Provide a thorough summary of the case study

TEAM QUALITY CASE STUDY DISCHARGE PHONE CALLS OBJECTIVES I 1.' . EValuate the impact of cultural competency on patient satisfaction'scores. 2 - Explain how to track patient experience measures in order to set organizational priorities. ' ' 3. Distinguish common cause variation from special cause variation for quality measures. - ' ' - 4. Identify causal associations within- healthcare quality management problems. I . ' INTRODUCTION St. John's River Community Hospital (SIRCH) is a 253-bed acute-care hospital serving the St. John's River Valley area for over 40 years. SIRCH started as a ISO-bed hospital, and it grew along with the community for the better part of four decades. The St. John's River Valley area is home to a large Hispanic community, composing about 42% of the total population. Katrina \"Kat\" Vasilova is Director of Patient Experience and Service Excellence for SIRCH. Her job is to champion the organization's culture to assure the highest level of experience for patients and their families. Kat analyzes results of patient experience survey data and collab- orates with senior leadership and department managers to develop and implement improve- ment strategies. Her position requires extensive knowledge of quality management tools and approaches, such as Lean and/0r Six Sigma. CASE SCENARIO \"St. John's River Community Hospital, how may I direct your call?\" \"Oiga, gusted me podria explicar por qu me siguen llegando esas llamadas automaticas en ingls?\" was the very agitated response on the other side of the line. \"I'm sorry, Miss, I do not understand what you are saying; is there somewhere you would like me to transfer your call to?\" replied the dumbfounded call center representative. "Sorri, si, isorri! Me too sorri, porque ya van dos meses desde que yo estuve en su hospital y me siguen llamando en ingles para folou-op o que se yo ni que. jY los he llamado varias veces y nunca nadie me puede explicar como puedo hacer para parar estas llamadas!" con- tinued the patient in her broken-English-and-Spanish conversation. "Miss, please, let me try to find someone who can help me understand. Is it Spanish... uh, espanol, that I'm hearing?" replied the representative, trying to be as helpful as she could. iSi, espanol, si! ; Gracias a Dios, por fin alguien entiende espanol!" replied the patient. OK, let me put you on hold while I try to find someone; give me a minute, OK?" answered the representative and immediately placed the patient on hold. "Mire, por favor, digale a..." the patient stopped abruptly when she heard the hold music and message. ";Hola! Esta todavia ahi? ;Ay, por favor!" she said while hanging up the phone, feeling defeated. Elsewhere in a meeting room at SJRCH ... "Kat, we are still not where we should be on patient experience scores." said Sylvia Sosa, COO of SJRCH, during January's staff meeting. Sylvia showed the following chart to demon- strate the patient experience average monthly score. The chart showed the Overall Rating of Hospital score according to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey (Figure C1 1.1). The HCAHPS survey allows hospitals to measure patients' perceptions of their hospital experience and to compare different facilities and orga- nizations with one standard instrument. "You are correct, Sylvia. Much to our dismay, we are still struggling to come back to the level we were at 8 months ago," answered Kat. She then looked around the table at her col- leagues and continued, "When you look at this chart, it seems pretty evident that the average has shifted. This usually means that a process change has caused the ratings to fall. What I mean by that is that when a process is stable and standardized, you expect the data to fluctu- ate within certain parameters, but when you see a big shift, such as what we see here, it is a sign that we need to stop and look at the process. It appears something has changed. There- fore, I had one of the analysts on my team run some quick analyses. We are almost ready to SJRCH PATIENT EXPERIENCE (HCAHPS OVERALL RATING) RUN CHART 95% 90% 85% 80% 75% 70% $ 3 9 8 8 8 8 2017 2018 Pt Exp FIGURE C11.1 St. John's River Community Hospital (SJRCH) patient experience score.give you a full debrief. It will take more than the few minutes we have now, so I will set up time for us to discuss this next week.\" \"Great! I look forward to it,\" replied Sosa. On her way out of the meeting, Sosa went by the information desk. \"We just had another one of those Spanish calls, Ms. Sosa,\" the representative said, handing her a sticky note. \"But, by the time Iwas able to get someone to translate, the person hung up. I feel terrible!\" \"Another one? ,'Ay, Dias mic! Cmo puede ser esto?\" complained Sosa. \"OK. Thank you for keeping track of this and letting me know.\" Sosa wondered why these calls from Spanishspeaking patients kept coming in and felt concerned that call center staff did not know what they needed. \"This is unacceptable!\" Sosa thought as she walked back to her ofce. \"Here I am, a Spanish-speaking executive, leading an organization in a community with a large Hispanic population, with a call center that is not equipped to handle calls from Spanish-speaking patients! How outof-touch are we? Oh, my God! Have I allowed myself to desensitize myself to the needs of the population, my people? This needs to change!\" The following week, Vasilova and her analyst, Romeo Fernandez, sat down with Sosa to go over their ndings. \"Sylvia, I will let Romeo run us through his analysis and feel free to stop him at any point if you need to ask any questions, and I will do the same,\" announced Vasilova. \"OK, Romeo, take it away!\" \"Thank you very much, Kat,\" replied Romeo. \"Ms. Sosa, when Kat and I started talking about this a few weeks ago, we noticed that the run chart, shown in Figure C11.1 here, de- nitively shows that the mean of the process shifted. To further illustrate this, I ran some statistics and created the Control Chart for the process and you can see that here,\" he said as he showed a chart on the screen (Figure C112). \"This Control Chart shows the average patient experience scores. If the metric were operating under common cause variation, we would expect that the variation in the scores would stay between the upper control limit (or UCL) and the lower control limit (or LCL) 3' \"What this shows us,\" Romeo continued, \"is that something happened around April or May that caused this process to become out of control,\" he said as he stood up and pointed SJRCH PATIENT EXPERIENCE (HCAHPS OVERALL RATING) CONTROL CHART 95% 90% UCL 85% WW v, 30% Average \"AT-"K 75% 70% '- >5 2 _ D) D. \"" > O :5 2 E 3, 1 2 s 8 2 3 2017 2018 ww- Pt Exp UCL - LCL Average FIGURE C11.2 SJRCH patient experience score control chart. LCL, lower control limit; UCL. upper control limit; SJRGH, St. John '5 River Community Hospital. at that area on the chart. \"These results show some sort of special cause variation caused by some sort of unexpected part of the process.\" Sosa turned to look at Kat and was surprised to see a hint of a grin on Katrina's face. \"Why are you smiling?\" asked Sosa- \"Do you remember what happened in April?\" asked Vasilova, looking intently at Sosa. \"Gosh, Kat, a lot of things happened in April, could you be more specic?\" replied Sosa playing along. \"Sorry,\" replied Vasilova still smiling. \"Do you remember What new process we started in April to follow up with patients after they get discharged from the hospital?\" \"I got it!\" replied Sosa with the excitement of someone who has solved a mystery. \"Postdischarge phone calls!\" \"Not just phone calls. . .\" added Vasilova. \"Automated calls!\" they both said in unison. \"Ding! Ding! Ding! The robocalls,\" said Romeo as he advanced his slide to show one still with the Control Chart, adding pointers to when the automated calls started and when the process moved out of control (Figure (311.3)- \"Are you saying the robacalls are to blame for our slipping patient experience scores?\" asked Sosa incredulously. \"I am going to need more detail here. Why do you think that? I mean, other than the data you are showing me.\" \"Well, I was just as puzzled as you are right now,\" answered Vasilova sounding honest. \"Then, I had Romeo take a deeper dive into our patient experience data. He sliced it six ways from Sunday and found some very interesting stuff. Romeo, do you want to share with Sylvia the rest of your analysis?\" \"Certainly!\" replied Romeo hardly able to contain himself. He proceeded to share several looks at patient experience (gender, age, language, zip code), and when he nished, Sylvia SJRGH PATIENT EXPERIENCE (HCAHPS OVERALL RATING) CONTROL CHART 95% 90% UCL __._____________,,____._._____--- Robocalls started in Apr 85% ._. i: 2 x_' '_x E :1st point out of control 80% 75% 70% 201 8 - Pt Exp -- UCL -- LCL Average FIGURE C1 1.3 St. John's River Community Hospital Patient Experience Control Chart show- ing when automated calls started and when the process moved out of control. LCL. lower control limit; UCL, upper control limit. Sosa's eyes were opened wide and her jaw dropped to the oor. She looked back at Vasilova, who, at this point was grinning from ear to ear (see Case 11 Data le provided in the Instruc- tor's and Student ancillary materials). \"Data are power, isn't it?\" Vasilova asked rhetorically. \"Oh, my gosh, guys! The mysterious Spanish calls!!!\" screamed Sosa, not able to hold back. Now, the puzzled faces were those of Vasilova and Romeo. \"Wait, what?\" asked Vasilova. \"What Spanish calls are you talking about?\" \"I think you guys just solved two problems in one,\" replied Sosa. \"I feel like hugging you guys! DISCUSSION QUESTIONS 1. 2. 3. ' 7 patient experience scores. Which of the many views of the data that Romeo provided shows the most promise to help answer the question of why the patient experience scores have slipped? .What do you think of Kat Vasilova's approach to data analysis?- Discuss the connection Sylvia Sosa found between the mysterious Spanish calls and the There is a difference between correlation and causation, as represented by Sylvia Sosa's * incredulity that the automated calls were to blame. Discuss how data analysis helps us move beyond correlation and into causation. Dis cuss how the degree of cultural competency of an; organization can affect patients'- satisfaction