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Quality Case Study

Team Instructions

Read the general case summary below and then the Quality Task Force write-up assigned. Develop a write-up for the case and your task force questions that follow. The questions do not require you to have all the answers, but they should lead you to ask the right questions. If your team thinks you need more content information on certain areas (i.e. details about the organization or data), identify that need by defining the questions you would ask to obtain that information.

Case Summary

Fairview Hospital Background

Fairview Hospital (FHosp) is a 230-bed not-for-profit community hospital facility. With a total staff of nearly 2000, the facility has a proud reputation for providing good patient care and staff employment since 1949. Since 2000, Fairview Hospital has reorganized its business relationships with the nearly one hundred physician practices in its service area.

The hospital has current management agreements with forty-seven of the fifty-five physician practices in the area. This includes a total of 73 physicians. This means that the physicians remain independent contractors, usually reimbursed based on productivity and specialty. The hospital provides total management of the affiliated practices, including billing services, management of practice staff, and management decisions for the practice.


Last year there were nearly 250,000 outpatient visits with affiliated physicians. Last year, Fairview Hospital admitted 16,300 inpatients. For 2,550 of these total patient admissions, congestive heart failure (CHF) was documented as the primary or secondary diagnosis. Of these CHF patients, 48 percent were female and 52 percent were male, with a mean age of 63. Approximately 50 percent of these patients had a documented medical history of CHF, and approximately 50 percent were newly diagnosed. The average length of stay for a CHF patient with a primary or secondary diagnosis was 4.2 days. The payer mix for the group was 50 percent Medicare, 30 percent private insurance, 10 percent Medicaid and 10 percent indigent or charity. As part of the hospital’s three- to five-year plan to excel in cardiac services, the hospital and its affiliated physician practices decided to focus on CHF as one of its quality improvement goals this year. A strategic goal

Fairview Hospital adopted a strategic goal of Continuous Quality Improvement throughout its health system. As a preliminary step, the management team assigned Quality Improvement task forces in most sections of the hospital. You are one of those task forces charged with improving quality measures for one area of the system.




Task Force C: Clinical Managers

Your team represents the six clinical managers of the hospital. There is one manager for every two clinical units at FHosp. A nursing supervisor (NS) is assigned to each shift in each unit of the hospital (total of 36 nursing shift supervisors).


1 Clinical Manager

|                       |

1 Unit                1 Unit

/     \                 /      \

NS  NS           NS      NS

The nursing supervisor has responsibility for clinical and administrative oversight of the nursing staff for that shift. The nursing shift supervisors have specific responsibilities including:

  • Monitoring and ensuring adequate nursing staff coverage on each shift
  • Serving as a resource to unit charge nurses
  • Assisting with emergencies, such as codes
  • Serving as the administrator’s liaison for patient complaints that are out of the ordinary or that unit staff are unable to handle
  • Ensuring that admissions
  • Transfers
  • Discharges of patients between units or departments at FHosp occur smoothly
  • Helping to resolve interdepartmental conflicts.


Recently, in an effort to cut costs, the hospital approved a proposal to eliminate the day-shift nursing supervisor. The rationale was that patient care unit managers (some of whom are traditional nurse managers and some of whom are non-clinical administrative managers) are present during the day and should be able to absorb the functions of the shift supervisors. Since this change was implemented, it has become more difficult for the nursing supervisors to do their jobs on the evening and night shifts. One problem is that patients who should have been discharged in the morning are being delayed until the afternoon. Because your bed occupancy is typically around 80 percent, these delays are causing bottlenecks for new admissions from surgery and from the emergency department. In particular, the general medicine floors-including the telemetry unit where the CHF patients are and where approximately 70 percent of admissions come through the emergency department- are faced with these problems. You have heard comments of concern from nurses throughout the hospital.


  1. Identify the performance gap that needs to be addressed by the task force.
  1. Are there any causal factors that must be addressed to positively impact the performance gap?
    1. Maybe do a fishbone analysis here?- Cassie
  • Select one specific performance measure that you will improve and detail the needed improvements.
    • If there are standards / benchmarks for this improvement measure, identify and refer to them
  • Apply one of the Quality Improvement models presented in class to your performance gap improvement plan.
    • Identify and summarize the specific steps you will take.
  1. Who are the key personnel who should participate in the improvement plan and why?
  2. Specify the indicators / measures you will monitor and if not measures normally tracked by the hospital’s electronic health record, how are you going to collect the data.
  3.    Describe your planned implementation plan for improving the performance gap identified.



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Category: Sample Questions