Case Study

Sample Case Study Analysis: Review of Quality Improvement Measures

Case Study Analysis

This analysis draws basis from a patient’s local hospital. The hospital drew impetus from the case study of a 26-year-old woman who experienced a gradual shortness of breath in a period of three days. Her experience was free of other symptoms like cough, fever, or wheezing. She decided to go to her local hospital when it became increasingly difficult to breath.

Of interest were the wait times that the woman endured before she could obtain a proper evaluation and diagnosis of her condition, which could be a comorbidity. From her case, wait times were determined as follows; after staying in the waiting area before registration for an undisclosed duration, the patient was registered and made to wait for 20 minutes before the triage nurse took the patients history and vital signs. The patient then returned to the waiting area for some time before detailed history, physical exam, blood tests, X-ray, lung scan, and electrocardiogram. Another three-hour wait followed before her evaluation was out. The physician diagnosed the patient with asthma and informed her that it was nothing serious.

Impetus for Performance Improvement

A meeting between the hospital’s administrators, the director of the hospital’s performance improvement, and the physician director revealed worrying trends in the hospital, notably diminishing patient satisfaction, increased elopements, and patients collapsing in the teeming waiting room.

This brought a need to reorganize the department in order to increase efficiency and address the fundamental problem of excess wait time; the physician director believed that the wait time was inevitable given that most of the patients were severely ill, and the existing resources were inadequate. The performance of the hospital in terms of wait time had to improve, though there was need to measure its performance and benchmark with other hospitals

The performance improvement director requested a departmental reorganization. The hospital developed an ine-month plan to measure, analyze, and improve quality of care. The plan focused established wait times, patient satisfaction, patient return visits with same problem within 72 hours as the measures to use.

To do this, the hospital undertook some restructuring to bring in new staff, reorganize staff functions, and institute new procedures and policies that would govern service delivery. The management also added incentives to boost Image 2service delivery. The hospital’s changes were;

  • Introduction of a ‘greeter’ to welcome patients, guide them through the registration process, and identify serious cases. The greeter could help serious cases to skip the registration process
  • The triage nurse moved to the waiting area
  • An electronic sign indicating average wait times in the waiting room


To analyze the plan, one must look at quality from the customer’s point of view. ‘Quality’ represents an individual’s subjective evaluation of an output and the personal interactions that take place as the individual obtains the output. It is rooted in that individual’s expectations, which depend upon the individual’s past experiences and needs. Quality evaluations therefore arise from, and are part of, an individual’s value system. One can measure and change,as a value system, quality expectations over time through education.

Several concepts can measure quality. Quality has two main components—content and delivery. Content quality is concerned with the medical outcome that results. It also refers to whether the output does what the customer believes it should do-whether the output functionally meets the customer’s expectations.

Delivery quality refers to all aspects of the organization’s interaction with the customer in delivering the output. It is determined day by day, moment by moment, in thousands of individual, temporary relationships. It reflects an individual customer’s interaction with the health care system—a patient will consider whether the hospital was clean and whether the nurses were caring and offered rapid services.The patients will also have expectations on how their interaction with employees should be,

To analyze the effectiveness of the quality improvement measures, one may use tools like questionnaires and customer focus groups. Patients and their relatives fill questionnaires to convey their satisfaction and their feelings towards different aspects of the treatment. The questionnaires may also require costumers (patients) to comment on the wait times. (Nash,2006)

The measures used in determining quality improvement can transport time for AMI patients, the smoothness of admission or discharge, courtesy of hospital employees, availability of good emergency care, number of emergency department patients who return with the same symptoms, and the time for getting an EKG for patients with chest pain.
According to a research conducted on four leading hospitals by Sharon Silow-Carroll, Tanya Alteras, and Jack A. Meyer Health Management Associates in April 2007, hospitals that successfully implemented quality improvement measures followed a strikingly similar process of change as detailed in the diagram below;

Silow-Carroll ES chart 1


The first step is evident in the hospital’s institution of the quality improvement program after recording alarming declines in patient satisfaction, increased patient ‘elopements’ and alarming cases of patients falling in waiting rooms. The hospital’s performance improvement director proposed a restructuring of the emergency department to reduce wait times and respond to cases that were delay sensitive by allowing them to skip the registration procedure and obtain quick treatment. The hospital introduced a ‘greeter’ and moved the triage nurse to the waiting room after identifying it as a possible avenue for longer wait times.

The hospital’s quality improvement strategies may succeed since the laid out plan follows laid out concepts and uses realistic measures to measure its improvement.

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Carroll, Sharon Silow.Alteras, Tanya, and Meyer, Jack A. Health Management Associates

(2007)  Hospital Quality Improvement: Strategies and Lessons from U.S. Hospitals.The Common Wealth Fund.

Nash, David B. (2006)The Quality Solution: The Stakeholder’s Guide to Improving Health Care. Jones & Bartlett Learning,.

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