PUBH6150
Introduction to Quality and Safety in Health Care
Semester 2, 2017
Assessment Three
Due Date: 30 september
Weight: 30%
Refer to Modules 2 & 3
Part A
15 marks
1. Variation
a) The causes of process variation can be classified as special or common. From your work environment or experience, provide one example of a special cause of variation and one example of a common cause of variation. Your answer should convey an understanding of the fundamental difference between the two types of variation in processes. (Maximum 300 words)
b) Explain why it is important to reduce variation in processes in health care. (Maximum 200 words)
2. You are a manager in a surgical ward. You have been advised that only 50% of patients are receiving follow-up phone calls after discharge. Ideally all patients should receive a call.
a) What data would you collect to determine if the advice is reliable (that is, to confirm that the rate of follow-up phone calls is so low)? Hint: be specific about the data items you would collect.
b) Assuming the advice is reliable, how would you identify the reasons for the low follow-up rate?
c) What tools would you use to collect and display the data for a) and b)?
d) How would you decide on an improvement strategy?
Part B
15 marks
1. The events and decisions involved in an elective surgery scheduling process are:
• Patient seen in outpatient service
• Physician identifies need for surgery
• Physician schedules procedure with designated departmental scheduler
• Designated scheduler reviews block operating room time available
• Acceptable date?
• If yes – designated scheduler schedules case
• If no – designated scheduler contacts other physicians with unused time
• Physician releases time?
• If yes – designated scheduler schedules case
• If no – open non-block time available?
• If yes – designated scheduler schedules case
• If no – designated scheduler reviews block operating room time available
The flow chart on the next page can be used to represent this process.
Allocate the appropriate letter to each event and decision. Your answer should be a simple list of the letters A-I with the event/decision next to the appropriate letter.

2. A team was asked to investigate surgical delays.
a) A brainstorming session uncovered the following causes of delays:
• Surgeon late
• Anaesthesiologist late
• Supplies not ready
• Incorrect information in schedule
• Equipment unavailable
• Room not cleaned
• Recovery room full
• Earlier/previous case delayed
Present this information using an appropriate quality improvement tool. A hand-drawn diagram is sufficient, scanned and pasted into your assignment.
b) Subsequent surgical delays were classified by cause:
Surgeon late 19 Room not cleaned 6
Anaesthesiologist late 15 Recovery room full 15
Supplies not ready 32 Earlier/previous case delayed 45
Incorrect information in schedule 37 Other 5
Equipment unavailable 5
Draw an appropriate graph to indicate which categories offer the greatest potential for improvement. (A hand-drawn graph is sufficient.)
What proportion of this problem is caused by the three major causes?


3. A hospital is concerned about the number of patients who leave the emergency department without being seen by a doctor. Throughout 2015 they aimed to reduce the number to 30 or less patients per month.
What type of chart is this, and what does it tell you about the hospital’s performance in relation to the goal? (Maximum 120 words)
4. A general medicine department monitors the performance indicator ‘Time from receipt of referral to commencement of allied health intervention’. This is referred to as wait time.
Weekly average wait times (in minutes) for the discipline of physiotherapy are plotted in the chart on the next page. The hospital implemented a quality improvement strategy at week 13 which aimed to lower times to intervention to within 24 hours (1440 minutes).
Comment on the variation in average wait time over the 24 weeks. Would you say that the quality improvement strategy has achieved its aim? How do the UCL and LCL lines help you to answer this question? (Maximum 150 words)