Quality Improvement Projects in Health Care Problem Solving in the Workplace

by Eleanor Gilpatrick

• ISBN13: 9780761911661
• ISBN10: 0761911669
• eBook ISBN(s): 9781452251257
• Format: Hardcover
• Copyright: 1998-12-23
• Publisher: Sage Publications

Summary

This book provides a review of basic terminology and offers guidelines to the untrained researcher for carrying out 'nuts-and-bolts' quality improvement research. Fourteen case studies involving actual health care situations help to demonstrate how such a research project can be implemented.

Table of Contents

List of Tables	xi	(2)
List of Figures	xiii	(2)
Preface	xv	(3)
Acknowledgments	xviii
Part I. Basic Concepts and Manual	3	(136)
1. Basic Concepts	3	(39)
Introduction	3	(1)
Structure of This Book	4	(3)
Why Another Book About Quality Improvement?	7	(3)
The JCAHO and Quality Improvement	10	(5)
Concepts, Terms, and Definitions	15	(15)
Objectives and Evaluation of the Project	30	(6)
Organizational Culture and Ethics	36	(6)
2. Does the Problem Really Exist?	42	(41)
Roadmap	42	(2)
Getting Started	44	(8)
Get Approval for the Project Plan of Work From Key Manager(s)	52	(2)
Identify the Specific Parameters of the Project	54	(4)
Identify the Causes to Be Studied	58	(5)
Design Detailed Data Collection to Verify the Problem and Its Extent	63	(8)
Get Data Collection Dates Into the Calendar	71	(2)
What Criteria Will Be Used to Prove the Problem?	73	(3)
Prove Whether the Problem Exists and Its Extent	76	(3)
Progress Assessment: The Progress Report	79	(4)
3. Finding and Verifying Causes	83	(25)
Design Additional Data Collection on Causes	83	(1)
Data Already Collected	84	(1)
Additional Objective Cause Data	85	(2)
Subjective Cause Data: Interviews and Questionnaires	87	(10)
Schedule Data Collection for Causes Not Already Dealt With	97	(1)
Identify the Criteria to Prove Each Cause	97	(7)
Prove the Causes of the Problem	104	(4)
4. Finding Solutions	108	(13)
Identify Management's Feasibility Limits	108	(1)
Get Ideas on Possible Solutions	109	(5)
Get Feedback on Selected Solutions	114	(1)
Presenting the Solutions	115	(6)
5. Implementing Solutions and Making Them Operational	121	(18)
Introduction	121	(1)
Implementation and Evaluation Plans	122	(4)
Determine Whether the Solutions Are Successful	126	(1)
Identify the Steps to Make the Solutions Operational	126	(1)
Consider Adopting New Indicators to Monitor the Solutions	127	(5)
Final Comments	132	(1)
References	133	(6)
Additional Reading	135	(4)
Part II. Cases	139	(180)
Case 1. Getting Nursing Home Residents Into Physical Therapy in a Timely Fashion	139	(20)
Proving the Problem	139	(7)
Identifying Causes	146	(8)
Solutions	154	(2)
Implementing Solutions and Making Them Operational	156	(3)
Case 2. Patients Waiting for Radiation During Scheduled Visits	159	(15)
Proving the Problem	159	(6)
Identifying Causes	165	(5)
Solutions	170	(1)
Implementing Solutions and Making Them Operational	171	(3)
Case 3. Late Notification of Critical Values by a Hospital Laboratory	174	(18)
Proving the Problem	174	(6)
Identifying Causes	180	(8)
Solutions	188	(2)
Implementing Solutions and Making Them Operational	190	(2)
Case 4. Time Spent in Rehabilitation by Amputation Patients in a Municipal Hospital	192	(15)
Proving the Problem	192	(6)
Identifying Causes	198	(4)
Solutions	202	(4)
Implementing Solutions and Making Them Operational	206	(1)
Case 5. Incomplete Laboratory Referrals in an HMO Center	207	(15)
Proving the Problem	207	(6)
Identifying Causes	213	(6)
Solutions	219	(2)
Implementing Solutions and Making Them Operational	221	(1)
Case 6. HMO Patients' Problems With Crutches and Canes	222	(7)
Proving the Problem	222	(5)
Identifying Causes	227	(1)
Solutions	228	(1)
Implementing Solutions and Making Them Operational	228	(1)
Case 7. Dealing With Hemolyzed Blood Samples in a Hospital Laboratory	229	(12)
Proving the Problem	229	(6)
Identifying Causes	235	(4)
Solutions	239	(1)
Implementing Solutions and Making Them Operational	240	(1)
Case 8. Errors in Filling Prescriptions in a Hospital Pharmacy	241	(11)
Proving the Problem	241	(6)
Identifying Causes	247	(3)
Solutions	250	(2)
Case 9. A Labor-Management Health and Safety Committee	252	(11)
Proving the Problem	252	(4)
Identifying Causes	256	(5)
Solutions	261	(1)
Implementing Solutions and Making Them Operational	262	(1)
Case 10. Nurse Attendance at Mandated Classes in an Outpatient Department	263	(11)
Proving the Problem	263	(5)
Identifying Causes	268	(3)
Solutions	271	(1)
Implementing Solutions and Making Them Operational	272	(2)
Case 11. Compliance With Discussions and Documentation of Advance Directives in a Home Care Agency	274	(14)
Proving the Problem	274	(4)
Identifying Causes	278	(7)
Solutions	285	(3)
Case 12. Use of a Reminder Letter to Encourage Follow-Up Visits	288	(10)
Proving the Problem	288	(2)
Identifying Risk Factors	290	(5)
A Solution	295	(1)
Implementing Solutions and Making Them Operational	296	(2)
Case 13. Use of an Internal Audit in an Intermediate Care Facility	298	(10)
Proving the Problem	298	(4)
Causes	302	(1)
A Solution	303	(1)
Implementing Solutions and Making Them Operational	304	(4)
Case 14. Use of Data on Unusual Occurrences in an Emergency Medical Service	308	(11)
Proving the Problem	308	(3)
Identifying Causes	311	(5)
Solutions	316	(3)
Appendix 1. Outline for the Written Project Plan of Work	319	(7)
Appendix 2. Detailed Tables and Practice Exercises	326	(41)
Background Reading Related to the Cases	367	(8)
Index	375	(14)
About the Author	389