Proposed Solutions to Various Problems Within the Hospital

Suppose you are the administrator of a community health center that provides primary care to a multi-ethnic, multi-lingual urban community. Many, but not all, of the patients live below the poverty line. Physicians and nurses see a large volume of patients with challenging medical and psychosocial issues. Lately you have realized that the scheduling of patient visits has become something of a nightmare. Because of the high volume of patients, the wait for an appointment for routine care can be anywhere from six to eight months or more. Even acutely ill patients often wait for two to three days to see a health care provider. Out of frustration, many patients are walking in without appointments, often during lunch hour or late in the afternoon when everyone is getting ready to leave. What makes the problem so challenging is that 20 to 40 percent of patients fail to show up for appointments on a given day. Because of this high no-show rate, every other appointment on physicians' schedules is double-booked with the expectation that, out of the 30 to 35 scheduled patients, only 20 to 25 will actually show up. Occasionally, however, most of the patients do show up – and when a significant number of acutely ill patients also arrive, the work environment becomes unbearably chaotic for everyone. Providers become harried and more likely to make mistakes, patients wait for long periods of time in crowded waiting rooms, and the atmosphere becomes increasingly hostile as the stress level mounts.
As health care professionals, your leadership team feels responsible to find the most effective ways to serve your patient population. One possible approach that was suggested was to conduct a survey to identify some specific reasons that contribute to such a high percentage of no-shows. When patients were surveyed about their reasons for not coming to appointments, a few common reasons emerged:
A sick patient waited so long to be seen that she got better and didn't need the visit – or got worse and had to go to the emergency room.
A patient did not have a phone, or his phone number changed, so he never received the reminder message the day before the appointment.
A patient showed up for the appointment, but at the wrong date or time. He misunderstood because of a language barrier.
A patient was afraid to take time off work and risk losing her job. It would have been much easier for her to make an evening or weekend appointment.
​​It is clear that the quality and experience of health care for many of these patients is suffering partly because of a simple lack of access to care. And it has become increasingly clear also that the better-insured and English-speaking patients could be getting better access: they are more likely to get a timely appointment because they are more demanding of the system, and they are more likely to keep and show up for their appointments because of better communication. You are interested in finding a way to promote more equitable access to health care.
Using the Lean thinking, improvement suggestions , determine how you would work to rectify this situation. Describe what you recommend to be changed or implemented to improve workflows, as well as increase the level of equitable access and high quality care provided to your patient population. Decide on at least 5 concrete changes you would make, how you would go about implementing the changes, and what you would expect to achieve with your chosen solution. Then, use the checklist below to ensure that your written case study contains the following required elements.
Submit a written work that is a minimum of 4-6 double spaced pages. Please note your reply should be comprehensive. All work must include a proper title page and works cited page for references used. Your work should follow the proper rules for APA guidelines, including but not limited to spelling and grammar. Please see the course rubric for more details.
Particular reference materials are to focus on those that analyze the issue(s) and provide alternatives for the student to think about. Students must use case study, peer reviewed articles and other vital sources of secondary research to synthesize, analyze and offer solutions to these organizational dynamics. Best possible reference materials include periodicals such as The Harvard Business Review, Knowledge@Work, The Wall Street Journal, MGMA journal, HFMA journal, etc. Please note that the use of “wiki's” are unacceptable in academic work as are blogs and unauthorized websites. Included in this are the use of sites such as “dictionary dot com.” All reference works must be scholarly therefore it is suggested to use the available links in the electronic library to aid your efforts.
Process Improvement Case Study Outline/Submission Checklist
Introduction
Clearly states the problem or situation faced;
Clearly states why corrective action was needed; and
Clearly explains what might happen if the situation is not corrected.
Alternatives considered
Describes actions taken to arrive at the alternative solutions considered; e.g., research, who was involved in finding the possible solution, meetings, etc.;
Clearly discusses ALL of the possible alternatives considered; and
Each alternative includes a discussion of the advantages and disadvantages of the possible solution.
Chosen solution
Presents a detailed list of procedures used to choose the particular solution, for example:
Who was involved?
What were all of the factors considered?
What process was used to reach the decision?
Why was that particular solution chosen?
Presents a detailed list indicating how the solution was implemented, for example:
Who was in charge of implementing the solution and overseeing the process?
What was the step-by-step process?
What was the time frame involved?
Lessons learned
A summary and analysis of findings, for example:
How did the solution affect personnel, morale, workloads, process flow, financials?
Would a different solution have worked any better? If the process were repeated, what would be done differently?
In addition to content, the case study project is evaluated on construction and presentation. Please review the following points before submitting your final project:
The writing is clear, all terminology and acronyms are defined;
Nothing in the sentence structure or word choice distracts the reader;
There is a smooth transition between ideas and sections;
The subheadings between sections lead the reader to the next point;
It is written in an objective and impartial manner;
The case study is formatted according to appropriate style guidelines; and
The case study has been proofread for grammar, punctuation, sentence structure and spelling