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here are many different perspectives and measurements when it comes to quality and quality of care, especially in healthcare organizations (HCOs). In the provided study, the health plan is required to provide transportation for members to and from all medical appointments and services. Unfortunately, members are either not being picked up or are not on time to their appointments which are called “interrupted trips” due to the scheduling of health plan employees. According to Ozcan (2017), this would be measured as miss-utilization in which, healthcare providers, or employees of the health plan in this case are causing harm to the quality of care for members. It results in poor outcomes, negligent care, a waste of resources and increase in stays or appointments for those members. Also, it leads to poor satisfaction and potential loss of trust for those members.

The facility can reduce the number of interrupted costs by implementing methods such as quality control (QC), total quality management (TQM), continuous quality improvement (CQI), reengineering and Six-Sigma. While each method may be effective, Six-Sigma is a quality improvement concept that has a goal of significantly reducing the chances of an error or problem. In this situation, the problem of interrupted trips and the goal would be to reduce the number of interrupted trips to a minimum or even zero. Six-Sigma will help improve service costs, service delivery and patient satisfaction in quality of care. What this method will do is help improve the knowledge and capabilities of employees in the health plan department. They will be able to improve in scheduling transportation for members which will decrease the number of interrupted visits. 

The interrupted trips that have occurred for these health plan members can have an impact on perceived quality of care. According to Berwick (2001), there are six dimensions of quality in healthcare which include: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Based on these dimensions and the problem of interrupted trips, the dimensions to be impacted would be effectiveness, patient-centeredness, timeliness and efficiency. The HCO would have little to no effectiveness or efficiency of the transportation and resources regarding that because patients aren’t able to make it to their appointments, resulting in a waste of money, time and resources. In terms of timeliness, patients are not making it to their medical appointments on time or at all, and some of those appointments may put the patient at risk of harm or even death. Lastly, patient-centeredness would be significantly impacted, patients will not feel like they are respected and will feel neglected. Employees may not be taking the necessary time to schedule transportation on time for patients and this will be detrimental to the HCO and patients. All in all, the quality of care will drop significantly from the standpoint of the HCO and patients alike. 


Prospective health plan should review Department of Medical Assistance Services (DMAS) service record and reviews. Also, health plan should conduct discussions with transportation services to share our vision and expectations. Discussions should focus on concern regarding “interrupted trips”.  Questions should be raised regarding reasons for this issue. Is it staffing issue? If so, how is the matter being addressed? Should more qualified individuals be hired? DMAS must work with human resources to gather additional transportation drivers. Is staff trained to drive patients to certain appointments? For example, COPD patients carry portable oxygen machines. Some drivers may not want to be responsible if patient needs help with portable machine. Training should be scheduled for all drivers to learn how to communicate with patients, how to assist them when arriving at the appointment and taking patient to their destination. I would suggest including a clause in the contract regarding their accountability. The intent is to ensure our patients do not miss scheduled appointment. 

If necessary, incorporate a backup plan. Backup plan is our right to have an additional transportation service to avoid organization incompetence.  Offer DMAS a trial period for their services, monitor daily trip activity to ensure 100% satisfaction. Designate a point person to maintain contact with DMAS to report issues. Interrupted chips leads to health plan’s reputation are affected, patient confidence lessens, and DMAS’ behavior decreases quality of care unfavorably. 

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