IHI QI 102 (created by me)

The Model for Improvement begins with three questions designed to clarify the following concepts: a. Mission, goal, strategy b. Will, ideas, and execution c. Aims, measures, changes d. Plan, do, act

c. Aims, measures, changes

TRUE OR FALSE: When testing changes, you should be sure to gain consensus and buy-in from all the people who would eventually be affected by the change. True False

False

TRUE OR FALSE: You and your team should reflect on the results of every change. False True

True

Aim Statement #1:We aim to reduce harm and improve patient safety for all of our internal and external customers. a. Strong b. Weak

b. weak

Why might an improvement team consider collecting balancing measures? a. To demonstrate they were justified in using resources for the project b. To show that they met their aim c. To make sure they didn't unintentionally introduce undesired changes d. To make sure they're able to publish their results

c. To make sure they didn't unintentionally introduce undesired changes

Aim Statement #2:By June of 2015, we will reduce the incidence of pressure ulcers in the critical care unit by 50 percent. a. Strong b. Weak

a. strong

An aim statement should include the following: a. Specific time frame, team membership, and numeric goals b. Numeric goals, specific time frame, and the patient population or system affected c. Patient population or system affected, estimated cost of improvement, and numeric goals d. All of the above

b. Numeric goals, specific time frame, and the patient population or system affected

Measure: Average number of days on mechanical ventilation a.Outcome measure b. Process measure c. Balancing measure

b. Process measure

Measure: Readmission of ventilated patients to the ICU who then require mechanical ventilation a. Outcome measure b. Process measure c. Balancing measure

c. Balancing measure

You're a dental assistant at a small clinic. Sometimes patients with unresolved problems need to come in for recall appointments. However, you notice that it's a real challenge to schedule these recalls within a week of the initial appointments. Which of the following techniques might be most useful as you search for a good idea for change? a. Quit and start working in a new clinic that functions more effectively. b. Tell a member of the office staff that it would be great if follow-ups were scheduled more quickly. c. Review the process for scheduling these appointments with colleagues to identify opportunities for improvement. d. Research possible upgrades to the appointment scheduling software.

c. Review the process for scheduling these appointments with colleagues to identify opportunities for improvement.

Which of the following statements is true? a. The Model for Improvement is appropriate for many types of clinical improvement efforts. b. The Model for Improvement is one of multiple improvement models applicable to health care. c. Lean is a helpful methodology for improving value and reducing waste in health care. d. All of the above

d. All of the above

TRUE OR FALSE: You should never end a test of change before the planned time. True False

False

At Clinic A, the plan is to meet as a team and start with 10 patients. The team will note how many clinicians washed their hands before and after each patient encounter to learn what might be the barriers to hand washing. The team will continue to track 10 patients per week as various interventions are tested and then will determine if hand hygiene compliance gets better over time. At Clinic B, the plan is to meet as a team and choose a test to implement. The team will randomly assign patients to two groups, making sure both have similar attributes. The team will then develop a database, and over the next six months, measure how many clinicians in each group washed their hands before and after each patient encounter. After that, the team will implement the chosen intervention with one of the groups and reassess hand hygiene compliance as compared to the control group. Which of the clinics is measuring for improvement? a. Clinic A b. Clinic B

a. Clinic A

Based on the aim of the project, indicate whether the project measure is an outcome measure, process measure, or balancing measure. Aim #1: Reduce the incidence of ventilator-associated pneumonia (VAP) by reducing the number of ventilator days in the intensive care unit (ICU) by 20 percent within five months.Measure: Percentage of patients with ventilator-associated pneumonia a. Outcome measure b. Process measure c. Balancing measure

a. Outcome measure

Measure: Average number of minutes spent in the waiting room per patient a. Outcome measure b. Process measure c. Balancing measure

a. Outcome measure

Medical staff at a community health center were concerned about the oral health of many of their patients. To improve patients' oral and overall health, they wanted to improve the coordination between medical and dental services, with medical providers more reliably providing appropriate referrals for dental care based on patients' age and risk factors. What would you identify as the best outcome measure for the project? a. Patients' oral health, as measured by caries risk assessment b. Cost of patients' treatment c. Rate of job satisfaction of the medical care providers d. Percentage of patients referred for dental care

a. Patients' oral health, as measured by caries risk assessment

What's the main benefit of using change concepts to come up with improvement ideas? a. Using change concepts can help you develop specific improvement ideas that might not have occurred to you initially. b. Using change concepts makes it much more likely that the implementation will go smoothly. c. Using change concepts makes PDSA cycles unnecessary. d. Using change concepts will lead you to focus on quantifiable technological improvements.

a. Using change concepts can help you develop specific improvement ideas that might not have occurred to you initially.

You are working on shortening the time it takes patients with chest pain to get to the cardiac catheterization lab in your hospital. Your aim is to have 90 percent of patients brought to the lab within 45 minutes of arrival to the hospital. You decide to try a care protocol that another hospital in the area implemented with great success.After implementing the new protocol, you observe that patients are getting to the lab more quickly than before, but not as quickly as you had predicted. You examine the data and realize that there are really multiple issues delaying patients' arrival to the catheterization lab. Specifically, the emergency department needs to notify the lab staff in advance, but this communication rarely happens. Further, the schedule that the emergency department uses to contact the lab staff is riddled with errors. Based on the recommendations in this lesson, what should you do next? a. Work on improving both the schedule and communication at the same time. b. Discipline the emergency department staff who have failed to contact the catheterization lab in the past. c. Focus on improving the communication between the emergency staff and the catheterization staff. d. Focus on fixing the schedule.

a. Work on improving both the schedule and communication at the same time.

Aim Statement #4:Our most recent data reveal that, on average, we reconcile the medications of only 35 percent of our discharged inpatients. We intend to increase this average system-wide to 50 percent by April 1, 2017, and to 75 percent by August, 31, 2017. a. Strong b. Weak

a. strong

You're working on trying to reduce waiting times for patients. Your formal aim is to reduce the average waiting time for all patients to less than 20 minutes by next November. For a few months, you have tried different changes and dutifully gathered data on several process measures and your outcome measure, which is the average number of minutes in the waiting room per patient. For a few months, your team members have tried different changes and dutifully gathered data, which they've displayed on this run chart. You're meeting with your office team to review this graph. Upon studying it, would you say the changes the team is testing are leading to improvement? a. Yes b. No

a. yes

Having a clear aim statement is important in quality improvement work because: a. Professional guidelines require clear aim statements to prevent health care-related infections. b. Aim statements provide a clear and specific goal for the team or organization to reach. c. Aim statements remove all obstacles from quality improvement projects. d. All of the above

b. Aim statements provide a clear and specific goal for the team or organization to reach.

Defining a family of measures helps you answer which of the three questions of the Model for Improvement? a. What are we trying to accomplish? b. How will we know that a change is an improvement? c. What changes can we make that will result in improvement? d. None of the above

b. How will we know that a change is an improvement?

Starting with small tests of change: a. Should be done only with the consent of all clinical and administrative staff members b. Improves the likelihood of buy-in from leaders and staff c. Allows you to start testing on live patients right away d. Means you don't need to do any planning before each test

b. Improves the likelihood of buy-in from leaders and staff

An orthopedic clinic in a busy metropolitan area would like to improve its patient scheduling process. More specifically, the clinic wants to improve its efficiency and the satisfaction of its patients. Applying the Model for Improvement to the clinic's improvement goal, which of the following is the most reasonable aim statement? a. Modify the scheduling process to allow both front desk staff AND nurses to directly schedule appointments. b. Increase the number of patients reporting they are "very satisfied" with the clinic's scheduling by 50 percent within six months. c. Implement two PDSA cycles within six months of beginning the project. d. Create an efficient process for scheduling return appointments at the time of checkout.

b. Increase the number of patients reporting they are "very satisfied" with the clinic's scheduling by 50 percent within six months.

Which of the following statements is true? a. All changes lead to improvement; therefore, all improvement requires change. b. While not all changes lead to improvement, all improvement requires change. c. The changes that are known to lead to improvement should be implemented before testing. d. All of the above

b. While not all changes lead to improvement, all improvement requires change.

Aim #2: Reduce the average waiting time for all patients to under 20 minutes by next August.Measures: Patient cycle times (e.g., time to registration, time from arrival to triage, time from triage to bed placement) and the percentage of time staff arrive for their shifts on time a. Outcome measures b. Process measures c. Balancing measures

b. process

Aim Statement #3:We will reduce all types of hospital-acquired infections. a. Strong b. Weak

b. weak

Brenda, the office manager at a dental practice, noticed many patients were missing their appointments. With the support of her colleagues, she decided to conduct a small improvement project to improve the process for reminding patients of upcoming visits, with the goal of having fewer "no shows." During a team meeting, Brenda's team members review her aim statement. Which of the following comments from a team member would most strongly suggest Brenda has selected an appropriate aim? a. "It will be very simple to achieve." b. "It is very unlikely to change as the project evolves." c. "It feels like a very meaningful project for both the patients and the practice." d. All of the above

c. "It feels like a very meaningful project for both the patients and the practice."

You are working on shortening the time it takes patients with chest pain to get to the cardiac catheterization lab in your hospital. Your aim is to have 90 percent of patients brought to the lab within 45 minutes of arrival to the hospital. You decide to try a care protocol that another hospital in the area implemented with great success. After several tests, you decide to try implementing a modified version of the protocol at your institution. Which of the following might you do within the "S" portion of your next PDSA cycle? a. Strategize how to move this to another hospital in the system. b. Develop the final plan for the protocol implementation. c. Analyze information collected. d. Document unexpected observations.

c. Analyze information collected.

Measures: Percentage of staff reporting they're satisfied at work and total staffing costs a. Outcome measures b. Process measures c. Balancing measures

c. Balancing measures

You are working on shortening the time it takes patients with chest pain to get to the cardiac catheterization lab in your hospital. Your aim is to have 90 percent of patients brought to the lab within 45 minutes of arrival to the hospital. You decide to try a care protocol that another hospital in the area implemented with great success. The care protocol was successful at the other hospital. Why would it be important to test this proven change at your hospital? a. Because the last success may have been a fluke b. So that you can publish your results c. Because this change may not be as effective in your hospital d. None of the above; testing the new process would be a waste of time

c. Because this change may not be as effective in your hospital

As an office manager, you notice there's a high rate of "no shows" for appointments at your practice. People often tell you they scheduled the appointment far in advance, and simply forgot to go. You decide it's worth a try to improve this problem by sending reminders via text message. Which change concept are you using? a. Improve Work Flow b. Optimize Inventory c. Design Systems to Prevent Errors d. Manage Time

c. Design Systems to Prevent Errors

When trying to improve a process, one reason to use PDSA cycles rather than a more traditional version of the scientific method (such as a randomized, controlled trial) is that: a. PDSA cycles are easier to run with a large team of people. b. The results of PDSA cycles are more generalizable than other methods. c. PDSA cycles provide a mechanism to adjust improvement ideas as the project progresses. d. All of the above

c. PDSA cycles provide a mechanism to adjust improvement ideas as the project progresses.

An orthopedic clinic in a busy metropolitan area would like to improve its patient scheduling process. More specifically, the clinic wants to improve its efficiency and the satisfaction of its patients. After assembling a team and working through the three questions of the Model for Improvement, the orthopedic clinic decides to implement an automated reminder phone call 24 hours prior to each clinical appointment. The clinic's improvement team hopes that this small change will improve scheduling. What is the team's next step? a. Report their results to clinic leadership and prepare a poster for a national meeting. b. Develop their project-level measures. c. Test their change plan using the PDSA cycle. d. Take a well-deserved break.

c. Test their change plan using the PDSA cycle.

Brenda, the office manager at a dental practice, noticed many patients were missing their appointments. With the support of her colleagues, she decided to conduct a small improvement project to improve the process for reminding patients of upcoming visits, with the goal of having fewer "no shows." Which of the following is the most effective aim statement for this project? a. Within three months, we will email patients before their appointments, which will decrease the number of patients who miss appointments. b. We will improve our reminder process so that no patients will miss appointments unless there is an emergency c. Within three months, 90 percent of patients will show up for their appointments. d. We will ensure all patients have an up-to-date email address on file and send email reminders the day before appointments. * Must be completed

c. Within three months, 90 percent of patients will show up for their appointments.

Which of the following changes falls under the heading of "eliminating waste"? a. Dispensers full of hand sanitizer are placed throughout an office, thus improving compliance with hand hygiene protocols. b. An office starts tracking the percent of patients that complete their treatment plans each year, in order to determine a benchmark for improvement. c. An office invites patients to participate in a patient experience survey, thus making them feel like valued clients. d. Clinicians type all notes directly into a computer rather than writing them in a patient's chart, thus saving paper.

d. Clinicians type all notes directly into a computer rather than writing them in a patient's chart, thus saving paper.

As you recall, the IHI staff member's change idea involves leaving work by 5:30 PM each workday. Which of the following is an example of using technology to help her do so? a. Comparing the time she leaves to that of the person who seems to go home earliest each day. b. Taking work home each night on a laptop computer. c. Cancelling two meetings every day. d. Scheduling a reminder into her work calendar that pops up daily at 5:15 PM with the message, "Leave!"

d. Scheduling a reminder into her work calendar that pops up daily at 5:15 PM with the message, "Leave!"

As a nurse manager of a medicine unit in an academic hospital, you're aware that your unit has a high rate of patient readmissions. In fact, 36 percent of the patients discharged from your unit are readmitted to the hospital within 30 days. After reviewing the literature, you become aware that this rate is quite high compared to national standards. Working with other members of your unit, you develop a plan to call patients on the phone within 48 hours of discharge, with the aim of cutting readmission rates to 18 percent. Which of the following is the best example of a process measure that the team may collect as part of this improvement effort? a. The reasons for readmission to the hospital b. The cost of the labor associated with the calls c. The rate of patients being readmitted within 30 days d. The percentage of patients receiving a call within 48 hours of discharge

d. The percentage of patients receiving a call within 48 hours of discharge

A good aim statement helps improvement teams answer which question from the Model for Improvement? a. What change can we make that will result in an improvement? b. How will we know a change is an improvement? c. How good, for whom, by when? d. What are we trying to accomplish?

d. What are we trying to accomplish?