Case Study Background You have been brought in to manage a portfolio of several specialty clinics in a large multi-physician group practice in an academic medical center. The clinics reside in a multi-clinic facility that houses primary care and specialty practice as well as a satellite laboratory and radiology and pharmacy services. The practice provides the following centralized services for each of its clinics: registration, payer interface, and billing. The CEO of the practice has asked you to initially devote your attention to Clinic X to improve its efficiency and patient satisfaction. Access Process A primary care physician, patient or family member calls the receptionist at Clinic X for appointment. If the receptionist is in the middle of helping a patient in person, the caller is asked to hold. The receptionist then asks the caller, “How may I help you?” If the caller is requesting an appointment within the next month, the appointment date and time is made and given verbally to the caller. If the caller asks additional questions, the receptionist provides answers. The caller is then given the toll free pre-registration phone number and asked to preregister before the date of the scheduled appointment. If the requested appointment is beyond a 30 day period, the caller’s name and address are put in a “future file” because physician availability is given only one month in advance. Every month, the receptionist reviews the future file and schedules an appointment for each person on the list, and a confirmation is automatically mailed to the caller. When a patient preregisters, the financial office is automatically notified and performs the necessary insurance checks and authorizations for the appropriate insurance plan. If the patient does not preregister, when the patient arrives in the clinic on the day of the appointment and checks in with the specialty clinic receptionist, she is asked to first go to the central registration area to register. Any obvious problems with authorization are corrected before patient returns to the specialty clinic waiting room. Receptionist’s Point of View The receptionist has determined the best way to not inconvenience the caller is to keep her on the phone as short an amount of time as possible. The receptionist also expresses frustration with the fact that there are too many things to do at once. Physician’s Point of View The physician thinks too much of his time is spent on paperwork and chasing down authorizations. The physician senses that appointments are always running behind and that patients are frustrated, no matter how nice he is to them. Patient’s Point of View Patients are frustrated when asked to wait in a long line to register, which makes them late for their appointments, and when future appointments are scheduled without their input. As a result of this later factor, and work of childcare conflicts, patient often do not show up for these scheduled appointments. Office Nurse’s Point of View The office nurse feels that he is playing catch up all day long and explaining delays. The office nurse also wishes there was more time for teaching. Billing Office’s Point of View The billing office thinks some care is given that is not reimbursed because of inaccurate or incomplete insurance or demographic information or that care id denied authorization after the fact. Data On the Picker Institute website (pickerinstitute.org), you will find the following patient expectations and dimensions of care for adults and children in their outpatient experiences with a hospital or clinic outpatient appointment: Respect for patient s’ values, preferences, and expressed needsCoordination and integration of careInformation and educationPhysical comfortEmotional support and alleviation of fear and anxietyInvolvement of family and friendsTransition and continuityAccess to care Your last quarter’s worth of performance data for clinic is Overall satisfaction with visit 82% Staff courteous and helpful 90% Waiting room time 64% Examination room wait time is less than 15 minutes 63% Patient no-show rate 20% Patient cancellation rate 11% Provider cancellation rate 10% Preregistration rate 16% Average number of patient visits per day 16 Range of patient visits per day 10-23 Instructions – Decide which problem your group wants to focus on as your first priority. Describe the problem and why you chose this problemState the goal for this improvement effortIdentify the fundamental knowledge that is required on the team to solve this problem. Define the people you will invite to participate on the team and the fundamental knowledge they bring to the team.Document the current process (as is described in the case) using a process flow chart.Identify your customers and their expectations.Explore and prioritize root causes of the problem by doing the following:Brainstorm root causes and document the causes on a fish bone diagramDescribe how you would collect data about how frequently root causes contribute to the problem.From the points mentioned below select and explain the ones that apply to improving your process. Be sure to take into account what you have learned from your work in question 1-6Eliminate waste (e.g., things that are not used, unnecessary duplication)Improve workflow (e.g. minimize handoffs, move steps in the process closer together, find and remove bottlenecks, do tasks in parallel, adjust to high and low volumes)Manage time (reduce steps and waiting times)Manage variation (create standard work)Design systems to avoid mistakes (use reminders)Incorporating what you learned in above steps, improve the process and document the improved process with a process flow chart or work flow diagram.Decide what you will measure to monitor the voice of the process and briefly how you would collect the dataBriefly explain your change effort using PDCA cycle. Source Kelly, D.L. (2011). Applying Quality Management in HealthCare. AUPHA.

Create a 7 to 15-minute video in which you present strategies, programs, or policies related to improving outcomes for your chosen global health issue and reflect on the experience of advocating to a chosen audience.In this assessment, you will report on your experience developing strategies, programs, and policies toward improving outcomes related to your chosen global health issue. Part of the assessment will require you to present at a meeting of a relevant professional organization or at a meeting with a relevant government official. Be sure you budget the time to complete this aspect of the assessment.A variety of national and international documents guides policy development across the globe. In the United States, Healthy People 2020 provides goals and a vision for "a society in which all people live long, healthy lives" (HealthyPeople.gov, n.d., "Vision," para. 1). The United States also has a guiding document to inform health policy at the international level. In its global health initiative, the United States outlines health and human services priorities that guide the funding and program development for more than 80 countries (KFF, 2017). Finally, at the international level, the United Nations' MDGs guide the efforts of local governments and external funding sources to meet not only health needs but also social needs of developing countries (Merson, Black, & Mills, 2012). The SDGs will continue the work of the MDGs.Though consensus documents help to inform health policy, funding for programs is imperative if benefits are to be sustained over time. For this assessment, you will continue that discovery as you learn about the role global health initiatives have in supporting and formulating public policy in the health sector. Even if policy and funding are in place, health programs can fail if social and cultural concerns are not addressed.References HealthyPeople.gov. (n.d.). About Healthy People. Retrieved from https://www.healthypeople.gov/2020/About-Healthy-PeopleKFF. (2017). The U.S. government and global health. Retrieved from http://kff.org/global-health-policy/fact-sheet/the-u-s-global-health-initiative/Merson, M. H., Black, R. E., & Mills, A. J. (2012). Global health: Diseases, programs, systems, and policies (3rd ed.). Burlington, MA: Jones & Bartlett Learning.Assessment Summary Global population health is everyone’s concern, and nursing leadership has a role in increasing knowledge and supporting the use of available resources to the fullest. Members of the nursing profession have a responsibility to advocate for others in need of care. This can be accomplished in many ways.Membership in professional organizations such as the Association of Nurse Practitioners (ANP), the American Nurses Association (ANA), or the National Association of School Nurses (NASN) provides an opportunity for networking, as well as advocacy. In these interactions, you can share knowledge and learn about other populations and how to influence policy with a focus on disease management and health prevention and promotion. Opportunities to develop strategies for improvement within a strong political group will provide strength for change.Learning about the needs of countries that have been devastated by natural disasters and further compromised by disease prompts one to take action. In many cases, preexisting barriers must be addressed before resources can even be effective. Focusing on your previously identified country, plan strategies that you feel would address the key issues by priority. Perhaps use the resources available or plan for future changes to alleviate and modify these issues.In this assessment, you have a choice between Exercise A or B. Please read each one carefully before making your choice.Exercise A. You are requested to attend a meeting of one of the professional organizations within your community. Each organization usually has chapters that should be active within designated regions. At this meeting, present your developed strategies and allow time to answer questions and provide additional information as feedback by the group. If action items are being considered, a committee may be formed and further work groups developed. A summary of this meeting needs to be written up and future plans discussed.Exercise B. Contact the office of your state senator or Congressional representative and schedule an appointment. These politicians have local offices within your voting district where you should be able to visit with them. At your meeting, the agenda should include your concerns about global population health and progress that is being made through policy decisions. To prepare yourself for this meeting, review what Congress has been working on to improve the health of global populations. As a nurse leader, be prepared to discuss how to influence change through the strategies you have prepared.& A summary of this meeting needs to be written up and future plans discussed. Remember, as nurses, we are involved in lobby days, during which groups of nurses go to the capitol and demonstrate advocacy as change agents. Nurses can affect the future.Preparation Check that your recording equipment and software are working properly and that you know how to record and upload your video. If using Kaltura, refer to Using Kaltura [PDF] for directions on recording and uploading your video in the courseroom.Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@Capella.edu to request accommodations. If you are unable to record a video, please contact your instructor as soon as possible to explore options for completing the assessment.Assessment Instructions Complete this assessment only after you have had your meeting or presentation based on whether you chose Exercise A or B above.After selecting your exercise, make sure you have prepared your strategic plan, policy proposal, and any presentation or speaking notes you will need for your meeting of choice. You should leverage the work you have done in the previous assessments related to your chosen global health issue. The research, interviews, data collection, writing, and project proposal or educational resource that you have already completed should help to inform and support your preparation for your presentation or meeting. Remember, the goal of your meeting or presentation is to advocate for specific actions to help improve the current and future outcomes of your chosen global health issue.You will make a video in which you discuss, present, and reflect on your experiences related to your topic, the meeting or presentation, and any outcomes achieved.One possible way to organize your video is as follows:Introduction and Background (2–4 minutes)Provide a brief overview of which option you chose, why you chose that option, and some details about your preparations for your presentation or meeting. Explain the rationale and preparation to present strategies and potential policies related to a global health issue to a relevant audience. Which option did you choose? Why did you pursue this option? How did you prepare for the presentation or meeting? How did you work to ensure that your strategies or policies were culturally sensitive? What resources did you use to develop your presentation or speaking points? What research about your audience did you perform? How did you tailor your message to your audience? How was your global health issue relevant to the audience you chose? What were your goals for the presentation or meeting? Condensed Presentation (3–5 minutes)Provide a condensed version of your presentation. Focus on the key information and vital points from the longer presentation or meeting that you already had. The key is to make the information succinct, accessible, and compelling. Show you believe in and have passion for your cause. Be genuine. Your audience will know if you are faking enthusiasm. Advocate for sustainable resources and policy development to improve outcomes related to a chosen global health issue. What is the issue? What are your goals? What are you asking the audience to do or contribute? Why is the issue important (to the audience and the global community as a whole)? Why is your plan or policy an appropriate approach to drive improved outcomes? Explain how investment in sustainable resources and policy development align with the mission or goals of a nongovernmental organization or government program. How will working on your chosen issue benefit the audience? How does your proposal align with the mission or goals of the audience? Reflection, Summary, and Outcomes(2–4 minutes)In this final section, reflect on your experience of presenting or leading a meeting related to your chosen global health issue and summarize any takeaways or outcomes that you have from the presentation or meeting. Reflect on the experience of presenting and advocating for sustainable resources and policy development to improve outcomes related to a chosen global health issue. How did the presentation or meeting go? What went well? What would you change if you had to give it again? How did it feel to be advocating for your plan or policy? Summarize key takeaways and outcomes of your presentation to a relevant audience. What were your most important takeaways from the experiences? What, if any, outcomes have resulted or seem plausible at this time?