Note: The following text is a case study of quality improvement in health care using the QISS system. Even though the text is geared toward showing the usefulness of QISS, it also demonstrates one systematic way of going about quality improve- ment in health care. For that reason (not to support QISS), I have placed it on the TQM BBS for download. --Tom Glenn, SysOp, TQM BBS QISS - QUALITY IMPROVEMENT SUPPORT SYSTEM A CASE STUDY Susan Fleming, City Hospital's quality coach, was asked to suggest new project teams to the Quality Improvement Council. In preparation, she turned on her microcomputer, called up the QISS program, selected the Customer Feedback module and asked QISS to prepare a Pareto diagram showing (for the last six months) the number of complaints related to different hospital services. The Pareto chart showed that Discharge Planning received the second highest number of complaints (after Billing). Susan then prompted QISS to display the number of Discharge Planning complaints per month over the last year. The run chart showed that complaints had been steadily increasing over the last five months. Next she asked to see all Discharge Planning complaints for the last month and, after reading the complaints, found that the most common complaint was that patients and their families were not adequate- ly trained in "take-home medications." Two weeks later, Susan and the new project team leader (Jim Kimble) used QISS' Project Tracking module. They entered informa- tion about their new project so that it would be available to other hospitals participating in QISS and than asked QISS to list all Discharge Planning projects in hospitals in the QISS network. They found seven projects and learned that two of them were related to Patient Education. A review of the project summaries showed that General Hospital's project was near completion. Susan and Jim then entered the Network module to send a message to the contact person at General Hospital. Jim sent an E-mail message introducing City Hospital's project, asking if a flow diagram had been prepared at General Hospital for the patient education process. The next day Jim received an E-Mail response saying the diagram and others had been faxed. The contact at General Hospi- tal (Dawn Merrill) encouraged Jim to keep her updated on project progress. Upon receipt of the fax, Jim went to the Resources module to identify references that address the purpose and method of preparing the display charts he had been sent. Jim also checked the Resources module to determine if an article was available on Patient Education. He found two articles which were appropriate. Review of the abstracts suggested that one article deserved further reading. He found the article in a medical journal and learned that one hospital had developed video tapes that were given on discharge to particular patients and their families. The idea intrigued him. Jim decided to see if other hospitals had been doing some creative thinking about the subject. He posted a notice on the QISS Bulletin Board asking if any hospitals would be interested in joining an electronic Discussion Group on Discharge Medication Patient Education. Seven hospitals offered to join and a closed discussion group was formed. For the next five weeks, the members of the group used the computer to discuss ideas on how to improve Patient Education and together came up with several suggestions that Jim decided to pursue. QISS facilitated cooperation between the organizations and two of the hospitals subsequently joined with City Hospital in a joint project on Discharge Planning. A few weeks later, Susan and Jim were discussing a conflict that had been brewing between two members of the quality improvement team. City Hospital had a large transplant population and a survey of patient knowledge had shown that improvements in prednisone education were needed. There had been a growing debate between some who felt that video tapes would be at least as good as classes offered for patients and, in the long run, far less expensive than classes for family members. Jim was confused about the emotional involvement of the members in the conflict but was not quite sure how to handle the situation. He decided to use the QISS Decision Aid program (a program originally developed for international negotiations that had been shown in field test to help resolve conflict). The program helped Jim better understand the sources of this particular conflict and generate ideas for how it might be resolved. Over time, the conflict was resolved and a decision to use video tapes as a new instructional medium was made. Jim was interested in whether tapes of this sort existed. He placed a notice on the QISS Bulletin Board. He asked for information on any consultants or organizations on patient education that were working in this area. He found that two organizations had worked on this topic with other QISS hospitals. Jim contacted the two organizations and found that while neither was developing video tapes, one knew of a university that was producing and testing such a tape for transplant patients. Jim contacted the university and arranged to become a Beta test site for the tape. Jim updated the Project Tracking program in QISS (as he had done periodically throughout the project) to share his experiences with others. As time progressed, City Hospital became a heavy user of QISS. They developed a tremendous network with other TQM organizations and felt they also had a good "handle" on the numerous projects in which they were involved. They also found QISS to be a good tool for training and educating new staff about TQM.