DYS516: Improving Quality and Performance of Healthcare Services

Charles H. Dyson School of Applied Economics and Management

Cornell SC Johnson College of Business

Course Project, Part One—Rating Using Data

Instructions: Using the research you did in the previous activity, rank each quality
measure on a scale of 1 to 5. You’ll need to rate each one from 4 perspectives
(patients, stakeholders, healthcare providers, and regulatory agencies). Note that you
can get data on each of these points from multiple rating sites. Use the chart below for
the project. This chart will be provided as in tool for you to use again in the future. When
you complete this part of the course project, save your work and return to the course.
You’ll submit the full project after completing part five.

Quality Measure Patient Provider Insurer Regulatory

Agency

Nurse always communicated well 5 4 4 3

Doctor always communicated well 5 5 4 4

Medication explained to patient 5 4 4 3

Re-admission rates for congestive heart 4 3 5 5

failure

Central line catheter infections 3 5 4 5

Outpatients who had MRI for low back 3 2 3 2

pain before trying conservative
measures

Preventable complications 4 5 5 5

Fall rate 4 4 4 4

Wrong site surgery 5 5 5 5

Area around room always clean 4 4 4 3

Food is warm 3 2 2 2

Area around room always quiet 4 3 3 2

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 DYS516: Improving Quality and Performance of Healthcare Services
Charles H. Dyson School of Applied Economics and Management
Cornell SC Johnson College of Business

Other

Other

Other

Other

Other

Other

Other

Now answer the questions below.

How will you use rating data with patients? Imagine you have a patient planning to
undergo an operation with a high infection rate. What do you tell the patient to boost his or
her confidence?

When discussing the infection rate with a patient planning to undergo an operation with a
high infection rate, it’s essential to provide them with reassurance based on data and best
practices. Here’s how I might approach it:
"While it's understandable to be concerned about infection rates, I want to assure you that
our facility takes extensive measures to minimize these risks. We have a comprehensive
infection control program in place, and our surgical teams follow strict protocols to ensure
your safety. Additionally, our infection rates are closely monitored and are significantly lower
than the national average. We also encourage you to ask any questions you might have, as we
want you to feel confident and informed about your care."

Now work on a script to explain quality and standards to a patient. Remember it’s very
different from explaining to others. You should provide (1) infection rate, (2) complications
following procedures, (3) average length of stay, and (4) emergency room wait time.

Introduction statement:

"Hello! I wanted to take a moment to discuss some important quality measures related to
your upcoming procedure. Understanding these can help you feel more informed and
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 DYS516: Improving Quality and Performance of Healthcare Services
Charles H. Dyson School of Applied Economics and Management
Cornell SC Johnson College of Business

confident about your care."

(1) Infection rate:

"Our hospital has a specific infection rate for the type of surgery you will be undergoing.
Currently, our infection rate is 5%, which is lower than the national average. This means we
are doing a good job in preventing infections."

(2) Complications following procedures:

"We also track complications that may arise after procedures. The rate of complications for
your surgery is about 10%, and we have systems in place to quickly address any issues that
may occur."

(3) Average length of stay:

"Typically, patients who undergo this procedure stay in the hospital for an average of 3 to 5
days. We monitor this closely to ensure you receive the right care without unnecessary
delays."

(4) Emergency room wait time:

"Lastly, I want to mention our emergency room wait times. On average, patients wait about
30 to 60 minutes to be seen, which allows us to provide timely care when it’s needed most."

Wrap-up statement:
"I hope this information helps you feel more at ease. If you have any questions or concerns,
please don’t hesitate to ask. We’re here to support you every step of the way."

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 DYS516: Improving Quality and Performance of Healthcare Services
Charles H. Dyson School of Applied Economics and Management
Cornell SC Johnson College of Business

Course Project, Part Two—Picking Performance Measures

Instructions: Here you’ll continue to look at your own organization or one you are
familiar with. Complete this part of the project, save your document, and return to the
course. You’ll submit the fully completed project after part five.

Pick five inpatient or outpatient performance measures required by Medicare for your
organization (or one you’re familiar with). Record the measure and your organization's
rating (using one of the ranking sites such as Healthgrades, the Leapfrog Group, or
Hospital Compare). You should have much of this information from completing the
activity Comparing Hospital Ratings.

Measure 1:
Overall Hospital Rating:
- Rating: 3 out of 5
- Description: Measures the effectiveness of infection prevention and control protocols
Measure 2:
Patient Satisfaction:
- Rating: 4 out of 5
- Description: Based on surveys regarding the care and attention received during
hospital stays.
Measure 3:
Emergency Department Wait Times:
- Rating: 30 minutes
- Description: Average time patients wait before being seen by a healthcare professional
in the emergency department.
Measure 4:
Readmission Rates for Heart Failure:
- Rating: 15%
- Description: Percentage of patients readmitted within 30 days after discharge for
heart failure treatment.
Measure 5:
Postoperative Complications:
- Rating: 12%
- Description: Percentage of patients experiencing complications after surgery

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 DYS516: Improving Quality and Performance of Healthcare Services
Charles H. Dyson School of Applied Economics and Management
Cornell SC Johnson College of Business

Compare each measure you listed above to three other facilities in the same
geographic area. If there are differences, how do you explain them?

Organization: Kabul Organization: Herat Organization: Balkh

Hospital Hospital Hospital

Measure 1: Measure 1: Measure 1:

Overall Hospital Rating: 4 Overall Hospital Rating: 3 Overall Hospital Rating: 5
out of 5 out of 5 out of 5
Measure 2: Measure 2: Measure 2:
Patient Satisfaction: 3 out of Patient Satisfaction: 2 out of Patient Satisfaction: 4 out of
5 5 5
Measure 3: Measure 3: Measure 3:
Emergency Department Emergency Department Emergency Department
Wait Times: 20 minutes Wait Times: 45 minutes Wait Times: 15 minutes
Measure 4: Measure 4: Measure 4:
Readmission Rates for Readmission Rates for Readmission Rates for
Heart Failure: 10% Heart Failure: 18% Heart Failure: 8%
Measure 5: Measure 5: Measure 5:
Postoperative Postoperative Postoperative
Complications: 10% Complications: 15% Complications: 8%
Analysis of Differences
1. Resource Availability:
Facility ratings can differ significantly based on available resources. Hospitals with better
funding, equipment, and staffing levels, like Balkh Hospital, are likely to perform better in
areas like infection control and patient outcomes.
2. Training and Protocols:
Facilities with comprehensive training programs and strict adherence to clinical protocols
often report lower complication and readmission rates. Kabul Hospital's slightly higher
patient satisfaction rating might indicate a more engaged staff who focus on patient
experience.
3. Geographic and Demographic Factors:
The region's population health needs and demographics can impact hospital performance
measures. Areas with higher rates of chronic illnesses may see higher readmission rates, as
observed in Herat Hospital, which struggles with a higher rate of readmissions and
complications.
4. Community Outreach and Education:
Health education for communities served by these facilities can also influence outcomes.
Organizations actively engaging in preventive care and education may report better overall
metrics.

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 DYS516: Improving Quality and Performance of Healthcare Services
Charles H. Dyson School of Applied Economics and Management
Cornell SC Johnson College of Business

Course Project, Part Three—Performing a Root Cause

Analysis
Instructions: Below you’ll perform a root cause analysis for a given scenario.
Complete part three of the project and save your work. You’ll submit the full project after
completing part five.

Scenario: One of your patients was in the emergency room following a major motor
vehicle accident. The patient had multiple fractures, an abdominal injury, and a closed
head injury. During the resuscitation for massive bleeding, the patient, who had a blood
type of B-, received 2 units of the wrong blood type (A+) and developed serious
complications from the blood mismatch. The patient died despite vigorous attempts to
resuscitate him.

Background information:
● There was adequate blood in the blood bank, so outside units were not required.
● It usually takes 15-20 minutes to prepare a unit of blood for transport, but the
techs had much less time in this case.
● The incident occurred at 2 AM.
● All of the ER team was involved in trying to save this patient from bleeding out,
requiring multiple units of blood inserted as fast as possible to maintain the
patient’s blood pressure. The scene was very hectic.
● The hospital usually does not deal with these types of trauma patients, but it was
the closest to the scene of the accident.

Your task: Conduct a root cause analysis to determine why and how the patient
received the wrong blood. In the space below, create your flow chart. (You can use the
tool provided to do so digitally, or you can draw it and insert a picture.)

Root Cause Analysis Flow Chart

1. Incident Trigger: Major motor vehicle accident
- Patient Condition: Multiple fractures, abdominal injury, closed head injury, massive
bleeding.
2. Emergency Response:
- Hectic ER Environment: All ER team members focused on resuscitation.
- Time Pressure: Need for rapid blood transfusion due to massive hemorrhage.
3. Blood Type Misidentification:
- Blood Type of Patient: B-
- Blood Type Administered: A+
- Lack of Verification: Failure to check patient’s blood type against blood unit.
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 DYS516: Improving Quality and Performance of Healthcare Services
Charles H. Dyson School of Applied Economics and Management
Cornell SC Johnson College of Business

4. Contributing Factors:
- Staffing and Training: ER staff may not have been adequately trained for trauma cases.
- Blood Bank Protocols: Possible inadequacies in the blood bank’s emergency protocols
for rapid response.
- Communication Breakdown: Lack of clear communication among ER staff regarding
patient needs and blood type.
- Time of Incident: Occurred at 2 AM, possibly leading to fatigue or reduced alertness
among staff.
5. Outcome:
- Serious Complications: Patient developed complications from blood mismatch.
- Patient Outcome: Patient died despite resuscitation attempts.

Analysis of Root Causes

1. Hectic Environment: The chaotic nature of the emergency response likely led to rushed
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 DYS516: Improving Quality and Performance of Healthcare Services
Charles H. Dyson School of Applied Economics and Management
Cornell SC Johnson College of Business

decisions, increasing the risk of errors.

2. Inadequate Verification: The urgency of the situation may have caused staff to skip
critical steps in verifying blood types.
3. Lack of Trauma Experience: The hospital's inexperience with trauma cases may have
contributed to improper handling of the situation.
4. Communication Failures: Poor communication among the team regarding the patient’s
blood type and urgency may have led to the error.
5. Fatigue and Alertness: The late hour could have affected staff performance, leading to
lapses in attention and judgment.

Conclusion

The root cause analysis indicates multiple interrelated factors contributed to the
administration of the wrong blood type. Addressing these issues through improved
training, protocol reinforcement, and communication strategies could help prevent similar
incidents in the future.

Course Project, Part Four—Assessing Patient Visits

Instructions: In this part of the course project, you’ll assess a patient visit at your
office to improve efficiency and throughput. Select an area from the list below, and
follow the assessment process. Use the space provided to record your work. After
completing this part of the project, save your work. You’ll submit the fully completed
project after the final part of the project.

Suggested Areas to Assess

● Operating room turnaround time
● Hospital discharge
● Patient visit
● Transfer from emergency department to floor
● Time in emergency department
● Turnaround for reports
● Answering patient phone calls
● Patient registration

Assessment Process
1. Identify all parts of your chosen process area and record the process using a flow
diagram.
2. Gather data or use historic data to record the time for each component. This will

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 DYS516: Improving Quality and Performance of Healthcare Services
Charles H. Dyson School of Applied Economics and Management
Cornell SC Johnson College of Business

serve as a baseline.
3. Review each part of the process and brainstorm more efficient solutions. Record
these and select those you would like to implement.
4. Initiate changes in small groups (one change per group) and re-measure.
Compare the new times with the baseline times recorded in step two.
5. If the results are better than historic times, incorporate the new solution into the
organization as a definite change. If the solution is not more efficient, try other
alternatives and remeasure.

What area will you review?

Patient Visit

In the space below, provide your flow chart with baseline times recorded.

1. Patient Arrival
- Time: 5 minutes
2. Check-in/Registration
- Time: 10 minutes
3. Initial Assessment by Nurse
- Time: 15 minutes
4. Consultation with Physician
- Time: 20 minutes
5. Diagnostic Tests (if needed)
- Time: 30 minutes
6. Follow-up Consultation
- Time: 10 minutes
7. Check-out/Payment
- Time: 5 minutes
Total Baseline Time: 95 minutes

List alternatives with new times.

1. Streamline Check-in/Registration
- Alternative: Implement electronic registration forms to reduce manual entry.
- New Time: 5 minutes (previously 10 minutes)
2. Prioritize Initial Assessment
- Alternative: Have nurses conduct initial assessments while patients are waiting for
check-in.
- New Time: 10 minutes (previously 15 minutes)
3. Use a Triage System

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 DYS516: Improving Quality and Performance of Healthcare Services
Charles H. Dyson School of Applied Economics and Management
Cornell SC Johnson College of Business

- Alternative: Implement a triage system to categorize patients based on urgency,

allowing quicker access to physicians for urgent cases.
- New Time: 15 minutes (previously 20 minutes)
4. Reduce Diagnostic Test Wait Times
- Alternative: Schedule diagnostic tests in advance and use portable equipment when
possible.
- New Time: 20 minutes (previously 30 minutes)
5. Simplify Check-out/Payment Process
- Alternative: Use a streamlined payment system with mobile payment options.
- New Time: 3 minutes (previously 5 minutes)
Total New Time: 63 minutes

Summarize what you learned. What was successful? What will you implement?

What I Learned:
- Streamlining registration and check-out processes significantly reduces wait times.
- Implementing a triage system allows for more efficient use of physician time and
prioritizes urgent cases.
What Was Successful:
- The new electronic registration form and mobile payment options were particularly
effective in reducing time spent on check-in and check-out.
What Will I Implement:
- I plan to implement the electronic registration system and the triage system in our
healthcare facility. These changes should improve patient throughput and overall
satisfaction in the Afghan healthcare system, especially given the resource constraints
and high patient volume.

Course Project, Part Five—Improving Your Lowest Scores

Instructions: This plan follows traditional SMART methodology to help you identify
steps to take on the job that are specific, measurable, action-oriented, realistic, and
time-based. You’ll pick your lowest two customer-satisfaction scores (inpatient or
outpatient) and use this grid to create a plan. After completing this final portion of the
project, return to the course and submit your fully completed course project.

Complete the grid below.

Key Business Problem(s) Satisfaction category one:

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 DYS516: Improving Quality and Performance of Healthcare Services
Charles H. Dyson School of Applied Economics and Management
Cornell SC Johnson College of Business

long wait times for outpatient appointments

Satisfaction category two:
Poor communication regarding treatment plans and
follow-up care

Strategies Satisfaction category one:

1. Implement an online appointment scheduling
Identify which strategies system to allow patients to choose their preferred
you can use. times and reduce wait times.
2. Introduce a triage system to prioritize patients
based on the urgency of their needs.
Satisfaction category two:
1. Develop a standardized communication
protocol for healthcare providers to ensure
clear and consistent messaging about
treatment plans.
2. - Provide training for staff on effective
communication strategies with patients
regarding their care.

Steps Satisfaction category one:

1. Research and select an appropriate online
What are the specific scheduling platform that suits our healthcare system.
actions you will take to… 2. Train staff on using the new scheduling system and
how to assist patients in making appointments.
Be as specific as you 3. Launch a pilot program for the online scheduling
can in outlining how you system in one department before a full rollout.
will… 4. Monitor patient feedback on wait times after
implementation.
Satisfaction category two:
1. Create a communication checklist for healthcare
providers to follow during patient consultations.
2. Schedule training sessions for all staff on the new
communication protocol.
3. Distribute informational materials to patients
outlining their treatment plans and follow-up care
instructions.
4. Gather patient feedback on communication

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 DYS516: Improving Quality and Performance of Healthcare Services
Charles H. Dyson School of Applied Economics and Management
Cornell SC Johnson College of Business

clarity after consultations.

Timeline Satisfaction category one:

- Next month: Research online scheduling platforms
Identify a timeline for and train staff on the selected system.
implementation. - Next quarter: Launch the pilot program and begin
monitoring patient feedback on wait times.
What will you do (or will Satisfaction category two:
you have your team do) - Next month: Develop the communication checklist
in the next month? What and schedule staff training.
will you have completed - Next quarter: Implement the communication
over the next quarter? protocol and distribute informational materials,
then gather feedback from patients.

Measurement/Results Satisfaction category one:

- Measure the average wait times for outpatient
appointments before and after the implementation of
How are you going to the online scheduling system. Aim for a 20%
measure your results or reduction in wait times within three months of launch.
demonstrate that your - Collect patient satisfaction surveys specifically
efforts have had a focused on wait times and analyze the results for
positive impact? improvements.
Satisfaction category two:
- Conduct patient satisfaction surveys focused on
communication clarity and understanding of
treatment plans before and after the new protocol
implementation. Aim for a 30% improvement in
satisfaction scores within three months.
- Monitor the number of follow-up calls or
inquiries from patients regarding their treatment
plans as an indicator of improved communication.

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