(35 Points) The goal of this final assignment is to give you an opportunity to demonstrate your ability to apply CQI principles and tools we have covered in this course, with a focus on those covered

(35 Points)

The goal of this final assignment is to give you an opportunity to demonstrate your ability to apply CQI principles and tools we have covered in this course, with a focus on those covered in Modules 7-13.

You are being asked to respond to a series of questions based on the scenario provided and what you have learned in this class.  This is a fictional scenario but based on a real-life former work situation.

Please answer each question with a paragraph or two reflecting course materials and including citations/references from lectures and readings.  You may include attachments to illustrate the tools and techniques described in your response but don’t use them to replace the required discussion.

Your entire response should be no more than 10 pages double-spaced or five pages single spaced (size 12 font in each case,) excluding the title page, reference list and attachments.  Point values for each question are shown. 

Case scenario

The Guilford County Department of Public Health (GCDPH) in Greensboro, NC provides family planning services to women and men. Services are offered at three different locations in the county collectively completing approximately 7000 visits annually.  Services provided include physical exams, birth control, health education, counseling, laboratory tests, pregnancy tests, and testing and treatment of sexually transmitted diseases. Visits can include interaction with a number of staff including: reception and intake staff, lab techs, nurses, physician assistants, and physicians.

County-specific data on the need for or use of family planning services are not routinely collected.  The most recent state survey (Behavioral Risk Factor Surveillance Survey) from 2016 indicates  nearly half (49%) of women of reproductive age are at risk of unintended pregnancy

GCDPH is increasingly being asked to do more without being provided more resources. They have a four week wait time for appointments and are looking for ways to increase clinic efficiency in hopes of seeing more patients to reduce their wait time for appointments.

You were recently hired at GCDPH as a project manager and have been asked to help with this quality initiative because the health director learned you had taken a quality improvement course in your MPH. Most of the staff working in GCDPH Family Planning Clinic have many years of experience and excellent clinical skills, but few have experience with CQI and none have an MPH.

You wisely decided the first task was to form a CQI team.  The team has met and set the following aim:

·      We aim to increase the use of family planning services for men and women of reproductive age in Guilford County by July 2023.  This is important because higher use of family planning allows spacing of pregnancies and prevents unintended pregnancies and associated health risks.  We will achieve this aim by using QI methods to streamline our family clinic services by decreasing the total visit time from 2 hours to one hour.  This will allow us to increase the number of patients we see per day and reduce the wait time for appointments.

Note:  It is not necessary to have first-hand clinical experience to understand and respond to this challenge.  All of you have experienced health care clinic visits before, so reflect on past experiences.  If you feel you need additional insights, the IHI website has some good articles on improving clinic flow, or you can search the web and PubMed for articles on improving clinic flow.

Please answer each of the questions below to illustrate how you would approach this challenge.  In your response, demonstrate that you understand the tool and you understand how to apply the tool to this Case Scenario. (You do not have to submit the actual tools, but you must answer each part of the question.) 

1.    Identifying and prioritizing quality gaps (9 Points)

a.    Describe at least three tools you could use to better understand the clinic visit process.  For each tool, provide a brief description of the tool, how you would use it in this setting, what information you would need to use the tool and the benefit or insights the tool would provide to your team’s challenge.

2.    Designing and implementing improvement changes (9 Points)

a.    Describe the categories of potential change concepts.  Give examples of how each category is applicable to this concern in this clinic.

b.    Describe at least three tools or approaches you could use to generate specific change concepts.  For each tool, provide a brief description of the tool, how you would use it in this setting, what information you would need to use the tool and the benefit the tool would provide to your team’s challenge.

c.    List one potential change idea that might come out of the process you describe.

d.    Select an improvement model and describe how the model could be applied to testing the change idea you just identified in question 2c.

3.    Using data for quality improvement (9 Points)

a.    Describe the measures your team might want to collect.  For each measure, state what category of measure it is (structure, process, outcome or balancing), how it could be collected and why is it important.

b.    Your aim is to decrease Total Visit Time (the time from registering patients at the front desk to completing the visit).   The GCPHD Family Planning Clinic Director retrospectively collected data on visit time for prior month using a daily sample of patient data. You decide to analyze the baseline and create the chart below: Explain to your team what type of chart this is and why you chose to use it?  What does the chart included above tell you about the clinic process? What other questions might you want to answer about the process?  What other types of graphs might you use to help understand the process?

c.    How would you know if the change idea you identified in 2c, and tested in 2d, led to improvements? 

4.    Scaling and sustaining improvement (5 points) 

a.    Assume your tests of change resulted in an improvement.  You are ready to make recommendations about implementing at scale. What factors should you consider as you plan for scaling the improvement?  Give examples of how this applies to this case.

b.    Assume you successfully scaled the improvement and want to be sure the gains are sustained.  What recommendations do you have for the health director regarding the actions to take to increase sustainability.   Give examples of how this applies to this case. 

5.    Clarity of writing and expression (3 Points). Express your responses in full sentences and appropriately reference them using a combination of the asynchronous lecture content and course readings and supplemental materials.

List of Possible Tools to Use

·      Driver Diagram

·      Fishbone Diagram

·      Run Chart

·      Control Chart

·      PDSA Cycle and FEMA

·      Lean and Six Sigma

·      Measuring with Numbers and Rates

·      Measuring with Attributes and Perceptions