This chapter introduces tools for continuous improvement and patient safety. It discusses four types of continuous improvement tools: identifying customer needs, documenting processes, diagnosing problems, and monitoring progress. Specific tools are described like process flowcharts, fishbone diagrams, and run charts. Patient safety tools include failure mode and effects analysis (FMEA) and root cause analysis. A case study finding describes a patient issue with a broken call bell at night. A root cause analysis using a fishbone diagram identified that policies and procedures from the QA Manager and Nursing Director were not defined for night staff. Recommendations include defining proper policies/procedures, setting standard operating procedures, training nurses, and periodic equipment checkups.

1. CHAPTER: 3
THE MANAGER’S
TOOLBOX
PRESENTED TO:
Prof. K.V.S.S.N Murty
PRESENTED BY:
Dr. Apurva Sharma
Dr. Satyam Kumar

2. FOCUS
 To introduce commonly used continuous
improvement and patient safety tools.
 To practice using continuous improvement and
patient safety tools.

3. CONTINUOUS
IMPROVEMENT TOOLS
These are of 4 types:
 Identifying customer and stakeholder
expectations
 Documenting a process
 Diagnosing the problem
 Monitoring progress

4. Identifying customer needs
 Asking and observing.
 Focus groups.
 On the basis of literature.

5. Documenting a process
 Process flowchart
 Work flow diagram
 Lead- time analysis

6. Diagnosing the problem
 Fishbone diagram
 Check sheet
 Pareto diagram

7. Monitoring progress
 Run charts

8. PATIENT SAFETY TOOLS
 FMEA- Proactive
 Root cause analysis- investigative tool

9. CASE STUDY- FINDINGS
 After discharge, patient wrote letter to hospital.
 Laparoscopic surgery turned into open surgery.
 Call bell was broken in night.
 Patient phoned to nursing station but no one
answered.
 Certified nursing assistant (CNA) came.
 Call bell fixed, but electricity problem.
 Nurse asked patient to yell & left closing the
door.

10. DATA WE COLLECTED
 People participated- director of nursing, Q.A
Manager, nurse.
 Event occurred in NIGHT.
 Service impacted- maintenance department,
nursing department.
 Full services impacted- electrical dept.
 human factors were relevant to the event-
ignorance
 equipment performance- because of call bell
broken, patient got dissatisfied with room.

11.  controllable factors- if nurse can come on first
phone call, the outcome was little bit effected.
 Staff- staff is qualified but proper indications not
given

12. Root Cause Analysis
 Fish bone diagram.
 Main causes-
Policies & procedures
Equipment's & resources
Patient factors
Work environment
Communication
Task factor
Team factor

13. Root cause
 The Q.A Manager did not defined the
policies for night shift staff.
 Q.A Manager is the root cause of the
problem but at the same time we cannot
deny that Nursing director also did not
defined SOP’s for nurses.

15. RECOMMENDATIONS
 Proper policies and procedures should be
defined by the Q.A Manager and Nursing
Director.
 Standard operating procedures are set for all
staff in the hospital.
 Training program for nurses.
 Maintenance staff should be in night plus
electrical backup.
 Periodic checkup of all equipments in hospital.

16. THANK YOU!