Quality improvement initiative to improve communication domains of patient satisfaction in a regional community hospital with Six Sigma methodology.

BACKGROUND: Communication gaps, whether incomplete or fragmented communication, have been the cause of many disasters in human civilisation. Coordination of healthcare is directly related to proper communication and handoffs among multidisciplinary teams throughout multiple shifts during a patient's hospitalisation. LOCAL PROBLEM: Patient surveys and direct patient feedback at Mayo Clinic Health System in Mankato, Minnesota, indicated that patient communication with physicians and nurses had declined in 2017 and 2018. Viewing this as an opportunity for improvement, our leadership initiated several changes to increase physician and nurse communication with patients, which resulted in no notable improvements. METHODS: A systematic quality improvement approach was implemented by using Six Sigma methodology. Stakeholders from multidisciplinary teams were assembled as the project team. The five steps of Six Sigma methodology (Define, Measure, Analyse, Improve and Control) were followed to create a quality improvement intervention. INTERVENTION: We developed a standardised and easy-to-use bedside team rounding tool to improve patient communication with physicians and nurses. RESULTS: Postintervention patient satisfaction top-box scores exceeded target improvements for both physician (from 78.5% to 82.0%, p<0.01) and nurse (from 80.5% to 83.1%, p=0.04) communication domains. Physicians had a 33-point increase in percentile rank (from 41st to 74th percentile rank), and nurses had a 25-point increase in percentile rank (from 59th to 84th percentile rank). This increase in communication ranked our institution at the top of national benchmark organisations. CONCLUSIONS: Overwhelmingly positive patient feedback was achieved, and postintervention employee satisfaction was primarily positive when compared with preintervention satisfaction.

Optimizing inpatient bed management in a rural community-based hospital: a quality improvement initiative.

BACKGROUND: Appropriate use of available inpatient beds is an ongoing challenge for US hospitals. Historical capacity goals of 80% to 85% may no longer serve the intended purpose of maximizing the resources of space, staff, and equipment. Numerous variables affect the input, throughput, and output of a hospital. Some of these variables include patient demand, regulatory requirements, coordination of patient flow between various systems, coordination of processes such as bed management and patient transfers, and the diversity of departments (both inpatient and outpatient) in an organization. METHODS: Mayo Clinic Health System in the Southwest Minnesota region of the US, a community-based hospital system primarily serving patients in rural southwestern Minnesota and part of Iowa, consists of 2 postacute care and 3 critical access hospitals. Our inpatient bed usage rates had exceeded 85%, and patient transfers from the region to other hospitals in the state (including Mayo Clinic in Rochester, Minnesota) had increased. To address these quality gaps, we used a blend of Agile project management methodology, rapid Plan-Do-Study-Act cycles, and a proactive approach to patient placement in the medical-surgical units as a quality improvement initiative. RESULTS: During 2 trial periods of the initiative, the main hub hospital (Mayo Clinic Health System hospital in Mankato) and other hospitals in the region increased inpatient bed usage while reducing total out-of-region transfers. CONCLUSION: Our novel approach to proactively managing bed capacity in the hospital allowed the region's only tertiary medical center to increase capacity for more complex and acute cases by optimizing the use of historically underused partner hospital beds.

Developing a Quantitative Staffing to Workload Tool in an Ambulatory Setting.

Ambulatory staffing to workload based on visit volume in an outpatient setting is an elusive formula, and the literature describing such processes is limited. One health system tasked a multidisciplinary team with developing an ambulatory staffing to workload tool to meet the needs of staff, management, and leadership. The resultant tool includes an automated dashboard for determining staffing needs on the basis of quantified workload, prospective modeling, and historical dashboards to demonstrate actual staffing (full-time equivalents) to workload (outpatient volumes) compared with budget.

Three-Dimensional Finite Element Analysis of Maxillary Protraction Using Diverse Modes of Rapid Palatal Expansion.

INTRODUCTION: Three-dimensional finite elemental analysis (FEA) is a contemporary research instrument for the numeric simulation of a real physical system's mechanical process. FEA can be used as a very effective tool to analyze and compare various aspects of rapid palatal expanders and to determine the stress distribution in maxillofacial bones and displacement and the biomechanical effects it has on the circummaxillary sutures. This study evaluates the effects of different modes of rapid palatal expansion on maxillary protraction as a treatment modality in skeletal Class III malocclusion by determining the stress and displacement along the circummaxillary sutures using the FEA. MATERIALS AND METHODS: Initially, a three-dimensional finite element simulation of the maxillofacial skeleton and sutures was obtained by Mimics software (Leuven, Belgium) from the cone-beam computed tomography (Dentsply Sirona, USA) images of a 30-year-old adult with normal occlusion. A geometrical preparation of the three expansion appliances, (A) hybrid MARPE (miniscrew-assisted rapid palatal expander) appliance (Fav anchor, India), (B) tooth-borne HYRAX (hygenic rapid expander) appliance (Welcare orthodontics, Kerela), and (C) bone-borne modified MARPE appliance (Biomaterials, Korea), was transferred to ANSYS WORKBENCH, 2020 R1 software (ANSYS, Inc., USA), and three finite element models with each appliance were prepared. A protraction force of 500g was applied to the occlusal plane that is directed 20 degrees inferiorly. The tensile stress, compressive stress, and the amount of displacement on the circummaxillary sutures were assessed and compared in all the three appliances. Young's modulus (kg/mm2) and Poisson's ratio (V) were used to calculate the stress and displacement in sutures adjacent to the maxilla in different aspects. RESULTS: On analyzing the stress distribution, the tensile stress was found to be maximum in the medial aspect of the frontomaxillary suture of the bone-borne modified MARPE appliance (C), and the minimum tensile stress was found in the lateral aspect of the sphenozygomatic suture in hybrid MARPE (A). Again, the compressive stress distribution was found to be maximum in the medial aspect of the frontomaxillary suture in all three simulations and the minimum compressive stress in the superior aspect of the internasal suture in hybrid MARPE (A) along with the frontonasal suture at its medial aspect for tooth-borne HYRAX (B) and bone-borne modified MARPE (C). Displacement of the maxilla in all the planes was observed to be the largest for the bone-borne modified MARPE (C) appliance. On the contrary, the minimum displacement was found in the tooth-borne HYRAX (B) appliance.  Conclusion: The findings reveal that all three modes of rapid palatal expanders produced stress and displacement along the circummaxillary sutures on the application of protraction force with bone-borne modified MARPE being more effective in treating posterior crossbites thereby correcting the skeletal Class III malocclusions successfully.

A Digitally Capable Mobile Health Clinic to Improve Rural Health Care in America: A Pilot Quality Improvement Study.

Objective: To address the problem of limited health care access for patients in rural southern Minnesota, a digitally capable mobile health clinic (MHC) quality improvement initiative was launched in a rural community-based health system. Methods: This project was designed and implemented according to our institutional strategic plan, guiding principles for virtual community care, and existing approved standards of care. A quality improvement development and pilot implementation framework was rapidly developed using Agile methodology. Results: The resulting technology and equipment selection, overall clinic design, vehicle vendor selection, clinical schedule and workflows, staffing model, equipment and technology selection, and testing were achieved in 12 months. The pilot site communities were chosen on the basis of size, interest, and lack of existing access. Four underserved rural communities now have access to telehealth consultations, laboratory testing, and in-person primary care examinations. By April 30, 2022, the MHC had provided 1498 patient appointments while maintaining our standards of care. Newly established broadband internet access for these communities and their residents was a valuable secondary outcome. Conclusion: By designing and implementing an MHC quality improvement intervention that provides both in-person and advanced telehealth options for patients in rural communities, our institution rapidly provided a potential solution for the rural health care crisis. The MHC not only replaces traditional brick-and-mortar facilities but also expands service offerings and access to technology for rural communities and the people who live and work in them.

Outpatient Practice Reactivation in an Integrated Community Practice During the COVID-19 Pandemic.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has impacted health care organizations throughout the world. The Southwest Minnesota Region of Mayo Clinic Health System, a community-based health care system, was not immune, and in March 2020, our outpatient services were deferred and decreased by 90%. Method: This article is a review of the approach we used to safely reactivate outpatient care, the tools that we developed, and the outcomes of these reactivation efforts. A novel Outpatient Practice Reactivation Framework was established and used that included Outpatient Clinic Appointment Dashboard, Decision Matrix, Access Management, Virtual Care, and Patient Safety. This framework was guided by patient demand for care and by safety principles, as recommended by state and federal agencies and our internal infectious disease department guidelines. Results and Conclusions: Over the course of 9 weeks, ambulatory visit volumes and clinic utilization rates returned to pre-COVID levels (Pre-COVID fill rate range: 87% to 94%, post-COVID fill rate range: 86% to 89%) exceeding target fill rate of 80%, as a result of establishing the initiative as a shared priority, committing to a robust schedule and decisive actions, creating and maintaining a well-defined structure, taking an inclusive approach, overcommunicating and providing sufficient data for transparency, developing guiding principles, and training and educating staff.

Early correction of class III malocclusion with rapid maxillary expansion and face mask therapy.

A case report is presented of a class III malocclusion with a class III skeletal pattern and maxillary retrusion. Patient, a 10-year-old boy was treated with an orthopedic face mask in conjunction with rapid maxillary expansion and standard pre-adjusted edgewise appliance. Treatment was completed after 3 years and proved to be stable following the active treatment.