IHI PS 203

Why does Dr. Gerald Hickson refer to safety incidents at his organization simply as "disturbances"? (A) Because he wants to encourage people to report absolutely anything that could threaten safety. (B) Because Star Wars is his favorite movie. (C) Because 98 percent of issues reported are false alarms. (D) Because there are two sides to every story.

(A) Because he wants to encourage people to report absolutely anything that could threaten safety.

Why is psychological safety a crucial component of a culture of safety? (A) It allows people to learn from mistakes and near-misses, reducing the chances of further errors (B) Without it, people won't be interested in improvement work. (C) It allows people to remove unsafe members of the team quickly. (D) Without it, patients will not follow their doctors' advice.

(A) It allows people to learn from mistakes and near-misses, reducing the chances of further errors

Which of the following is a tool that helps leaders assess culpability after a medical error? (A) Just culture algorithm (B) Strategic plan (C) Performance review (D) Patient safety and quality dashboard

(A) Just culture algorithm

During lunch on your interview day with some of the nurses from the unit, someone mentions that the opening on the unit came about because they had to fire a nurse who had violated basic safety procedures multiple times. This nurse, you learn, received supplemental training and several chances to do better, but he continued with the violations until he was fired. Based on this information, what might you infer about the culture of safety in this unit? (A) The unit still focuses on blame and shame and does not have a culture of safety. (B) The unit has a reasonable culture of safety because it makes a distinction between unsafe processes and unsafe behaviors. (C) The unit has a reasonable culture of safety because it fired someone who made mistakes. (D) The unit has a reasonable culture of safety because it recognizes that even basic safety procedures cannot always be followed.

(B) The unit has a reasonable culture of safety because it makes a distinction between unsafe processes and unsafe behaviors.

At the large multi-specialty clinic in which you work, there have been two near misses and one medical error because various clinicians did not follow up on patient results. Different caregivers were involved each time. After the second near miss, the physician involved was asked to leave the clinic. This appears to be an example of which of the following? (A) Just culture (B) Unfair attribution of blame (C) Reckless behavior (D) A and B

(B) Unfair attribution of blame

To establish a just culture, Dr. Bob Wachter says we need to balance ______ and ______: (A) Crime and punishment (B) Professionalism and accountability (C) "No blame" and accountability (D) Fairness and accountability

(C) "No blame" and accountability

Your spouse has just landed an excellent job — but it's far away, and you'll both have to move. You have just begun your search for a job in the city where you'll be living. You log into your email one day and are thrilled to discover that the largest hospital in that city has received your resume and would like to interview you. As you prepare for your interview, which of the following questions should you plan to ask in order to determine whether the hospital has a culture of safety? (A) "How many hours of continuing education will I be expected to do annually, and do you pay for those credits?" (B) "Are the staff members at this hospital happy?" (C) "What is the process to address safety concerns brought forward by the staff?" (D) "What are the last three medical errors that have occurred at this hospital?"

(C) "What is the process to address safety concerns brought forward by the staff?"

How do you think the leadership's decision to fire the employee will affect the safety of the organization? (A) The system will be safer because an employee who made an error no longer works there. (B) The system will be safer because other employees will learn by example not to make the same error. (C) The system will be less safe because employees are less likely to be honest when they make errors. (D) A and B

(C) The system will be less safe because employees are less likely to be honest when they make errors.

On your way off the unit after your interview, you see a physician come up to one of the nurses. The physician asks the nurse if a particular patient has received her antibiotics, two hours after a "stat" order was placed. The nurse replies, "No, pharmacy hasn't delivered it up yet. I was just about to call them about it." Which of the following responses by the physician would best indicate that the unit has a culture of safety? (A) "Don't blame the pharmacist for a mistake that you made." (B) "Pharmacy always takes way too long - and patients are hurt because of it. I think we should talk to the nurse manager about this." (C) "When I put in a 'stat' order I expect that it will be done within 30 minutes or less. Why did you wait until I asked you about the antibiotic to do something about it? This patient is really sick." (D) "I know it has been a crazy day. I can call the pharmacy. If you are having trouble getting something done in a timely manner, please tell me."

(D) "I know it has been a crazy day. I can call the pharmacy. If you are having trouble getting something done in a timely manner, please tell me."

Which of the following opinions did Dr. Bob Wachter express in his response to Paul Levy's blog about the wrong-site surgery discussed in this lesson? (A) Coming out with the error in public was unwise. (B) The case was clear-cut and should not have been the subject of debate. (C) It was a mistake not to punish staff for cutting corners and neglecting rules. (D) Circumstances could exist where the providers were to blame for the error.

(D) Circumstances could exist where the providers were to blame for the error.

One hospital CEO insists on including performance data in the hospital's annual report. "We do very well on most measures, except for one or two, but we put those in anyway," she says. "We want to hold ourselves accountable." Does this practice demonstrate effective or ineffective leadership? (A) Ineffective leadership: Because results are an important indication of leadership, publicly sharing poor results is an unwise practice. (B) Ineffective leadership: Leaders are people who have followers, and sharing poor results might cause the leader to lose some followers. (C) Effective leadership: It is good to share results in the annual report, but the leadership would be even more effective if it shared only the strongest results. (D) Effective leadership: Being transparent, even about poor results, is a mark of a good leader.

(D) Effective leadership: Being transparent, even about poor results, is a mark of a good leader.

A nurse who realized that his colleagues weren't consistently following up on patient results reported the problem to the clinic leadership right away. Which response would be most consistent with a culture of safety? (A) Transferring the nurse to another clinic (B) Thanking the nurse and asking him to keep quiet about it (C) Placing the item on the agenda for the leadership meeting next year (D) Investigating the problem and seeking systems solutions

(D) Investigating the problem and seeking systems solutions

Your clinic is working hard to improve its hand hygiene compliance rates, but the progress has recently plateaued. You survey staff to learn more about their experiences. Which finding would suggest it may be time to start punishing individual providers who violate the hand hygiene policy? (A) Most staff members do not understand the hand hygiene policy. (B) Most staff members find soap dispensers difficult to find or access. (C) Most staff members find it difficult to remember to use soap dispensers without reminders. (D) Most staff members find the hand hygiene policy is clear and easy to follow.

(D) Most staff members find the hand hygiene policy is clear and easy to follow.

Which of the following is an effective approach to using data in a culture of safety? (A) When data shows improvement, wait to celebrate until you've proven the change can be sustained over the long term. (B) Let people know they are being evaluated so they'll be motivated to work harder. (C) Focus on quantitative data only to ensure credibility. (D) Pair data with human stories to help others understand its importance.

(D) Pair data with human stories to help others understand its importance.

A 36-year-old patient with kidney failure comes to the hospital to have a special arteriovenous fistula placed in his left arm to allow him to begin dialysis in a few weeks. The surgical team is about to operate on the wrong arm but a junior member of the care team notices the mistake and speaks up. Which of the following actions is most likely to improve the hospitals safety system? (A) Engage in open conversation about what happened and why. (B) Enforce a brief leave of absence for the providers who were caught making a mistake. (C) Privately thank the caregiver who caught the mistake. (D) No action is needed because the patient was not harmed.

A) Engage in open conversation about what happened and why

Which of the following statements is consistent with the definition of a just culture? (A) Occasional reckless behavior is acceptable. (B) Systems issues can lead individuals to engage in unsafe behaviors. (C) Human misbehavior is the most common cause of adverse events. (D) Safety depends on an overarching "no blame" approach to adverse events.

B) Systems issues can lead individuals to engage in unsafe behaviors.