Case Study: Total Quality Management: The Patient Process at East-Southern Kentucky Community College Medical Clinic 
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 DataMonthComplaint Type 1Complaint Type 2Complaint Type 3Complaint Type 4Complaint Type 5Complaint Type 6Total VisitsSeptember3141174813115841October21278411152971November1148112428311175December7144121738121042January153012141741671February21626128511631March27951623641512April4734313153781May421217182473Total248402872091543119097 Complaint Type DescriptionsComplaint TypeComplaint Description1The quality of service received.2Waiting time was too long.3Follow-up care was not available.4Clinic was hard to find in the health center.5The medical care/treatment took too long.6The 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:

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.  
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.
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.  
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.
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.  
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:  

Construct a Pareto Chart for the data regarding complaints to the health center that is presented in Table 1.  Describe two conclusions from examining this data.
Develop a control chart for the waiting time complaint (complaint #2). Explain how the control chart is developed and show the calculation process.
Illustrate the causes for Complaint #2 in a fishbone diagram. (Note: refer to the readings for examples.)
Develop a flow chart for the process that the clinic uses for a patient who comes into the ambulatory center. Draw two conclusions from examining the flow chart regarding either or both of the following: 

How the process affects the patient.
Potential sources of unnecessary complexity.

Determine three improvements to streamline the patient process based on the insights that you gain from examining the process flow chart as well as your understanding of total quality management concepts from your course readings. 

Propose improvements to a health services organization based on total quality management (TQM) concepts.