HLTH 4925 Week 10 Revision Rationale Memo Example

Memorandum

To: Seminar instructor

From: Student, BS in Healthcare Administration

Date: Month Day, Year

Re: Revision of the operations management proposal on the referral backlog: aim, baseline, measures and theory of change, with the reason for each change

Purpose

This memo accompanies the revised version of the referral backlog proposal I first wrote for the operations management course and reflected on in week 2. The revised pages show what changed. This memo explains why each change was made and connects it to evidence from earlier in this seminar. The clinic is described as a composite, and figures are approximate values shaped to match my workplace.

Change 1: The Aim Now Names Patients

What changed. The original aim was to reduce the referral backlog. The revised aim is to cut the median wait between the day a referral reaches us and the day the patient's specialty visit is booked from 11 business days to 7 within three months.

Why. The original instructor comment, your measures do not match your aim, pointed to a deeper problem I identified in week 2: the aim itself was stated in terms of our work, the backlog, rather than its effect on patients, the wait. A backlog can shrink while patients still wait if referrals are processed in the wrong order. Naming the patient's wait makes the aim the thing that matters.

Change 2: A Baseline Is Stated

What changed. The revision states a baseline: a median of 11 business days from arrival to scheduled appointment, based on 120 referrals received in one month, pulled from the scheduling system with arrival and scheduling dates.

Why. The instructor's question, where is the baseline?, was the comment I resisted most. In week 2 I recognized that I had relied on experience instead of evidence. Pulling the data took about two hours, and it changed my understanding: I had believed waits averaged about a week, and the actual median was longer.

Change 3: Measures Match the Aim

What changed. The original measures, referrals processed per day and staff satisfaction, are replaced by three: the median days from arrival to scheduled appointment, which is the outcome; the share of referrals arriving incomplete, which is a process measure; and the number of referrals waiting more than 14 days, which is a balancing measure to make sure complex referrals are not left behind while easy ones move quickly.

Why. In week 2 I committed to writing beside each measure how it shows progress toward the aim. The outcome measure is the aim itself. The incomplete share tracks the lever identified in the week 4 applied case. The balancing measure protects against the risk that the backlog falls because staff choose the easiest referrals first.

Change 4: The Theory of Change Uses the Applied Case

What changed. The original proposal asked for a temporary coordinator. The revision drops that request and proposes reducing incomplete referrals through a checklist sent to the five referring offices that send the most incomplete referrals, plus a short call to each office manager.

Why. The week 4 applied case used Little's law to explain why a temporary coordinator cleared the backlog only for a month (Little, 1961). With coordinators running near full capacity, the queue rebuilds after any temporary fix, a pattern operations texts describe for any service running close to its limit (McLaughlin & Olson, 2017). Incomplete referrals add work because each one is handled twice, so reducing them lowers the load permanently. Researchers have argued that managing variability and unnecessary work in patient flow can improve access without adding resources (Litvak & Fineberg, 2013). The revised proposal is cheaper and, according to the analysis, more likely to last.

Change 5: The Process Map Carries Times

What changed. The process map now carries median times at each step for twenty referrals, showing that insurance authorization accounts for the largest single wait and that the incomplete-referral loop adds a median of four days when it is taken.

Why. The week 3 artifact analysis found that the original map documented the process but could not support a claim of analysis because it carried no times. Adding times lets the map identify where delay occurs, which is analysis. It also supports the choice of incomplete referrals as a lever, since the loop is the largest delay the clinic controls; insurance authorization depends on outside payers.

What Did Not Change

The checklist idea, the process boundaries and the background section are unchanged. They were sound in the original, and the instructor did not question them. Revising them would have suggested the original was wrong in places it was not.

What the Revision Shows About Growth

In week 2 I claimed I now understood that measures are part of an argument and that experience is not a substitute for evidence. This revision is the test of that claim. The aim now names the outcome for patients, the baseline comes from data, each measure is tied to the aim and the theory of change rests on an analysis rather than on what my manager tried. The changed pages show the result; this memo shows that each change came from a specific earlier finding. The proposal will go into the portfolio under the caption chosen in week 8, and that caption, which promised an aim, a baseline and matched measures, is now accurate.

References

Little, J. D. C. (1961). A proof for the queuing formula: L = λW. Operations Research, 9(3), 383-387. https://doi.org/10.1287/opre.9.3.383

Litvak, E., & Fineberg, H. V. (2013). Smoothing the way to high quality, safety, and economy. New England Journal of Medicine, 369(17), 1581-1583. https://doi.org/10.1056/NEJMp1307699

McLaughlin, D. B., & Olson, J. R. (2017). Healthcare operations management (3rd ed.). Health Administration Press.