| Course | HC 405 Healthcare Quality |
|---|---|
| Unit | Unit 7 |
| Paper type | Small test of change log |
| Length | About 1,020 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BS in Healthcare Administration |
| Updated | October 2026 |
Free sample paper for HC 405 Unit 7
One Technician, One Shift, Then Wider: A Test of Change Log for Flagging Fragile Accesses and Staggering Second-Shift Starts at Gulfview Kidney Center
Student Name
Health Care Administration, Herzing University
HC 405: Healthcare Quality
Instructor Name
February 26, 2026
One Technician, One Shift, Then Wider: A Test of Change Log for Flagging Fragile Accesses and Staggering Second-Shift Starts at Gulfview Kidney Center
Aim
Reduce vascular access events that reach Gulfview Kidney Center's second-shift patients from about 2.9 a month, the 2025 average, to one or fewer a month by June 30, 2026, without increasing the time second-shift patients wait to start treatment.
Measures Collected During the Tests
Outcome: second-shift vascular access events reaching a patient, counted from event reports and confirmed with the charge nurse at the end of each test day. Process: share of flagged accesses with a tag at the station when the second-shift patient arrived; number of changeovers in which a technician had to put one patient on the machine while a second of their own patients was waiting to be taken off. Balancing: minutes from scheduled chair time to the start of treatment for second-shift patients, taken from machine start times. Counts are collected by hand on a one-page sheet by the charge nurse during each test, because the tests are too short for monthly data to show anything. The cycles follow the plan, do, study, act structure of the Model for Improvement (Langley et al., 2009).
Cycle 1: Fragile Access Tag, One Technician, One Shift
Change tested: at the end of the first shift, the first-shift technician places an orange tag on the station of any second-shift patient whose chart lists a new or difficult access. The second-shift technician reads the tag and either asks a senior technician to cannulate or uses the portable ultrasound.
Who and how long: one second-shift technician and the first-shift technician on the same row, Monday, February 2.
Prediction, written before the test: all flagged patients will have a tag, and the second-shift technician will change approach for each one.
What happened: four patients on the row had flagged accesses; three were tagged. The first-shift technician forgot the fourth while handling an alarm. The second-shift technician used the ultrasound for one tagged patient and asked the senior technician to cannulate another. No access events occurred.
Conclusion: the tag works when placed, but depends on memory at a busy moment. Adapt: add tag placement to the first shift's end-of-shift checklist.
Cycle 2: Tag With Checklist, All Second-Shift Technicians, One Week
Change tested: the tag, with a line on the first-shift closing checklist requiring the technician to confirm tags against the flagged list.
Who and how long: all four second-shift technicians and their first-shift counterparts, February 9 to 13.
Prediction: at least 90% of flagged sessions will be tagged; access events will be fewer than the usual one a week.
What happened: 25 of 27 flagged sessions were tagged, 93%. One infiltration occurred, in a patient whose new fistula had not been flagged in the chart at all.
Conclusion: the tag holds up across a full week. The single event came from a gap upstream, a new fistula not yet flagged. Adapt: the vascular access coordinator will flag every access in its first eight weeks of use automatically, and the charge nurse will read the flagged list aloud at the shift-change huddle.
Cycle 3: Staggered Starts, One Technician, One Shift
Change tested: the four patients assigned to one second-shift technician start in two pairs, 15 minutes apart, rather than all at once.
Who and how long: one technician, Monday, February 16.
Prediction: the technician will never be connecting one patient while another of theirs is ready to come off, and the second pair will start no more than 15 minutes later than usual.
What happened: no overlaps occurred. But the second pair started 18 minutes later than usual, not 15, because the first shift on that row ended late, and one patient in the second pair complained about the wait.
Conclusion: staggering removes the overlap, but only if the first shift's end times are also staggered; otherwise the delay moves to the patients. Adapt: stagger the end of the first shift on the same row to match.
Cycle 4: Staggered Starts and Ends, Two Technicians, One Week
Change tested: paired starts for two second-shift technicians, with the first-shift patients on their rows scheduled to finish in matching pairs.
Who and how long: two technicians, February 23 to 27.
Prediction: overlaps in no more than one of ten changeovers; no increase in average wait to start.
What happened: one overlap in ten changeovers, when a first-shift treatment ran long after a low blood pressure episode. No access events on the two rows. Average wait to start for the second-shift patients on these rows was 11 minutes, compared with 13 minutes in the week before. Both technicians said the changeover felt calmer.
Conclusion: adopt for the two rows, and widen to all four second-shift technicians in March, keeping the same measures. Before widening, the charge nurse will review the first-shift schedule for the other two rows, since staggered ends there require moving two first-shift patients by 15 minutes, which each has agreed to try for a month.
A note on what the four cycles did not test: neither change addresses experience levels on the second shift, which the fishbone analysis identified as a contributing cause. Moving a senior technician to the second shift is a scheduling decision with wider effects on staff and is being discussed separately with the facility administrator, rather than tested informally, because it changes people's working hours.
What the Log Shows So Far
Four cycles in four weeks produced two changes that appear to work and one upstream fix, flagging every new fistula automatically, that the team would not have found without a small test. The numbers are too small to prove an effect: a week with no events could happen by chance. The monthly count of second-shift events from March onward, plotted against the 2025 average, will show whether the changes reduce events on a scale that matters. The changes are consistent with national guidance on careful assessment of new and difficult accesses (Lok et al., 2020) and with published evidence that most dialysis errors happen in the minutes just before and just after the session itself (Gu et al., 2014).
References
Gu, X., Itoh, K., & Suzuki, S. (2014). An error taxonomy system for analysis of haemodialysis incidents. Journal of Renal Care, 40(4), 239-248. https://doi.org/10.1111/jorc.12081
Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.
Lok, C. E., Huber, T. S., Lee, T., Shenoy, S., Yevzlin, A. S., Abreo, K., Allon, M., Asif, A., Astor, B. C., Glickman, M. H., Graham, J., Moist, L. M., Rajan, D. K., Roberts, C., Vachharajani, T. J., & Valentini, R. P. (2020). KDOQI clinical practice guideline for vascular access: 2019 update. American Journal of Kidney Diseases, 75(4, Suppl. 2), S1-S164. https://doi.org/10.1053/j.ajkd.2019.12.001
The Herzing HC 405 Unit 7 instructions
Unit 7 asks you to keep a log of small tests of change. Expect an aim, measures, and for each cycle the change, who and how long, the prediction, what happened, what was learned and the next step. Students often ask how small a test should be. Start with one person on one shift, then widen only when the change works. Write a prediction before each test, since comparing results with predictions is how teams learn. Collect simple data during the test, such as whether the tag was placed. Include a balancing measure so a gain does not create a new problem. Let each cycle's lessons shape the next one.
How the HC 405 Unit 7 example is put together
The log opens with the aim, its baseline and its deadline. The measures section lists events reaching patients, the share of flagged accesses tagged and changeover time. Cycle 1 records that the tag was placed for most flagged patients but missed when the first-shift technician was busy. Cycle 2 adds a checklist line and records tagging at 93% across all four rows. Cycle 3 finds that staggering one technician's starts by 15 minutes eased the rush without delaying the shift. Cycle 4 matches first-shift finishes to second-shift starts for two technicians and notes one problem with patient transport. The summary reports two changes ready to spread and one upstream fix discovered along the way.
HC 405 Unit 7 rubric: what full points look like
Herzing's rubric for a test of change log usually covers the aim, measures and the structure of each cycle. Predictions written before each test and lessons that shape the next cycle carry the most weight, because they show learning rather than activity. Aim points reward a measurable target, baseline and date. Measure criteria look for outcome, process and balancing types. Cycle credit goes to a clear change, scope, prediction, result and next step. Scale points reward starting small and widening only when results support it. The summary should state what is ready to spread. The log draws on The Improvement Guide by Langley and colleagues, the Gu dialysis error taxonomy and the 2019 KDOQI access guideline.
Common HC 405 Unit 7 mistakes, and how to avoid them
Test logs in HC 405 Unit 7 commonly lose points by skipping predictions. Another frequent problem is starting with the whole unit instead of one person. Students often record what happened without saying what was learned. Balancing measures are missing. Cycles repeat the same test without change. Data are collected loosely or not at all. The next step does not follow from the result. The aim has no date. Staff who ran the test are not asked what they noticed, though their observations often explain results the numbers cannot. Finally, let each cycle teach the next, because graders reward a log that shows a team getting smarter with every test rather than simply staying busy.
Get a HC 405 Unit 7 example written to your instructions
Send the Unit 7 instructions and the rubric from your HC 405 classroom, plus the process and the change your section wants tested. We write a custom example with a measurable aim, three cycles in identical blocks, predictions recorded ahead of results and a decision at the end, back in 24 to 48 hours. The first custom sample is free.
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- HC 405 Unit 4: Patient satisfaction review
- HC 405 Unit 5: Incident trend summary
- HC 405 Unit 6: Fishbone diagram analysis
- HC 405 Unit 8: Improvement pitch memo
- HA 630 Unit 7: Service line growth plan
- HA 635 Unit 7: Turnover and retention study
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HC 405 Unit 7 questions, answered
How small should the first cycle be?
Smaller than instinct suggests. One person, one shift, five patients is a perfectly respectable first cycle, and its purpose is to find out whether the change is even workable before anybody invests in it. Small tests fail cheaply and produce learning fast. A first cycle covering a whole unit for a fortnight has skipped the stage the tool was designed around.
Do I have to actually run the cycles?
Read your instructions, since some sections expect a planned log and others want a test you genuinely carried out. Where the cycles are planned rather than run, say so plainly and write the predictions as predictions. Never present a planned cycle as though results came back, because invented data is the one failure that cannot be repaired by rewriting.
What goes in the study step?
The comparison between what you predicted and what happened, followed by what that difference teaches. Most drafts write down what occurred and stop, which leaves out the reasoning. Two or three sentences are enough: the prediction, the result, the gap between them, and what the gap suggests about the change or about the process you were testing it on.
Where can I find a free HC 405 Unit 7 sample paper?
The full HC 405 Unit 7 small test of change log is free on this page, four PDSA cycles at a dialysis center with predictions, results and lessons. A log for another improvement can be written to order.
What is a PDSA cycle?
Plan, Do, Study, Act: plan a small test with a prediction, run it, study the results against the prediction and act on what was learned. This sample logs four cycles that widen step by step.