1. Evaluate the mission statement of Rex Hospital.

Rex Hospital is committed to providing high-quality and affordable medical care that is primarily patient-oriented. It aims to become a leading center of innovation, while bringing healthcare closer to the general populace. It also works towards maintaining personalized medical care to their patients, while maintaining a conducive working environment for their staff. In addition, it works towards maintaining their status as a pioneer in hospital management through improved administrative systems, financial management and clinical systems. Rex Hospital also aims to come up with solutions to the continually changing health needs of the community they serve, so as to fully satisfy their customers.

2. How does the competitive environment of the Triangle influence the situation here?

The fact that several major healthcare providers operate in Rex Hospital’s area of operation has had profound effects on the hospital’s operations and by extension on its achievements.  In order to achieve its status of the leading hospital in Wake County and its environs, the hospital has been forced to come up with innovations that help keep ahead of its competitors that include the University of North Carolina Medical School in Orange County and Duke University Medical School in Durham County. Rex Hospital also needed to compete against the three hospitals in Wake County, which include the Wake Medical Center that was traditionally viewed as the county hospital. To overturn this, Rex Hospital needed to provide services superior to those of its competitors, since Wake County was a very strategic market for the hospital due to its rapidly growing population and financial stability of its residents. The combined effect of these competitors has made Rex Hospital come up with innovations that have helped it assume the status of the leading healthcare provider in the area.

Basics

3. How has the historical development of quality systems at Rex Hospital affected the evolution of its quality improvement effort? Rex Healthcare and Service Line Teams 559

Different independent surveys have placed Rex Hospital at the helm of quality service delivery, image and reputation, community health programs, personalized patient care and quality working environment for its staff. This is a great improvement from the hospital’s humble beginning in 1894. Efforts to implement clinical pathways have paid off, with the software now being used for variance identification. This has not always been the case, since previously the software was used only for documentation. The installation of the Trendstar cost-reporting system was a major milestone in the hospital’s history. The system is largely responsible for the efficient steering of the hospital. The current improved data infrastructure has been achieved due to a series of quality systems developments, which have in turn ensured quality improvement. The creation of the management departments in October 1995 and subsequent improvement of management and performance have also had a profound effect on the advancement of the hospital.  The Mediqual Atlas data collection helped the hospital in self–assessment, hence their planning. All these factors have led the hospital where it is today

4. Evaluate the performance improvement reporting structure as outlined in Exhibit 5–3.

The performance improvement structure involves setting up specialized centers in the hospital’s sphere of operation based on prevalence of medical conditions in these areas. Most such centers have been set up in Raleigh, which is the main base of operation for the hospital. They include Cancer, Convalescent, Same Day Surgery, Wellness, Family Birth, Heart, Breast Care and Primary Care centers among others. In addition, similar centers have been established in Cary, Apex, Garner and Wake Forest. These specialized centers have not only improved the quality of service, but also widened the range of the hospital’s operation and eased the accessibility of medical services. The hospital’s employee assistance program, RexAware, has improved human resource management, while the Information and Resource Center (Healthnet) and Rex Business Health Services center - both located in Raleigh - have done a lot to impart health knowledge to the general population. Explaining the hospital’s operations to the population has also been instrumental in improving customer relations.

5. Evaluate the makeup of the service line team and explain its impact on the quality improvement effort.

The service line team was assembled from representatives of both policy makers and implementers. This makes the composition of the team more viable, as it can not make unrealistic recommendations, which would be the case if the team was comprised of only policy makers. They would not set their targets low, as it would be the most likely scenario in the event the team was comprised of only implementers. This also brings harmony, as the staff feel part of the decision-making process knowing that their views are respected. The inclusion of members of the board, on the other hand, creates checks and balances and ensures that the maximum potential of the hospital is realized. 

Implementation

6. What do you think of the 1995–1996 reorganization creating the two new departments: case management and performance improvement-risk management?

The reorganization that created the two departments was directly responsible for the great achievements that followed them. They led to more specialization, as each department had to tackle challenges emanating from its side of divide. This, therefore, explains why immediately after creation, the hospital won so many awards, mostly relating to management. The departments must have been under dedicated staff for them to implement the changes that they did within such a short time of operation. Setting up such departments in any firm helps bring the workers in the department closer, thus encouraging teamwork, as the workers start to feel a sense of belonging. This seems to have been the case in Rex Hospital, considering the achievements they accomplished within such a short time. The Performance Improvement Committee also did its work well by ensuring compliance of the two departments.

7. What recommendations do you have about the reporting systems used for performance improvement (Exhibits 5–3 and 5–4)?

The reporting systems are accurate and comprehensive, since they touch upon all aspects of medication and take into account the patient and healthcare provider’s viewpoint. They would, however, be more accurate if a common scale was formulated for the indices that measure degree, such as customer satisfaction and staff views, while those that measure numbers should be compared with those of the previous season of count. Also, the reporting systems should delve deeper and report on the reasons why the reports appear as they do. They should also consider secondary factors and have a way of addressing them, if they are negative.

8. What further recommendations do you have to the individuals responsible for clinical quality improvement at Rex Hospital? 

The people responsible for the clinical quality improvement should keep in mind that the present and future of the hospital are in their hands. As such, they should aim to increase their efficiency at the team level, which will improve the overall clinical quality. They should also aim to establish a lasting system that takes into consideration demographic factors, such as population increase, unemployment levels and financial status of the general population. The hospital should, therefore, have long-term as well as short-term plans for clinical improvement. It may be necessary to have some members of the staff working towards long-term sustainability. Periodic goals may also be set and reviewed at the end of every period (for example, annually).

Application

9. Rex Hospital has since been acquired by the University of North Carolina Health Care System (www.unchealthcare.org). How would you modify its quality improvement programs to enhance their potential contribution to teaching CQI to health professionals in training? `

The quality improvement systems should now be treated as a unit of the university’s system. As such, innovations that have proved workable for other healthcare units of the University of North Carolina should be tested on a small scale in the Rex Hospital operations, once they have been confirmed to work at Rex Hospital. If proved to be more effective than the existing systems, they can be fully replaced. On the same note, since Rex Hospital has not been an educational center, they should use the policies that have led to their success in healthcare provision, such as team building to ensure success in training medical personnel as well. 

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