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IHI Questions

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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?

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.

Heather, the medical director of the medicine ward, wants to lower the 30-day readmission rate of the patients on her unit (i.e., the percentage of patients readmitted to the hospital within 30 days of discharge). She meets with the nurse manager and other stakeholders, and, together, they develop a process to improve the way the ward discharges patients and transfers care back to each patient's primary care provider. The team tests the change on the ward and runs multiple PDSA cycles to improve the process. The data look promising. Heather and her team continue to test the new idea. Assuming things continue to go well, what might they eventually do? (A) Share the innovation with other units and/or hospitals. (B) Utilize the IHI Framework for Spread. (C) Develop a communication and dissemination plan. (D) All of the above.

Heather, the medical director of the medicine ward, wants to lower the 30-day readmission rate of the patients on her unit (i.e., the percentage of patients readmitted to the hospital within 30 days of discharge). She meets with the nurse manager and other stakeholders, and, together, they develop a process to improve the way the ward discharges patients and transfers care back to each patient's primary care provider. The team tests the change on the ward and runs multiple PDSA cycles to improve the process. The data look promising. What improvement project phase have Heather and her team just completed? (A) Spread (B) Pilot (C) Implementation (D) Planning

Imagine that your health care organization is trying to reduce worker fatigue. Your improvement team is working on a planned nap program in which you offer the opportunity for staff members working a shift of more than 12 hours to take a planned nap. You have identified a designated room for the nap, and you have communicated with the staff about the importance of rest in ensuring patient safety. Unfortunately, data reveal that workers are not taking advantage of the program. Your team is frustrated, because this program worked at another hospital in a neighboring town. In the example, which of the following is a process change? (A) The planned nap (B) The data that show whether staff members are taking a planned nap (C) The belief that a planned nap can support patient safety (D) None of the above

Which of these is a question particularly associated with the "theory of knowledge" component in Deming's System of Profound Knowledge? (A) What motivates people to act as they do? (B) What is the variation in results trying to tell you about the system? (C) What are your predictions about the system's performance? (D) What is the whole system that you're trying to manage?

Which of the following are strategies to help members of a QI team establish common goals? (A) Create a team roster. (B) Share stories. (C) Write down a shared work plan. (D) All of the above

Which of the following best describes a workable level of unity? (A) When everyone on a team is unanimously in favor of a proposal (B) When a team is unable to reach a consensus and cannot move forward. (C) When a group is willing to try an action together, even if there isn't complete agreement on what to do (D) When an authority figure makes a rule that everyone must follow

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

Which of the following charts would be best to justify focusing on a few large problems and ignoring many smaller ones? (A) Pareto chart (B) Scatter plot (C) Histogram (D) Run chart

Which of the following countries has had a relatively inexpensive universal health insurance system for more than 50 years? (A) Chile (B) Germany (C) Japan (D) The US

Which of the following describes data stratification? (A) Plotting observations to show the relationship between two sets of data (B) Classifying and separating data according to specific variables (C) Plotting data over time (D) Illustrating the relative frequency of occurrence

Which of the following descriptions best describes "leadership"? (A) A firm, unyielding position on what should be done to solve a problem (B) A set of beliefs based upon principle (C) A positive, "let's do something about it" attitude toward problems (D) A posture of resistance to those in authority

Which of the following improvement efforts is the best example of increasing the effectiveness of care? (A) Decreasing adverse drug events by having a pharmacist on rounds in the intensive care unit (B) Shortening wait times at a clinic by allowing patients to self-register on a computer in the waiting room (C) Improving the percent of clinic patients achieving their goal blood pressure by instituting a series of reminders for providers about evidence-based processes (D) Instituting quarterly focus groups of patients seen in the emergency department to better identify patient concerns

Which of the following improvement efforts is the best example of increasing the equity of care? (A) Decreasing adverse drug events by having a pharmacist on rounds in the intensive care unit (B) Shortening wait times at a clinic by allowing patients to self-register on a computer in the waiting room (C) Instituting quarterly focus groups of patients seen in the emergency department to better identify patient concerns (D) Through staff development and weekly feedback, equalizing the likelihood that a patient will receive pain medication regardless of race, ethnicity, or education

Which of the following is a basic principle of improvement? (A) Improvement must come from the bottom up — not the top down. (B) Every system is perfectly designed to get the results it gets. (C) Data should always drive improvement. (D) When examining a complex system, consider all the parts separately.

Which of the following is a problem with static data? (A) It doesn't adequately portray variation. (B) It is often inaccurate. (C) It can't display mean, median, or mode. (D) All of the above

Which of the following is a rule for determining non-random patterns? (A) A run of six points or more (B) An astronomical point (C) A trend of three points or fewer (D) A and B

Which of the following is a trend in modern health care across industrialized nations? (A) Providers are becoming more specialized. (B) The disease burden is shifting toward acute conditions. (C) There is growing demand for complicated procedures. (D) A and C

Which of the following is an example of an effective measurement technique for improvement? (A) Always strive for perfection. (B) Use quantitative and qualitative data. (C) Always set aside designated time for data collection. (D) All of the above

Which of the following statements is a reason for improving the US health care system? (A) The US has fallen behind in biomedical innovation. (B) The US lacks the means to measure health care quality and access. (C) The US government and citizens alike are struggling to afford the cost of care. (D) All of the above

Which of the following statements is true about using data for improvement? (A) Both quantitative and qualitative data can be useful. (B) The data should tell a story. (C) A run chart is one of the most helpful tools for displaying data. (D) All of the above.

Which of the following statements is true: (A) During the past 15 years, the cost of care has been a growing problem for many developed nations. (B) During the past 15 years, most countries around the world have used similar approaches to improve health care quality and access. (C) Among industrialized nations, there is a perfect correlation between quality rankings and the number of dollars spent on health care. (D) All of the above

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.

Which of the following traits do histograms, Pareto charts, and scatter plots have in common? (A) They are all bar charts. (B) They are all visual tools to display data. (C) They all show change over time. (D) All of the above.

Why should you consider collecting a family of measures when undertaking an improvement? (A) It makes the project more publishable. (B) A single measure may not be enough to determine the impact of a change on the system. (C) All improvement projects are so complex that they require multiple measures. (D) All of the above

(GRAPH AND CHART ON DESKTOP) Using Rule 3, does this chart show non-random patterns? (A) Yes, there are too many runs. (B) Yes, there are too few runs. (C) No. (D) It is impossible to tell.

(GRAPH ON DESKTOP) How many runs are there? (A) 9 (B) 10 (C) 11 (D) 12

(GRAPH ON DESKTOP) In the above chart, how many useful observations are there? (A) 27 (B) 36 (C) 37 (D) 40

(GRAPH ON DESKTOP) When did a PDSA cycle occur? (A) February 05 (B) March 05 (C) June 06 (D) July 07

A hospital is trying to implement a new patient assessment form. They want to first test the usability and efficacy of the form. Let's say the hospital has an English-speaking nurse (Nurse Moss) assess one English-speaking patient with the new form. It is a successful test and the improvement team wants to increase the scale of the next test. What would they do? (A) Have a Spanish-speaking nurse give the assessment to one of her Spanish-speaking patients. (B) Have a different English-speaking nurse give the assessment to one of her English-speaking patients. (C) Increase the number of patients Nurse Moss assesses by a factor of 5. (D) Increase the number of patients Nurse Moss assesses by a factor of 10.

A hospital is trying to implement a new patient assessment form. They want to first test the usability and efficacy of the form. When determining sample size for the first test, it is most important to: (A) Look at similar research to see what sample size other organizations use. (B) Weigh the potential consequences of a test that does not lead to improvement against the belief in success. (C) Use a random sampling technique, so results can be extrapolated. (D) Ask all staff members what sample size they think should be used.

According to Herbert Kaufman, which of the following are reasons health care workers commonly resist change? (A) The expected autonomy of health care workers (B) A real or perceived limit on resources (C) An accumulation of policies, procedures, regulations (D) All of the above

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

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) 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.

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. 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.

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) 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.

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. 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

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 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

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. 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

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. After six months of data collection and four linked PDSA cycles, you are preparing to present the results of your unit's readmissions project to the hospital board. The graph looks like this so far: (GRAPH ON DESKTOP) 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

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.

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). 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.

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). 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.

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). 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.

During a clinical rotation on the medical-surgical floor of a hospital, you notice several patients have developed urinary tract infections (UTIs) associated with their Foley catheters (tubes inserted into the bladder to drain urine). Your staff physician agrees that this is a problem and offers to help with an improvement project. Together, you work through several PDSA cycles to reduce the rate of UTIs on your floor. When designing the run chart, it is important to include: (A) Units of time on the Y axis (B) The rate of UTIs on the X axis (C) Units of time on the X axis (D) A and B

During a clinical rotation on the medical-surgical floor of a hospital, you notice several patients have developed urinary tract infections (UTIs) associated with their Foley catheters (tubes inserted into the bladder to drain urine). Your staff physician agrees that this is a problem and offers to help with an improvement project. Together, you work through several PDSA cycles to reduce the rate of UTIs on your floor. Which of the following methods would you recommend to display your improvement data? (A) Draw a bar chart. (B) Write a list of numbers. (C) Create a two-column table. (D) Draw a run chart.

Imagine that your health care organization is trying to reduce worker fatigue. Your improvement team is working on a planned nap program in which you offer the opportunity for staff members working a shift of more than 12 hours to take a planned nap. You have identified a designated room for the nap, and you have communicated with the staff about the importance of rest in ensuring patient safety. Unfortunately, data reveal that workers are not taking advantage of the program. Your team is frustrated, because this program worked at another hospital in a neighboring town. What would be a good way for the team to respond to the resistance to the change? (A) Share data that shows the process change is associated with a decrease in adverse events. (B) Abandon the idea. (C) Tell a story about a patient whom medical science was able to save. (D) A, B

Imagine that your health care organization is trying to reduce worker fatigue. Your improvement team is working on a planned nap program in which you offer the opportunity for staff members working a shift of more than 12 hours to take a planned nap. You have identified a designated room for the nap, and you have communicated with the staff about the importance of rest in ensuring patient safety. Unfortunately, data reveal that workers are not taking advantage of the program. Your team is frustrated, because this program worked at another hospital in a neighboring town. What's the likeliest reason the program failed? (A) The nap wasn't long enough. (B) The room for the nap was too noisy. (C) The culture of the organization did not support napping during a shift. (D) Workers weren't as tired as managers thought they were.

Imagine that your health care organization is trying to reduce worker fatigue. Your improvement team is working on a planned nap program in which you offer the opportunity for staff members working a shift of more than 12 hours to take a planned nap. You have identified a designated room for the nap, and you have communicated with the staff about the importance of rest in ensuring patient safety. Unfortunately, data reveal that workers are not taking advantage of the program. Your team is frustrated, because this program worked at another hospital in a neighboring town. Which of the following represents a culture change? (A) The planned nap (B) The designated room for the nap (C) The staff education about the nap (D) The belief that a planned nap can support patient safety

Imagine you're a member of a newly formed improvement team that has taken up the challenge to reduce health care-associated infections at your hospital. You have an idea for a change to the room cleaning process that you want to test, but you're slightly nervous because improper cleaning and disinfection can carry a high risk for patients with compromised immune systems. You haven't run any PDSA cycles yet. Which of the following would be the best next step? (A) Have one housekeeper use the process with one room cleaning. (B) Have all housekeepers use the process for a week. (C) Have one housekeeper use the process on five room cleanings. (D) Confirm the "face validity" of the new cleaning process by demonstrating it with a couple of housekeeping staff members and a supervisor.

In a run chart, the variable being measured is typically placed on what axis? (A) X axis (B) Y axis (C) Either axis (D) Neither axis; the run chart does not compare variables.

In designing a performance improvement team, it is helpful to: (A) Choose people who are unlikely to disagree with one another (B) Have a mix of different types of people on the team (C) Have everyone on the team exhibit similar personality preferences (D) All of the above

In order to persuade the "logical" individuals in the room, what should you be sure to include in your presentation about improving care for patients with diabetes? (A) Average blood pressure and cholesterol levels (quality of care measures) of the clinic's patients with diabetes (B) A photograph of a patient who suffered unnecessarily from poorly controlled diabetes (C) A list of the providers in the clinic with the worst patient satisfaction measures (D) A reminder of the Board of Trustees' stated goal of improving chronic disease care

In regard to health disparities around the world, which of the following statements is most true? (A) Inequitable medical care is the primary driver of health disparities. (B) Where a child is born significantly affects his or her life expectancy. (C) The root causes of health disparities are complex. (D) B and C

In the lesson, IHI fellow Jana Deen explained that she went back to her roots and focused on patients to start making changes in health care. What other resources might be helpful as you seek to improve health care? (A) Social networking sites like Facebook and Twitter (B) National conferences (C) Listservs (D) All of the above

Michael S., a 49-year-old factory worker, is brought to the hospital after developing chest pain at work. He is quickly diagnosed with an acute myocardial infarction (heart attack). However, he waits almost two hours to get to the catheterization lab and have his blocked coronary artery opened. Ultimately, he suffers permanent damage to his heart. The hospital where Michael is recovering reviews its patient satisfaction survey results in order to improve its care and patient outcomes. Leaders poring over the data note that 90 to 100 percent of patients rate staff as "excellent" in the following categories: listening, answering questions, being friendly and courteous, and giving good advice based on specific needs and preferences. Which aim is the hospital generally achieving? (A) Equitable (B) Safe (C) Effective (D) Efficient (E) Timely (F) Patient-centered

Personality and work style profile assessments can help to: (A) Identify the personalities present and work to everyone's strengths. (B) Identify why some people will never respond well to change. (C) Determine who has the right expertise to be on an improvement team. (D) A and C

Reggie is a new pharmacist in a surgical intensive care unit. He notices that it is taking an average of three hours from the time an order is placed until a patient receives an antibiotic (the goal is one hour). What might Reggie do if he were to act like a leader? (A) Look into the cause of the problem and research how other ICUs have solved it. (B) Tell his supervisor about the data. (C) Transfer to a different ICU that has improved outcomes. (D) Make sure that patients during his shift get antibiotics faster by paying close attention to orders.

Reggie takes a look at the time between antibiotic order and administration in the other ICUs in his hospital. He discovers that most of the ICUs have the same problem. This is an example of which of the following actions of leaders discussed in this lesson? (A) Reframing the issue (B) Connecting to a powerful ally (C) Forming a clearer picture of the problem (D) Proving his case

Sandy Liu, a cardiac care unit nurse, notices that a few of her patients are suffering from inadequate pain control. Currently, a patient who needs pain medication must call the front desk, which then calls the nurse, who then goes to the patient's room to find out what he or she needs. Sandy finds out that a hospital in the next county has a simpler process: Patients can send a text message directly to the nurse to request pain medication. Sandy goes to her manager and suggests that they form a team to work on improving pain control and test this change in the cardiac care unit. After a successful pilot, which of the following should Sandy's improvement team undertake as a next step? (A) Work on seeing that the change is widely adopted by the unit, such as by making it a formal policy and training new staff on it. (B) Continue to run PDSA cycles. (C) Spread the change to other hospitals in the network. (D) A and B

Sandy Liu, a cardiac care unit nurse, notices that a few of her patients are suffering from inadequate pain control. Currently, a patient who needs pain medication must call the front desk, which then calls the nurse, who then goes to the patient's room to find out what he or she needs. Sandy finds out that a hospital in the next county has a simpler process: Patients can send a text message directly to the nurse to request pain medication. Sandy goes to her manager and suggests that they form a team to work on improving pain control and test this change in the cardiac care unit. How should Sandy and her improvement team try out the new process for improving pain control? (A) Test the new process with one patient and closely review the results. (B) Bring together a group of stakeholders to develop an implementation plan. (C) Test the new process throughout the hospital to build a pool of data. (D) None of the above: There is no need to test this process because another hospital has already proved it to be effective.

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

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

Transcendental Nursing Home is working on decreasing its rates of catheter-associated urinary tract infections (UTIs) among its residents. While reviewing data, the improvement team notices that the UTI rate on Floor 3 is half that of the rest of the floors. They decide to visit the unit and find out what it is doing differently. After speaking with caregivers on Floor 3, the improvement team discovers that there is a particularly dedicated head nurse on the unit whose mother died after a catheter-associated UTI. This nurse orients all new providers and also provides feedback when she sees that catheters are being placed unnecessarily in patients. Which component of Deming's System of Profound Knowledge do this nurse's actions best represent? (A) Appreciation of a system (B) Understanding variation (C) Theory of knowledge (D) Psychology (human behavior)

Using Deming's System of Profound Knowledge is helpful in quality improvement because: (A) It's a systematic set of procedures for implementing improvement. (B) It can help break down complex quality issues into smaller, more understandable parts. (C) It can help figure out who is to blame after an error. (D) It's a helpful way to secure funding from external sources for planned improvements.

What are the four phases of an improvement project? (A) Plan-Do-Study-Act (B) Innovation-Pilot-Study-Act (C) Plan-Implement-Pilot-Spread (D) Innovation-Pilot-Implementation-Spread

What aspect of the run chart helps you compare data before and after a PDSA cycle? (A) The average of the values (B) The baseline median (C) Annotations of when specific changes were tested (PDSA cycles) (D) B and C

What can quality improvement teams learn from Renoir, Monet, and Cezanne? (A) Improvement, like artistic work, should be a solo journey. (B) Your personal compass always points the way. (C) Teamwork can lead to creative ideas. (D) All of the above

What famous Italian economist is credited with the theory behind the 80/20 rule? (A) Vilfredo Pareto (B) Benedetto Cotrugli (C) Joseph M. Juran (D) Michelangelo Histogram

What is the minimum number of data points you should usually have to look for signs of improvement on a run chart? (A) 6 (B) 10 (C) 15 (D) 25

What is the order of the four steps teams typically follow to get to a place where they are running smoothly? (A) Forming, storming, norming, performing (B) Norming, performing, forming, storming (C) Storming, forming, norming, performing (D) Performing, storming, forming, norming

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.

When drawing a histogram, which is a good number of categories to include on your X axis? (A) 1-5 (B) 6-12 (C) 13-24 (D) >24

When effective leaders hear others complaining about a problem, which action would they most likely take? (A) Change the subject to talk about something interesting. (B) Try to learn how big the problem really is. (C) Add their own complaints to the chorus. (D) All of the above

When increasing the number of patients or events from one PDSA cycle to the next, it is usually helpful to multiply by what number? (A) 2 (B) 5 (C) 10 (D) 20

When planning a sequence of PDSA cycles for a change that involves patients, which of the following is a true statement? (A) Patient characteristics in each PDSA cycle should be as uniform as possible to allow valid comparisons. (B) The number of patients in each cycle should stay fixed, to allow valid comparisons. (C) We would expect the number of patients involved to grow rapidly from early cycles to later cycles. (D) None of the above

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

When you are graphing a proportion or a percent, what should you look at to help you understand the bigger picture? (A) The denominator of the measured value (B) The numerator of the measured value (D) The median of the denominator (E) The median of the numerator

Which of the following BEST describes the purpose of a histogram? (A) To show the relationship between two variables (B) To show variation in weight over time (C) To show distribution of continuous data (D) None of the above

Why was it important for the Institute of Medicine (IOM) to develop its six aims for health care? (A) So that accreditation organizations would be better able to evaluate hospitals (B) So that health care organizations would have a better idea of what they needed to improve (C) So that lawmakers could focus their attention upon specific areas when working on health care reform (D) All of the above

Within the following data set, what is the median? [2.5, 7.2, 2.5, 2.9, 4.7, 3.6, 4.7] (A) 2.5 (B) 3.6 (C) 4.0 (D) 4.7

You and a fellow medical student have learned that in many countries, doctors avoid wearing long-sleeved coats at work because the coats can carry harmful bacteria such as methicillin-resistant Staphylococcus aureus (MRSA). You and your friend would love to see providers in the US stop wearing the coats. A conference of hospital and clinic leaders is coming up. How might you pique their interest in this issue of wearing long-sleeved coats? (A) Tell them the story of one patient who became sick with a health care-acquired infection. (B) Tell them how much money could be saved if long-sleeved coats were banned. (C) Show them data about how American MRSA rates compare with those of other countries. (D) All of the above

You are working on decreasing adverse events related to medication errors, a serious problem on your pediatrics unit. After gathering some data, you present it to your colleagues on the unit. The result is several days of heated discussion among various caregivers. As a leader, at this point you should: (A) Meet with the hospital's chief executive and ask her to mandate the changes you have in mind. (B) Work to engage as many individuals on the unit as possible, investigating the source of their worries and responding to their concerns. (C) Recognize the level of anxiety this topic has provoked and back off for a while to allow people to digest the information. (D) Consider trying out your ideas on another unit to avoid causing more anxiety on this one.

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) 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.

You are working to improve the care of diabetics in your community health clinic, and today you're giving a presentation to the clinic's leadership. You begin by telling the story of Kevin, a diabetic in the clinic who underwent a below-the-knee amputation after years of poorly controlled diabetes. What is the reason for telling this story? (A) Motivate by guilt. (B) Engage the largest possible number of people in the room. (C) Demonstrate that the data that you collected is valid. (D) Expose a possible legal liability.

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

You volunteer at a student-run clinic associated with your academic health center. As a member of the student board, you are constantly looking for ways to improve the clinic. One common complaint is that it takes too long to check patients in once they arrive, and you decide to tackle this problem. Which of the following is the best way to collect baseline data for this improvement project? (A) Look at a few patients every day for a week. (B) Look at 10 percent of patients for a year. (C) Look at 100 percent of patients for a month. (D) There is no reason to collect baseline data.

You volunteer at a student-run clinic associated with your academic health center. As a member of the student board, you are constantly looking for ways to improve the clinic. One common complaint is that it takes too long to check patients in once they arrive, and you decide to tackle this problem. Which of the following might be an outcome measure for this effort? (A) Average number of minutes between patient arrival at the clinic and completion of check-in (B) Number of patients seen by the clinic (C) Average number of students helping to check a patient in (D) None of the above

You're on a team seeking to improve the process for treating patients with sepsis. (Sepsis occurs when chemicals released into the bloodstream to fight infection trigger inflammatory responses throughout the body). Which of the following is an example of "advocacy"? (A) Listening to your teammate's idea to improve screening for sepsis. (B) Stating your idea for updating the sepsis protocol. (C) Adapting your idea for the sepsis protocol based on your teammate's input. (D) A and C

You're working on an improvement project at a community mental health center. Your project aim: "Within two months, 100 percent of our patients will wait less than 30 minutes to be seen by a physician." You decide to gather data on patient wait times over a week-long period in order to establish a baseline. What might be an important consideration as you plan your data collection strategy? (A) Whether you'll provide food for the patients who wait more than 30 minutes. (B) What exactly you mean by "wait less than 30 minutes to be seen" — does this include the time the patient spends checking in, for instance? (C) How to establish consensus among the clinic's caregivers about the value of the project before gathering data. (D) How to inform the supervisors of individual physicians quickly when those physicians' patients wait more than 30 minutes.

Your hospital has recently begun using the World Health Organization (WHO) Surgical Safety Checklist in all of its operating rooms. As chief of surgery, you have been hearing different reports about the use of the checklist; apparently, some surgeons are all for it, while others remain skeptical. You are curious about finding out how well and often the checklist is actually being used. Which of the following might be a good first step to take? (A) Request that an assistant be assigned to the administrative details, so that you can focus on the true work of leadership. (B) Go to the operating rooms and observe the checklist being used a few times. Collect some data about the use of the checklist (C) Talk to surgical nurses about their experience with the checklist. (D) B and C

ou'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.

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