As Spath (2013) describes it, the PDSA (Plan-Do-Study-Act) improvement model is the most widely recognized improvement process today, consisting of four fundamental steps (Chapter 5). In this paper, the PDSA cycle will be applied to a particular practice problem. Therefore, the improvement project will be suggested, and the discussion entry will be given.
The PDSA Improvement Project
Plan
The objective of this project is to reduce the long wait times and delays for outpatient diagnostic services since it creates the patients’ dissatisfaction with the treatment and it could also “pose an important threat to healthcare quality and safety in outpatient settings” (Singh, Meyer, & Thomas, 2014, p. 727). The plan is (1) to distribute the incoming requests by the groups of diseases, because it would ameliorate the process of handling the inquiries, and (2) to “promote the implementation of enhancements to electronic health record systems that would facilitate communication among providers and between providers and patients” (Giardina et al., 2013, p. 1373). The reduction of the wait time and the delayed diagnosis is an expected result. The result will be determined by the decrease of the interval between the patient’s request and the received treatment. The feedback from the patients will also be considered.
Do
For two weeks the particular receptionists will be processing only the particular type of requests (e.g., the one only deals with inquiries about mental health, the other concerns just colds, etc.). Additionally, the pre-attendance check-in online system will be introduced.
Study
During two weeks, the delay time was reduced approximately by one third. In the overall result, the online check-in system showed higher efficiency in patients’ serving. They expressed a higher level of satisfaction with the treatment. The distribution of the inquiries by the types of diseases also increased the productivity, but at a slightly lower rate than the online system.
Act
Since the pre-attendance check-in online system showed its efficiency, it is suggested to promote it in all outpatient diagnostic units (for example, by printing the pamphlets with instructions for individual use). However, the distribution of requests between receptionists should be changed: it is suggested that inquiries should be distributed by the type of check-in (online or offline). The feedback from the patients should be collected as often as possible to evaluate the level of satisfaction and to detect potential paths for improvement.
Discussion
Of course, the suggested improvement project should be further complemented in the process of applying. The described PDSA cycle could be included in a Rapid Cycle Improvement project alongside with other related PDSA projects. Since the issue of delays in treatment and diagnosis is a part of a more complex problem, occasional confluences with different fields of study will occur. For example, in the diagnostic sphere, there are “pre-determined sequences that relate the number of tests to the specific combination of tests”, which could be reduced to prevent overtesting (Dai, Akan, & Tayur, 2016, p. 5). Furthermore, “the physicians routinely experience uncertainty and challenges in ordering and interpreting diagnostic laboratory tests”, and such uncertainty could be reduced by improving ordering and reporting methods (Hickner et al., 2014, p. 268). Also, there is a capability of dual diagnosis (for example, mental health and substance addiction treatment), and the increase in productivity, which is obtained by such technique, justifies the legitimacy of such method (McGovern, Lambert-Harris, Gotham, Claus, & Xie, 2014). In conclusion, one could observe the necessity of repeating the described PDSA cycle to improve the situation continuously. Also, one should apply it to a broader range of outpatient diagnostic units and services, because it would improve the current state of outpatient treatment and prevent inefficient strategies in the healthcare system.
References
Dai, T., Akan, M., & Tayur, S. (2016). Imaging room and beyond: The underlying economics behind physicians’ test-ordering behavior in outpatient services. Manufacturing & Service Operations Management, 19(1), 99-113.
Giardina, D. T., King, B. J., Ignaczak, A. P., Paull, D. E., Hoeksema, L., Mills, P. D.,… Singh, H. (2013). Root cause analysis reports help identify common factors in delayed diagnosis and treatment of outpatients. Health Affairs, 32(8), 1368-1375.
Hickner, J., Thompson, P. J., Wilkinson, T., Epner, P., Shaheen, M., Pollock, A. M.,… Taylor, J. R. (2014). Primary care physicians’ challenges in ordering clinical laboratory tests and interpreting results. The Journal of the American Board of Family Medicine, 27(2), 268-274.
McGovern, M. P., Lambert-Harris, C., Gotham, H. J., Claus, R. E., & Xie, H. (2014). Dual diagnosis capability in mental health and addiction treatment services: An assessment of programs across multiple state systems. Administration and Policy in Mental Health and Mental Health Services Research, 41(2), 205-214.
Singh, H., Meyer, A. N., & Thomas, E. J. (2014). The frequency of diagnostic errors in outpatient care: Estimations from three large observational studies involving US adult populations. BMJ Qual Saf, 23(9), 727-731.
Spath, P. (2013). Introduction to healthcare quality management (2nd ed.). Chicago, IL: Health Administration Press.