participate on the team and the fundamental knowledge they bring to the team.
  4. Document the current process (as is described in the case) using a process flow chart.
  5. Identify your customers and their expectations.
  6. Explore and prioritize root causes of the problem by doing the following:
    1. Brainstorm root causes and document the causes on a fish bone diagram
    2. Describe how you would collect data about how frequently root causes contribute to the problem.
  7. From the points mentioned below select and explain the ones that apply to improving your process. Be sure to take into account what you have learned from your work in question 1-6
    1. Eliminate waste (e.g., things that are not used, unnecessary duplication)
    2. 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)
    3. Manage time (reduce steps and waiting times)
    4. Manage variation (create standard work)
    5. Design systems to avoid mistakes (use reminders)
  8. Incorporating what you learned in above steps, improve the process and document the improved process with a process flow chart or work flow diagram.
  9. Decide what you will measure to monitor the voice of the process and briefly how you would collect the data
  10. Briefly explain your change effort using PDCA cycle.


Kelly, D.L. (2011). Applying Quality Management in HealthCare. AUPHA.

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