Colby General Hospital (a)

Abstract

This case presents an operating challenge: how does an organization sustain the initial progress achieved through its new quality-improvement system. Nurses and other clinical staff feel that the culture does not support the acknowledgment of mistakes, and the operations manager is trying to ascertain whether this blame-game environment is the cause of the improvement slowdown or whether there are other factors. Students are asked to apply systems-thinking tools to reveal their hypotheses of the causes of the improvement problem and to create a stock-flow map of the system structure. A systems-dynamics model can be used in class or as a preparation assignment. The simulation model enables students to develop a deeper understanding of the systems-dynamics behavior. The subsequent cases in the series (UVA-OM-1043 and UVA-OM-1044; UVA-OM-1045 is an abridgement of the A, B, and C cases) provide students with opportunities to practice the quantification of systems relationships (dominated by soft variables) and to develop a simulation model. Excerpt UVA-OM-1042 COLBY GENERAL HOSPITAL (A) Jen MacDonald finished reading the most recent biweekly review report and realized that nothing had changed. As director of operations for Colby General Hospital, MacDonald had been working hard for over a year instituting a new review practice aimed at reducing the number of mistakes made in the hospital. Although the initial results, following a slow start, showed a steady decrease in the rate of mistakes made, the past few months had seen no change at all. (Exhibit 1 illustrates the mistake performance time chart.) As she leaned back in her chair, MacDonald could not stop trying to figure out why the rate of making mistakes had leveled out. Were there forces at play to prevent her staff from improving their performances? If so, what were they, and how did they impact the rate at which her staff was making mistakes? The Review Initiative As with most health institutions, Colby General Hospital had been under increased pressure to contain costs because of insurance practices. Despite the rising number of patients being served by the hospital, the lower reimbursement level had resulted in no change in staff size. With a higher patient to staff ratio, each employee was forced to perform more patient care and/or supporting administrative tasks on a daily basis than he or she had in the past. To date, however, this has had no significant impact on the ratio of mistakes to tasks. Knowing that there were a growing number of mistakes being made on a regular basis, MacDonald implemented a quality improvement process. Her process called for each mistake to be formally reported, so that it could be reviewed by an improvement team, learned from, and thus prevented in the future. This improvement process was designed to create a “knowledge bank” that would be the basis of new or revised procedures. Furthermore, this new knowledge and these procedures would hopefully stimulate supervisors to help all employees to reach the hospital's goal of error-free patient care and supporting tasks. . . .