Jackson Health System (JHS), a collection of care facilities residing all over the city of Miami, provides a wide variety of services. The hospital claims to deliver “world-class care” to anyone who comes through its doors, assisting patient requests ranging from emergencies to plastic surgery (“About Jackson Health System”, n.d.). This proposal aims to evaluate the challenges faced by the Jackson Health System and provide an informative, evidence-based improvement initiative to overcome them.
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As in many cases with other multi-component organizations, Jackson Health System experiences trouble with universalizing patient experience. Despite the efforts to provide “world-class care” and recruiting the best professionals in the field, Miami’s academic non-profit struggles to meet customer expectations in providing fast and well-coordinated care to its clients (“About Jackson Health System”, n.d.). This is likely to be happening because some of its facilities are often overbooked, and each patient receives fragmented attention. A more detailed look reveals that emergency care at the Jackson Memorial Hospital is at fault.
About 60% of reviews on a crowd-supported review forum Yelp.com awarded the hospital with just one star, most complaining about the quality of care and observance of little coordination internally. Clients often describe being sent to waiting rooms in the emergency care units and spending hours when in significant discomfort or severe pain awaiting their treatment (“Jackson Memorial Hospital”, n.d.). Analyzing different concerns leads to the conclusion that the hospital’s largest issue is the mismatch between the volume of patients and the number of staff available to treat them in emergency rooms. In such a critical setting, the delivery of required services is crucial not only for client safety but also to the reputation of the hospital. Conflicting messages coming from different divisions of JHS may negatively affect the perception of the hospital system, reducing the number of clients. Therefore, the issue of adverse emergency room experiences needs to be tackled immediately via a quality improvement initiative.
Before delving into the precise steps needed to resolve the situation of the Jackson Memorial Hospital, it is necessary to identify the best tactic based on existing research. For instance, scientists in Nizwa Hospital in Oman developed a Maternity Dashboard to advance the quality of delivered services by monitoring organizational performance (Patel, Rafi, Tashfeen, & Yarubi, 2019). Overall, Nizwa Hospital faced a problem similar to that of the emergency care unit in JMH: overbooked facilities and lack of trained staff to deliver services. The tool was designed to “compare the current performance against expected standards and ensure that the principles of clinical governance are safeguarded in daily clinical practice” (Patel et al., 2019, p. 195). Following a study by Draycott et al. (2008), the researchers hoped to use the Maternity Dashboard to “convince the Trust Board…to reduce the number of bookings” to ensure patient safety (as cited in Patel et al., 2019, p. 197). Although the dashboard faced challenges in implementation due to the lack of local and universal standards for quality indicators, the researchers did not lose hope and will continue to monitor the hospital performance.
Another study describes how investing in skilled personnel can improve hospital infrastructure and quality of care. Padula, Nagarajan, Davidson, & Pronovost (2019) examined 55 U.S. academic hospitals to evaluate how the organizations that hired specialized workers compared to those that did not succeed in terms of performance and expenditure. They found that higher numbers of qualified nurses in hospitals led to a “decreased in pressure injury rates by -17.7% relative to previous quarters” (Padula et al., 2019, p.1). Naturally, such outcomes lead to higher patient safety and lower labor costs in case of adverse situations. Therefore, the study identified that a quality improvement infrastructure adopted by hospitals that hired more specialized labor had a positive effect on client satisfaction and the organization’s balance sheet.
However, not all studies find correlations between quality improvement initiatives and clinical outcomes. Agarwal et al. (2019) held randomized trials to measure the effectiveness of procedures performed on patients hospitalized with heart failure. After 14 trials, no consistent effect has been found from implementing quality improvement interventions. Neither did the clinical outcome depend on the length of hospital stay or patient quality of life. Although this research indicates that conditions as critical as heart failure might not benefit from designed interventions, there is still a possibility that overall developments in hospital infrastructure can improve the quality of provided services.
After analyzing relevant literature, it is feasible to develop the initial plan for the Jackson Memorial Hospital. First and foremost, JMH management needs to identify the ratio of patients per member of staff for the emergency care unit (ER). Next, restrictions should be imposed on the volume of clients admitted to the ER, and partnerships need to be made with hospitals providing similar services in case of overbooking. Furthermore, JMH needs to hire a secretary that would be responsible for referring patient-occupied nurses to the right specialist to avoid wait times and ensure patient safety. These systems would follow the examples of Patel et al. (2019) and Padula et al. (2019), addressing client satisfaction in emergencies.
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There are several ways to assess the success of the initiative. One of them is asking patients to rate the quality of service immediately after its completion. As this practice is commonplace, there is a chance that a comparative dataset already exists. In this case, the post-initiative data can be compared to the old one to make appropriate conclusions. Alternatively, the above plan can be executed as a pilot program for a few months and put on pause for the same amount of time. Then, enough data would be acquired to test the same hypothesis and conclude whether it has been successful. In the language of statistics, the management will be evaluating the results of a two-sample t-test for the difference of the mean ratings as a control variable. The latter would be accounted for by a dummy indicating the presence of the program. Other variables can include the number of hours spent in the waiting area and the time of day, as both can affect the patient experience. To identify further factors and build a robust model, Jackson Memorial Hospital can survey the customers of the emergency care unit.
In conclusion, timely quality improvement initiatives can assist JHS in universalizing client experiences across all facilities to achieve higher customer satisfaction. The analysis of such attempts in scientific literature paints a largely successful picture, although the results of individual programs depend heavily on their design. Therefore, Jackson Memorial Hospital needs to act fast and approach change holistically, adopting several improvement measures to secure consistent patient flow and care delivery.
About Jackson Health System. (n.d.) Web.
Agarwal, A., Bahiru, E., Yoo, S. G. K., Berendsen, M. A., Harikrishnan, S., Hernandez, A. F., … Huffman, M. D. (2019). Hospital-based quality improvement interventions for patients with heart failure: A systematic review. Heart (British Cardiac Society), 105(6), 431–438.
Padula, W. V., Nagarajan, M., Davidson, P. M., & Pronovost, P. J. (2019). Investing in skilled specialists to grow hospital infrastructure for quality improvement. Journal of Patient Safety, 1-5.
Patel, M. S., Rathi, B., Tashfeen, K., & Yarubi, M. A. (2019). Development and implementation of maternity dashboard in regional hospital for quality improvement at ground level: A pilot study. Oman Medical Journal, 34(3), 194–199.