| Course | HLTH 4393 Quality Management for Healthcare Administrators |
|---|---|
| Module | Module 4 |
| Paper type | Improvement plan using PDSA and Lean |
| Length | 1,170 words, about 4 pages plus title and reference pages |
| Format | APA 7 student paper |
| School | American College of Education |
| Program | B.S. in Healthcare Administration |
| Updated | September 2026 |
Free sample paper for HLTH 4393 Module 4
A Clock on the Tracking Board and a Printer on the Cart: Planning PDSA Cycles and Lean Changes for Emergency Troponin Turnaround
Student Name
American College of Education
HLTH4393: Quality Management for Healthcare Administrators
Module 4 Assignment
Instructor Name
October 26, 2026
Where the Plan Starts
The analysis in the previous module showed that emergency troponin turnaround at our composite community hospital is stable at about 58% of results within an hour of the order, well short of the 90% target, and that late second draws and specimens held before sending together explain 60% of late results. Because the process is stable, the plan cannot rely on effort; it must change the process. This paper sets out the aim, the method and the first tests of change.
The aim is specific: by the end of March, 90% of emergency department high-sensitivity troponin results will be reported within 60 minutes of the order, measured weekly on the existing p-chart, without the hemolysis rate rising above its current 2.8%.
Choosing the Methods
Two methods fit the problem. Lean thinking looks for waste in a process, such as waiting, unnecessary motion and batching, and removes it. Most of the delay in this process is exactly that: nurses walking to a distant printer, specimens waiting in a basket and second draws waiting for someone to remember. Holden (2011), reviewing 18 articles on Lean in 15 emergency departments, found that patient care usually improved after implementation, with many departments reporting shorter length of stay and waiting times, and identified employee involvement, management support and preparedness for change as factors in success. He also noted that effects on staff were rarely measured, a gap this plan addresses.
Lean identifies what to change, and the plan-do-study-act cycle provides the way to test each change. Six Sigma was considered but set aside: its statistical tools suit processes that are already reasonably capable and need variation reduced, whereas this process needs its structure changed first.
Doing PDSA Properly
The plan-do-study-act cycle is widely used and often poorly applied. In a systematic review of 73 articles reporting its use in health care, Taylor et al. (2014) found that only 14 of the 73 described a real series of repeated cycles, that many skipped the idea of testing small before testing big, and that just 7 of the 47 studies detailed enough to judge fed the cycles with numbers gathered monthly or more often. This plan is built to avoid those failings. Every cycle states a prediction before it starts, begins on a small scale, uses data collected at least daily and ends with a written verdict on the change, whether it stays as tested, gets reworked or is abandoned, before the next cycle is allowed to start. A PDSA cycle without a prediction is just a change with a report attached.
Change One: A Timed Second Draw
The first change addresses the largest cause. The pathway's second troponin will be built as a timed order that is placed with the first and becomes due exactly two hours after the first specimen's collection time. When the order is placed, a clock icon will appear on the emergency department tracking board beside the patient's name, turning yellow at 15 minutes before the draw is due and red when it is due.
Cycle 1 will test the change for one week on day shift in one of the department's three pods, about 40 patients. The prediction is that the share of second draws collected within ten minutes of the due time will rise from about half to at least 80%. The nurses in the pod will record, on a simple sheet, any time the icon was missed or wrong. If the prediction holds, Cycle 2 will extend the change to the whole department on day and evening shifts for two weeks, predicting that second-draw results meeting the 60-minute standard will rise from 49% to 75%. Cycle 3 will add night shift, where the single phlebotomist may need the icon to show on the laboratory's collection list as well.
Change Two: Label and Send at the Bedside
The second change removes two forms of waste identified on the process map: the walk to the central printer and the batching of specimens. Two portable label printers will be mounted on collection carts, one assigned to the hallway beds, so that labels print where the blood is drawn. At the same time, the department will adopt a standard of sending every troponin specimen through the tube within five minutes of collection, and the basket beside the central printer will be removed.
Cycle 1 will run on the hallway cart for one week on evening shift, predicting that the median time from collection to laboratory receipt for hallway patients will fall from 15 minutes to under eight. The team will also ask the nurses who use the cart whether it saves or costs them time, because a change that adds work to already busy nurses will not last. If the result holds, the second cart will follow, and the tube station sharing at night will be reviewed with facilities.
Change Three: Testing Venipuncture for Troponin Draws
Hemolysis redraws were a smaller cause of late results but add a needle stick and the longest delays. In a crossover comparison, Lowe et al. (2008) found far fewer hemolyzed samples when nurses drew blood by venipuncture than through intravenous catheters, and this hospital's own data showed the same pattern. A single cycle will test drawing second troponins by venipuncture in one pod for two weeks, predicting hemolysis for those specimens will fall below 1%. Because venipuncture takes longer and adds a stick for the patient, the cycle will also track collection time and ask patients about their experience before any wider adoption.
Measurement, Roles and Timeline
The primary measure will remain on the weekly p-chart, and daily data for each cycle will be kept on run charts in the break room, so the team and staff see results as they happen. A shift below the baseline center line in the hemolysis rate, or above it in length of stay, would stop the relevant cycle for review. The team is co-led by the emergency nurse manager and laboratory supervisor, with an informatics analyst for the timed order and the tracking board. The first cycles begin in November; the timed order requires about three weeks of build and testing. By the end of January the team expects all three shifts to be using the timed order and both carts, which leaves February and March to judge from the p-chart whether the process has shifted to a new level. Because Holden found that the effects of Lean on staff were rarely measured, the team will also ask emergency nurses and laboratory staff three short questions at the end of each cycle: whether the change saved or cost them time, whether it made their work harder to finish, and whether they would keep it. A change that improves turnaround but leaves nurses further behind on other care will be adapted before it spreads, and the answers will be reported to the quality committee alongside the p-chart.
References
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
Lowe, G., Stike, R., Pollack, M., Bosley, J., O'Brien, P., Hake, A., Landis, G., Billings, N., Gordon, P., Manzella, S., & Stover, T. (2008). Nursing blood specimen collection techniques and hemolysis rates in an emergency department: Analysis of venipuncture versus intravenous catheter collection techniques. Journal of Emergency Nursing, 34(1), 26-32. https://doi.org/10.1016/j.jen.2007.02.006
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862
Reading the HLTH 4393 Module 4 instructions
HLTH 4393 Module 4 usually asks you to turn an analysis into a plan for improvement using a named method. Most prompts ask for an aim statement, a choice of method such as PDSA, Lean, Six Sigma or a combination, the specific changes you will test, how you will measure results and a timeline with responsibilities. Some versions require a PDSA worksheet or a list of cycles; others ask you to compare two methods before choosing one. Graders expect the changes to follow from causes you have already identified, so refer back to your earlier data. Keep the first tests small and write down what you predict will happen. Look at Canvas for whether a Gantt chart or driver diagram is required as an appendix.
How the HLTH 4393 Module 4 example is put together
This model plan starts from the stable but poor baseline and writes an aim that is specific, dated and protected by a balancing measure. It chooses Lean to find waste and PDSA to test changes, supports the choice with a review of Lean in emergency departments and explains why Six Sigma was set aside. A section on doing PDSA properly draws on a systematic review of how the method is misapplied and sets rules for this plan. Each of three changes is specified in detail and tested in sequenced cycles, from one pod to the whole department, with a numerical prediction for each. The paper ends with how data will be displayed, when a cycle stops, who leads and when each step happens.
Where the points sit in the HLTH 4393 Module 4 rubric
Improvement plan rubrics usually reward an aim that is specific and measurable, changes that follow from the analysis, correct use of the chosen method and a feasible implementation plan. The aim criterion checks for a number, a date and a measure. Graders look for changes tied to causes found earlier, not a list of good ideas. The method criterion rewards PDSA cycles with predictions, small initial scale and planned iteration, or Lean tools applied to named forms of waste. Measurement earns points when primary and balancing measures are both included. Feasibility covers roles, resources and a timeline. Support from quality improvement literature and APA 7 formatting complete the scoring in most sections.
HLTH 4393 Module 4 help from the desk
Plans often lose points by describing a single large change launched everywhere at once, which is not a PDSA cycle at all. Another common error is an aim like improve turnaround time with no number or date. Students also name Lean or Six Sigma without applying any of their tools, or pick a method that does not fit the problem. Write a prediction for every cycle, since the study step compares results against it. Plan how staff will experience the change, because changes that add work tend to fade. Include a balancing measure. If you are planning improvements for falls, discharge delays or clinic no-shows instead, send your analysis and prompt, and we will draft a Module 4 plan built on your findings.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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HLTH 4393 Module 4 questions, answered
What does HLTH4393 Module 4 usually ask for?
In many sections, the fourth HLTH4393 module asks you to plan an improvement using a recognized method such as PDSA, Lean or Six Sigma, with an aim statement, specific changes, tests of change, measures and a timeline. Your classroom's instructions decide the method.
How do you write a PDSA cycle?
State the change and a prediction, run it on a small scale, collect data during the test, compare results with the prediction, and decide whether to adopt, adapt or abandon the change before the next cycle.
When should you use Lean instead of Six Sigma?
Lean suits processes full of waiting, motion and batching that need restructuring; Six Sigma suits processes that already work reasonably well and need variation reduced.
Where can I find a free HLTH 4393 Module 4 sample paper?
Right here. The complete Module 4 improvement plan for emergency troponin turnaround is on this page, with the aim statement, three changes, sequenced PDSA cycles with predictions and a measurement timeline.
Why do PDSA projects often fail?
Reviews show many skip predictions, test changes at full scale at once, run a single cycle rather than a sequence, or collect data too rarely to guide the next step.