Dr. William Jones has been the director of the health center clinic at East-Southern Kentucky Community College (ESKCC) for about six months. Having been a part of a much larger medical center in the past, he has seen the benefits of total quality management (TQM) and feels that it would help improve the operations at the ESKCC clinic. He has made some positive changes to the staffing of the clinic, but now feels that he must tackle making improvements to its operations. Consequently, he has created a TQM team (of which you are a part) and has made certain that they have received the necessary training to start examining the various processes within the health center's operations.

The ambulatory health service department of the ESKCC health center clinic has received increased complaints from the ESKCC student body and staff concerning the services it offers in its walk-in urgent care clinic. Dr. Jones feels that this center would be an excellent starting point for the TQM team.

The Data

The team is presented with the following data regarding student/staff complaints:

Patient Complaint Data

Month	Complaint Type 1	Complaint Type 2	Complaint Type 3	Complaint Type 4	Complaint Type 5	Complaint Type 6	Total Visits
September	31	41	17	48	13	115	841
October	21	27	8	41	11	52	971
November	11	48	11	24	28	31	1175
December	71	44	12	17	38	12	1042
January	15	30	12	14	17	41	671
February	21	62	6	12	8	51	1631
March	27	95	16	23	6	4	1512
April	47	34	3	13	15	3	781
May	4	21	2	17	18	2	473
Total	248	402	87	209	154	311	9097

Complaint Type Descriptions

Complaint Type	Complaint Description
1	The quality of service received.
2	Waiting time was too long.
3	Follow-up care was not available.
4	Clinic was hard to find in the health center.
5	The medical care/treatment took too long.
6	The medical center could not find the individual's medical records.

The Patient Review Process

The process for a patient (either a student or a staff member) coming in because of a problem is as follows:

1. When a patient arrives at the clinic, the patient first sees the receptionist, who checks to see if the patient was seen before. If so, the receptionist pulls the medical record from the file. If the patient is new, the receptionist has the patient complete the necessary forms and creates a medical record.
2. Patients are seen by the physician in the order they arrive. If one of the two examination rooms is empty, the nurse escorts the patient to the examination room and records the patient's medical complaint. If no examination rooms are available, the nurse escorts the patient to a waiting area until an examination room is available.
3. When the patient is in the examination room, the nurse performs routine tests. The nurse then writes the complaint and findings on a medical examination form, a form that will be subsequently filed with the patient's medical record.
4. The physician examines the patient and orders medical tests, if necessary. A diagnosis and treatment plan is presented to the patient by the physician; a written copy of this plan and any other appropriate instructions are written on the medical examination form.
5. When the physician releases the patient, the patient returns to the receptionist, who prepares a bill. If the patient has health insurance, the bill is sent to the health insurance carrier.
6. The patient leaves after either paying the bill (by cash, check, or credit card) or signing the forms to authorize payment by his or her health insurance company. If the health insurance company refuses to pay or partially pays the bill, the receptionist bills the patient by mail. Any patient with an unpaid bill or bad credit history is refused subsequent treatment until the old bill is paid.

Instructions

As a member of the ESKCC TQM team, you are asked to put together a report that recommends improvements to the overall patient process. Create a 46 page report in a Word document (copy and paste any charts created in Excel) addressing the following tasks:

Question

1. Illustrate the causes for Complaint #2 in a fishbone diagram. (Note: refer to the readings for examples.)