Question

This assignment involves controlling the number of nursing hours at VMH. You will work with Lee Jordan, Director of Medical/Surgical Nursing. VMH employs over 500 people in nursing, both full and part-time, and has an annual nursing budget of $5,000,000. Nurses must always be present at VMH-three shifts daily, seven days per week, 365 days per year. VMH is seeking a 5% reduction in the nursing FTE (full-time equivalents).

"Good morning. I'm Lee Jordan. I'm pleased that you will be working on this assignment. I look forward to someone like you familiar with statistical process control techniques to help me in controlling the nursing department's operations. The Med/Surgical unit has 38 employees, of which 25 are registered nurses (RNs), while the remaining 13 are nurse assistants or unit secretaries. The 38 employees represent the equivalent of 28 FTEs. Each employee is budgeted for a predetermined number of hours. It is particularly costly when employees budgeted for 80 hours per pay period work additional time because they must be paid overtime wages. Currently, five RNs, two Nurse Assistants, two Unit Secretaries/Nurse Assistants, and one department secretary, are budgeted for 80 hours per pay period. We also have access to an in-house nursing pool (the "Float Pool") for additional staff when needed."

"VMH has budgetary and productivity goals that I must consider when staffing the units. Productivity is measured in nursing hours per patient day (NHPPD). We currently operate at an actual NHPPD of 8.74 hours. The target NHPPD is 8.00. Before I change staffing, I like to discuss changes with the staff. The turnover rate in hospitals is very high to begin with, so I prefer talking with the staff about any proposed staffing changes."

"You can think of the nursing department as a "process" whose performance in terms of nursing hours per patient per day (NHPPD) is subject to variations over time. I have the NHPPD data (select Medical Surgical Dept) for the past three months. I want you to analyze this data and come up with some specific suggestions. Also, since you are applying statistical process control techniques, I want you to help me respond to the queries on quality and process control issues from the staff in other departments. Please look at Will Hartman's Data on Billing Errors (select Billing Office), Doug Jennings' Data on Patient Surveys (select Quality Improvement Teams), and Margot Hamilton's Data on Room Cleaning (select Human Resources) and give me some recommendations."

1. Develop a confidence interval for FTEs within which the Medical/Surgical Unit will be efficient and will maintain quality at least 95 percent of the time (z = 1.96).

2. Examine the data and determine whether Jordan is really in control of nursing hours. If not in control, explain why.

3. Describe how the Medical/Surgical Nursing Unit can bring the nursing hours per patient day (NHPPD) down to 8.00. What arguments would you use to persuade the staff to buy into having a target NHPPD equal to 8.00?

4. Using your knowledge of process control charts, suggest how Lee should respond to the other three statistical problems. For any control charts that you develop, you are told to use a z value equal to 3.

A) - Will Hartman, in the Business Office has tracked billing errors for the past 21 weeks. Based on this data, determine control limits for billing errors. Explain any concerns you have about using the percentage of bills with errors as a valid measure for this analysis.

B) - Analyze trends in patient surveys about the meals served at VMH. Doug Jennings, in Dietary, thinks the number of OUTSTANDING responses has been declining, but he is not certain if that decline is statistically significant.

C) - Margot Hamilton, in Housekeeping, has tracked defects in room cleaning. Interpret the data and determine whether or not corrective action is required.

Answer 1

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1. Develop a confidence interval for FTEs within which the Medical/Surgical Unit will be efficient and will maintain quality at least 95 percent of the time (z = 1.96).

C.I. = (8.775, 8.636)

Margin of Error=0.0695

Max= 9.6

Min= 7.8

Mean= 8.7056

Standard Deviation=0.332

2. Examine the data and determine whether Jordan is really in control of nursing hours. If not in control, explain why.

It is clear from the confidence interval that there are values outside the acceptable range. This shows that the system is out of control.

3. Describe how the Medical/Surgical Nursing Unit can bring the nursing hours per patient day (NHPPD) down to 8.00. What arguments would you use to persuade the staff to buy into having a target NHPPD equal to 8.00?

When it comes to decreasing the target NHPPD the administration needs to look closely at what is value adding and non value adding. There are tasks and activities that cannot be removed from the schedule of the nurses and there are also other tasks that could be dropped. This idea of cutting any non value adding activities will lead to a leaner and more efficient nursing staff.

4. Using your knowledge of process control charts, suggest how Lee should respond to the other three statistical problems. For any control charts that you develop, you are told to use a z value equal to 3.

A) - Will Hartman, in the Business Office has tracked billing errors for the past 21 weeks. Based on this data, determine control limits for billing errors. Explain any concerns you have about using the percentage of bills with errors as a valid measure for this analysis.

UCL=18.782

Mean=9.524

LCL=0

After calculating the Upper Control Limit I can see that the value for sample number 3 of 19 puts the process out of control. This is the only value that is outside the acceptable range but it is enough to declare it out of control. Concerns about this sample revolve around the size of the sample. We are only looking at 21 weeks, not even 6 months of information, by analyzing a much bigger sample we will have a better idea of the scope of these defective records. Also, without being able to see the total number of records per week it is hard to judge how significant these numbers are because we don't have an idea of the magnitude of them. If there are only 100 records in the sample the percentage of defective records is much higher than a sample of 10,000 records.

B) - Analyze trends in patient surveys about the meals served at VMH. Doug Jennings, in Dietary, thinks the number of OUTSTANDING responses has been declining, but he is not certain if that decline is statistically significant.

There is a decrease in the number of OUTSTANDING responses but I would not consider it statistically significant. There is also not a lot of data given in order to make a real definitive answer but based on the information given I wouldn't say the decline is significant.

C) - Margot Hamilton, in Housekeeping, has tracked defects in room cleaning. Interpret the data and determine whether or not corrective action is required.

After analyzing the Upper Control Limit and the Lower Control Limit we don't feel that corrective action is required. All of the data falls within the control limits which are three standard deviations above and below the mean.

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