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Case Study 1: Statistical Thinking in Health Care

Read the following case study.

Ben Davis had just completed an intensive course in Statistical Thinking for Business Improvement, which was offered to all employees of a large health maintenance organization. There was no time to celebrate, however, because he was already under a lot of pressure. Ben works as a pharmacist’s assistant in the HMO’s pharmacy, and his manager, Juan de Pacotilla, was about to be fired. Juan’s dismissal appeared to be imminent due to numerous complaints and even a few lawsuits over inaccurate prescriptions. Juan now was asking Ben for his assistance in trying to resolve the problem, preferably yesterday!

“Ben, I really need your help! If I can’t show some major improvement or at least a solid plan by next month, I’m history.”
“I’ll be glad to help, Juan, but what can I do? I’m just a pharmacist’s assistant.”
“I don’t care what your job title is; I think you’re just the person who can get this done. I realize I’ve been too far removed from day-to-day operations in the pharmacy, but you work there every day. You’re in a much better position to find out how to fix the problem. Just tell me what to do, and I’ll do it.”
“But what about the statistical consultant you hired to analyze the data on inaccurate prescriptions?”
“Ben, to be honest, I’m really disappointed with that guy. He has spent two weeks trying to come up with a new modeling approach to predict weekly inaccurate prescriptions. I tried to explain to him that I don’t want to predict the mistakes, I want to eliminate them! I don’t think I got through, however, because he said we need a month of additional data to verify the model, and then he can apply a new method he just read about in a journal to identify ‘change points in the time series,’ whatever that means. But get this, he will only identify the change points and send me a list; he says it’s my job to figure out what they mean and how to respond. I don’t know much about statistics — the only thing I remember from my course in college is that it was the worst course I ever took– but I’m becoming convinced that it actually doesn’t have much to offer in solving real problems. You’ve just gone through this statistical thinking course, though, so maybe you can see something I can’t. To me, statistical thinking sounds like an oxymoron. I realize it’s a long shot, but I was hoping you could use this as the project you need to officially complete the course.”

“I see your point, Juan. I felt the same way, too. This course was interesting, though, because it didn’t focus on crunching numbers. I have some ideas about how we can approach making improvements in prescription accuracy, and I think this would be a great project. We may not be able to solve it ourselves, however. As you know, there is a lot of finger-pointing going on; the pharmacists blame sloppy handwriting and incomplete instructions from doctors for the problem; doctors blame pharmacy assistants like me who actually do most of the computer entry of the prescriptions, claiming that we are incompetent; and the assistants tend to blame the pharmacists for assuming too much about our knowledge of medical terminology, brand names, known drug interactions, and so on.”
“It sounds like there’s no hope, Ben!”

“I wouldn’t say that at all, Juan. It’s just that there may be no quick fix we can do by ourselves in the pharmacy. Let me explain how I’m thinking about this and how I would propose attacking the problem using what I just learned in the statistical thinking course.”

Source: G. C. Britz, D. W. Emerling, L. B. Hare, R. W. Hoerl, & J. E. Shade. “How to Teach Others to Apply Statistical Thinking.” Quality Progress (June 1997): 67–80.

Assuming the role of Ben Davis, write a three to four (3-4) page paper in which you apply the approach discussed in the textbook to this problem. You’ll have to make some assumptions about the processes used by the HMO pharmacy. Also, please use the Internet to research articles on common problems or errors that pharmacies face. Your paper should address the following points:

1.Develop a process map about the prescription filling process for HMO’s pharmacy, in which you specify the key problems that the HMO’s pharmacy might be experiencing. Next, use the supplier, input, process steps, output, and customer (SIPOC) model to analyze the HMO pharmacy’s business process.
2.Analyze the process map and SIPOC model to identify possible main root causes of the problems. Next, categorize whether the main root causes of the problem are special causes or common causes. Provide a rationale for your response.
3.Suggest the main tools that you would use and the data that you would collect in order to analyze the business process and correct the problem. Justify your response.
4.Propose one (1) solution to the HMO pharmacy’s on-going problem(s) and propose one (1) strategy to measure the aforementioned solution. Provide a rationale for your response.
5.Use at least two (2) quality references. Note: Wikipedia and other Websites do not qualify as academic resources.
Your assignment must follow these formatting requirements:

•Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA format. Check with your professor for any additional instructions.
•Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
The specific course learning outcomes associated with this assignment are:

•Describe how organizations use statistical thinking to be more competitive.
•Apply the basic principles of statistical thinking to business processes.
•Apply the SIPOC model to identify OFIs in business processes.
•Use technology and information resources to research issues in business process improvement.
•Write clearly and concisely about business process improvement using proper writing mechanics.







Subject Nursing Pages 9 Style APA


Statistical Thinking in Health Care

In the current competitive business environments, decisions are driven by data. Business professionals are expected to justify their decisions on the basis f data. As such, they need decision support systems that are statistical model-based. Statistical skills enables professionals to intelligently gather, analyse, and interpret data that is relevant to their decision making in order to solve problems within a diverse context, reduce guesswork, and add substance to their decisions (Britz, Emerling, Hare, Hoerl, & Shade, 1997). The current case of the HMO pharmacy involves analysis of relevant data through statistical approach to identify, analyse, and develop a solution to the identified problem. The HMO pharmacy is facing the problem of incorrect prescriptions.

Process Map for HMO Pharmacy

The first step is to define the problem through four questions; what the problem is? When it happened? Where it happened? And its impact (Ratnaningtyas & Surendro, 2013). The problem is wrong prescriptions in the HMO pharmacy. There could be a number of causes to the problem and these needs to be identified. There is no specific when in this case. For where the answer is that prescription, errors are being investigated for the HMO pharmacy during prescribing, preparing, and administering of the medications. The potential impact of these errors is that they could cause harm/death to patients who receive wrong medication. There is also the potential of facing legal action against the involved employees or the pharmacy.




The process map for HMO pharmacy




Medical errors




HMO Pharmacy


Prescribing, preparing, & administering medication



Impact to the goals


Patient safety

Potential for patient harm

Employee impact

Potential for legal action against employee


Never event


Potential for legal action against the pharmacy

Patient sev\rvices

Patient receives wrong type of dose

(Paddock, 2014)

Pharmacist measures medication

Pharmacist selects medication

Physician selects dose of medication

Physician writes prescription

Physician selects type of medication

















(Paddock, 2014)



The SIPOC Analysis of HMO Case




MD                          valid prescription                            prescription            patient       99.99% acc-

Patient                     patient information                         drug monograph     client         uracy

Client                      payment                                          saving opportunity MD

Call centre agent     drugs                                               client bail                USPS

Robotics                  mailing supplies                                                             pharma


Step 5-

Ship Rx to patient

Step 4-

Resolve exceptions

Step 3-

Check eligibility and patient info

Step 2-

Enter order into system

Step 1-

Get Rx &payment

Order entry clerk





(Paddock, 2014)

Root Causes

HMO pharmacy has identified that their ability to deliver the correct prescription of medications is inadequate. As a result, patients are not receiving the right medication in some cases. Failure to provide the right prescription has increased the number of complaints and damaged the pharmacy’s reputation.

The nurse gives patients the wrong medication because of an ineffective check of the medication. The nurse might also grab the wrong medication or be given the wrong medication. Studies have established that errors in prescription are caused by interruptions or mistakes occurring during the task. This might be because the prescription was for wrong medication or because the prescription was filled incorrectly. The prescription may be filled incorrectly in case the pharmacist grabs the wrong medication due to similar looking bottles on the self. The pharmacist may also misinterpret the prescription due to illegible handwriting. For prescriptions to be filled incorrectly, the check of the prescription must be ineffective.

Identified failures:                                                                        

  • Patients receiving wrong medication
  • Patient does not receive the needed medication
  • Patient receives wrong dose of medication

Potential root causes:

  • Ineffective check of prescription by pharmacists
  • Doctor writes wrong prescription
  • Prescription for wrong medication
  • Pharmacist selects wrong medication
  • Similar sounding names

The main root causes of the HMO problem are common causes. This is because such causes and the problems they cause are common in pharmacies. They are caused by frequent errors within the process of issuing medication to patients (Polk, 2011). However, although they are common causes, they may be problematic in terms of the quality of service delivered by the pharmacy to patient.

Tools to Analyse the Business Process

To gain significant insight into the issue, two process-mapping tools will be used; functional deployment process map and top-down chart. The top-down chart is used to document the core process and its related sub-processes. The functional deployment process maps is used to document sub-processes in the process, the sequence of individual steps and decisions as well as those responsible for them (Paddock, 2014). The main idea is to understand how customers define and prioritize needs and expectations of the company’s services in term of quality, cost, delivery, service and safety, and corporate responsibility.

Quality focuses should be on collecting data on attributes such as reliability, freedom from defects, responsiveness, service dimension, availability, and service features. Data needed on cost has to do with price to consumer. Data on delivery should focus on lead times, turnaround times, cycle times, setup times, and delays. Service and safety data should focus on friendly service, customer-required maintenance, service safety, product safety, and service requirements. Data on corporate responsibility should emphasize on regulatory and legal compliance and ethical business conduct (Paddock, 2014).

Solution to HMO Problem

The most effective solution to the HMO problem is checking of prescriptions for the various attributes. Pharmacists should check any prescription before it leaves the HMO pharmacy. They should also check medications before they are given to patients. There is also a need to check the identity of patients before issuing medication. Finally, pharmacists must check the dose to ensure it is the correct one before it is given to patients (Root Cause Analysis, 2015).

One effective strategy for measuring the above solution is the DMAIC strategy. It is use to ensure quality of a process. It is a data driven improvement cycle for reducing various and defects (Root Cause Analysis, 2015).

D-Define: This involves defining the business case. It entails identifying the problem, writing a problem statement, identifying customer needs, and identifying the critical to quality.

M-Measure: This involves identifying the core metrics for the problem. Each metric is defined and the current state of the process mapped out.

A-Analyse: This step involves analysing all the relevant data and process maps. Investigations and root causes are summarized, and root causes are validated.

M-Measure: In this stage, potential solutions are brainstormed. It also involves evaluating complexity, cost, benefit, and risk. Finally, the solution is assessed for effectiveness.

I-Improve: It involves addressing the issues of problem containment. Focus should be on prevention and elimination of the non-value added activities. This implies maximizing the effectiveness f the solution while minimizing complexity and cost.

C-Control: This is where opportunities are identified for standardization. Stability, controls, and benefits of the solution are determined.

DMAIC is an effective tool for measuring and improving processes within organizations. It is systematic and data driven.


Britz, G., Emerling, D., Hare, L., Hoerl, R., & Shade, J. (1997). How to teach others to apply statistical thinking. Quality Progress, (6). 67.

Chapter 11: Root Cause Analysis, Six Sigma, and Overall Quality Control and Lean Concepts. The First Process to Bring Quality and Cost-Effectiveness to Medical Care Delivery. (2015). Practical Predictive Analytics and Decisioning Systems for Medicine, 143-164. doi:10.1016/B978-0-12-411643-6.00011-9

Paddock, S. M. (2014). Statistical Benchmarks for Health Care Provider Performance Assessment: A Comparison of Standard Approaches to a Hierarchical Bayesian Histogram-Based Method. Health Services Research49(3), 1056-1073. doi:10.1111/1475-6773.12149

Polk, J. D. (2011). Lean Six Sigma, Innovation, and the Change Acceleration Process Can Work Together. Physician Executive,37(1), 38-42.

Ratnaningtyas, D. D., & Surendro, K. (2013). Information Quality Improvement Model on Hospital Information System Using Six Sigma. Procedia Technology9(CENTERIS 2013 – Conference on ENTERprise Information Systems / ProjMAN 2013 – International Conference on Project MANagement/ HCIST 2013 – International Conference on Health and Social Care Information Systems and Technologies), 1166-1172. doi:10.1016/j.protcy.2013.12.130










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