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Introduction

The Plan Do Check Act (PDCA) cycle is a robust performance improvement method, which works very well in a health care setting. The cycle provides a simple, yet effective method of measuring and modifying change depending on the quality outcome of the change the health care setting is attempting to attain. It is an improvement process founded on a systematic process of proposing a change in the process, applying the change, evaluating the outcomes, and taking the correct action (Greasley, 2009). Through breaking role and function into variables, the PDCA cycle, assists the leadership in comprehending the medical and clinical environment and method of offering care (Harmon, 2003). The below Plan-Do-Check-Act Process analyzes medical services offered by the Southern Illinois Healthcare Foundation and seeks to address the quality issue, as well as the concept of continuous improvement (CQI).

The Southern Illinois Healthcare Foundation (SIHF) is a community-based, Federally Qualified Health Center (FQHC) network with almost 40 health centers in seven counties of Southern Illinois. For over 25 years, the mission of the foundation has been to create access to healthcare through delivering primary care, behavioral, dental  and other support services to the people requiring more medical care in Southern Illinois. SIHF offers primary care services in obstetrics’/gynecology (OB/GYN), pediatrics, dentistry, family medicine, behavioral health, and internal (adult) medicine. With the PDCA approach, SIHF can solve the numerous problems it encounters in provision of medical services and plan for future changes, which can go much more smoothly (Standard Australia, 2001).

The PDCA process above is applicable to the medical services division in SIHF, and it can continuously improve quality allowing the measurement of the current performance, analysis of processes, as well as identification of improvement actions (Plan). The improvement actions are then implemented (Do) and the benefits of these implementation actions measured (Check). Once measured, the improvements can be standardized, communicated and reassessed (Act). Through this process, the PDCA cycle offers systematic knowledge acquisition through focused data collection and measurement, which validates that the improvements are valuable. The Plan-Do-Check-Act process will be applied to the seven medical services in SIHF.

Pediatrics

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SIHF offers pediatrics health services for newborn babies of up to 18 months of age. To implement the main pediatric health functions of assessment, policy development, and assurance within the continuous quality improvement process, SIHF has to ensure an ongoing cycle moving towards continuous improvement. During the planning stage, SIHF has to identify patients’ problems and expectations regarding health care and seek to understand the current problem within this care. SIHF should also measure the problem, identify the root causes, and, lastly, plan for improvements. The stakeholders with similar goals in SIHF should formulate similar goals. The stakeholders can derive the problem from internal and external sources. For instance, the administration may assume that most of the patients are receiving recommended counseling on caring for children with autism. Their assumptions may be that the clinicians are incorporating autism education into their practice. SIHF can collect data to confirm these assumptions.

In Quality Management, SIHF can develop a methodology for chart review and assess the percentage of parents who have had the counseling and those who have not. Having such information, further drill-down analysis of the data can be performed, as well as assessment of the records of children patients who do not receive counseling. The other assumption might be that children whose parents receive counseling on caring for autistic children do better healthwise than those who do not receive counseling. Another problem might be children developing pneumonia when on ventilators due to improper weaning.

The staff and administrators should meet together to determine assumptions to be measured and children health care processes to be improved. To do that, analysis of the health care processes, as well as identification of the improvement actions are necessary. SIHF should then establish processes and objectives for delivering processes essential for obtaining results in line with expected goals or targets.

The second stage (the Do Stage) entails implementing the plan/improvements or executing the process and collecting data for charting and analysis in the last two stages (Greasley, 2009). It entails setting up improvements interventions or programs. For instance, SIHF can make it compulsory for every autistic child parent(s) to receive counseling on care for such children. For instance, it can convene and charge a multidisciplinary task force to develop a method to implement a low risk and safe environment for the children, determine particular requirements for credentialing pediatricians and set up a consistent method for proper patient selection, identification and assessment.

The third stage entails determining the results (CHECK) through monitoring the set indicators. The quality management department together with the multidisciplinary task force can set up a database for monitoring relevant indicators from pre-counseling to post counseling for ongoing review. The SIHF can use an outcome database to asses every program through using common uniform denominators and numerators and common data definitions. These methods can track and trend patient’s demographics, outcomes, as well as complications. The measures of objective outcomes are used to analyze the outcome of the patients. The fourth and last phase is the ACT phase, which entails standardizing or holding the gains/outcomes and improving assessment. In this phase, SIHF can include continuous education of relevant pediatricians across the system. In case the plan has achieved the set goals, it should document and standardize the process. If not, the process should be redesigned to meet the objective by going through the PDCA cycle once again. The result of this PDCA cycle in SIHF when it comes to pediatricianservices can be improved children health care services and more effective organizational processes, which result in reduced costs to the hospital and system. 

Obstetrics & Gynecology

SIHF also offers obstetrics and genecology services for women at several of its health care center locations. Like in the improvement of quality of pediatrician services, SIHF should identify women problems and expectations concerning health care and seek to understand the current problem within the OB/GYN care. Within the planning stage, SIHF should also measure the problem, identify the root causes, and plan for improvements. The stakeholders with similar goals in SIHF should formulate similar goals and an assumption regarding women OB/GYN health care services; in other words, they should formulate hypotheses. The relevant stakeholders should derive the hypothesis from internal and external sources. For instance, due to an increase in C-section surgical sites infection, SIHF can use the PDCA cycle to reduce such infections.

The PDCA cycle can be used to assess the current practices and establish ways they can be improved during the planning stage. As regards quality management, gynecologists and other stakeholders can develop a methodology for chart review and assessment of the percentage of individuals who have had the C-section surgical sites infection and those who have not, including conditions that led to the infection. Having such information, further drill-down analysis of the data can be performed, as well as assessment of the records of patients with C-section surgical sites infection. During the planning stage, the current practices can be evaluated and new strategies developed to enable SIHF to reduce infection rates.

The second stage (the Do Stage) in improving OB/GYN health care services entails implementing the plan/improvements or executing the process and collecting data for charting and analyzing the CHECK and ACT stages. This entails setting up improvements interventions or programs. To target C-section surgical site infections in its patients, SIHF can reinforce a number of continuous intervention programs or interventions such as re-education and stringent enforcement of jewelry restrictions among the delivery and labor staffs. It can also reinforce the OR scrub policy, which proscribes personal clothing from exposure under pediatricians scrub attire during C-section procedures. Such interventions can help reduce the rate of C-section surgical site infections.

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In the third stage (CHECK Stage), SIHF can determine the results through monitoring the set indicators; i.e. reduction of surgical site infection in women. Like in improvement of pediatric services, the quality management department can set up a database for monitoring relevant indicators from pre- C-section surgery to post-surgery C-section for ongoing review. SIHF can use the outcome database to asses every program through using common uniform denominators and numerators, as well as common data definitions; this method can tract and trend patient’s demographics, their outcomes, as well as the complications. The measures of objective outcomes can be used to analyze the outcome of the patients. During the last stage (ACT Stage), SIHF can standardize or hold the gains/outcomes and improve its assessment. In this phase, SIHF can include continuous education for the relevant pediatricians across the system. These four processes in the PDCA cycle can assist SIHF in improving OB/GYN health care services offered to women. For instance, SIHF can reduce C-section surgical site infections by adopting or implementing improvement protocols or interventions. During the act stage, the improvement team should assess whether the set goals were achieved as set forth. In case the plan has achieved the set goals, it should document and standardize the process. If not, the process should be redesigned to meet the objective by going through the PDCA cycle once again.

Family Medicine

 SIHF family medicine is a medical specialty, which offers continuous and comprehensive health care for both individuals and families. There are practice doctors and nurse practitioners at SIHF who see every patient regardless of gender or age. The PDCA cycle can also be used to improve the quality of family medicine in SIHF and ensure continuous quality improvement. During the plan stage, SIHF should measure the problem, identify the root causes, and plan for improvement. For instance, SIHF may recognize that the services offered for curing chronic back pain and substance abuse are not satisfactory, and that the patients do not recover within the set duration. SIHF can use the PDCA cycle to address these problems.

During the plan stage, SIHF should measure this problem, identify its root causes, and plan for improvement. During the plan phase, evaluation of present practices and action planning take place. In this case, SIHF stakeholders would determine how well SIHF is dealing with the health problems of substance abuse and chronic back pain. Potential problems in dealing with these problems may be uncovered at this stage, thus indicating the need for improvement. At this point, SIHF should assemble an improvement team to investigate the situation. The team’s job will be to comprehend the problems using process analysis methods and then using statistical analysis to identify the underlying issues causing the inadequacy of treatment. The team then identifies alternatives for improvement, after which action is planned. For instance, the team can select specific improvements, such as buying new machines for managing a chronic back pain or hiring well-qualified staff for dealing with the issue of substance abuse.

During the second stage (the Do step), SIHF should implement improvement actions. Implementation will involve making changes to techniques, processes, personnel, and equipment. These changes will necessitate significant training for the people, who will undertake the changed activities. During the check stage, the improvement team will be using measures and patients input to determine whether change was implemented as planned, whether it achieved the desired results, and whether corrective actions are required. During the act stage, the improvemennt team should assess whether the set goals were achieved. In case it has achieved these goals, it should document and standardize the process. If not, the process should be redesigned to meet the objective by going through the PDCA cycle once again.

Adult Medicine

SIHF adult medicine branch focuses on medicine only for men and women who are 18 years and older. Most of the doctors focus on internal medicine, which deals with prevention, detection, as well as treatment of non-surgical diseases in adults. The PDCA cycle can also be used to improve the quality of adult medicine healthcare services in SIHF, as well as ensure continuous quality improvement. During the plan stage, SIHF should measure the problem, identify the root causes, and plan for improvement. For instance, SIHF may recognize that the rate of coronary diseases arising from obesity is increasing; therefore, it will have to measure the problem, identify its root causes and plan for improvement. SIHF should assemble an improvement team to investigate the situation and comprehend the problems by using process analysis methods. The team should then identify alternatives for improvement, after which action is planned. For instance, the team can select specific improvements, such as establishing education programmes for the community and using vans to promote healthy diets and implications of unhealthy diets.

In the Do step, SIHF should implement the improvement actions. Implementation should involve making changes to techniques, processes, personnel, and equipment. In the CHECK process, the improvement team should determine whether change was implemented as planned, whether it achieved the desired results, and whether corrective actions are required. In the Act stage, the improvement team should assess whether the set goals were achieved as set forth. In case it has achieved these goals, it should document and standardize the process. If not, the process should be redesigned to meet the objective by going through the PDCA cycle once again.

Dental Services

SIHF offers dental services at five of its health facilities in Southern Illinois. In the plan stage, SIHF has to identify the patients’ problems and their needs in terms of dental services. During the planning stage, SIHF should measure the problem, identify the root causes, and lastly plan for improvements. For instance, the team might realize the need to enhance dental surgery for patients’ comfort and convenience. The team can analyze the health care processes and identify improvement actions. To identify these problems, SIHF can opt for dental laser surgery, which causes less discomfort, shorter and fewer appointments and easier recovery. The second stage will entail implementing improvement interventions and programs. The third stage will entail determining the effectiveness of the results. The team should set up a database for monitoring relevant indicators. The fourth or last phase is the ACT phase, which entails standardizing or holding the gains/outcomes and improving assessment. In case the plan has achieved the set goals, it should document and standardize the process. If not, the process should be redesigned to meet the objective by going through the PDCA cycle once again.

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Behavioral Health

The behavioral health services include mental therapy, mental health, and psychiatry. SIHF professionals should specialize in treating behavioral disorders of the human brain. In the plan stage, SIHF should measure the problem, identify the root causes, and plan for improvement. For instance, SIHF may recognize that the behavioral health services are not satisfactory, especially with the increasing number of problems. Therefore, SIHF can use the PDCA cycle to address these problems. In the plan stage, SIHF should measure the problem, identify its root causes, and plan for improvement. In the plan phase, evaluation of present practices and action planning take place. In this case, SIHF stakeholders would determine how well SIHF is dealing with the problem. At this point, SIHF can assemble an improvement team to investigate the situation and identify the underlying issue causing the inadequacy in treatment. The team would then identify alternatives for improvement, after which action is planned. For instance, the team can select specific improvements, such as hiring a new staff or improving the medical equipment.

In the second step (Do step), SIHF should implement the improvement actions. Implementation would involve making changes to techniques, processes, personnel, and equipment. The check step comes next and requires the improvement team to use measures and patient input to determine whether change was implemented as planned, whether it has achieved desired results, and whether corrective actions are required. In case the process has not achieved its objectives, the team should redesign the process to meet the objective by going through the PDCA cycle once again.

Pharmacy Outreach

The objective of the pharmacy outreach is to assist patients to manage diabetes in an effective way through access to special modified counsel, regiments, and disease education. Patients who are part of this program have the chance to look for professional counseling on safe and effective use of recommended medicines. In the plan stage, SIHF has to identify problems with the outreach program. During the planning stage, SIHF should measure the problem, identify the root causes, and plan for improvement. For instance, the team might realize that there is a need to stop the increasing number of diabetes cases. The team can identify improvement actions. The second stage will entail implementing improvement interventions and programs. The third stage will involve determining the effectiveness of the results. The team should set up a database for monitoring relevant indicators. The fourth or last phase is the ACT phase, which entails standardizing or holding the gains/outcomes and improving assessment. In case the plan has achieved the set goals, it should document and standardize the process. If not, the process should be redesigned to meet the objective by going through the PDCA cycle once again.

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