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AMBULATORY HEALTH SERVICE AT A UNIVERSITY

Ambulatory health service at a university

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Introduction

Evidence suggests that the ambulatory health service at a university is experiencing a high number of student complaints regarding the services offered at the institution’s walk in urgent care clinics. From data collected, the most common complaints are long waiting times and missing medical records and poor quality of services. Other complaints were lack of follow-up of care, challenges finding the urgent care clinic’s building and long duration of medical treatment. This quality analysis focuses on long waiting times which is one of the main complaints expressed by the students.

Control Chart

Table 1: Process Data

Complaint Type	Waiting Times	LCL	CL	UCL
September	38	-25.1629	44	113.1629
October	24	-25.1629	44	113.1629
November	50	-25.1629	44	113.1629
December	40	-25.1629	44	113.1629
January	31	-25.1629	44	113.1629
February	60	-25.1629	44	113.1629
March	97	-25.1629	44	113.1629
April	31	-25.1629	44	113.1629
May	25	-25.1629	44	113.1629
	Average	44
	Std dev	23.05428

The Control limit for this case will be the average monthly waiting times. To find the extreme limits of the process, three standard deviations are added on either side of the average. A plot of the waiting times as shown in figure 1 does not have points above the upper control limit and lower control limit. The X-bar control chart therefore implies that the process is in control.

Figure 1: X-Bar Control Chart

Cause and Effect Diagram

Although the process is in control, to address the complaints related to long waiting times. The highest numbers of hospital visits are in the month of February and March and so is the number of complaints related to waiting to longer times. The urgency care clinic can use a cause and effect to better understand the driving and restraining factors. Time is spend trying to locate the clinic, during the consultation and medical treatment procedure and trying to locate the medical records of patients. Lack of follow up to care also increases hospital revisits increasing demand and hence wait times. A fish-bone diagram provide din figure 2 below provides an overview of the driving forces for the long wait times.

( Long waiting times Lack of follow up of care Searching for the clinic building Searching for medical records Long medical cases Poor quality of c are Poor Infrastructure No poster for directions No telemedicine Patients do not complete doses Incorrect records Missing records Physician shortage Missing records Unskilled shortage Misdiagnosis Wrong prescription ) ( Figure 2 : Cause and Effect Diagram )

Recommendations

The university’s urgent care clinic should adopt electronic medical records, provide follow up care and implement a value based physician compensation model. Adopting digital medical records would make it to access, update and share medical records of patients. This would reduce the amount of time spend in the intake and treatment process (Mikula & Jacobsen, 2018). An electronic health care records platform also increases accuracy of patient information and reduces diagnosis and prescription errors. Providing follow up care improves effectiveness and outcome of care and hence reduces the need for hospital revisits (Carmel et al., 2017). Implementing value based physician compensation would pressurize physicians to improve the quality of care they provide (Bunkers et al., 2016). In turn, physicians will be motivated to reduce the length of medical cases including supporting follow up to care.

Conclusion

The increased number of student complaints regarding the services offered at the institution’s walk in urgent care clinics is a matter that commands the attention of the management. Long waiting time increases patient dissatisfaction with care. There are many factors that are contributing to the long wait times. For example, a lot of time is wasted trying to locate patients’ medical records and in diagnosis and treatment. The management should consider implementing strategies that reduce the wait times and hence improve the outcome of care. Recommended strategies include adopting electronic medical records and improving staffing levels to match demand especially in March and February.

References

Bunkers, B., Koch, M., Lubinsky, J., Weisz, J. A., & Whited, B. (2016). Value-based physician compensation: a link to performance improvement. Healthcare financial management: journal of the Healthcare Financial Management Association, 70(3), 52-58.

Carmel, A. S., Steel, P., Tanouye, R., Novikov, A., Clark, S., Sinha, S., & Tung, J. (2017). Rapid primary care follow-up from the ED to reduce avoidable hospital admissions. Western Journal of Emergency Medicine, 18(5), 870.

Mikula, T., & Jacobsen, R. H. (2018, August). Identity and access management with blockchain in electronic healthcare records. In 2018 21st Euromicro conference on digital system design (DSD) (pp. 699-706). IEEE.

X-bar Control Chart

Waiting Times September October November December January February March April May 38 24 50 40 31 60 97 31 25 LCL September October November December January February March April May -25.162851300391033 -25.162851300391033 -25.162851300391033 -25.162851300391033 -25.162851300391033 -25.162851300391033 -25.162851300391033 -25.162851300391033 -25.162851300391033 CL September October November December January February March April May 44 44 44 44 44 44 44 44 44 UCL September October November December January February March April May 113.16285130039093 113.16285130039093 113.16285130039093 113.16285130039093 113.16285130039093 113.16285130039093 113.16285130039093 113.16285130039093 113.16285130039093

Complaints