DRAFT: This module has unpublished changes.

MHA@GW Module 6

Quality and Performance Improvement

Module 6 Key Competencies


Change and Innovation


    • Planning and implementing change
    • Skills in strategic planning
    • Uses appropriate techniques that will shape the future of the health care management organization through change and innovation.

Decision Making


    • Solving business problems
    • Posesses the ability to utilize decision making processes that leads to the selection of the most optimal course of action from a group of alternatives

Project Management 


    • Planning and managing projects
    • Posesses the ability to utilize decision making processes that leads to the selection of the most optimal course of action from a group of alternatives

Quality Management 


    • Quality improvement within health services organizations
    • Performance improvement within health services organizations
    • Exhibits opportunities for constant improvement and ongoing assessment of patient care, customer feedback, risk management, provider qualifications

Quantitative Analysis 


    • Application of statistical process control methods to conduct quantitative analysis
    • Demonstrates the ability to effectively use quantitative tools and methods to collect, organize, arrange, analyze, interpret and evaluate date for decision-making 


My Development



          I have been looking forward to the content of this module for some time now. The topics of quality and performance improvement are ubiquitous throughout the health care landscape. As a result, from my perspective as a physician assistant (PA) on the front-line of delivering patient care services, it has appeared to me that the nomenclature associated with quality and performance improvement was filled with terms that appeared to be used interchangeably. The structure of the course brought clarity upon many of the distinct theories and tools used to intentionally structure change that will result in an improvement. In reflecting upon this course, I have realized some key takeaways, recognized an application in my current role, and enhanced my skill as a healthcare leader.


          My first key takeaway was understanding the improvement philosophy contributed by Dr. W. Edwards Deming. His theory of profound knowledge contains the following four elements: appreciation for a system, knowledge about variation, theory of knowledge, and psychology (Deming, 2000). I found the knowledge about variation to be very insightful. Particularly, the understanding of the differences between common cause and special cause variation has provided me with a deeper insight into the strategies that should be utilized to address the root causes contributing to each category of variation.


          A second key takeaway was the understanding of the importance of integrating statistical process control (SPC) into improvement efforts. The collection and evaluation of data associated with a process is essential to identifying opportunities for improvement (Longest & Darr, 2014). The importance of data to the improvement process was emphasized with coursework that involved using a dataset to create a run chart and to create a control chart in order to determine if a process was within statistical control. For me, I was able to use the cycle time data for postoperative patient encounters from my own clinic to enhance my learning.


          A third takeaway was the understanding that even processes under statistical control representing only common cause variation can be improved (Joiner, 1994). In this case, the strategies for improvement are directed toward achieving further reduction in variation which, in turn, will narrow the upper control limit and lower control limit about the statistical mean. This was also applicable to the analysis of the control chart for the cycle time data used from my own clinic. This understanding guided my development to use Plan, Do, Study, Act (PDSA) to test an intervention to reduce cycle time variation for patient encounters by cross training clinic nurses to perform EKG tests and draw bloodwork thereby improving throughput efficiency.   


          The coursework within this module has also made me recognize a potential application in my current role. My aim would be to improve the efficiency of communication between the members of our office administrative assistant team and the members of our advanced practice provider (APP) team with the creation of an In-basket pool within my organization’s electronic health record (EHR) system. Currently, my organization’s EHR electronic messaging system is used by the administrative assistants in a manner that is similar to the way that e-mail is used. For each message regarding a patient care need, the sender enters the name for each individual member of the APP team to receive the message. This current method creates inefficiency for the administrative assistant creating the In-basket message, and it also creates inefficiency for the APP team as more then one team member could be simultaneously addressing the same patient care need identified by the In-basket message. The improvement would be to create an In-basket messaging pool that would include all members of the APP team. The administrative assistant would then send the electronic message to the In-basket pool. The APP team members would not only be able to view the message, but each member of the APP team would be able to electronically take ownership of a specific message by selecting the message. Once the message has been selected, this would electronically indicate to the other members of the APP team that the message is currently being addressed. This would eliminate redundant work effort as APP team members would be able to clearly identify the patient related messages remaining in que to be addressed. I plan to start a conversation with our teams to explore the possibility of developing a PDSA around this need to improve the efficient use of our In-basket messaging feature within our EHR.


          My skill as a leader in healthcare has been enhanced through the knowledge that I have gained by studying and learning the content of this course. In healthcare there is no shortage of individuals with recommendations to make various changes. This course has moved me from being one more voice that is calling for a change to becoming an improvement practitioner. I am now equipped with the knowledge to distil calls for change into interventions that can be tested for evidence of improvement. Specifically, the questions posed by the Model for Improvement will give me the guidance to discern what is trying to be accomplished; to discern when a change is an improvement; and to discern the change that can be made that will result in an improvement (Langley, et al., 2009). I now understand the process of moving through the PDSA cycle. In addition, I also now understand that not detecting an improvement when using the PDSA cycle to test an intervention does not represent a failure to be used to support a decision that improvement efforts should be abandoned. The correct course of action in response to not detecting improvement would be to proceed to re-enter the PDSA cycle after re-tooling the intervention in much the same way that a scientist would revise the hypothesis after evaluating the results of an experiment before proceeding to conduct the next experiment.


          In closing, the quality and performance content of this module has moved me from being one more voice calling for a change within my own organization to be an improvement practitioner equipped with the knowledge and tools to work in collaboration with others to lead initiatives that can successful identify, implement, and spread improvement throughout a health services organization.    




Deming, W. E. (2000). The New Economics for Industry, Government, Education. 2nd ed. Cambridge, Massachusetts, United States of America: The MIT Press.


Joiner, B. L. (1994). Fourth Generation Management The New Business Consciousness. (J. H. Bessent, Jr., Ed.) United States of America: McGraw-Hill, Inc.


Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. (S. Edition, Ed.) San Francisco: Jossey-Bass (Wiley).



DRAFT: This module has unpublished changes.