Table 2: Patient Satisfaction Pre-Evaluation Stage Week Day Shift S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 Baseline Sun Day 5 6 6 6 7 6 6 5 7 5 Baseline Sun Night 7 4 4 4 5 5 7 3 4 3 Baseline Mon Day 5 6 7 4 5 6 7 3 6 7 Baseline Mon Night 3 4 6 4 5 7 4 3 5 6 Baseline Tues Day 6 6 6 7 5 4 6 7 7 5 Baseline Tues Night 5 5 4 6 6 7 4 3 4 3 Baseline Wed Day 6 7 6 5 5 5 4 5 6 7 Baseline Wed Night 3 3 3 5 7 6 7 5 4 5 Baseline Thur Day 6 6 6 7 3 4 5 4 5 6 Baseline Thur Night 2 5 7 7 7 3 3 4 4 4 Baseline Fri Day 3 4 7 7 5 3 4 5 5 7 Baseline Fri Night 3 4 5 6 4 4 5 7 3 4 Baseline Sat Day 5 7 7 5 4 5 5 7 7 7 Baseline Sat Night 7 7 2 5 5 4 3 4 5 4 Evaluation Stage Week Day Shift S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 1 Sun Day 7 7 7 7 4 5 6 7 7 7 1 Sun Night 3 5 1 4 5 2 6 3 7 1 1 Mon Day 4 4 5 6 7 5 4 5 5 6 1 Mon Night 5 5 6 7 3 4 2 4 2 3 1 Tue Day 5 5 6 6 7 3 4 5 4 4 1 Tue Night 3 3 5 7 7 6 1 2 4 5 1 Wed Day 6 6 6 6 6 7 5 5 4 5 1 Wed Night 7 7 5 7 6 3 2 5 4 3 1 Thu Day 7 7 7 7 5 5 6 4 4 4 1 Thu Night 6 6 6 5 4 6 7 5 4 4 1 Fri Day 5 5 5 5 5 3 7 7 5 4 1 Fri Night 5 4 6 5 5 3 7 5 4 4 1 Sat Day 6 6 6 6 6 7 7 5 5 4 1 Sat Night 3 3 5 4 4 5 6 7 4 5 2 Sun Day 6 6 6 7 5 4 3 3 3 4 2 Sun Night 5 5 5 5 5 7 6 6 7 6 2 Mon Day 6 6 7 6 5 4 3 5 4 5 2 Mon Night 4 5 6 4 1 2 5 6 7 4 2 Tue Day 7 7 5 6 7 5 4 5 4 4 2 Tue Night 2 2 2 2 3 4 5 1 4 5 2 Wed Day 6 6 6 7 7 5 5 4 4 3

2 Wed Night 5 6 4 5 2 5 7 1 5 4 2 Thu Day 3 3 3 5 5 7 7 6 7 4 2 Thu Night 3 2 3 6 5 4 1 2 5 4 2 Fri Day 3 3 3 5 4 4 5 7 5 7 2 Fri Night 6 2 3 6 4 5 7 5 6 5 2 Sat Day 4 4 4 5 5 7 1 6 6 6 2 Sat Night 7 3 4 5 5 7 5 3 7 4 3 Sun Day 3 4 3 4 3 4 5 4 5 7 3 Sun Night 7 5 5 7 4 6 2 7 7 5 3 Mon Day 7 7 5 6 7 4 5 6 7 5 3 Mon Night 2 5 5 6 7 2 4 5 4 5 3 Tue Day 7 7 7 7 7 6 6 6 5 6 3 Tue Night 6 2 2 2 2 1 4 5 7 6 3 Wed Day 6 6 6 5 4 7 5 3 4 7 3 Wed Night 4 3 3 6 5 4 2 4 4 1 3 Thu Day 3 3 3 4 5 7 7 6 4 5 3 Thu Night 7 2 4 2 6 4 7 5 6 4 3 Fri Day 3 3 5 7 5 7 7 7 7 7 3 Fri Night 5 7 7 7 7 7 4 5 6 7 3 Sat Day 5 5 6 6 7 7 4 5 4 7 3 Sat Night 4 7 7 7 5 6 2 5 7 7 4 Sun Day 4 4 5 3 3 5 4 6 3 4 4 Sun Night 4 7 7 7 5 6 7 2 4 5 4 Mon Day 5 5 5 7 6 4 5 7 5 7 4 Mon Night 4 6 6 4 2 5 7 7 6 2 4 Tue Day 3 3 6 4 4 5 4 5 4 4 4 Tue Night 5 7 7 5 2 1 7 7 5 4 4 Wed Day 7 7 7 5 4 3 5 4 7 5 4 Wed Night 3 6 6 6 7 5 2 5 4 6 4 Thu Day 3 3 5 7 6 2 4 7 7 6 4 Thu Night 2 7 7 7 4 5 6 3 3 7 4 Fri Day 6 6 5 7 2 5 6 7 7 7 4 Fri Night 5 6 7 6 6 6 7 5 2 7 4 Sat Day 7 7 7 6 2 5 4 5 6 7 4 Sat Night 6 6 6 6 7 1 5 2 6 7

Table 3: Patient Quality Evaluation Pre-Evaluation Stage Week Day Shift S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 Baseline Sun Day 6 7 6 7 7 5 4 5 6 6 Baseline Sun Night 4 5 6 7 5 4 5 6 6 7 Baseline Mon Day 6 4 5 6 6 6 7 4 5 5 Baseline Mon Night 4 5 5 5 7 7 7 5 6 5 Baseline Tues Day 2 7 7 7 5 7 6 7 5 5 Baseline Tues Night 3 5 6 5 6 6 7 7 4 4 Baseline Wed Day 7 7 7 7 6 4 5 6 7 7 Baseline Wed Night 3 3 5 6 7 5 6 7 5 6 Baseline Thur Day 6 6 6 7 3 4 5 4 5 6 Baseline Thur Night 6 6 7 5 7 5 6 6 6 7 Baseline Fri Day 4 5 6 5 4 5 6 7 5 4 Baseline Fri Night 6 6 6 5 7 5 4 5 6 6 Baseline Sat Day 7 7 7 7 6 6 5 4 7 5 Baseline Sat Night 2 2 5 7 6 7 5 6 7 6 Evaluation Stage Week Day Shift S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 1 Sun Day 6 5 6 7 4 5 6 4 5 6 1 Sun Night 7 6 5 3 2 7 4 5 6 6 1 Mon Day 7 5 6 4 1 7 6 6 5 4 1 Mon Night 6 6 6 6 6 7 5 5 5 4 1 Tue Day 5 4 6 7 6 4 4 5 6 7 1 Tue Night 6 6 6 5 4 7 5 5 7 4 1 Wed Day 5 6 6 6 6 4 7 5 6 7 1 Wed Night 4 5 7 6 6 6 6 5 5 7 1 Thu Day 7 4 7 7 6 6 6 6 6 4 1 Thu Night 7 7 7 7 5 6 4 7 5 6 1 Fri Day 7 5 7 7 5 2 6 4 7 7 1 Fri Night 4 6 7 7 6 3 6 5 4 7 1 Sat Day 6 3 5 7 6 5 4 7 6 6 1 Sat Night 7 6 6 7 6 6 5 4 7 6 2 Sun Day 4 5 5 7 6 4 6 5 6 6 2 Sun Night 7 4 5 7 6 4 6 6 6 6 2 Mon Day 5 7 4 7 6 4 6 6 6 6 2 Mon Night 5 5 7 7 6 6 5 7 6 6 2 Tue Day 5 6 5 7 6 6 4 4 6 6 2 Tue Night 6 5 6 7 4 6 5 5 5 6 2 Wed Day 5 4 5 7 4 6 6 6 6 6 2 Wed Night 4 7 4 7 4 5 7 5 7 6

2 Thu Day 7 5 7 7 4 5 6 5 4 7 2 Thu Night 5 6 5 7 5 5 6 5 5 7 2 Fri Day 6 5 6 5 5 5 5 7 2 4 2 Fri Night 6 5 4 4 5 5 6 7 1 5 2 Sat Day 5 7 7 6 5 5 5 7 5 6 2 Sat Night 4 5 3 5 6 5 6 7 4 7 3 Sun Day 7 6 2 4 6 5 6 7 7 7 3 Sun Night 5 6 5 7 6 6 7 7 5 7 3 Mon Day 6 5 6 6 6 6 5 7 6 4 3 Mon Night 7 4 5 5 5 6 6 6 6 5 3 Tue Day 4 7 4 6 5 6 6 6 5 6 3 Tue Night 5 5 7 7 5 6 5 6 2 5 3 Wed Day 6 6 5 5 5 6 6 6 5 4 3 Wed Night 5 3 6 4 5 6 7 6 4 5 3 Thu Day 5 4 5 6 7 7 5 6 5 6 3 Thu Night 7 5 6 5 7 7 6 5 6 3 3 Fri Day 7 4 7 6 7 7 7 7 6 6 3 Fri Night 7 7 5 5 5 7 5 7 5 5 3 Sat Day 7 5 6 6 5 7 6 5 4 4 3 Sat Night 7 6 5 4 5 7 5 5 5 7 4 Sun Day 5 6 5 7 5 7 6 5 5 5 4 Sun Night 6 5 6 7 5 7 7 7 6 6 4 Mon Day 5 6 5 6 5 7 5 7 6 5 4 Mon Night 4 6 4 6 7 5 6 5 6 7 4 Tue Day 7 6 7 6 7 5 5 6 6 7 4 Tue Night 5 5 5 3 7 5 5 6 6 7 4 Wed Day 6 4 6 5 7 5 5 6 6 5 4 Wed Night 5 7 5 5 5 5 5 6 7 6 4 Thu Day 6 6 4 7 5 5 7 6 7 6 4 Thu Night 7 5 7 4 5 5 7 7 4 6 4 Fri Day 6 7 6 6 5 5 5 7 5 6 4 Fri Night 6 7 5 6 6 5 6 7 6 6 4 Sat Day 7 5 6 5 6 4 7 5 5 6 4 Sat Night 4 5 5 7 6 7 5 5 4 6

Table 4: Time to be Seen Pre-Evaluation Stage Week Day Shift 1 2 3 4 5 6 7 8 9 10 Baseline Sun Day 35 48 55 75 35 44 58 65 67 82 Baseline Sun Night 45 85 64 28 45 62 74 81 35 70 Baseline Mon Day 45 55 71 85 90 65 45 65 74 48 Baseline Mon Night 49 48 67 75 75 65 47 91 80 101 Baseline Tues Day 42 62 55 78 82 48 35 76 59 42 Baseline Tues Night 57 35 83 48 48 39 61 48 90 37 Baseline Wed Day 38 75 81 52 45 67 48 92 81 37 Baseline Wed Night 67 45 92 62 74 45 76 79 100 42 Baseline Thur Day 55 90 64 85 67 67 82 101 37 42 Baseline Thur Night 45 45 57 90 60 72 49 67 63 50 Baseline Fri Day 49 65 45 106 39 85 37 68 74 69 Baseline Fri Night 58 73 102 57 43 100 78 54 60 45 Baseline Sat Day 56 58 57 38 74 85 63 42 47 68 Baseline Sat Night 72 61 63 90 25 90 75 68 75 73 Evaluation Stage Week Day Shift 1 2 3 4 5 6 7 8 9 10 1 Sun Day 78 75 68 90 48 67 52 48 75 90 1 Sun Night 78 68 67 90 84 57 60 43 78 82 1 Mon Day 90 47 59 67 69 73 48 59 83 74 1 Mon Night 67 90 104 74 56 74 46 74 57 55 1 Tue Day 55 70 60 81 43 51 42 90 74 45 1 Tue Night 75 43 85 46 72 90 43 66 51 50 1 Wed Day 50 57 62 75 45 90 47 60 55 41 1 Wed Night 74 85 75 39 64 44 51 54 28 47 1 Thu Day 102 75 86 48 90 67 75 83 74 65 1 Thu Night 28 75 90 111 86 75 46 67 58 74 1 Fri Day 90 45 67 120 75 37 45 91 76 47 1 Fri Night 90 74 35 85 67 63 90 74 65 45 1 Sat Day 78 65 90 100 85 76 47 90 84 95 1 Sat Night 68 75 78 85 76 90 110 68 79 85 2 Sun Day 64 48 75 100 35 42 90 74 60 41 2 Sun Night 41 38 50 75 28 60 35 47 68 74 2 Mon Day 90 45 35 74 60 81 24 81 60 48 2 Mon Night 35 25 70 60 41 80 31 47 66 30 2 Tue Day 90 30 65 74 120 38 101 62 74 60 2 Tue Night 60 45 80 74 52 65 48 91 74 65 2 Wed Day 87 64 75 89 25 75 84 63 47 69 2 Wed Night 45 65 45 35 67 27 54 35 47 60

2 Thu Day 38 68 12 64 74 35 74 60 42 82 2 Thu Night 65 61 90 110 115 45 60 51 76 58 2 Fri Day 91 62 65 48 59 90 110 64 70 65 2 Fri Night 75 67 90 90 74 35 84 62 45 74 2 Sat Day 90 110 85 125 65 84 90 74 65 54 2 Sat Night 65 84 73 90 54 57 60 45 74 54 3 Sun Day 67 45 47 68 90 76 82 47 68 74 3 Sun Night 85 75 64 79 90 110 57 85 67 45 3 Mon Day 90 90 95 75 48 64 72 38 45 27 3 Mon Night 35 38 45 70 60 60 40 38 45 60 3 Tue Day 80 47 90 110 58 76 42 47 90 52 3 Tue Night 37 38 110 90 52 58 74 73 54 95 3 Wed Day 67 85 80 41 37 56 50 48 60 70 3 Wed Night 90 111 50 57 45 60 80 47 84 90 3 Thu Day 90 74 80 51 72 45 74 68 83 80 3 Thu Night 75 80 54 90 110 45 74 65 67 90 3 Fri Day 85 47 67 63 82 90 42 74 45 74 3 Fri Night 67 90 45 40 37 52 60 65 67 64 3 Sat Day 60 65 67 69 63 70 75 72 58 64 3 Sat Night 37 39 45 68 70 80 51 42 74 74 4 Sun Day 75 62 45 80 72 57 67 63 68 74 4 Sun Night 75 45 40 70 64 60 35 54 74 61 4 Mon Day 68 71 75 80 49 53 64 67 65 70 4 Mon Night 83 41 53 61 60 70 45 42 38 33 4 Tue Day 78 79 90 85 95 74 85 47 67 60 4 Tue Night 60 45 70 61 42 80 74 60 70 40 4 Wed Day 70 68 65 49 58 70 63 65 67 72 4 Wed Night 90 65 28 37 45 40 68 45 50 61 4 Thu Day 65 65 74 75 70 53 57 69 74 81 4 Thu Night 85 65 90 37 25 48 40 45 61 55 4 Fri Day 68 74 85 68 49 58 67 78 68 69 4 Fri Night 80 45 38 28 70 60 45 78 37 44 4 Sat Day 90 78 85 68 90 67 85 74 72 85 4 Sat Night 45 64 42 38 45 67 80 34 45 45

Table 5: Time to Decision Pre-Evaluation Stage Week Day Shift 1 2 3 4 5 6 7 8 9 10 Baseline Sun Day 180 195 255 175 300 105 75 300 400 125 Baseline Sun Night 220 195 185 300 210 155 105 90 135 175 Baseline Mon Day 198 155 210 240 180 175 205 215 225 145 Baseline Mon Night 210 250 175 145 210 206 210 280 145 120 Baseline Tues Day 300 155 90 145 210 205 140 126 145 90 Baseline Tues Night 120 145 180 210 205 325 360 185 125 100 Baseline Wed Day 240 205 210 145 185 300 145 160 185 190 Baseline Wed Night 300 210 205 245 135 185 160 165 210 225 Baseline Thur Day 255 185 300 140 95 120 135 145 110 200 Baseline Thur Night 358 210 225 140 180 60 145 150 210 205 Baseline Fri Day 360 250 145 185 300 130 150 145 200 145 Baseline Fri Night 254 175 145 90 125 105 125 145 300 140 Baseline Sat Day 300 210 180 145 130 95 127 145 200 210 Baseline Sat Night 185 300 145 210 205 150 160 150 125 150 Evaluation Stage Week Day Shift 1 2 3 4 5 6 7 8 9 10 1 Sun Day 145 185 165 125 205 210 245 250 125 185 1 Sun Night 245 125 300 165 175 205 210 154 145 200 1 Mon Day 165 185 250 240 125 95 130 145 185 200 1 Mon Night 250 140 255 125 185 175 240 260 145 150 1 Tue Day 300 145 250 145 175 185 215 240 185 220 1 Tue Night 125 145 185 205 210 280 105 95 145 150 1 Wed Day 245 125 85 185 175 240 230 245 225 175 1 Wed Night 175 185 210 240 205 165 135 145 160 225 1 Thu Day 145 185 275 150 145 190 205 240 240 220 1 Thu Night 165 185 150 225 250 280 300 250 165 250 1 Fri Day 95 185 205 210 145 175 135 180 190 145 1 Fri Night 165 145 165 185 205 240 230 145 175 185 1 Sat Day 185 245 240 260 145 185 190 205 225 255 1 Sat Night 175 145 175 190 125 300 125 205 240 225 2 Sun Day 210 165 175 180 150 250 240 230 205 165 2 Sun Night 225 190 245 260 125 135 180 245 185 145 2 Mon Day 300 245 195 205 145 175 190 220 250 265 2 Mon Night 165 190 205 240 185 190 135 255 280 145 2 Tue Day 145 165 210 225 250 145 168 175 240 300 2 Tue Night 185 165 182 148 125 240 260 145 125 145 2 Wed Day 165 200 300 310 400 165 125 140 175 260 2 Wed Night 205 145 225 300 145 185 165 95 250 250

2 Thu Day 225 145 125 185 175 205 240 225 200 145 2 Thu Night 240 160 180 150 135 125 205 145 175 170 2 Fri Day 230 125 95 185 165 145 125 185 190 165 2 Fri Night 165 190 240 250 300 145 190 260 165 250 2 Sat Day 145 125 145 185 125 190 210 230 145 150 2 Sat Night 185 165 185 190 250 260 230 200 145 200 3 Sun Day 190 165 190 300 145 175 205 220 215 230 3 Sun Night 250 145 185 145 125 95 240 150 125 150 3 Mon Day 240 245 125 175 250 260 300 145 255 245 3 Mon Night 260 145 125 180 300 145 250 245 220 120 3 Tue Day 230 200 205 125 168 165 135 245 255 125 3 Tue Night 240 165 145 300 185 205 240 230 225 125 3 Wed Day 125 125 145 205 225 240 185 210 190 195 3 Wed Night 135 225 125 140 250 260 245 235 185 190 3 Thu Day 250 200 145 185 225 145 185 200 165 180 3 Thu Night 165 95 185 204 130 145 120 145 165 185 3 Fri Day 165 150 145 185 204 160 250 300 145 187 3 Fri Night 165 245 125 185 205 235 245 190 200 205 3 Sat Day 400 185 250 135 190 165 210 205 225 210 3 Sat Night 300 195 240 260 175 190 185 240 250 125 4 Sun Day 165 145 185 190 95 145 300 175 145 120 4 Sun Night 245 120 150 160 280 190 205 300 145 200 4 Mon Day 155 147 205 240 250 165 180 300 145 140 4 Mon Night 185 205 210 165 175 250 300 175 260 280 4 Tue Day 120 145 180 165 185 150 210 205 200 145 4 Tue Night 245 125 175 180 190 245 250 300 400 256 4 Wed Day 300 145 260 195 280 175 300 250 204 125 4 Wed Night 265 245 185 190 305 145 160 250 245 190 4 Thu Day 240 120 125 130 185 195 205 225 145 185 4 Thu Night 245 240 185 190 200 305 175 165 190 240 4 Fri Day 300 245 250 210 185 260 240 135 175 185 4 Fri Night 225 150 210 245 260 185 300 145 210 222 4 Sat Day 222 145 105 95 240 135 280 250 245 145 4 Sat Night 210 245 225 185 260 300 285 145 205 210

Problem Setting: The Smith Clinic has recently decided to pursue a total quality of care initiative in the emergency department (ED) where customer input is a vital portion of the equation. In doing so, management has decided to use statistical process control tools as a mechanism to determine where or if there are any issues in the current system. The main customer-related metrics under consideration are customer satisfaction, evaluation of the quality of care, the time it takes to be seen by the medical staff and the time it takes for a final decision to be made i.e., admitted, released, etc.). The data are collected by a third party organization via telephone interviews with respondents identified from hospital records so as to ensure the matching of the patient to the specific visit date time (see Table 1 for the description of the items being assessed). The emergency department currently is staffed by two 'crews' whereby there is a day team and a night team. The data on each of the metrics is shown in Tables 2-5 and is denoted as being attributable to either of the crews. Your job as the newly appointed quality champion is to make an assessment of the current status of the initiative while offering specific recommendations for what (if anything) needs to be done. In your answer, you would be expected to address both the current SPC system as well as any potential changes you think would benefit the clinic. Specifically, you should, at a minimum, generate the following: 1. Control charts for each relevant metric across shifts 2. Control charts for each relevant metric per shift 3. A series of recommendations as to what, potentially, needs to be done in this instance Problem Setting: The Smith Clinic has recently decided to pursue a total quality of care initiative in the emergency department (ED) where customer input is a vital portion of the equation. In doing so, management has decided to use statistical process control tools as a mechanism to determine where or if there are any issues in the current system. The main customer-related metrics under consideration are customer satisfaction, evaluation of the quality of care, the time it takes to be seen by the medical staff and the time it takes for a final decision to be made i.e., admitted, released, etc.). The data are collected by a third party organization via telephone interviews with respondents identified from hospital records so as to ensure the matching of the patient to the specific visit date time (see Table 1 for the description of the items being assessed). The emergency department currently is staffed by two 'crews' whereby there is a day team and a night team. The data on each of the metrics is shown in Tables 2-5 and is denoted as being attributable to either of the crews. Your job as the newly appointed quality champion is to make an assessment of the current status of the initiative while offering specific recommendations for what (if anything) needs to be done. In your answer, you would be expected to address both the current SPC system as well as any potential changes you think would benefit the clinic. Specifically, you should, at a minimum, generate the following: 1. Control charts for each relevant metric across shifts 2. Control charts for each relevant metric per shift 3. A series of recommendations as to what, potentially, needs to be done in this instance