Reply from Cynthia Robinson

I work in primary care. The facility is a federally qualified health center (FQHC) which is in the heart of a rural community that provides access to healthcare. The healthcare center was in a persistent battle to improve healthcare services to deliver a high quality of life to the community. The QI team uses innovative models and frameworks to assist in QI.


The healthcare team noticed noncompliance and follow-up appointment rates were at an all-time low last year. The trending downhill slope placed the facility in a financial bind. The facility relies on grants for operation; therefore, an immediate change was needed. The quality team developed a patient satisfaction survey. The questionnaire scores healthcare professionalism, cleanliness, safety, healthcare services delivered, satisfaction, the opportunity to ask questions, and wait time. The survey also allows the patient to provide feedback on how the facility can improve and inform of any concerns. The survey permits the patient to give positive feedback. Giving positive feedback is used to motivate and praise staff for their hard work.

Methodologies Used

One reason projects fail is because faculty is resentful of adjusting to change. The company searched for a framework that would fit the organization’s resilience. Kaizen is an up-to-date framework currently used to improve patient satisfaction. Kaizen originated within the Japanese business. Kai means change and zen means for the good. Kaizen aims to make continuous improvements in a feasible time frame. This method allows the company to make small improvements. The Kaizen method has allowed the company to involve everyone’s contribution in small increments (Sichinsambwe, 2023). It is proven that people adjust to change when change is introduced slowly. The framework consists of setting goals to improve patient satisfaction rates, reviewing the current state, developing an improvement plan, implementing improvement, and fixing what does not work. The perfect example of the framework is the tortoise versus the rabbit’s story. The rabbit led the race, but the tortoise won the race. 

Lean management is another method currently used to improve the survey scorecard. The lean management framework allows the employees to have a voice in new and old procedure methods. Resources are presented to staff by reviewing their scorecards and informing them on areas of improvement needed (Morduchowicz et al, 2020).  The management team supported employees and created an award program so that employees were motivated to implement the new plan. The QI team has meetings with the staff to examine employees’ mindset toward the new change.

Pre/Post metrics

Before incorporating the patient satisfaction survey, there was a 25% decline in patient compliance with medication therapy and follow-up care. As an FQHC facility, the organization did not meet the required measures for quality improvement which placed it at risk of severe financial repercussions. This called for immediate action.

After implementing changes according to the patient satisfaction survey, follow-up care increased by 15% in 90 days. The organization was able to increase the quality of care by decreasing BP and A1C through close monitoring of follow-up visits. 

Three types of Quality tools

The fishbone is a great tool to examine the cause and effect of poor patient satisfaction surveys. This framework could view variables that lowered patient satisfaction such as personnel attitude, patient care provided, and inefficient care. This allows QI to sort out possible changes. The QI risk manager can gather surveys and inform the group of areas that need improvement. The flow chart can be used to organize the plan and communicate the process plan to the team. The team can visualize the process and its clarity. The project planning and implementation tool allows the team to examine the current patient care (Shah, 2019). Using the patient survey poll, the team can identify weaknesses in current practice and identify potential solutions to promote positive views from the patient. The team can develop an improvement plan, test the plan, and place the plan into standard of care.

Compare and contrast statistics

Descriptive statistics explain the data. For example, descriptive statistics can calculate the proportion of middle-aged adults and geriatric population in the patient satisfaction survey. Enumerative statistics focus on the judgment of results. Enumerative statistics are consistent with the probability of results without supportive data. For example, an obese woman will be diagnosed with diabetes because she is overweight. Analytic statistics aim to measure risk factors for improvement (Nash, 2019). This method can improve quality and process by using collected data to implement a new process plan to improve productivity. For example, analytic statistics can use credible data from patient surveys to identify issues, organize a feasible plan with staff, test the plan, and implement it for continuous improvement.


American Society for Quality (ASQ). (2022). Quality toolsLinks to an external site..

David Nash. (2019). The Healthcare Quality Book: Vision, Strategy, and Tools, Fourth Edition: Vol. Fourth edition. AUPHA/HAP Book.

Md Nor, M. Z., Said, A. H., Che Man, M., & Yusof, M. Z. (2024). Patient’s satisfaction towards healthcare services and its associated factors at the highest patient loads government primary care clinic in Pahang. The Medical Journal of Malaysia79(1), 34–41.

Morduchowicz, S., Lee, J. S., Choi, L., Kivlahan, C., Null, D., Smith, S., & Feldman, M. D. (2020). Utilizing Lean Leadership Principles to Build an Academic Primary Care Practice of the Future. Journal of General Internal Medicine35(12), 3650–3655.

Shah, A. (2019). Using data for improvementLinks to an external site.British Medical Journal364, I189.

Sichinsambwe, C., Simasiku, P. L., Sikombe, S., & Nyimbili, H. (2023). Kaizen practices and performance improvement in Zambian manufacturing companies. Cogent Engineering10(1), 1–26.

Steere, L., Rousseau, M., & Durland, L. (2018). Lean Six Sigma for intravenous therapy optimization: A hospital use of lean thinking to improve occlusion management (PDF)Links to an external site.Journal of the Association for Vascular Access, 23(1), 42–50


7 pts


Provides two peer responses by day 6 of the discussion forum. Provides two peer posts on two different days. Demonstrates building on peer postings and extending the discussion. Questions posed are thoughtful and relevant. Includes substantial factually correct content which demonstrates evidence of comprehension, application, and/or appraisal. Includes evidence of self- reflective content which demonstrates views, beliefs, and/or feelings. Interaction demonstrates respect and sensitivity to others.


My original post:


Intensive care practice offers an opportunity to apply quality improvement methodologies in areas such as patient transfer from the Intensive Care Unit (ICU) to the Inpatient Unit (IU). This is due to the number of associated risks that present during the handoff of care between units, including lack of standardization, variability in the transfer process, compromised communication, and differences in care after transition. The Sigma Six methodology uses a DMAIC (Define, Measure, Analyze, Improve, and Control) approach to develop improved healthcare frameworks (Ahmed, 2019). The first step would be to identify patients who require transfer between units, analyze their specific requirements, and define the objectives and scope of improvement. Statistics will then determine what metrics will be used to evaluate improvement. This information will be used to define study objectives. This could be patient satisfaction, cost of service levels, or readmission to a higher level of care. An analysis would then be conducted to reveal issues in system processes or loopholes that may undermine patient care. Afterward, potential improvements are considered and implemented to mitigate challenges emerging in these stages of patient care. Finally, monitoring frameworks are implemented to ensure sustained improvement and report any outliers or problems that may arise.

Data is essential in analyzing systematic problems, defining problems, and inferring conclusions. Statistics like averages, ranges, and medians help to display data in ways that allow information to be organized (Ben‐Aharon et al., 2019). The average or mean represents the sum of total observations in a particular study divided by the number of total observations. At the same time, the range is the difference between the smallest and the most significant number in a set of observations. Conversely, the median can be described as the middle number given a set of observations. While all the statistics are computed in different ways, they are integral in identifying trends in certain areas and help summarize data ranging over long periods, easing the analysis process. They can also help analyze data points on a graph as they give a standard of comparison.

Tools such as an Excel control sheet, balance scorecard, and a quality plan would ensure success in improving the process of transferring patients from the ICU to the IU. Maintaining a balance scorecard would be essential to evaluate the multilevel performance of initiated changes (Raval et al., 2019). A quality plan would help to organize intervention mechanisms. An Excel control sheet would be vital in recording data at different intervention analysis points.


Ahmed, S. (2019). Integrating DMAIC approach of Lean Six Sigma and theory of constraints        toward quality improvement in healthcare. Reviews on Environmental Health34(4), 427-   434.

Ben‐Aharon, O., Magnezi, R., Leshno, M., & Goldstein, D. A. (2019). Median survival or mean        survival: which measure is the most appropriate for patients, physicians, and        policymakers? The Oncologist24(11), 1469-1478.   

Raval, S. J., Kant, R., & Shankar, R. (2019). Benchmarking the Lean Six Sigma performance          measures: a balanced score card approach. Benchmarking: An International   Journal26(6), 1921-1947.

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