Narrow focus performance improvement area. This area focus chosen organization develop a QI plan. Research methodologies integrating QI strategies performance measurements. Research information technology applications components QI management.
Organizational QI plan
The Scottsdale Memorial Hospital seeks to reduce the waste of food within its operations and also to increase the health and satisfaction of its patients through the provision of more nutritional and tastier foods. In this effort, they have devised four specific goals, namely the completion of an internal study to assess current consumption and waste, the creation of a new menu (with the aid of a specialist chef), the delivery of the new menus to the patients and the completion of a new study for the new menu and the adjacent waste. The expectation is for the waste of food to be decreased after the implementation of the second menu.
The data necessary to complete this effort would be gathered with the aid of questionnaires, interviews and sampling methods (direct research). Each of the methods is characterized by its own strengths and limitations, and an important need of the project is represented by measurement. So far, it has been proposed by employ graphical representations and pie charts. At this level, the focus falls on the presentation of methodologies through which to integrate QI strategies into performance measurement. Additionally, information technology can be applies and benchmarks and milestones are also discussed.
2. Methodologies for integrating QI strategies into performance measurements
In the success of the hospital's menu replacement to reduce food waste, a crucial role is played by measurement. It is as such necessary to ensure that the measures are completed at the utmost highest quality standards, even with the inclusion of quality improvement strategies. At this level then, there are three potential methodologies to be used in the integration of QI strategies into performance measurement. These refer to the following:
The Root Cause Analysis (RCA)
The Plan-Do-Study-Act (PDSA) model, and last
The Six Sigma methodology (Hughes, 2008).
The Root Cause Analysis model for implementing QI in performance measurement is characterized by its thorough assessment of a phenomenon in order to analyze the causes which had led to its manifestation. The phenomenon is assessed after it has already occurred, so the methodology does not reveal the possibility to implement changes in the current phenomenon, only to draw lessons for the future. The RCA model assumes that the errors in a phenomenon are given by the system, rather than by the individual factors.
The Plan-Do-Study-Act model, unlike the RCA model, is one which allows for ongoing changes to be implemented and affected within the health care organization. The model focuses on the development and implementation of small size projects, which can be implemented in efficient conditions and with immediate results. The scope of the PDSA methodology is that of creating relationships between variables and results (e.g. menu change and its impact on food waste). The shortage of the PDSA is represented by the need to simultaneously identify and integrate multiple variables, such as the data collected, the measurement of the results, the interpretation of the data and so on.
Last, the Six Sigma model is an effort to assess and improve the process also in a cyclic manner, by identifying problems and implementing solutions. Also, with the aid of the Six Sigma methodology, the organization becomes able to also assess the results of its implementations.
"Six Sigma, originally designed as a business strategy, involves improving, designing, and monitoring process to minimize or eliminate waste while optimizing satisfaction and increasing financial stability.52The performance of a process -- or the process capability -- is used to measure improvement by comparing the baseline process capability (before improvement) with the process capability after piloting potential solutions for quality improvement" (Hughes, 2008).
As it has been mentioned above, the three models are all characterized by specific strengths and weaknesses, better centralized in the table below:
The Root Cause Analysis
- Assesses causes of the problem (deeper understanding of issues)
- Provides recommendations for improvement
- Qualitative analyses rather than statistically supported evidence
- RCA is only an analysis and cannot generate improvements by itself
- Requires intensive labor and interdisciplinary specialists (Hughes, 2008)
- Cyclic nature and ongoing change
- Large volume of work and data uncertainties
The Six Sigma model
- Focus on the patient
- Increase in efficiency and cost reduction
- Cause identification and problem prevention
- Integrates employee training
- Uncertainty of defects assessed
- High labor demands from specialized staffs and ongoing assistance
- Process rigidity and real time barriers (Six Sigma, 2010)
Based on the presentation of these three methods, it is now concluded that the most useful method to integrate QI into performance measurements would be represented by the Six Sigma methodology. This is explained by the advantages of the method, but more so by the fact that the model is created in such a manner that it provides support at the level of four pre-established objectives of the hospital. Specifically, with the aid of the Six Sigma method, the hospital can assess current food waste (and its causes), create a new menu, implement it and then assess the results of the change.
3. Information technology application
In the improvement of performances at the Scottsdale Memorial Hospital, an important focus also falls on the identification of IT applications which can create additional benefits. The three more notable examples in this sense include the following:
Practice-based research networks
Integrated delivery system research networks
Web-based systems for data collection and analysis.
The practice-based research networks focus on IT applications which collect relevant information from the community (including patients and medical staffs) and then transform it into knowledge useful for performance improvement. They virtually create powerful databases, supported by information from various locations, and which are easily accessed by medical staffs across the country.
"The PBRNs foster a user-driven agenda, where clinical and research ideas emanate directly from the front-line clinicians who are seeing patients in their daily practice, and they provide the Agency with a unique opportunity to conduct real-world effectiveness research in living laboratories" (Ortiz and Clancy, 2003).
The integrated delivery system research networks are based on similar principles, yet the data provided by the databases is specific and generated by specialized medical institutions. The information is easily accessible, yet it has limited relevance since it does not integrate patient feedback of food waste.
The web-based systems for the collection and analysis of data represent a new frontier in the integration of technology and quality improvement. They are characterized by their usage of already existent data from various data bases, which reduces the need for specialized staffs. The data is as such uploaded from the system, and only completed by personnel when necessary. The aggregation of the data is completed in an automatic manner, through validated processes across the databases. The statistical analyses are also completed in an automatic manner with the aid of the built-in statistical engine and the results and reports are retrieved in real time manner and in a various formats, including graphical representations (Kumar, 2004).
In the case of the Scottsdale Memorial Hospital, the implementation of the three IT systems can be completed to create additional benefits for performance enhancement. For instance, they can reduce the need for specialized staffs, allowing more resources to be allocated towards medical care and the creation of cost efficiency. Then, the workload for data collection and analysis is also decreased. Also, decisions would be made more rapidly due to increased accessed to information.
4. Benchmarks and milestones
In the utilization of quality indicators, the organization makes intense usage of benchmarks and milestones. The benchmarks represent criteria for comparisons, and some examples as to how these are used include the setting of limits on the expected…