Question 1 [20 Points]: Emergency department crowding is an important public health problem.
There are many
ways to measure emergency department crowding but it is not clear which measure is best. The following pilot
study shows that two widely used measures can be easily collected in English emergency departments:
“Comparison of the International Crowding Measure in Emergency Departments (ICMED) and the National
Emergency Department Overcrowding Score (NEDOCS) to measure emergency department crowding pilot
study”.
a) Please read the study and provide a one-page comprehensive summary. After understanding NEDOCS
concept, please provide a brief critique of the work. Which one do you think is a better measure (ICMED)
or NEDOCS and why? The pdf of the articles can be found on myCourses.
b) The online NEDOCS calculator is available here: https://providers.otddi.com/edwin/nedocs_calc.html.
Out of all the variables used as an input to calculate the NEDOCS score, please consider these three
variables: “Number of ED Beds”, “Longest admit time”, and “Total Admits in the ED”. Please study the
effect of each variables on the NEDOCS score separately by varying its value from reasonable lower limit
to a reasonable upper limit and plot (using Excel: e.g., number of ED beds from 15 to 25 with increments
of 1 on the x-axis and NEDOCS score on the y-axis). Please comment on the results with a focus on the
variable(s) that they have highest effect on NEDOC score.
Question 2 [20 Points]: Please answer the following questions:
a) In support of its mission to improve the quality of health care provided to the public, the Joint Commission
includes the review of organizations' activities in response to sentinel events in its accreditation process,
including all full accreditation surveys and random unannounced surveys. Go to the Joint Commission’s
website and study carefully and thoroughly their Root Cause Analysis (RCA) framework for analyzing
sentinel events. Then, search for at least one example that illustrates an actual application of this
framework (even if it’s a partial implementation). Once you study this implementation, please include the
completed (or partial) table (responding to the 24 questions in the template, if available). Based on your
review and analysis of this application, provide a paragraph or two that highlight your observations on this
approach, including advantages, disadvantages, limitations, challenges, etc.
b) For each of the following case studies (already discussed in class), please develop your own 1) 5-whys
analysis and 2) causal tree analysis for the lab safety example (page 242) and near-miss in general
medicine (page 246).
Question 3a [10 Points]: Use Pareto analysis to identify the “vital few” factors that contributed to errors during
surgical setup. Research has shown that there are 8 types of surgical setup errors with collected data as shown in
the table below. Discuss and comment on the results. Show your work and include a copy of your Pareto
Chart/table from Minitab.
Error Type Frequency
Wrong Supplier 67
Excess Count 24
Too Few Count 17
Wrong Size 10
Wrong Sterile Instrument Set 10
Missing Item 8
Damaged Item 6
Other 2
Question 3b [10 Points]: The city hospital has to analyze and solve the various complaints of patients, which are
submitted to the Head Nurse Office. In total, there are 845 received complaints, starting from the complaint forms
filled in by the medical service beneficiaries, which were grouped into the categories shown below. Discuss and
comment on the results. Show your work and include a copy of your Pareto Chart/table from Minitab.
Complaint Type Frequency
Solving Time 320
Information Provided 210
Received Treatment 92
Too Many Formalities 75
Time Table 60
Waiting Time 53
Personnel Skill 18
Forms Missing 13
Others 4
Question 4 [20 Points]: Please answer the following questions:
a) Provide a detailed critique of the process map described in Figure 2-3 in the lecture notes (page 226)/
Then, please redo the process map using a 1) another improved process map and 2) a Swim-Lane
Diagram. If possible, please use the MS Visio Software. If not, please use any other flowcharting
software. Based on the developed swim-lane diagram, please develop an ‘activity lane and role map’
table as discussed during class time.
b) Please identify a healthcare process that’s of interest to you (e.g., emergency room, inpatient pharmacy,
radiology, labs). Then look for two different sources (papers, case studies, etc.) that have
documented/analyzed this process. Provide a screenshot of the two process maps (from two different
sources) that were used to describe the selected process (e.g., two studies documenting patient flow in
an emergency room). Once found, 1) describe the differences and similarities between these process
maps and provide an overall critique and 2) develop an improved but comprehensive process map based
on knowledge gained from studying the two different approached used to document the process.
Question 5 [20 Points]: Please answer the following questions:
a) Reducing waste in healthcare processes and operations will eventually minimize the associated cost by
eliminating unnecessary steps, etc. Medical overuse is one of the issues that lead to high healthcare
costs. Over the years, medical overuse has been addressed by many researchers. After providing a one-
page summary of the following IHI White Paper, explain how to achieve ‘lean healthcare’ and review/state
the unnecessary services and their associated costs: Going Lean in Health Care, IHI Innovation Series
White Paper, 2005: http://www.ihi.org/knowledge/Pages/IHIWhitePapers/GoingLeaninHealthCare.aspx .
[Page Limit: 2 pages]
b) Please provide one-page comprehensive summary of the “"Eating Soup with a Fork” keynote speech by
Dr. Donald Berwick, MD, MPP, Institute for Healthcare Improvement (IHI). Once you are logged on to the
IHI website, you can go http://www.ihi.org/resources/Pages/AudioandVideo/Don-Berwick-National-Forum-
Keynote-2007.aspx to view the video (or https://youtu.be/70eQKaZ5Bhs). In addition, please write a
paragraph or two to summarize your personal reflections/thoughts after listening to the speech.
