Quality in Healthcare

Case Studies

Real-world examples of how quality can make a difference in the delivery of healthcare.

Using DMAIC to Improve Nursing Shift-Change Assignments
In this case study involving an anonymous hospital, nursing department leaders sought to improve efficiency of their staff’s shift change assignments. Upon value stream mapping the process, team members identified the shift nursing report took 43 minutes on average to complete. Using DMAIC and other quality tools, team members improved the process’ sigma level from 0.7 to 3.3. Read the online case study presentation or download Using DMAIC to Improve Nursing Shift-Change Assignments(PDF).
February 2016

Using Control Charts in a Healthcare Setting
This teaching case study features characters, hospitals, and healthcare data that are all fictional. Upon use of the case study in classrooms or organizations, readers should be able to create a control chart and interpret its results, and identify situations that would be appropriate for control chart analysis. The case is best suited for MBA operations courses and modules, particularly those focused on operations/process improvement. It also could be used in a hospital setting at a facility that has embraced a continuous improvement philosophy. the online case study presentation or download Using Control Charts in a Healthcare.(PDF)
December 2015

Aligning, Improving Key Measures Net Texas Healthcare Organization Baldrige Honor
When St. David’s HealthCare first adopted the Baldrige criteria, leaders viewed it as an improvement framework to shape a culture of quality and performance excellence. Once immersed in the framework, leaders used it as a tool to help align and improve the work of the organization and key performance measures. The organization’s emergency departments served as a prime example of improving key metrics, as wait times were significantly shortened to meet competitive challenges. In 2014, St. David’s HealthCare earned the nation’s top honor for performance excellence, the Malcolm Baldrige National Quality Award. Read the online case study presentation or download Aligning, Improving Key Measures Net Texas Healthcare Organization Baldrige Honor (PDF).
August 2015

Lack of Reported Medication Errors Spurs Hospital to Improve Data Focus, Patient Safety
A quality improvement project at Medcare Hospital in Dubai centered on unreported medication errors. A cross-functional team used the FOCUS-PDCA model to determine root causes and identify potential improvements. Upon implementing a variety of low-cost solutions, staff members felt more comfortable in reporting errors, thus providing valuable information for building safer systems. Read the online case study presentation or download Lack of Reported Medication Errors Spurs Hospital to Improve Data Focus, Patient Safety (PDF).
June 2015

Polish Dialysis Center Employees Use Visual Management to Increase Safety, Improve Organization of Medical Facility
The Regional Nephrology Centre (RNC) Dializa in Poland uses efficient and effective methods of lean philosophy to ensure patient safety and a high-quality level of medical services. The RNC was experiencing problems related to workspace organization, use of utility rooms, and treatment space shared among patients. Staff used visual management (VM) lean methods such as 5S, gemba, and kaizen to improve organization and efficiency of hospital space. Read the online case study presentation or download Polish Dialysis Center Employees Use Visual Management to Increase Safety, Improve Organization of Medical Facility (PDF).
March 2015

Systematically Improving Operating Room Patient Flow Through Value Stream Mapping and Kaizen Events (PDF, 450 KB)
In this case study, learn how Thomas Jefferson University Hospitals in Philadelphia, PA, used value stream mapping to identify and execute seven lean projects within the perioperative department over four years. October 2013

Doctors, Nurses Overcome Workplace Hierarchies to Improve Patient Experience Scores in Phoenix ER
Using the DMAIC approach and Pareto analysis, a vision team of physicians and nurses at Banner Health in Arizona sought to improve patient experience scores within the emergency room while reducing litigation risks. By instituting a number of process improvements, leaders were able to decrease the likelihood a patient files a complaint prior to ER discharge by 89 percent. October 2013

Six Hospitals Combat Regional Emergency Department Congestion With Lean (PDF, 371 KB)
Representatives from six urban hospitals in the Canadian province of British Columbia that partner to serve mental health and addiction patients worked together to curb emergency department congestion by deploying a single care model across all sites. More than 80 staff from the hospitals assisted with this effort by employing lean tools, obtaining benchmarking data, and standardizing work activities. Recognizing that the technical side is only one piece of the puzzle, leadership and the project team turned to a formal set of critical success factors to engrain the change into the culture. November 2012

Journey to Perfect: Mayo Clinic and the Path to Quality
Part of an initiative to explore the “Next Generation of Quality Leadership,” this case study will describe the development of the Mayo Clinic’s culture of quality and how leaders drove a system-wide transformation using a unique quality model that included aspects of continuous improvement, the Baldrige criteria, lean, and Six Sigma. July 2012

Imaging Core Lab Takes Quality Beyond Regulatory Requirements with ISO 9001
Medical Metrics Inc. (MMI), had an existing quality management system structured to meet FDA regulations, but it was missing a framework to help drive organizationwide improvement. MMI worked with an external consultant to create an integrated management system—a fusion of regulatory requirements with the ISO 9001 framework—and received certification to the standard in less than seven months. Read the online case study presentation or download Imaging Core Lab Takes Quality Beyond Regulatory Requirements with ISO 9001 (PDF).
June 2012

Critical Success Factors Lead to Second Baldrige Award (PDF, 119 KB)
After its flagship hospital received a Baldrige Award in 2006, North Mississippi Health Services deployed the Baldrige Criteria throughout the entire organization. Focusing on its five critical success factors, the system received the Baldrige in 2012.

Trading Accreditation for Performance Excellence Model (PDF, 386 KB)
To move forward on its journey to excellence, Spectrum Care searched for the right quality framework and discovered the New Zealand Business Excellence model. At the same time, the organization concluded that its accreditation process failed to provide a significant challenge, so it returned its “certification” to the auditing body. Using an organization-wide approach, Spectrum Care applied the new framework to all service areas and activities. The organization earned a Silver Award from the New Zealand Business Excellence Foundation in 2010.
February 2012

Department of Defense Tools Help Hospital Foster a Culture of Patient Safety (PDF, 536 KB)
Abington Memorial Hospital created a culture of patient safety and improved communication among staff using the TeamSTEPPS™ program. Created by the Department of Defense and the Agency for Healthcare Research and Quality, TeamSTEPPS™ is a teamwork system based on lessons learned from “high reliability organizations,” such as military operations, aviation, and community emergency response services.
October 2011

ASQ Certification: My Competitive Advantage in a Tough Economy (PDF, 361 KB)
This recent college graduate jumpstarted his career in healthcare by obtaining the CQIA and CSSBB certifications. Within two years after landing his first job, he received two promotions and tripled his salary.
September 2011

Reducing Wait for MRI Exams Gives Akron Children's Hospital Competitive Edge
The Radiology Department in this northeastern Ohio hospital used Lean Six Sigma to reduce wait times for MRI exams by days and weeks. Following the improvement project, the hospital earned $1.2 million in first-year incremental revenue.
April 2011

Healthcare Provider Formalizes Improvement Framework, Captures State Honors (PDF, 720 KB)
ChildServe adopted the Baldrige/IRPE (Iowa Recognition for Performance Excellence) framework to structure its process improvement journey, earning a bronze-level IRPE award in 2010 with its first application.
August 2011

A Better Way to Perform Portable X-rays
A cross-functional team at Aurora St. Luke’s Medical Center used lean tools to develop a new procedure for performing portable x-rays. Process improvements have reduced workers' compensation costs, increased productivity, and improved patient safety. Read the online case study presentation or download A Better Way to Perform Portable X-Rays (PDF).
March 2011

Barnes-Jewish Hospital Enhances Quality Patient Care by Embracing Lean (PDF, 530 KB)
The organization-wide lean curriculum at Barnes-Jewish Hospital combines an education program for all employees with focused improvements in value streams.
November 2010

Taking Process Improvement Beyond the Quality Department (PDF, 326 KB)
Since adopting the Baldrige criteria as a framework for process improvement in 2005, Genesis Health System has earned two statewide bronze-level performance excellence awards and one silver award.
June 2010

Quality Engrained in Culture at Iowa Hospital (PDF, 250 KB)
The plan-do-study-act (PDSA) cycle, data-based decision making, and lean methodologies are part of the quality culture at Guttenberg Municipal Hospital. In 2008, the hospital received a Silver Award in the Iowa Recognition for Performance Excellence program.
June 2009

Rural Hospital Thrives With Continuous Improvement and Innovation (PDF, 210 KB)
High patient satisfaction resulted from a culture change at Wright Medical Center. They shifted to a more open communication model and a pillar system that focuses on six areas of performance improvement. The hospital is now a destination of choice for healthcare in north central Iowa, with some of the highest patient satisfaction scores in the nation.
April 2009

Streamlined Enrollment Nets Big Results for Healthcare Leader
Kaiser Permanente Colorado used Lean Six Sigma to evaluate and improve Medicaid enrollment processes. A three-month project resulted in a 45 percent gain in Medicaid membership while increasing Medicaid revenue by more than $1 million annually.
January 2009

Great Ormond Street Hospital for Children: Ferrari’s Formula One Handovers and Handovers From Surgery to Intensive Care (PDF, 136 KB)
Great Ormond Street Hospital for Children (GOSH) benchmarked its handoff from cardiac surgery to the intensive care unit against pit stop techniques of the Ferrari Formula One race car team. Process improvements resulted in increased patient safety and decreased error rates.
August 2008.
Excerpted from chapter 10 of Benchmarking for Hospitals: Achieving Best-in-Class Performance Without Having to Reinvent the Wheel, by Victor E.Sower, Jo Ann Duffy, and Gerald Kohers.

Community Health Network Reduces Deadly Infections Through Culture of Reliability  (PDF, 223 KB)
Community Health Network (CHN) has achieved stunning results in reducing cases of ventilator-associated pneumonia (VAP) using specific bundles of care. Four of the network’s critical care or coronary care units have reported no cases of VAP for at least two years, and one unit has eliminated all cases of this deadly infection since December 2003.
June 2008

Emergency Department Prescribes Lean for Process Improvement (PDF, 179 KB)
When the Mercy Medical Center emergency department used lean techniques to improve process flow, patient satisfaction scores rose from the 30th to the 95th percentile. Value stream mapping helped identify and eliminate non-value-added steps.  
May 2008.

St. Luke’s Hospital Breaks Out of the Pack to Improve Patient and Physician Satisfaction (PDF, 238 KB)
Since implementing its Baldrige-based “breaking out of the pack” strategy, St. Luke’s Hospital has improved patient satisfaction scores from the 49th to the 90th percentile. The hospital was named a Press Ganey Success Story recipient in 2007 and a Silver Award winner in the Iowa Recognition for Performance Excellence program.
March 2008.

Prescription for Community-Based Healthcare Includes ISO 9001 (PDF, 270 KB)
The Community Anticoagulation Therapy Clinic demonstrates how ISO 9001 principles can provide a framework for a community model of care delivery and patient safety. Customer and provider surveys demonstrate 100% satisfaction with the clinic, which uses a controlled document system based on ISO 9001, internal and external auditing, and preventive and corrective action plans.
February 2008.

Pocono Medical Center: Faster Lab Results Using Six Sigma and Lean (PDF, 188 KB)
A Six Sigma/Lean project helped a laboratory develop a solution for delivering blood test results to doctors by 6 a.m. for critical care patients and by 7 a.m. for all other patients.
October 2006.

Bringing Order to Orders at the Nebraska Medical Center
(PDF, 118 KB)
The Nebraska Medical Center used Six Sigma to improve the completeness and availability of physician orders for patients; the project occurred within a Six Sigma program that has returned about $7.5 million in savings.
July 2006.

Dutch Hospital Implements Six Sigma (PDF, 61 KB)
A Six Sigma implementation at Red Cross Hospital in Beverwijk, the Netherlands, shows that even small projects can make a big difference.
Six Sigma Forum Magazine, February 2005.

Surmounting Staff Scheduling Challenges at Valley Baptist Health System (PDF, 53 KB)
A project on staff scheduling led to an overall reduction in the hourly cost of overtime and agency use, translating to $460 thousand in potential savings.
ASQ Six Sigma Forum, September 2003.

FMEA—the Cure for Medical Errors (PDF, 116 KB)
St. Joseph’s Hospital in West Bend, Wisconsin, has used failure mode and effects analysis to create a healthcare facility aimed at reducing errors and promoting patient safety and satisfaction through design.
Quality Progress magazine, August 2003.

Heroes Wear Scrubs Too (PDF, 54 KB)
After the collapse of the World Trade Center, teamwork helped emergency department staff at NYU Downtown Hospital meet a demand far greater than this small hospital normally handles.
News for a Change, April 2002.

Do you have a case study on quality in healthcare? Share your story

Featured advertisers

ASQ is a global community of people passionate about quality, who use the tools, their ideas and expertise to make our world work better. ASQ: The Global Voice of Quality.