In the current atmosphere of closer scrutiny of healthcare practices and procedures, front-line managers and health care providers must investigate potential problems in their work environment, whether at the behest of upper management, in order to meet Joint Commission on Accreditation of Health Care Organizations (JCAHO) standards, or through their own sense that “weÆre doing something wrong.” For the investigator with limited previous experience in evaluation or research, the prospect of undertaking this kind of investigation can appear daunting, to say the least. Quality Improvement Projects in Health Care was written just for this individual. Author Eleanor Gilpatrick, a seasoned investigator and professor of health services administration, provides a review of the basic terminology and guidelines for carrying out “nuts-and-bolts” quality improvement research. She then demonstrates how such a research project can be implemented through 14 case studies involving actual health care situations. Altogether, the cases speak to a broad array of issues and potential pitfalls for the unwary investigatorŭand they show that progress can be made in even the most difficult circumstances. Quality Improvement Projects in Health Care will be of interest to students and professionals in health sciences administration, nursing, allied health, and public health.

HMO Patients’ Problems with Crutches and Canes1
Case 6: HMO patients’ problems with crutches and canes

In this case, process errors produced at one stage of treatment were noticed at a later stage. The case is unusual because the internal consultant worked at an occupational level not usually associated with the role of the internal consultant.

Proving the Problem

The Problem and the Client

Fran worked as a physical therapy assistant in an HMO group that had nine ambulatory care facilities, of which four provided physical therapy services. Fran was concerned about the assistive devices already in use by patients when they appeared for their first physical therapy visit as ambulatory patients. She believed that crutches and canes were often too high or too low and that canes were ...

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