Module II Instructions:

Part 1 (15 pts): 

For any healthcare activity, four performance factors can be measured: structure, process, outcome, and patient experience. Identify one measure from each of these categories that could be used to evaluate the following ambulatory surgery center admission process:

Upon arrival, the patient reports to the center’s registration or admitting area. The patient completes paperwork, provides an identification card, and supplies insurance information, if insured. Money for the patient’s insurance co-pay or self-pay deposit is collected at this time. Often, patients register on the surgery center’s website before the date of admission to facilitate the registration process. An identification bracelet, including the patient’s name and doctor’s name, is placed around the patient’s wrist. Before any procedure is performed the patient is asked to sign a consent form. If the patient is not feeling well, a family member or caregiver can help the patient complete the admission process.

 

Measure Examples
Structure  
Process  
Outcome  
Patient Experience  

 

Part 2 (15 pts):  The Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare website (Find Healthcare Providers: Compare Care Near You | Medicare) allows you to compare performance at nursing homes throughout the United States. Go to this site and search for nursing homes within 50 miles of your location.

Which facilities rate highest in each of the following measurement categories?

  • Health inspections
  • Staffing
  • Quality measures

Which performance measures in these categories are the most important to consumers of nursing home services? Which performance measures are least important to consumers of nursing home services? What other factors might influence consumer choice?

 

Module III Instructions:

  1. Part 1 (20 pts):  Select the improvement model that would work best for the following performance problems. Explain your choices.
    • More than 25 percent of the insurance claims submitted by a clinic are rejected because of mistakes made by the clinic’s billing clerks.
    • Patients experience long wait times and delays for outpatient diagnostic services.
    • A large number of hospitalized patients develop a wound infection following surgery.
    • Labor costs are too high in the radiology department.
    • Patients’ overall satisfaction with the emotional support provided by nurses is lower than the satisfaction levels reported for other hospitals.
    • In a pediatric clinic, many Spanish-speaking patients are unable to communicate by phone with the receptionists and caregivers because of language barriers.

 

Part 2 (20 pts):

Imagine you are the supervisor of the health information management (HIM) department in a large outpatient clinic. This department manages patient records. Complaints about your department are becoming more frequent and intense than in the past. Some clinic employees have complained that the HIM department takes too long to retrieve patient records. Others have expressed dismay over the rudeness of HIM staff. You decide to talk about these problems with employees throughout the clinic.

The clinic’s receptionists respond to you defensively. They tell you that the HIM staff won’t answer the phone and that they want some backup when they are busy with patients. You talk to the HIM staff and find their stories are just as negative. They say they are being charged with more responsibilities but have no additional help. They also complain that the receptionists transfer calls that they should be handling. The clinic’s nurses are also upset with the HIM staff; they claim the department does not help them locate patient charts, causing long wait times for patients. The clinic’s physicians say they cannot assume additional tasks to alleviate the situation because their days are already chaotic.

  • What improvement tool would you use to identify all possible reasons for the increase in complaints about the HIM department?
  • What improvement tool would you use to gather data to confirm the reasons for the complaints about the HIM department?

You hypothesize that complaints spike on certain days of the week. What improvement tool would you use to analyze this theory?

The HIM staff tallies information about the causes of complaints. What improvement tool would you use to prioritize the problems?

What quality improvement tool would you use to define the current process for retrieving patient records?

You believe that cooperation between the clinic receptionists and HIM staff would improve if phone responsibilities were more clearly defined. To whom would you assign the task of defining roles and responsibilities?

After redesigning the record retrieval process, you want to monitor the effectiveness of your actions. What quality improvement tool would you use to determine whether the number of complaints has decreased?