CAHIIM Standard Assessed: 

Subdomain VI.C.  Work Design and Process Improvement

1. Construct performance management measures (Blooms 6)

Subdomain VI.I. Project Management

1.  Apply project management techniques to ensure efficient workflow and appropriate outcomes (Blooms 3)

Introduction:  College Community Hospital (CCH) is a 200-bed facility offering adult medical, surgical, orthopedic, and psychiatric care.  The hospital provides a full range of diagnostic and therapeutic services, including CT and MRI scanning and an eight-bed intensive care unit.  The 200 beds are distributed over six inpatient floors:

• 3A Acute Medicine
• 3B Diagnostic Medicine
• 3C Intensive Care
• 4A Acute Psychiatry
• 4B Orthopedics
• 4C General Surgery

One year ago, faced with decreased patient and staff satisfaction and rising costs, the management of CCH adopted a Total Quality Management strategy.  They formed a Quality Council and chartered several performance improvement projects.  Over a nine month period, projects were successfully completed in Dietary, Nursing, Psychiatry, Materials Management, Pharmacy, Health Information, and Outpatient Surgery,  they are now ready to begin the second round of projects.

One major source of dissatisfaction for physician and nursing staff has been slow turnaround time (TAT) for laboratory tests.  The lab performs about 3000 blood tests per week, the most common being CBC (complete blood count), serum electrolytes (sodium, potassium, chloride and CO2), BUN, a kidney function test, and blood sugar.

Given the high level of complaints about slow lab test turnaround time, the Assistant Administrator asked the Quality Council to initiate a Performance Improvement project team to tackle the problem of improving the number of tests completed within the hospital standard.  The Quality Council agreed, chartered a team, and asked the Assistant Administrator to act as Team Leader.

The Assistant Administrator was familiar with Total Quality Management concepts and recruited a team, including the Transport Supervisor, who had recently attended a class in PI Methods and Tools.  When all the recruiting was done, the team members were:

• Lotta Paper, Assistant Administrator – Team Leader
• Tom Trotter, Transport Supervisor – Quality Advisor
• Beth Harrast, Floor Secretary, 3A
• Harry Hiteck, Day Supervisor, Lab
• Sam Drawit, Day Phlebotomist
• Steve Spinner, Evening Lab Tech
• Cathy Filer, Health Information Management

Problems with scheduling the team meetings made in impossible to include a representative from the lab night shift.

Now, it’s time for the first team meeting.  Use your imagination and “pretend” you are Cathy Filer and you are attending this meeting!  Notice the personalities and behavior of each of the different team players.

———–CURTAIN UP——————–

Lotta:  First, I want to thank you all for volunteering for this team.  I think we have…..

Sam: (interrupting)  I wouldn’t exactly say we all volunteered.  In fact, I’d say I was drafted.

Lotta:  Well, I suppose some of you were picked.  I asked the managers for people who really know what goes on in this process.  So, you’re the experts.  And I asked Cathy Filer to join us because she may be able to help us to use the EHR system more effectively to help with this improvement opportunity.

Cathy:  I hope I can help!

Lotta:  Let me describe the problem.  We’re getting too many complaints about long turnaround times for lab tests – I mean from the time the physicians decide blood work is needed until the time the results are available to them.  Harry helped me pull some data together that will give us a picture of how big the problem is.  Everyone take a look at your handout.

Harry:  This bar chart shows the percent of tests that got done within the standard for the past year.  The average is about 84%.

Beth:  What are the standards, anyway?  No one ever told me there were standards.  I thought everything was stat, stat, stat!  I know I spend a lot of time calling down to see when results are going to be available.

Sam:  Maybe that’s because we’re not making the standards all that often, whatever they are.

Tom:  Let me explain these standards.  When the doc’s fill out the request, they indicate whether it is STAT, Urgent or Routine.  There are different turnaround time standards for each priority.  STATs are 2 hours, Urgents are 6 hours and it’s 24 hours for Routines.  The times are from when the test is ordered to when the results are available to the doc.

Steve:  Well, whatever the standard is, I know the problem isn’t the time we take to actually do the test.  We’ve been measuring our turnaround time within the lab for more than a year now.

Harry:  Steve’s right.  We did have some problems in the lab a couple of years ago.  We had some pretty ancient equipment.  But, we were able to replace most of that last year.

Cathy:  Well, that is great to know.  Since we already know that the turnaround time for actually doing the test, and I am assuming we can show data to back that up, then the team can focus our time on other parts of the process.

Sam:  I don’t know why we need a team to solve this one.  It’s pretty obvious to me that you guys may be able to do the tests quickly, but you leave specimens sitting in your receiving window for long times.  You probably measure your own turnaround time from when you take the specimen from the box, not when it gets there.

Steve:  That’s not true.  If you want to blame somebody, just last week, I noticed that the messenger service left results in our out box for more than an hour before picking them up.

Harry.  That’s right.  I think there are just a few “bad apples” around here, including in the lab.  I’m looking into that now.  I’ll find them……I have my ways.

Beth:  (to Tom)  Tom, we’re not supposed to be going right to what we thing the solutions are, are we?  Or finding ways to blame other people?

Tom:  (with a sigh) Beth’s right.  What we have to do is see if we can find out what’s wrong with this process.  We have to get out of the habit of thinking it’s always someone doing something wrong.  So, the first thing we have to do is to make a flow chart showing how this process works.  Then, we’ll think about what could be causing the problem of long turnaround times.  We’ll have to test our theories and collect data and make sure we find the root cause.  Until we do all that, we won’t have much of a chance of solving the problem for good.

Steve:  Boy, that sure sounds like a lot of work.

Lotta:  That’s why we’re here.  We’ll learn a lot and have some fun, too.  But, we’d better keep an eye on the ground rules we put together.  That will keep us focused on the problems, rather than on blaming others.

Tom:  OK, let’s get to the first step – flowcharting this beast.  You folks tell me the steps in the process and I’ll write them on these poster size Post-Its and stick them on the wall.  Then when we think we have all the steps we’ll move the Post-its around and put them in the right order.

Lotta:  Sounds good.  So, where does this process begin?  What’s the starting point of our flow chart?

Beth:  Well, here’s the doc, making his rounds or checking a patient.  He decides that some kind of test is needed and writes the request….sometimes the nurse writes the order and has the Doc co-sign it…..and whether it’s STAT, Urgent or Routine is written right on the order.

Cathy:  How does he write the request?  On a paper request sheet?  Are we using the Order Entry option in the EHR?

Beth:  No, they write it on a request slip.

Cathy:  That is good to note.

Steve:  You know, I think the doc’s overdo it on the Urgents.  I bet that plenty of the Urgents could really be Routines.  Maybe they’re in a big hurry to get out of here, so they make it an Urgent.

Harry:  Well, 24 hours is a long time to wait for a Routine.  Maybe the doc is making rounds in the afternoon and would like to have test results back for the next morning.

Beth:  Sure, that happens.  But, that’s not really unreasonable is it?  Maybe the standards should be tighter.

Harry:  For pity sakes, we’re not meeting the standards we have now.  I think the standards are set by the Patient Care Committee.  They’re all docs and you know they’ll just want to tighten them up if we bring this to their attention.

Beth:  Maybe so….but, I think we should look at the standards.  I wonder what that standards are at River Valley Medical Center.

Tom:  Hold on, hold on.  We’re supposed to be flowcharting now.  These are good thoughts, so let’s write them down in our idea log and make sure they get included with our minutes so we don’t forget them.  Let’s get on with this process.

Lotta:  Well, the requests go to you, Beth, don’t they?

Beth:  Right.  I stamp them with the patient’s name and medical record number.  Then I put them in the floor out box for lab pickup.

Steve.  The Routines go into the box, but you call us on the STATs and Urgents.

Beth:  That’s right.

Sam:  Then the lab notifies me and I go up, pick up the request and do the draw.  That’s assuming the patient is there.

Lotta:  What do you mean “assuming the patient is there?”

Sam.  Just that.  Sometimes I go up and there’s an empty bed.  Maybe I was given the wrong room numbers, or maybe the patient is visiting Radiology or PT, or whatever.  There’s nothing like having a STAT order and you can’t find the patient.

Lotta:  So, what do you do then?

Beth:  Usually, he comes over and harasses me – like I’m not busy enough already.

Tom:  OK, let’s put that on our chart as a problem.  If it happens fairly often, it could be part of the turnaround time problem.  But, let’s say the patient is there.  You do the draw, right?

Sam:  Right.  Then I take the specimen down to the lab and put it in the in box. (Under his breath)…..Where it grows old.

Steve:  OK Sam, I heard that.

Tom (intervening) Everyone did.  Let’s keep one eye on the ground rules until we get used to working as a team.

Harry.  The lab people are always checking the in box and, when there’s a specimen, we take it, set up the equipment and do the test.

Steve:  We put the results on the form and put it in the out box.  The messenger picks up the results when they come by on their rounds, and takes them back to the floor.

Beth:  When I get them , I put them with the chart and flag it.  Usually, if it’s a STAT, I make sure the doc knows the results are there.

Cathy:  OK, that sounds like the whole process, except when do the results get put into the patient EHR?

Beth:  We don’t.  The results get sent down at discharge with the rest of the paper chart and I think they get scanned.  I’ve seen scanned result slips before.

Cathy:  OK, another thing for me to think about.

Lotta:  OK, let’s get to work flowcharting this process.

——————-CURTAIN DOWN———————–

Assignment Instructions:

You will create a Team Charter for this case scenario.  Use the information in your Lesson to guide you through the process of creating the charter and use the information and people in this project packet to complete the charter.  Your charter must include:

1.  Team Name
2. Problem Statement
3. Goal Statement (a.k.a.: Aim Statement or Mission Statement)
4. List of Benchmark time standards
5. Team Members
6. Proposed start and end date
7. Benefits of the project

NOTES:

Your problem statement should be customer-focused, performance-related, and stated in measurable terms.  It should not imply a solution or a cause!  Here is an example:

“The current process for delivery, maintenance, storage, and purchase of pump controllers is fragmented and inefficient.  The result is wasted staff time, lack of available functioning equipment, inappropriate use of space and frustration on the part of the customers.”

Your Goal Statement should also be stated in measurable terms.  The statement should show a clear target for improvement.  For example:

“Pump controllers will be available in proper working order within 10 minutes of request from the floor 95% of the time, beginning in November 1992.

This goal statement offers 3 points of measurement for success.  1.) There is a minute goal, 2.) There is a goal for how often, and 3.) There is a timeline for reaching the goal.

Applied Research Report Assignment Instructions

Overview

The Non-Thesis student who plans to take an internship and not write a Thesis as part of our program, must complete the Applied Research Report Assignment and the Applied Research Presentation Assignment. Student desiring to learn a great deal pertaining to their selected research topic but intend not to conduct any original research in the form of a Thesis will write in a more pragmatic, practical, and applied manner. Students desiring to advance application of research and seek upward mobility in their current or future position in the Sport Profession often recognize additional competencies and knowledge with pragmatic application are essential. What better way to learn how to best apply practical research is to write about the practical applications of their research as it pertains to their career advancement.

Instructions

Utilizing the ideas you expressed in the first two Discussions, you will write a 10–15-page paper on a sport or recreation management topic of interest and relate it to ideas such as how you might go about practitioner research and professional development, the application of research in the workplace, knowledge transfer, integrating research skills to solve pragmatic problems, etc. In the development of this paper, you are encouraged to envision what kind of internship placement and/or career you desire and consider disciplinary connections from this (and other) course(s) to the internship site as a place of experiential learning. You must follow current APA format and include the following elements:

1. Title page with a running head

2. Abstract and keywords

3. Body

a. Introduction 

b. Discussion of key terms

c. Application and future integration

d. Summary/Conclusion

e. Reference list 

As you complete this assignment, please consult your textbook and review the Applied Research Report Grading Rubric for further details.

300–500 words

Assignment Description

Primary Response is due by Friday (11:59:59pm Central), Peer Responses are due by Tuesday (11:59:59pm Central).

Students will be expected to post their first initial Discussion Board posting by Friday of each week. Discussion posts will be graded, and late submissions will be assigned a late penalty in accordance with the late penalty policy found in the syllabus. NOTE: All submission posting times are based on midnight Central Time.

Students are expected to post their responses to peers by Tuesday. NOTE: All submission posting times are based on midnight Central Time.

Primary Task Response: Within the Discussion Board area, write 300–500 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas. 

Summative Discussion Board

Review and reflect on the knowledge you have gained from this course. Based on your review and reflection, write at least 300–500 words on the following:

• What was your most significant learning in this course? 
• How did participating in discussions help your understanding of the subject matter? Is anything still unclear that could be clarified?

For assistance with your assignment, please use your text, Web resources, and all course materials. Please use APA format when citing resources.

  

SOCW 6070-week 4 discussion 1 Looking Through Different Lenses

I have provided the case study and all resources I work for hospice and my lens is meeting people where they are in their journey and trying to help the whole person and family

As a social worker, you bring your own lens—that is, your own set of assumptions, biases, beliefs, and interpretations—into your interactions with clients and the human services professionals with whom you collaborate. Human services organizations have their own cultures that influence their organizational lenses. An organizational lens reflects key assumptions about the individuals to whom the organization provides services. These assumptions influence the organization’s policies and procedures which, in turn, impact service delivery. For example, an organization that focuses on understanding the perspectives of the clients it serves may allow clients to provide feedback about their client experience through membership on advisory boards or boards of directors. The clients may have the power to make recommendations and decisions about the organization’s policies and procedures.

Understanding cultural lenses—your personal lens, as well as those of the organizations and other individuals with whom you work and interact—will enable you to better serve your clients.

Focus on the Paula Cortez case study for this Discussion. In this case study, four professionals present their perspectives on the Paula Cortez case. These workers could view Paula’s case through a variety of cultural lenses, including socioeconomic, gender, ethnicity, and mental health. For this Discussion, you take the role of the social worker on the case and interpret Paula’s case using two of these lenses.

Post how you, as a social worker, might interpret the needs of Paula Cortez, the client, through the two cultural lenses you selected. 

Then, explain how, in general, you would incorporate multiple perspectives of a variety of stakeholders and/or human services professionals as you treat clients.

Support your post with specific references to the resources. Be sure to provide full APA citations for your references.

CASE STUDY also read Culture and Leadership chapter 15 pages 383 to 421

Paula has just been involuntarily hospitalized and placed on the psychiatric unit, for a minimum of 72 hours, for observation. Paula was deemed a suicidal risk after an assessment was completed by the social worker. The social worker observed that Paula appeared to be rapidly decompensating, potentially placing herself and her pregnancy at risk.

Paula just recently announced to the social worker that she is pregnant. She has been unsure whether she wanted to continue the pregnancy or terminate. Paula also told the social worker she is fearful of the father of the baby, and she is convinced he will try to hurt her. He has started to harass, stalk, and threaten her at all hours of the day. Paula began to exhibit increased paranoia and reported she started smoking again to calm her nerves. She also stated she stopped taking her psychiatric medications and has been skipping some of her HIV medications.

The following is an interdisciplinary team meeting being held in a conference room at the hospital. Several members of Paula’s team (HIV doctor, psychiatrist, social worker, and OB nurse) have gathered to discuss the precipitating factors to this hospitalization. The intent is to craft a plan of action to address Paula’s noncompliance with her medications, increased paranoia, and the pregnancy.

TEEM Dialogue 

Physician

Dialogue 1

Paula is a complicated patient, and she presents with a complicated situation. She is HIV positive, has Hepatitis C, and multiple foot ulcers that can be debilitating at times. Paula has always been inconsistent with her HIV meds—no matter how often I explain the need for consistent compliance in order to maintain her health. Paula has exhibited a lack of insight into her medical conditions and the need to follow instructions. Frankly, I was astonished and frustrated when she stopped her wound care treatments and started to use chamomile tea on her foot ulcers. Even though we have educated her to the negative consequences of stopping her meds, and trying alternative medications instead, she continues to do so.

Psychiatrist

Dialogue 1

As Paula’s psychiatrist for close to 10 years, I have followed her progress in and out of the hospital for quite a while—and I know her very well. She is often non-compliant with her medications, randomly stopping them after she reports she doesn’t like the way they make her feel. She has been hospitalized to stabilize her medications several times over the last 10 years, although she has managed to stay out of the psychiatric unit for the last three. Recently, she had seemed to appreciate the benefits of taking her medications and her compliance has much improved. She had been seeing her social worker regularly, and her overall mental health and physical health were improving. This has changed recently, after several stressful life events. We learned that Paula was pregnant by a man she met briefly at a local flower shop. She also reports he has been harassing her with threatening phone calls and unwarranted visits to her home. Paula disclosed to the social worker that she was neither eating nor taking her medication—and she had not gotten out of bed for days. Her decompensation was rapid and extremely worrisome and, therefore, called for a 72-hour hold.

OB Nurse

Dialogue 1

I have not known the patient long, but it does appear that she is trying her best to deal with a very difficult situation. Pregnancies are stressful times for even the healthiest of women. For Paula to learn she is pregnant at 43—in addition to her HIV and Hepatitis status and her bipolar diagnosis—must be so overwhelming. Adding to this, she has come to her two appointments alone and stated she has no one to bring along with her. When I inquired about the father of the child, she said he’s a bad man and he won’t leave her alone. She seemed truly frightened of him and appears convinced he will hurt her.

Social Worker

Dialogue 1

When Paula came to me and told me she was pregnant, I was indeed shocked by this announcement. She had never mentioned dating anyone, and with her multiple medical and psychiatric issues, I never thought this would be an issue we would address. Paula and I have developed a strong working relationship over the last two years, and she has shared many private emotions and thoughts. This relationship has been tested, though, since I suggested she be admitted to the hospital. Paula was furious with me, accusing me of locking her up and not helping her. It will take time to repair our working relationship. Once I rebuild that rapport, we will need to work together to find a way to address all of her concerns. We will need a plan that will address her medical needs, her psychiatric needs, and the needs of her unborn child.