Abstract
Objectives
To improve the quality of intrauterine device (IUD) services at Title X clinics.
Study Design
Failure Modes Effects and Criticality Analysis (FMECA) is a step-by-step approach,
adopted for healthcare, in which team members evaluate the systems and processes of
a specific type of clinical care (e.g., IUD care) in order to identify practices that
contribute to poor quality, unsafe, unreliable, or inefficient care. These weaknesses
are termed “failures.” The FMECA uses qualitative (e.g., meetings) and quantitative
(e.g., clinical operations) data to determine failure frequency and impact in order
to prioritize the parts of a clinical care system or process to be redesigned and
improved.
An FMECA was conducted in three community-based Title X family planning clinics on
the South and West Sides of Chicago, IL with all care team members; IUD clients were
also interviewed regarding their visit. Clinic administrative data was also assessed
to determine the frequency and impact of the identified failures.
Results
After combining the FMECA and clinical operations data, “critical” areas across all
three clinics were: (1) client does not show up for or cancels appointment; (2) client
is ineligible for an IUD insertion due to unprotected intercourse; and (3) limited
time for counseling, informing, and placing IUDs. As most insertions were successful,
failed IUD insertion was not considered a high-risk failure.
Conclusions
This process revealed that the failures most in need of improvement and redesign were
the scheduling and intake processes and the lack of time for counseling during certain
types of visits.
Implications
A systematic assessment of the underlying problems in IUD-care revealed three important
issues across three clinics: (1) client does not show up for appointment or cancels
appointment; (2) client recently had unprotected intercourse; and (3) limited time
for counseling, informing, and placing IUDs.
Keywords
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Article info
Publication history
Published online: July 01, 2014
Accepted:
June 17,
2014
Received in revised form:
June 15,
2014
Received:
April 22,
2014
Footnotes
☆This research was funded by FPRPA006053 (PI: Gilliam) from the Office of Population Affairs. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. During preparation of the manuscript, Summer Martins was supported by T76-MC00005 (PI: Hellerstedt) from the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
