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Strategic Building Blocks

Name

Institution

Course

Instructor

Date
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Strategic Building Blocks

Retrospective Analysis

In the project course MHI2015, my project topic was reducing cancellation and

no-show incidence rates in attending appointments at an outpatient physical therapy clinic. The

approach involved a GSOT framework where the research defined the goals, strategy, objectives,

and tactics. The goal was to design an evidence-based solution to reduce the rates of such no-

shows to below 7% from the current 20% using quantitative and qualitative data analysis

strategies to analyze data from the clinic’s EMR and other data sources. Tactics included

creating and listing potential interventions, including an SMS service, identifying and exploring

reasons for no-show rates as seen in a literature review, front desk staff data, patient interviews,

and patient education to reduce cancellations and no-shows. The central objective was to attain a

5 to 7 percent no-show or cancellation rate within twenty-four months.

During performing the project, several things went right, others failed to work and

some achievements were possible. One of the things that went right was the ability to organize

successful stakeholder meetings once a week to discuss possible approaches and solutions.

Another was the opportunity to access the required information from the clinic's EMR system

and the capacity to differentiate the variables that predicted a patient's no-show. Additionally, the

clinic allowed interviews from the front desk and patients to gather the information that would

illuminate all possible causes of no-show appointments. However, the project experienced some

challenges, including difficulty analyzing collected data since it took a lot of work to collect data

manually from the EMR system. Accessing the EMR system remotely was also challenging

because d/t connection issues or inability to access due to computer updates at the work

computer station, making login attempts difficult. There were also patient hesitancy cases in
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disclosing their reasons for no-shows and failed appointments and a lack of transparency in

determining why such patients found it difficult to attend their set appointments. Finally, another

difficulty involved stakeholder disagreement in building a sustainable clinical no-show policy.

Still, the project made several strides and achievements, including the ability to designate

factors contributing to no-shows and canceled appointments from the data collection and analysis

process. The project also proposed a solution that entailed an SMS reminder system that would

allow patients to confirm their appointment 24 hours before it was due. This new SMS system

introduced a new way of enhancing patient appointment confirmation processes at the clinic. It

allowed patients to press '1' to say they would attend and '2' to decline attendance. Additionally,

the project exposed the difficulties an institution would undergo in improving its appointment

attendance rates.

Application of Wicked problems to project retrospectively

The project contained different characteristics of wicked and tame problems. One

apparent wicked feature in this project is that the problem explored was a symptom of an

underlying issue. According to Termeer et al. (2019, p. 170), a wicked problem contains multiple

interlinked and heterogeneous variables and dynamics existing alongside informational

uncertainty and goal conflict due to the complexity of organizational systems. This complexity

makes trying to find the solution to one problem a bridge to discovering other underlying, related

and unrelated, problems contributing to the issue in question. Institutional factors, undisclosed to

the researcher in this project, were also responsible for the low appointment attendance rates.

However, the researcher noted some common issues that cause no-shows and canceled

appointments, including long waiting times, failure to provide guidance and instructions on

attendance, and failure to address transport and distance issues (Das et al., 2021, p. 716). These
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reasons were implicit and explicit in the clinic analyzed in the current project and indicate the

institutional failure to develop workable solutions to help their clients solve these issues and help

them attend appointments.

Another feature is the lack of progress and confusion experienced in determining the best

ways to solve the no-show and canceled appointment rates. Before the clinic decided that the low

attendance rates were a problem, they could not discern why patients failed to attend

appointments. There was little effort to design a solution to reduce the rates and improve the

clinic's revenue generation capacity. Additionally, the situation explored in this project showed

the characteristic of having more than one explanation for the problem (Termeer et al., 2019, p.

171). The clinic indicated a lack of consideration of social factors rather than the technical ones

affecting the nonattendance issue. Alkomos et al. (2020, p. 428) provide the following common

reasons as social factors accounting for the failure to attend clinical appointments, including

childcare, work, forgetfulness, feeling better, insurance problems, and lack of notification about

the appointment. Therefore, the lack of appointment attendance is symptomatic of the difficulty

in identifying one explanation as the main explanation. Explaining the cause of the problem is a

matter of the observer's perspective.

However, this project also contained some marks of a tame problem. One such feature is

the availability of a well-defined, stable problem statement. The research project intended to

identify and implement the best solution to address the outpatient clinic's no-show and low

appointment attendance rates. Additionally, the solution identified can be judged as either right

or wrong. In this case, the major solution implemented was developing an SMS system to remind

patients to attend their clinical appointments, which is the right thing to do. Others included

telehealth delivery implementation, calling patients, and a no-show policy. The solution also has
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a definite stopping point where the researcher can identify when the project solution arrives.

Another characteristic is that the clinic can easily try and abandon the suggested solutions.

Additionally, the problem identified belongs to similar problems that are solved in similar

ways. The solution to the problem involved identifying the technological tools employed in

solving the issue, enhancing the communication process, and improving data recording and

analysis. Finally, the project contained the feature of a tame problem by having a narrow set of

alternative solutions that can work effectively when well implemented (Shen, 2023, p. 8). From

the evaluation of the problem and its solution, the low attendance rates to clinical appointments

and no-shows classify as a tame problem because it contains more features common to a tame

problem compared to those specific to a wicked one.

Lessons learned and future recommendations.

Undertaking this project for a year was an illuminating experience. I learned that any

worthwhile project requires immense effort. It is necessary to abandon preconceived ideas and

knowledge about how things work and approach the problem with an open mind. The

progressive steps taken to reach the final report showed that changes to original thinking about a

problem are essential. I had to rethink my approach to the GSOT framework and change some

details to make the recommendations more plausible and actionable. This project also revealed

the interconnected nature of multiple elements that comprise a specific problem. I learned that

social, political, technological, and environmental issues are connected, and the complexity of

such interconnectedness determines the ability to develop solutions to a problem. One

recommendation to approach this type of project in the future would be to use a technological

solution to analyze data rather than using manual means. For instance, machine learning and

artificial intelligence approaches and solutions are feasible in ensuring automated data analysis,
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ensuring continuity in learning about why patients fail to attend appointments, and suggesting

solutions.

References
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Alkomos, M. F., Mendez, D., Mazzei-Pifano, D., Shafeek, F., Rodriguez, C., Ali, F., Banks, C.,

Melki, G., & Michael, P. (2020). Patients’ reasons for missing scheduled clinic

appointments and their solutions at a major urban-based academic medical center. Journal

of Community Hospital Internal Medicine Perspectives, 10(5), 426-

430. https://doi.org/10.1080/20009666.2020.1796903

Das, B., Neupane, D., Singh Gill, S., & Bir Singh, G. (2021). Factors affecting non‐adherence to

medical appointments among patients with hypertension at public health facilities in

Punjab, India. The Journal of Clinical Hypertension, 23(4), 713-

719. https://doi.org/10.1111/jch.14142

Shen, A. (2023). Lec 2-Advanced Topic in Health Informatics (Strategic Frameworks for

Solution Architecture) [Powerpoint slides]. Dalla Lana School of Public Health.

Termeer, C. J., Dewulf, A., & Biesbroek, R. (2019). A critical assessment of the wicked problem

concept: Relevance and usefulness for policy science and practice. Policy and

Society, 38(2), 167-179. https://doi.org/10.1080/14494035.2019.1617971