Thesis (M.A.) / Boston Medical Center’s pediatric outpatient clinic has resident clinic flow problems that negatively affect its patient care level. Due to system backup, in August 2012, resident patients spent an average of 71 minutes in the clinic for a scheduled 20-minute appointment. This study used quality improvement methodology (QI) to investigate potential solutions to the clinic flow problems. Our aim was, by May 2013 decrease the average patient time-in-clinic for resident vaccination patients between 2 and 30 months of age by 20%. Using Plan-Do-Study-Act (PDSA) cycles within QI, the research team implemented three interventions between August 2012 and May 2013 that focused on improving communication between members of the clinic medical team. Throughout the year, the research team measured the time-in-clinic for the patient population, plotted the data with run charts, and determined if the interventions resulted in a corresponding decrease in time. By May 2013, the interventions resulted in an average decrease in time across all resident classes. First years showed a 4.5% decrease. Second years showed a 5.7% decrease. Third years showed a 20% decrease. While these decreases are significant, due to time limitations, we could not determine if the interventions resulted in a lasting improvement to clinic flow. / 2031-01-01

In 2007 nonprofits became eligible to apply for the Malcolm Baldrige National Quality Award (MBNQA) and the state-level Baldrige-based Texas Award for Performance Excellence (TAPE). There exists minimal research on quality management frameworks to guide performance excellence in nonprofits and there is a lack of understanding regarding the applicability and utility of the MBNQA and TAPE Criteria as a framework for performance excellence for nonprofit organizations. This study looks at how one nonprofit organization deployed the TAPE Criteria framework across the organization and the extent to which organizational learning resulted and was integrated across the organization. The qualitative case study utilized naturalistic inquiry methodology to chronicle situational themes and relationships that emerged during the organization's year-long process of preparing an application for the TAPE. The study took place in a natural setting and the researcher was immersed in the organization's experience as a participant-observer assisting with developing the application. Data collection methods included direct observation, interviews, and document analysis. The case study approach provided a context and perspective for other nonprofit entities seeking to assess and improve performance. The TAPE Criteria framework is a systematic and structured approach to improving performance excellence and its methodologies are repeatable and based on facts and data. Leaders recognized the value of assessing the organization's current condition in a holistic manner, yet they distinguished and used only those parts of the Criteria that they found meaningful and effective. Leadership viewed the TAPE Criteria in light of how it could support its mission success, rather than supplanting management practices that had historically achieved organizational goals that met or exceeded customer needs and expectations. The results of the study are relevant and may assist nonprofit executives and administrators in applying and utilizing Baldrige-based improvement methodologies. The information gleaned from the study will help administrators of the TAPE to improve the usefulness and functionality of the framework across all business arenas. TAPE administrators should benefit from the research as it provides information on how individuals experienced and learned the taxonomy of the framework.

Bakgrund Överfulla akutmottagningar på akutsjukhusen är en aktuell diskussion som även rapporterats i media. För få vårdplatser och personalbrist anges bland annat som orsaker, vilket är en negativ påverkan för både arbetsmiljö och patientsäkerheten på akuterna. Samtidigt har vi en utmaning i en åldrande befolkning och brist på arbetskraft inom välfärdssektorn. Det sätter nya arbetssätt även i fokus.   Syfte  Syftet är att identifiera orsaker, konsekvenser och möjliga lösningar till kvarstannande problematiken för patienter på akuten som är klara för inläggning men väntar på vårdplats.    Teori De teoretiska ramverken som används är processteori, förbättringsteori samt teorier avseende kapacitetsplanering.   Metod Studien har en kvalitativ design som en fallstudie. En litteraturstudie för att inhämta teorier och metoder. Primärdata i den empiriska delen via observationer, intervjuer och webenkät med en svarsfrekvens på 25 %. Sekundärdata inhämtas från verksamhetens processbeskrivningar, statistik och övriga dokument. DMAIC-modellen används för att strukturera resultaten samt för analysen.   Resultat 10 % av inläggningarna når målvärden för totala ledtider, där variationen mellan mottagande enheter är stor. Bristande kompetens, bristande följsamhet, fördröjda beslut, ökat antal äldre som får vänta länge, som hänger ihop med brist på vårdplatser samt otillräcklig tillgänglighet i andra vårdformer beskrivs som orsaker.    Slutsats Prioriterade lösningar är utöver vårdplatssituationen att stärka kompetens tidigare i mottagandet vid akuten. DMAIC-metoden fungerar väl för att strukturera, analysera och prioritera möjliga förbättringsförslag vid kvarstannande på akuten. / Background Overcrowded emergency departments are a current discussion and reported in media. Hospital bed and staff shortages are given as reasons. This has a negative impact on work environment and patient safety. However, we have a challenge in an aging population and a lack of staff in the welfare sector. This puts new working methods in focus.   Purpose The purpose is to identify causes, consequences, and possible solutions to crowding in the emergency department.   Theory The theoretical frameworks used are process theory, improvement theory and theories regarding capacity planning.   Method The study has a qualitative design as a case study. A literature study to obtain theories and methods. Primary data in the empirical part via observations, interviews, and a web survey with a response rate of 25%. Secondary data is obtained from the process maps, statistics, and other documents. The DMAIC model is used to structure the results and for the analysis.   Results 10% of patients reach target values ​​for total lead times, where the variation between receiving units is large. Lack of competence, lack of compliance, delayed decisions, increased number of elderly people who must wait a long time, which relates to a lack of beds and insufficient availability of other forms of care are described as causes.   Conclusion Priority solutions are, in addition to increase the number of beds, to strengthen skills earlier in reception at the emergency department. The DMAIC method works well for structuring, analyzing, and prioritizing possible improvement proposals when staying in the emergency room.