The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts


-David Mussetter, BA, RRT, Tim Frymyer, BS, RRT, Mike Trevino, MS, RRT, Gary Weinstein, MD, FCCP, Presbyterian Hospital of Dallas, Dallas, Texas

Background: Well-structured Quality Improvement programs should be a priority for Respiratory Therapy departments in today’s environment of cost containment, budget cuts and staff reductions. Many Quality Improvement initiatives are very informal and their effectiveness is suspect with little data supporting their worth. Objective reproducible data allows for meaningful feedback to employees, leading to improved performance in key areas.

Method: Areas of importance were identified as Quality Improvement opportunities and objective measurements were developed for each. Areas included were staffing - flexing home staff when not needed, assigning full workloads, dividing work assignments equally, and controlling overtime. Timeliness of patient care was also monitored, looking at completion of patient protocol assessments in a timely manner, both pre-operatively and post-operatively. Employee performance areas included tardiness and productivity. Feedback was given in a variety of manners and focused primarily on the positive. Individualized quarterly reports were given to each therapist, showing their performance personally as well as compared to their peers. In addition, measurements related to specific opportunities recognized at the time of the employee’s annual review were given to each therapist quarterly. Three to four monitors were chosen each month and the top performing therapists in each area were recognized by having their name posted in the department, as well as receiving a reward, such as a restaurant gift card, ink pens, or movie tickets. Annual performance evaluations and associated pay increases were also reflective of these objective performance measures.

Results: Improvements were demonstrated to varying degrees in all targeted areas, from June 2003 to July 2004. While many goals were measurable as a department (see table), other data was better measured individually. Additional opportunities have been discovered for process improvement through these efforts and are in different stages of implementation.
Targeted Area % Improvement
Flexing staff home 84%
Average workload size 3%
Even distribution of work 25%
Overtime 33%
Protocol Timeliness  
Pre-op Day Shift 5%
Night Shift 4%
Post-op Day Shift 21%
Evening Shift 5%
Tardiness (from Aug. 2002) 61%

Conclusion: Our Quality Improvement program demonstrates a useful strategy for improving patient care and employee performance by rewarding and encouraging excellent respiratory care from objectively measured results. These improvements likely result from improved morale, employee ownership of performance, and subtle peer pressure. In addition, our initiatives foster improvements that are perpetual in nature.