IHI QI 103 Testing and Measuring Changes with PDSA cycles

How many data points do statisticians recommend to draw a median?

12 As you learned in this lesson from Dave Williams, the best answer is 12.

When increasing the number of patients or events from one PDSA cycle to the next, it is usually helpful to multiply by what number?

5 The 5X Rule recommends an increase by a factor of five whenever you finish one successful test and move on to the next.

Which of the following is a reason for using a dynamic display for data?

All of the above The best answer is all of the above. Summary statistics that are static in nature don't give you the appropriate picture of the variation that lives in your data. By plotting data over time, you can observe patterns and find evidence of improvement.

Which of the following statements is true about using data for improvement?

All of the above. The best answer is all of the above.

When graphing your data, you should:

Annotate the tests of change.

Which of the following statements is true?

B and C The best answer is B and C. It is possible and sometimes easiest to draw a run chart by hand. Other times, it can be helpful to use a computer program. The next course will teach you to draw a run chart using a spreadsheet computer program.

Which of the following describes data stratification?

Classifying and separating data according to specific variables Classifying and separating data according to specific variables — a practice called stratification — is a helpful way to understand the story data is telling. The goal of stratification is to find patterns in data that will help you understand the causal factors at work. Stratification helps inform teams' decisions about what changes to make, where, and when.

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?

Confirm the "face validity" of the new cleaning process by demonstrating it with a couple of housekeeping staff members and a supervisor. Based on your concern about patient safety, you'd likely first want to confirm the "face validity" of the new cleaning process by demonstrating it with a couple of housekeeping staff members and a supervisor. When testing changes that involve patients, it can be helpful to conduct an initial test using staff only. A simulation or practice session before going live is often a good way to uncover issues with high risk.

Which of the following methods would you recommend to display your improvement data?

Draw a run chart. Run charts are an effective way to view changes over time. They are much easier to interpret visually than a list of numbers or a static display of data such as a bar chart.

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?

Increase the number of patients Nurse Moss assesses by a factor of 5. The best answer is to increase the number of patients Nurse Moss assesses by a factor of 5. Scale is the number of interactions within the test — in this case, the number of patients receiving the assessment, and the 5X Rules recommends an increase by a factor of five in each subsequent test. Changing the conditions of the test — such as the language involved or the staff involved — would be a change in scope, rather than scale.

Which of the following is a problem with static data?

It doesn't adequately portray variation. Summary statistics that are static in nature don't give you the appropriate picture of the variation that lives in your data. Although you can accurately display data such as the mean, median, or mode, it is not a good way to observe change over time.

When designing your run chart, it is important to include:

None of the above The best answer is none of the above. You want your run chart to be as easy to read as possible. Including non-essential information (i.e., information that is not a key measure for your improvement project) such as rates of UTIs where you used to work or the ages of patients or types organisms associated with UTIs will add clutter to your chart and make it harder to understand.

When designing the run chart, it is important to include:

Units of time on the X axis The run chart should display units of time — whether it's days, weeks, or months — on the X axis. The Y axis is where you plot the key variable you are measuring, which in this case is the rate of UTIs.

When planning a sequence of PDSA cycles for a change that involves patients, which of the following is a true statement?

We would expect the number of patients involved to grow rapidly from early cycles to later cycles. As improvement work progresses and the number of cycles increases, we would expect the scope and scale of the tests to increase, meaning both a rapidly growing number of patients involved in the tests as well as increasing diversity in the test population.

When determining sample size for the first test, it is most important to:

Weigh the potential consequences of a test that does not lead to improvement against the belief in success. With improvement work, you should weigh the potential consequences of a test that does not lead to improvement against the belief in success. How small your first PDSA cycle should be rests on your degree of belief and the stakes involved.

In a run chart, the variable being measured is typically placed on what axis?

Y axis The measured value is usually represented on the Y axis of a run chart. The X axis is usually the time — minutes, hours, days, weeks, months, etc. — or a numerical sequence in cases where data doesn't correspond to units of time.