IHI: QI 102

1) Having a clear aim statement is important in quality improvement work because: a) Aim statements provide a clear and specific goal for the organization to reach. b) All grant agencies require clear aim statements when they are considering funding requests. c) Aim statements remove all obstacles from quality improvement projects. d) The leaders of all organizations expect to see these types of goals.

a) Aim statements provide a clear and specific goal for the organization to reach.

5) Gathering and reviewing data during an improvement project—that is, measuring—helps you answer which of the three questions of the Model for Improvement? a) How will we know that a change is an improvement? b) What are we trying to accomplish? c) What changes can we make that will result in improvement?

a) How will we know that a change is an improvement?

4) Which of the following changes falls under the heading of "eliminating waste"? a) Physicians type all consult responses directly into a computer rather than writing them in a patient's chart, thus saving paper. b) Dispensers full of hand sanitizer are placed throughout a floor, thus improving compliance with hand hygiene protocols. c) A clinic starts tracking the number of foot exams that diabetic patients receive each year, thus ensuring they receive evidence-based care d) A hospital invites patients to participate in the redesign of one of its centers, thus making them feel like valued members of a care team

a) Physicians type all consult responses directly into a computer rather than writing them in a patient's chart, thus saving paper.

4) The charge nurse in the emergency room asks Brenda to assemble a team to improve the delivery of pain medication. As she considers who to place on the team, Brenda should: a) Review the aim statement to make sure the team includes representatives of all processes affected by the team's aim. b) Create a team of volunteers. c) Create a team of managers and administrators. d) Make sure only nurses are on the team, as they are the most likely to help her achieve her aim.

a) Review the aim statement to make sure the team includes representatives of all processes affected by the team's aim.

1) You're a medical assistant at a community health clinic. Sometimes, patients with unresolved problems need to come in for follow-up appointments. However, you notice that it's a real challenge to schedule these follow-ups 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) Review the process for scheduling these appointments with colleagues to identify opportunities for improvement. b) Quit and start working in a new clinic that functions more effectively. c) Research possible upgrades to the appointment scheduling software. d) Tell a member of the office staff that it would be great if follow-ups were scheduled more quickly.

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

4) The orthopedic clinic plans the change to improve scheduling, and then it carries out a small test of change with three patients on Tuesday morning. What's the next thing the clinic's improvement team should do? a) Change their measures. b) Measure to see if the change led to improvement. c) Report their results to the clinic leadership and prepare a poster for a national meeting. d) Implement the new scheduling process based upon their initial impressions of how everything is working.

b) Measure to see if the change led to improvement.

4) What else should you add to the graph to best explain the improvement work your unit has done? a) The cost of the improvement effort b) Annotations to show when specific changes were tested c) Explanation of what a PDSA cycle is d) P-values showing statistical significance

b) Annotations to show when specific changes were tested

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

b) Improves the likelihood of buy-in from opinion leaders

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. 2) Applying the Model for Improvement to the clinic's improvement goal, which of the following is the most reasonable aim statement? a) Implement two PDSA cycles within six months of beginning the project. b) Increase the number of patients reporting they are "very satisfied" with the clinic's scheduling by 50 percent within six months. c) Modify the scheduling process to allow both front desk staff AND nurses to directly schedule appointments. 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.

2) 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

5) 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.

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

Brenda, an emergency room nurse, notes that there seems to be a significant delay between the ordering and the administration of pain medications in her department. She decides to conduct a small improvement project to reduce this delay and obtains the support of the charge nurse (head nurse). 3) Which of the following is the most effective aim statement for this project? a) Within one month, 95 percent of physicians will tell nurses when a pain medication is ordered on emergency room patients. b) Within three months, the emergency department will administer all pain medications within 45 minutes of order time. c) Within two months, improve the timeliness of pain medication delivery by allowing nurses to stock the most commonly used medications in the emergency unit d) Within three months, the emergency department will improve the timeliness of pain medication delivery to 100 percent of patients.

b) Within three months, the emergency department will administer all pain medications within 45 minutes of order time.

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

c) Aims, measures, changes

2) 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) Develop the final plan for the protocol implementation. b) Document unexpected observations. c) Analyze information collected. d) Strategize how to move this to another hospital in the system.

c) Analyze information collected.

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. 1) 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) In order to demonstrate the ability of this protocol to improve care in other hospitals for those that created it.

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

3) You notice that it's very easy to confuse medications at the community health center where you're working. They are lined up on the shelf and the labels are very similar. You decide that it's worth a try to highlight parts of drug names on certain labels to reduce confusion. Which change concept are you using? a) Manage Time b) Optimize Inventory c) Design Systems to Prevent Errors d) Improve Work Flow

c) Design Systems to Prevent Errors

5) 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) Cancelling two meetings every day. c) Scheduling a reminder into her work calendar that pops up daily at 5:15 PM with the message, "Leave!" d) Taking work home each night on a laptop computer.

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

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. 3) What is the team's next step? a) Take a well-deserved break. b) Develop their project-level measures. c) Test their change plan using the PDSA cycle. d) Report their results to clinic leadership and prepare a poster for a national meeting.

c) Test their change plan using the PDSA cycle.

2) Which of the following is an example of a process measure that you may collect as part of this improvement effort? a) The rate of patients being readmitted within 30 days b) The reasons for readmission to the hospital c) The percentage of patients receiving a call within 48 hours of discharge d) The cost of the labor associated with the calls

c) The percentage of patients receiving a call within 48 hours of discharge

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. 1) What would you identify as the outcome measure for the project? a) Average length of stay b) The cost of labor associated with the calls c) Rate of job satisfaction of those on the unit making the calls d) Percentage of patients that are readmitted to the hospital

d) Percentage of patients that are readmitted to the hospital

5) During Brenda's first group meeting, the members ask to review the aim statement to make sure they agree it addresses the current problem. With Brenda's approval, they all decide to rewrite it. However, when they meet to consider what would be a better aim statement, the group loses direction. In order to help them, Brenda might want to: a) Reconsider who should be on the improvement team. b) Move the meeting to a later date, so that she can come better prepared. c) Explain to the group that the aim is set, as both she and the charge nurse have already agreed on the wording. d) Remind the team of the Institute of Medicine's dimensions of health care quality.

d) Remind the team of the Institute of Medicine's dimensions of health care quality.

3) Why might you consider collecting balancing measures? a) To show that you met your aim b) To make sure you are able to publish your study c) To demonstrate to your hospital board that you were justified in using resources for this project d) To make sure you did not unintentionally damage other aspects of the unit's work

d) To make sure you did not unintentionally damage other aspects of the unit's work

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

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

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. 3) Based on the recommendations in this lesson, what should you do next? a) Focus on fixing the schedule. 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) Work on improving both the schedule and communication at the same time.

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

5) 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 are simpler to use than other methods. d) PDSA cycles provide a mechanism to adjust improvement ideas as the project progresses. e) Both C and D

e) Both C and D