Health sciences and medicine
Identifying a organization/ department problem or issue and suggest ways to implement change to solve the problem
Project description
The department problem: Holter monitors not being returned
The cardiology department currently provides a wide range of non invasive investigation that helps to identify rhythm abnormalities and blood pressure information. The most common investigations are ambulatory 24 hours (hrs) Holter, R-Test monitor and BP monitor. For these investigations the patients are required to attend the cardiology clinic and have the referred monitor fitted by a cardiographer following instructions and return the monitor after completion of the time required for recording.
The department has recently experienced issues with the Holter monitors not being returned on time or not at all, those affecting the smooth running of the service and other patients scheduled for appointments. There are currently 40 Holter monitors on the inventory. The department receives routine referrals for 24 hrs, 48 hrs, 72 hrs and 7 day Holter and an average fitting of 8-9 Holter monitors a day. Recently, one of the staff involved routinely in Holter fitting identified that 15 Holters are missing which is almost half of the stock. This shortage of monitors has resulted in cancelation of appointments, reduce the work of staff involved in analysis subsequently affecting the business targets of the department.
The department has recently experienced issues with the Holter monitors not being returned on time or not at all, those affecting the smooth running of the service and other patients scheduled for appointments. There are currently 40 Holter monitors on the inventory. The department receives routine referrals for 24 hrs, 48 hrs, 72 hrs and 7 day Holter and an average fitting of 8-9 Holter monitors a day. Recently, one of the staff involved routinely in Holter fitting identified that 15 Holters are missing which is almost half of the stock. This shortage of monitors has resulted in cancelation of appointments, reduce the work of staff involved in analysis subsequently affecting the business targets of the department.
Please use one of the root cause analysis model: for example fishbone diagram or cause and effect diagram, or 5 whys method. Whichever identify this problem better.
Use this website for models. http://www.12manage.com/methods_ishikawa_cause_effect_diagram.html
We normally advise patients to return the monitor in person to our cardiology reception Monday to Friday between 9 am and 17 pm or to the 24Hrs hospital main reception outside working hrs or weekend. If they can returned the monitor in person we give an envelope and ask them to post it by recording delivery. We give this information and instructions to the patient verbally and also in a written format.
Why this may occur?
We are a tertiary center highly specialist in congenital heart disease and electrophysiology. We see patients within a long distance away from the hospital.
The reason being for patient not returning the monitors may be that: the patients can’t get to the hospital because they live to far, or they are elderly or maybe they refuse to pay for recoding delivery. This may be also due to poor communication and instruction and lack of cooperation of the patients.
Use this website for models. http://www.12manage.com/methods_ishikawa_cause_effect_diagram.html
We normally advise patients to return the monitor in person to our cardiology reception Monday to Friday between 9 am and 17 pm or to the 24Hrs hospital main reception outside working hrs or weekend. If they can returned the monitor in person we give an envelope and ask them to post it by recording delivery. We give this information and instructions to the patient verbally and also in a written format.
Why this may occur?
We are a tertiary center highly specialist in congenital heart disease and electrophysiology. We see patients within a long distance away from the hospital.
The reason being for patient not returning the monitors may be that: the patients can’t get to the hospital because they live to far, or they are elderly or maybe they refuse to pay for recoding delivery. This may be also due to poor communication and instruction and lack of cooperation of the patients.
24 hrs is the gold standard however some doctors requested for longer period of time.
Also with the new guideline recommendation of monitoring atrial fibrillation (AF) post ablation more doctors request a 7day holter to assess the AF burden. This means that the monitors are out of service for 7days. If it’s not returned on time this also increase the time of the monitor being out of service for longer period of time. 7 day holter take also longer to analyse.
The implication of this
We had to canceled appointment due to shortage of monitors.
Patients were unhappy and complain about the service.
Reduce the work for the staff fitting the monitors and for those analyzing the tapes.
Doctors unhappy because we don’t have the results ready due to patients not returning the monitors.
Not meeting the business targets.
Suggest ways of implementing a change to improve and solve the problem.
Also consider benchmarking and brainstorming when implementing change.
For example buying more monitors? What may be the issue with this? Suggest more than one strategy.
May suggestion is to provide the patients with a prepaid envelope so that they don’t have to pay for it. In collaboration with royal mail we will be provided with pre paid envelopes.
Consider this implementation as the focus to critically discus this in relation to change and organization, decision –making and valuation, the importance of leadership and management, communication and skills, ethics and responsibilities, quality.
This strategy is going to be implemented.
Please consider the implication of this. Example: Budget, resistance to change
The written form for instruction will also change. Consider the effect of communication.
Also with the new guideline recommendation of monitoring atrial fibrillation (AF) post ablation more doctors request a 7day holter to assess the AF burden. This means that the monitors are out of service for 7days. If it’s not returned on time this also increase the time of the monitor being out of service for longer period of time. 7 day holter take also longer to analyse.
The implication of this
We had to canceled appointment due to shortage of monitors.
Patients were unhappy and complain about the service.
Reduce the work for the staff fitting the monitors and for those analyzing the tapes.
Doctors unhappy because we don’t have the results ready due to patients not returning the monitors.
Not meeting the business targets.
Suggest ways of implementing a change to improve and solve the problem.
Also consider benchmarking and brainstorming when implementing change.
For example buying more monitors? What may be the issue with this? Suggest more than one strategy.
May suggestion is to provide the patients with a prepaid envelope so that they don’t have to pay for it. In collaboration with royal mail we will be provided with pre paid envelopes.
Consider this implementation as the focus to critically discus this in relation to change and organization, decision –making and valuation, the importance of leadership and management, communication and skills, ethics and responsibilities, quality.
This strategy is going to be implemented.
Please consider the implication of this. Example: Budget, resistance to change
The written form for instruction will also change. Consider the effect of communication.
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