Improving Measurement Systems to Support Process Improvement Efforts in Health Care

Abstract

Quality problem or issue: To improve the operations of one federally qualified health center, this research sought to reduce patient cycle time. However, this investigation was impeded by the health center’s lack of an accurate and reliable measurement system. Initial assessment: To address this issue, this health center undertook a process improvement project in one of their faclitites. Through process mapping and measurement activities, project team members obtained a collective understanding regarding the inner workings of their process and identified problems with their measurement system regarding missing and infeasible data. Choice of solution: Through a series of process audits, project team members identified that measurement errors were due to not having a specific staff member assigned to check-out patients; later, they found this was due to medical assistants not fully understanding how to enter patient check-out times in the electronic medical record. Implementation: The accuracy and reliability of the measurement system was improved by assigning the task of checking out patients to medical assistants, and providing them with training about how to enter patient check-out times in the electronic medical record. Evaluation: The effect of the improvements made to the measurement system are evident given the decrease in the amount of infeasible patient cycle time data recorded (34% less) and the reduction in patient cycle time variation for the improved process. Lessons learned: This case study provides an example from which others can learn regarding the importance of measurement system accuracy and reliability with respect to process improvement efforts.