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Healthcare Management

Healthcare Management

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Published by: ebourshaid on Dec 27, 2010
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  • Recommendation for continued improvement
  • Root Cause Analysis:
  • Results and Improvement
  • Results and Recommendation
  • Main Objective
  • Reccomendations
  • Root Causes Analysis
  • Recommendation for Continuous Improvement
  • Solutions
  • Justification of Triage
  • The Planning Process and Implementation
  • Reccomendations for Continued Improvement
  • Background Information
  • Areas of Organizational Change
  • Practice/Recommendations for Change
  • Other recommendations
  • Forces and Constraints
  • Introduction and Problem Statement
  • The Aim of the Project
  • Prescription Forms in the Ministry of Health
  • How We Solved the Problem
  • Why WeUse the Prescription Form for Controlled Drugs
  • Reasons for Selecting These Alternatives
  • General Recommendation
  • Recommendations fro Continued Improvement
  • Conclusions and Recommendations
  • Implementation / Results
  • Aims and Objectives of the Laboratory
  • Project Timeline
  • Aim Of The Project “Smart Goals”
  • Problem Definition
  • Alternative Solution and Implementation
  • The Problem of the Project
  • Results and Conclusion
  • Program Schedule
  • Program Evaluation
  • Notes
  • Project Mission Statement
  • Organization and Communication
  • DATA
  • Strategic Goal of the Project
  • Operational Plans
  • Solution
  • Results and Recommendations
  • Background of the Subject
  • Objectives of Planning Project
  • Time Scale
  • Monitoring and Review
  • Recommended Solutions
  • Smart goal
  • Problem Root Cause
  • Selected Solution
  • Completion of the Project
  • Future Rollout of the Project
  • Evaluation
  • Project Initiation
  • Root Cause
  • Solutions and Plan for Implementation
  • Planning and Assessment
  • Problem Areas and Solutions
  • Alternative Solution and Plan for Implementation
  • Dr. Emtethal Al-Jishi

According to the following priorities:
1.Reduce over-referral by:

Establishing a multidisciplinary team to communicate with health centers
to set a policy for referral.

Establish a policy for discharge and referral to health centers.
2.Establish a reception to direct patients to different examination rooms.
3.Provide screening nurses to establish criteria for accepting patients for out-patient
careat appointment or emergency clinics.
4.Issue instructions to patients on appointment procedures, avoid knocking on
doors of consulting rooms, and wait in areas assigned for waiting.
5.Notices/instructions to be placed on walls to direct patients to different examination

6.Retrieving and sorting files in the clinic one day before appointments.
7.Arrange firms as a team with a nurse looking after each firm

About the Team

Weneed to identify team performance opportunities by:

Dividing into sub-teams for specific issues or improvement opportunities.

Staying together as a team will strengthen rethinking as a team, as well as
build confidence and commitment to one another in overcoming obstacles
and moving ahead.

Dr. Ebtisam Al-Alawi

Consultant, Ophthalmology Department
Salmaniya Medical Complex
Ministry of Health


Healthcare Management CQI Projects

Over Utilization of Laboratory Services at
Salmaniya Medical Complex: AStudy of
Hemoglobin Electrophoresis and Glucose-6-
Phosphate Dehydrogenase Activity

Problem Statement

The number of laboratory tests performed at the Department of Pathology,
Salmaniya Medical Complex (SMC), Kingdom of Bahrain has increased tremen-
dously during the last few years (Annual Report 1997). Previous studies showed
that 14.2% of requests for laboratory tests are repetitive, unjustified and unneces-
sary. This observation is to be tested.
Since haemoglobinopathies and G6PD are very common in Bahrain, it was felt that
tests requested by the clinicians to screen and diagnose these clinical conditions are
overutilized by repeating the same tests, as the laboratory findings will not change,
because the conditions are inherited and coded in the genetic structure of every indi-
vidual. The aim of this project is to verify this overutilization, quantify the problem
and establish measures to reduce and, if possible, cut this load. Follow-up is neces-

Root Cause Analysis

Toverify the problem, a one-week pilot study was carried out between 10 June 1998
and 16 June 1998. The results showed that 13.4% of all electrophoresis requests were
repetitive. This rate however is within the estimated annual increase of workload
and may also be over-inflated by the inclusion of the follow-up cases of hemoglobin
Aand F estimation. This part of the project requires further analysis.
As for G6PD, 6.2% of the tests were also repetitive and double the annual rate.
Moreover, since G6PD results are not affected technically or clinically, this signifi-
cantly represents unnecessary overutilization of laboratory service.
The possible causes of this overutilization include the following:
1.Doctors are unaware of the cost of medical procedures and are able to request
any test, whether clinically justified or not.
2.Doctors do not examine patients’ records and areunawarethat these tests
were previously done.
3.Health Center doctors often doubt the results of tests from their local laboratories
and refer the patients directly to SMC laboratory, but they are unaware of the
procedures carried out in SMC for their patients.
4.The test in question does not appear on the Discharge Summary Sheet of
5.The computer network of the Ministry of Health is not accessible for checking
of laboratory results.
6.Laboratory staff are aware of repetitive tests but have not taken further action
to find a solution due to past attempts which were unsuccessful.

Solutions and Implementation

The solution to the above problem is that SMC Laboratory accepts all requests but
perform the analysis only after checking the computer database to confirm that tests
werenot done before. But the laboratory should still provide a copy of previously
performed tests so that patients and doctors are served. The implementation of this


Healthcare Management CQI Projects

procedure using either Lewin’s or Kotter models was not possible because of a num-
ber of limitations. Instead, the Modified Comprehensive Approach of Change was
successfully applied in a two month study.


Atwo-month study was done and the following are the main findings:
1.6.3% of electrophoresis requests were repetitive and unnecessary. This rate is
less than the one-week pilot study due to the exclusion of follow up cases of
haemoglobin Aand F estimation.
2.5.6% of G6PD tests are also repetitive and unnecessary. This rate is nearly
similar to the one-week pilot study and can be regarded as a significant indicator
of overutilization.
3.Analysis of annual records and the two-month study showed that the estimated
number of monthly repetitive tests for electrophoresis and G6PD would be about
200 tests (100 each).
4.If LPPrates are considered as BD 9 for these two tests, than the average cost
of these tests would be 200 tests x BD 9 x 12 = BD 21,600.
5.SMC accounted for 47% of total electrophoresis and 36% of G6PD repetitive
tests and the remainder are from Health Centers.


The health authorities in Bahrain must address the problem of overutilization of all
diagnostic services and its cost implications on the health system, because haemo-
globinopathies arecommon in Bahrain. Overutilization of tests related to these dis-
eases must be prioritized. The issue on overutilization of laboratory services should
be given appropriate solutions for better improvement. All results must be entered
in the national computer database, which should accessible for doctors to verify pre-
vious tests and avoid duplication. Education on these laboratory tests and their
results should be provided to all concerned including patients; and results of these
tests must be shown on the cover page of the hospital record files, health cards and
other relevant clinical identification sheets. The computer network should be
expanded to cover all health delivery areas, and the number of terminals should be
sufficient for concerned parties to access information.

Dr. Faeq Al-Hilli

Chairman of Pathology Department
Ministry of Health


Healthcare Management CQI Projects

Ineffective Use of Paediatric Day Care Unit at
Salmaniya Medical Complex

Problem Statement

The 6-bedded Pediatric Day Care Unit, built as an extension to the Pediatric
Department, was opened in 1996, and is used for the care of patients suffering from
Thalasaemia Major and Sickle Cell disorders, who require life-long and continuous
treatment. They need special care, appropriate education and a pleasant environ-
ment to help in reducing their anxiety. Ineffective utilization of the Unit, its services
and facilities resulted in patients losing interest in their treatment plan and educa-
tion, and become non-compliant and stressful.
Patients’ dissatisfaction with the Unit was brought to the attention of the manage-
ment, who did not understand patients perception of the care they receive, or under-
stand the occasional complaints or expression of happiness related to the quality of
care, facilities, personnel and environment. Management did not have a perspective
of the problem and only solved superficial issues for a particular person or situation.
In order to provide quality care and increase productivity, an assessment of the ser-
vices at the Unit needed to be carried out to analyze the main causes of dissatisfac-
tion. Ateam was identified according to Belbin’s team role and participated in the
project from its development to its implementation.
Objectives of the study:

To determine patients/parents perception of the quality of care at the
Pediatric Day Care Unit.

To identify causes of patients’ non-compliance to the course of treatment.

To identify the quality and weaknesses in the system .

To demonstrate appropriate action and proper utilization of resources.

Root Cause Analysis

Asurvey was conducted for two weeks and the information that was collected ana-
lyzed to identify potential causes that seriously affected the patients and quality of care
at the Unit. The study revealed the following problems:
1.Inappropriate scheduling of operational time (Unit functions only in the morning,
making it difficult for parents to bring their children due to career commitments).
2.Presence of laboratory work being carried out in the Unit.
3.Inappropriate utilization of nurses role (shortage of staff-nurses work as labo-
ratory technicians).
4.Lack of space (space utilized by out-patients who seek laboratory work); 550
to 600 out-patients attend the unit per month.
5.Lack of patient education, interaction and communication (patients education
is affected; they lose interest in their treatment plan leading to non-compliance,
leading to recurrent admissions).
6.Patients find it difficult to cope with their treatment and schooling.

Alternative Solutions

Due to the wide range of the problem and limited prescribed time and resources, the
team focused on the best solutions that would lead to the enhancement of the qual-
ity of utilization of the Unit. Since problems were associated with each other, i.e.,
customer satisfaction and effective utilization of Pediatric Day Care unit, their


Healthcare Management CQI Projects

strength, weakness, opportunity and threat (SWOT) are interrelated, and the following
solutions were recommended for better management and control:
1.Restructuring of the work environment to encourage and reinforce patient/parent
satisfaction and compliance.
2.Reschedule operational timing of the Unit to evening hours, i.e. 2:00 p.m. to 10:00 p.m.
3.Shift laboratory work for outpatients to the main Laboratory, ensuring nursing
staff’s commitment to their patients in the Unit.


Apilot study of the proposed solutions was introduced, and on 1st January 2001 the
recommended solutions were implemented. An evaluation study was carried out,
and the resulting information indicated customer and personnel satisfaction.
Recommendations for continuous improvement:
1.To consider other problems that were generated by patients that need to be
resolved by teamwork.
2.We could have done better in the implementation phase by more staff training
and keeping everybody in Salmaniya Medical Complex informed of the
3.Social workers should have been involved in the team to ensure better
approach and continuity of care in the community (especially for socio-economic

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