HLT 362 Week 4 Quality Improvement Proposal Paper

Quality Improvement Proposal

This paper will provide an overview of a common problem associated with extended turn over time that occurs in operating rooms (ORs) across the nation.  It will also provide an explanation as to why a quality improvement initiative is needed to reduce the overall average turn over time.  This paper will also discuss how previous research demonstrates support for a quality improvement initiative to help alleviate this problem.

Additionally, this paper will discuss the steps necessary to implement a quality improvement initiative in the OR, as well as how the quality improvement initiative will be evaluated.  Lastly, this paper will identify the variables associated with this quality improvement initiative, test a hypothesis and provide a statistical test that can be used to prove the quality improvement initiative was successful.

Extended Turnover Time

Turnover time can be defined as the “procedure finish” time of the preceding surgical case to “procedure start” time of the following surgical case. By decreasing the overall turnover time, the throughput of the operating room should increase allowing the department to function more efficiently increase the hospitals total revenue.

Several different factors may contribute to an extended turnover time.  Some of these factors include lack of ancillary staff, poorly designed preference cards, challenging physical layout of the department, and lack of crucial equipment and supplies.

Need for a Quality Improvement Initiative

Quality improvement is defined by the Department of Health and Human Services and consists of “systematic and continuous actions that lead to measurable improvement in health services and the health status of targeted groups ( Helbig, 2018, para 28).

A decrease in turnover time is one of the essential contributors to surgical patients’ satisfaction.  The turnover time should consist of a balance between ensuring patient safety as well as increasing efficiency. Although as facilities try to achieve lessened turnover times, they may however have a higher cost attributed to them as the process will require additional ancillary personnel. 

Supporting Previous Research

Previous research has demonstrated the need for and support for approaches intended to lessen turnover times. Majbah Uddin, Robert Allen, and Nathan Huynh measured operating room turnover time using a mobile application in their study

They wanted to find out how well a mobile app created in collaboration with medical workers could monitor and cut down on OR turnover time. According to their study, the mobile application acted as a data gathering tool as well as a visual management tool, enabling them to continuously enhance the turnover process and support a more quick turnover.

Another study was conducted by six health care professionals ranging from doctors to nurses working together to determine if the Elective Change of Surgeon During the OR Day Has an Operationally Negligible Impact on Turnover Time.

The purpose of this study was “to compare turnover times for a series of elective cases with surgeons following themselves to turnover times for a series of previously scheduled, elective procedures where the following surgeon differed from the preceding surgeon” (Austin, Lam, Shin, Daily, Dunn, & Warren, 2014, para 1). Their research concluded that the turnover time for switching surgeons is definitely greater than that of the turnover time for the same surgeon. 

A third study researched as part of the backing for a quality improvement proposal is titled Factors Affecting Hand Surgeon Operating Room Turnover Time, which was conducted by eight health care professionals. The purpose of their study was to identify factors that contributed to hand surgeon turnover times.

Their research results noted that turnover time was considerably less when the surgeon remained in the OR and participated in the turnover as well as incentivizing the OR staff HLT-362V Quality Improvement Proposal Sample.

Necessary Steps for Quality Improvement Initiative

By applying a few fundamental steps to the turnover process, a reduction in overall turnover time can be accomplished.  Some of these steps include involvement by all staff members, strategically assessing the physical layout of the hospital, centrally locating the ORs inventory, assign a person to each task performed, and ensure physician preference cards are updated/accurate.

Additional necessary steps may include discussions with anesthesia providers on limiting lunch break, promoting surgeon punctuality, and setting a realistic and achievable target goal.

Quality Improvement Initiative Evaluation

One concrete way to evaluate the quality improvement initiative is by conducting quantitative research.  Quantitative research is “performed by evaluating numbers and numeric variables that result in measurable data” (Helbig, 2018, para 15).

After implementing all essential steps necessary a reduction in the mean turnover time should be noted.  Qualitative research can also be conducted to measure the effectiveness of the newly designed steps.  Physician satisfaction as well as patient safety can be measured using a survey to help determine the quality improvement effectiveness.

Statistics Application-Variables

Variables are defined as A data item such as characteristics, numbers, properties, or quantities that can be measured or counted. The value of the data item can vary or be manipulated from one entity to another. There are three different types of variables—dependent, independent, and extraneous (Ambrose, 2018, para 13). The dependent variable for studies associated with OR efficiency and throughput is Turnover Time.

Experimental variables that can be manipulated during this improvement proposal that will have a direct effect on the dependent variable include ancillary personnel involved, equipment and resource availability such as turn over packs and the application of a recommended practices for systematically cleaning the OR.  “As part of the process for rapid room turnovers, a developed system for “room turnover packs” should be created. These packs should consist of the OR table/bedsheet, the draw sheet, the kick bucket liners, and the various hamper liners” (Dean, 2015, para 24)

Hypothesis Testing

A well-written hypothesis gives directions for conducting the study. The hypothesis is a prediction of what will happen between the two variables. The hypothesis will identify both the independent and dependent variable (Ambrose, 2018, para 8). A hypothesis that can be used to during the quality improvement proposal related to the OR is; Increasing ancillary staff reduces turnover time.  To determine if this hypothesis is true, a correlation must be established between the ancillary staff and the essential role they play during turnovers. “A correlation indicates a mutual relationship or interdependence between two or more things” (Ambrose, 2018, para 9).

A null hypothesis that can help establish the lack of relationship between variables for this proposal is; There is no relationship between increasing ancillary staff and reducing turnover times.

Statistical Test

One way to determine the success of this quality improvement proposal would be to utilize a statistical test.  The test would involve a sample number of five hospital, each containing at least eight (8) OR’s.  To ensure accuracy the various hospitals  should be conducting similar surgery types and have a similar trauma designation. One hospital will be the control for this study by not changing any of their current procedures for turnover.

Two hospitals will adapt the necessary steps to reduce their tu rnover, and the last two will adapt only 1 step listed to reduce turnover times.  Turnover time  will be defined as the time from when the previous patient left the OR until the subsequent patient entered the OR.  The study should be conducted for a period of four months to allow staff to develop a routine with the implementation of turnover time reducing steps.

After the four months are completed, and the data is analyzed, the overall mean turnover time should be less for hospitals that implemented some or all of the necessary steps.  Ensuring that this study has a high confidence interval should reduce the margin for error.


Quality improvement strategies vary in their purpose and design. One such strategy is the Plan-Do-Study-Act (PDSA) cycle. June Helbig best explains this process as “once a problem has been identified, a plan is created to observe the problem and collect data (plan). After the plan has been made, it is tested on a small sample (do), and the data collected is analyzed (study). After the data is studied, changes are made based on what was learned (act)” (Helbig, 2018, para 27). Implementing essential steps is an excellent way to decrease overall turnover time ensuring the quality improvement proposal has been accomplished.

HLT-362V Quality Improvement Proposal Sample References

Ambrose, J. (2018). Applied Statistics for Health Care: Clinical Inquiry and Hypothesis Testing. Retrieved from https://lc.gcumedia.com/hlt362v/applied-statistics-for-health-care/v1.1/#/chapter/3

Austin, T. M., Lam, H. V., Shin, N. S., Daily, B. J., Dunn, P. F., & Sandberg, W. S. (2014). Elective change of surgeon during the OR day has an operationally negligible impact on turnover time. Journal of Clinical Anesthesia, 26(5), 343-349.

Dean, A. (2015). 8 Steps to Achieve 7-10 Minute Turnover Times in an ASC. Retrieved from https://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/8-steps-to-achieve-7-10-minute-turnover-times-in-an-asc.html

Gottschalk, M. B., Hinds, R. M., Muppavarapu, R. C., Brock, K., Sapienza, A., Paksima, N., . . . Yang, S. S. (2016). Factors Affecting Hand Surgeon Operating Room Turnover Time. Hand, 11(4), 489-494.

Helbig, J. (2018). Applied Statistics for Health Care: Statistics Analysis. Retrieved from https://lc.gcumedia.com/hlt362v/applied-statistics-for-health-care/v1.1/#/chapter/4

Uddin, M., Allen, R., Huynh, N., Vidal, J. M., Taaffe, K. M., Fredendall, L. D., & Greenstein, J. (2018). Assessing operating room turnover time via the use of mobile application. MHealth, 4, 12-12.

HLT-362V Quality Improvement Proposal Question Description

Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.

Include the following:

  1. Provide an overview of the problem and the setting in which the problem or issue occurs.
  2. Explain why a quality improvement initiative is needed in this area and the expected outcome.
  3. Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.
  4. Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
  5. Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
  6. Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center