| Course | IHP 435 Performance Improvement Measurement and Methodologies |
|---|---|
| Module | Module 4 |
| Paper type | project one improvement methodology selection |
| Length | About 1,000 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | BS Healthcare Administration |
| Updated | September 2026 |
Free sample paper for IHP 435 Module 4
Project One: Selecting an Improvement Method for Emergency Department Door-to-Provider Time
[Student Name]
Southern New Hampshire University
IHP 435: Performance Improvement Measurement and Methodologies
Project One
[Instructor Name]
[Date]
Project One: Selecting an Improvement Method for Emergency Department Door-to-Provider Time
Cedar Point Medical Center's emergency department takes a median of 42 minutes from a patient's arrival to the first evaluation by a provider, and about 4.5% of patients leave before being seen. Leaders have asked for an improvement project and have heard of several methods: PDSA, Lean and Six Sigma. The choice matters, because each method is built for a different kind of problem. This project describes the problem's character, compares the three methods against it, selects one with the reasoning shown and outlines the initial changes, measures and risks.
Understanding the Problem First
A team of the registration supervisor, a triage nurse, an emergency physician and a quality analyst built a value stream map by following twenty walk-in patients from the door to the provider and timing each step. The map showed that the steps adding value to the patient, triage assessment and the provider's evaluation, took a median of about nine minutes combined. The remaining time was spent waiting: in line at registration, in the waiting room after triage and in a treatment room before the provider arrived. Batching was common; the triage nurse often waited to call several patients at once, and rooms were cleaned in groups. Demand peaked between 11 a.m. and 9 p.m., while staffing was spread evenly across the day.
The problem, in other words, is mostly about flow and waste: delays between steps, batching and a mismatch between demand and capacity.
Comparing the Methods
PDSA is a method for learning quickly through small tests of change; it fits problems where the team has ideas but does not yet know which will work. Lean, which grew out of Toyota's car plants, centers on identifying the steps that add value for the customer, removing waste such as waiting and unnecessary movement and creating smooth flow matched to demand. Six Sigma is a data-intensive method for reducing variation and defects in a well-defined process, using statistical analysis to find root causes, and it fits problems where a process sometimes produces good results and sometimes fails unpredictably. Table 1 compares their fit to this problem.
Table 1. Method Fit for the Door-to-Provider Problem
| Method | Built for | Fit with this problem | Role in the project |
|---|---|---|---|
| PDSA | Rapid learning through small tests | Good for testing each change | Testing engine for changes |
| Lean | Removing waste and improving flow | Strong: delays are waiting and batching | Primary method |
| Six Sigma | Reducing variation and defects | Weak: problem is delay, not defects | Not selected now |
Note. Fit is judged against the value stream map findings.
Why Lean
Lean fits because the value stream map shows a flow problem dominated by waiting and batching. Its tools, such as value stream mapping, standard work, visual management and matching capacity to demand, address exactly those features. Six Sigma would be a poor first choice: the issue is not that registration or triage produces defects at variable rates, but that patients wait between steps. PDSA alone would help the team test ideas, but it does not supply the framework for seeing waste and redesigning flow. The project therefore uses Lean as its primary method, with PDSA cycles as the way to test each Lean change on a small scale.
What the Evidence Says About Lean in Emergency Departments
Holden (2011) critically reviewed studies of Lean in emergency departments. Most reported improvements such as shorter waits, reduced length of stay and fewer patients leaving without being seen, and some reported better staff experience. However, nearly all studies used before-and-after designs without comparison groups, and many described Lean as a set of tools rather than a management philosophy, which may limit how long improvements last. Holden called for stronger evaluation and attention to how Lean affects staff.
Mazzocato et al. (2010) conducted a realist review asking not only whether Lean works but how. They identified mechanisms through which Lean produces change: helping staff understand processes as a whole, organizing work to support flow, improving the detection and prevention of errors and building problem-solving habits among frontline staff. They emphasized that context, including leadership support and staff involvement, shapes whether these mechanisms operate.
A Note of Caution
DelliFraine et al. (2010) systematically reviewed health care studies of both methods and concluded that the evidence was weak: few studies used rigorous designs, and most were case reports from single organizations, often written by the people who led the projects. The review does not mean Lean fails, but it does mean Cedar Point should not assume success. The project must measure carefully, over time, with balancing measures.
Initial Changes
Three Lean changes will be tested first, each through PDSA cycles. First, a split-flow model in which a triage nurse and a provider see lower-acuity patients together at the front, reducing waits between triage and evaluation. Second, quick registration at arrival with full registration completed at the bedside, removing the front-desk line. Third, shifting one provider shift to begin at 11 a.m. to match demand. Visual boards showing waiting patients and room status will support flow.
Measures
The primary process measure is median door-to-provider time, plotted weekly on a run chart. Outcome measures are the walkout rate before a provider evaluation and patients' own ratings of their wait. A structure measure is provider hours during peak periods. Balancing measures are the 72-hour return rate and staff overtime, since faster front-end flow could lead to rushed evaluations or longer shifts.
Risks
The main risks are treating Lean as a set of quick tools, staff perceiving the changes as speed-ups imposed from above and gains fading after the project team moves on. The project addresses these by involving frontline staff in mapping and design, focusing on removing waiting rather than making staff work faster and building daily huddles around the visual boards so problems are solved as they arise.
Conclusion
The door-to-provider problem is a flow problem, so Lean is the right primary method, with PDSA cycles to test each change. The evidence supports Lean's promise in emergency departments while warning that results depend on context and careful measurement, which the project builds in from the start.
References
DelliFraine, J. L., Langabeer, J. R., & Nembhard, I. M. (2010). Assessing the evidence of Six Sigma and Lean in the health care industry. Quality Management in Health Care, 19(3), 211-225. https://doi.org/10.1097/QMH.0b013e3181eb140e
Holden, R. J. (2011). Lean thinking in emergency departments: A critical review. Annals of Emergency Medicine, 57(3), 265-278. https://doi.org/10.1016/j.annemergmed.2010.08.001
Mazzocato, P., Savage, C., Brommels, M., Aronsson, H., & Thor, J. (2010). Lean thinking in healthcare: A realist review of the literature. Quality and Safety in Health Care, 19(5), 376-382. https://doi.org/10.1136/qshc.2009.037986
What the IHP 435 Module 4 instructions ask for
Project One in IHP 435 usually asks you to select an improvement methodology for a defined problem and justify the choice. Expect four to six APA 7 pages. Describe the problem with data, ideally from a process map, and characterize it: is it about learning what works, about waste and flow or about variation and defects? Compare at least two methods against that character, choose one with the reasoning shown and support the choice with research. Outline initial changes, a measure set with a balancing measure and risks. Instructors reward papers where the reasoning, not the label, carries the argument, so show your comparison clearly. IHP 435 graders notice clean headings in IHP 435 papers.
How this IHP 435 Module 4 project one example is built
This project addresses a 42-minute median door-to-provider time in a composite emergency department. A value stream map of twenty patients shows about nine minutes of value-adding care, with the rest spent waiting and batching. A table compares PDSA, Lean and Six Sigma, and Lean is selected as the primary method with PDSA as the testing engine. Holden's critical review finds Lean often shortened emergency waits despite weak designs, Mazzocato and colleagues explain how Lean works and DelliFraine and colleagues caution that evidence is limited. Initial changes include split flow, quick registration and demand-matched staffing, with a full measure set and risks. IHP 435 students can reuse this structure for IHP 435 work. IHP 435 claims here trace to cited IHP 435 sources.
Where the IHP 435 Module 4 rubric puts the points
Methodology selection projects in IHP 435 are typically marked on how well the problem is characterized with data, the fairness of the method comparison, the logic of the choice, use of evidence, the quality of initial changes, the measure set and attention to risks, plus scholarly support and APA 7. Strong papers let a process map reveal the problem's character and match the method to it, while acknowledging limits in the evidence. Papers lose points when they choose a method because it is popular, describe methods without comparing fit or skip balancing measures. Combining a primary method with PDSA for testing is often credited when explained. IHP 435 marks favor careful formatting across IHP 435 sections. IHP 435 citations keep every IHP 435 argument credible.
IHP 435 Module 4 help: the mistakes that cost points
In IHP 435, Project One often loses points for choosing a method before understanding the problem, for one-sided evidence, for vague changes and for measures without a balancing check. Another common gap is confusing Lean's waste focus with Six Sigma's variation focus. Map the process, describe the problem's character, compare methods explicitly, justify the choice with evidence and outline changes, measures and risks. If your problem involves errors or defects rather than delays, add details to your IHP 435 notes and the analysis may lead to a different method. IHP 435 drafts start well from a IHP 435 outline. IHP 435 feedback already received guides IHP 435 revisions.
Get IHP 435 Module 4 written to your instructions
Send the IHP 435 Project One guidelines and the problem you are addressing. The paper will characterize the problem with data, compare methods against it, justify the choice with evidence and outline changes, measures and risks, within 24 to 48 hours, free the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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IHP 435 Module 4 questions, answered
Where can I find a free IHP 435 Module 4 Project One sample?
The full project appears here: choosing Lean for an emergency department door-to-provider problem, with a value stream map and method comparison.
When should a team choose Lean?
When the problem is mainly about waste and flow, such as waiting between steps, batching and mismatched capacity.
When is Six Sigma the better choice?
When a defined process produces defects or results that vary unpredictably and statistical analysis can find the causes.
Does Lean work in emergency departments?
Reviews report shorter waits and length of stay in many projects, but most studies use weak designs, so careful measurement is needed.
What is a value stream map?
A diagram of every step a patient passes through, with times, that separates value-adding steps from waiting and other waste.