HLTH 6882 Week 7 Improvement Pilot Design Memo Example

Memorandum

To: Director of Outpatient Services, Prairie Bend Community Hospital

From: Outpatient Manager, Visiting Specialist Clinic

Date: Week 7

Re: Approval to pilot the booking change on orthopedic sessions for one quarter

Request

I am asking for approval to test the booking change described in the change proposal on orthopedic sessions only, for three consecutive monthly session days, about one quarter. The test would move orthopedic referrals onto a holding list, open slots three weeks before each session, keep a short-notice list and send one-week reminders, with roughly ten weekly hours of the scheduler's time set aside for coordination. Cardiology and urology would continue as now. If the results meet the predictions below, I will return with a request to extend the change; if they do not, orthopedics returns to the current practice. Every figure here is illustrative.

Why Orthopedics

Orthopedics is the right test. It had the highest lost rate in the gap analysis, 29%, and the largest share of long-lead bookings, because it holds only one session day a month, so the change should show its effect most clearly there. It has about 40 booked slots per session day, enough that a change of several slots per session can be seen over three sessions. And it is small enough to reverse: one session day a month is a quarter of the clinic's specialist time.

A test on a single session day would be too small to read, since one day's result could move by chance. A clinic-wide change would not be a pilot, because there would be no way to reverse it cleanly and nothing to compare it with.

Predictions

This pilot is the planning step of a single plan-do-study-act cycle. A systematic review of how hospitals use this method found that most published applications skipped key features, including making predictions before testing and using small-scale tests (Taylor et al., 2014). To avoid that, the predictions are recorded here before anything starts:

1. The share of booked orthopedic slots kept will rise from the baseline of 71% to between 80% and 88% across the three session days.

2. Between 35% and 60% of late cancellations will be refilled from the short-notice list.

3. Coordinator work for orthopedics will take between 8 and 12 hours a week, including time spent calling the short-notice list.

4. Registration wait times on orthopedic session days will not rise by more than five minutes on average, because the float clerk covers registration.

If the kept share stays below 80%, the prediction will have been wrong, and the study step will ask which part of the change did not work as expected.

Comparison

Cardiology and urology will continue under the current practice during the pilot, and their kept rates will be reported alongside orthopedics. They are not a control group: they differ in specialty, session frequency and patient mix, and they were not chosen at random. They are a rough comparison that will show whether something affecting the whole clinic, such as winter weather or a staffing gap, moved all specialties at once. If all three rise together, the pilot result will be read with caution.

Logistics

Reports. After each orthopedic session day, the outpatient manager will pull the slot outcome report from the scheduling system, using the same definition of a lost slot as the gap analysis. The same report will be pulled for cardiology and urology sessions.

Short-notice list. The coordinator will log every late cancellation, every call made from the list and whether the slot was refilled, in a simple spreadsheet kept with the holding list.

Hours. The coordinator will record time spent on orthopedic booking tasks each day.

Registration waits. The registration lead will record check-in times on orthopedic session days, as is already done on one day a week for the quality committee.

Data over time. Each session day's result will be plotted in time order, the baseline median serving as the center line and the pilot's first day marked, following standard guidance on reading run charts (Perla et al., 2011).

Stop Rule

The pilot will stop early if any of three things happens: an urgent orthopedic referral is found to have waited on the holding list instead of being booked at once; the kept share on any session day falls below 65%, which is below the lowest orthopedic month in the baseline; or the specialist group reports that the change is disrupting its schedule. In any of those cases, orthopedics returns to the current practice the next business day, and I will report what happened.

What You Are Asked to Approve

I am asking you to approve four things for one quarter: about ten hours a week of the scheduler's time as outreach coordinator for orthopedics; float clerk coverage of registration on the three orthopedic session days; a change to the orthopedic slot template so slots open three weeks ahead; and the use of the reminder process for orthopedic patients, by text if the vendor module can be enabled for the pilot or by phone call if not. Nothing in this request changes the specialist contract, adds staff or affects cardiology and urology. Advanced access work suggests that changes to how existing capacity is booked can shorten delays without adding sessions (Murray & Berwick, 2003); this pilot tests whether that holds here.

References

Murray, M., & Berwick, D. M. (2003). Advanced access: Reducing waiting and delays in primary care. JAMA, 289(8), 1035-1040. https://doi.org/10.1001/jama.289.8.1035

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862