IHI QI

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A 2015 article from the Democracy Collaborative described how health care organizations to move from "contribution to accountability." Which of the following is the first step?

Doing good things for the community.

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?

Engage the largest possible number of people in the room.

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, whereas the goal is one hour.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?

Forming a clearer picture of the problem

What is the order of the four steps teams typically follow to get to a place where they are running smoothly?

Forming, storming, norming, performing

Which of the following relationships best reflects the informative model of the patient-provider relationship?

Hairstylist-client

In designing a performance improvement team, it is helpful to:

Have a mix of different types of people on the team

Which of the following best describes the idea of co-production of health care services, as described by Dr. Maren Batalden?

Health care is a service, not a product AND health care is always co-produced by patients and providers.

Personality and work style profile assessments can help to:

Identify the personalities present and work to everyone's strengths.

Which of the following is one of the three simultaneous goals of the IHI Triple Aim?

Improve the health of the population.

A hospital is trying to implement a new patient assessment form. They want to first test the usability and efficacy of the form.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 should they do?

Increase the number of patients Nurse Moss assesses by a factor of 5.

Michael Pugh talks about the distinction between management and leadership. Which of the following is most indicative of leadership?

Influencing people

Which model of the patient-provider relationship is exhibited when the expert provider simply provides information to patients, who hold decision-making power?

Informative

Which statement about storytelling is most accurate?

It can put a human face on otherwise abstract data.

Which of the following is a problem with static data?

It doesn't adequately portray variation.

Which statement about persuasion is most accurate?

It is one of the important tasks of leadership.

Which of the following statements is true?

It is possible to draw a run chart by hand AND computer programs can be helpful for drawing run charts but are not always necessary.

You're trying to improve patient satisfaction scores in your hospital's emergency department. You decide to poll 40 patients a day for three weeks. Your charge nurse says that the quality of service really fluctuates depending on the time of day. So your daily sample consists of 10 patients polled at 8 AM, another 10 at noon, another 10 at 5 PM, and the final 10 at 9 PM. This is an example of what kind of sampling?

Judgment

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?

Look at a few patients every day for a week.

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, whereas the goal is one hour. What might Reggie do if he were to act like a leader?

Look into the cause of the problem and research how other ICUs have solved it.

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 a process measure for this effort?

Number of students helping to check a patient in

What is the identified role of health care in the population health model developed by David Kindig and others at the University of Wisconsin?

One of several determinants of population health

Which of the following charts would be best to justify focusing on a few large problems and ignoring many smaller ones?

Pareto chart

A health care team meets behind closed doors to discuss the best treatment for a patient and decides to operate. They join the family of the patient, who is gathered in the waiting room, to announce their decision. Which model of the patient-provider relationship are they enacting?

Paternalistic

Imagine you're a first-year resident enjoying a meal at a restaurant on your day off, and another customer starts choking. The customer's companion shouts, "Is there a doctor here?" in a panic. You rush over to assist the patient, who can't breathe. Which of the following patient-provider relationship would be most appropriate in this situation?

Paternalistic

You gather some data about the use of a surgical checklist in your operating rooms and have an idea for an improvement. At the next month's meeting, you present the idea to your colleagues. The most likely outcomes will include:

People will have different reactions; some will support you, others will initially resist you.

From the viewpoint of the World Health Organization, "health" is defined as:

Physical, mental, and social well-being

Dr. Gonsalvez, 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 stage have Dr. Gonsalvez and her team just completed?

Pilot

You've got a summer job working at the headquarters of Jen & Berry's, an ice cream company. One day, the CEO herself (Jen, of course) walks by your desk. "We're testing a new flavor," she says, "Peanut Buttery Banjo Jamboree." She has high hopes customers will like the new flavor, and that it can replace "Chocolate Mocha Polka Party," the company's lowest-selling product. "But," she says, "we need some data to show that it's really an improvement." How would you figure out which flavor the company should sell?

Poll a small sample of customers in the region, including proportional numbers of people who read "Chocolate Lovers Monthly" and "Peanut Butter Today."

Which of the following is the main reason why minority patients receive lower quality care and less intensive care than white patients in the US?

Providers who grow up in societies with negative stereotypes about minority groups may have implicit biases that negatively affect care for those groups.

You are a radiology resident, and you're working to decrease the time it takes to get chest x-rays read in the hospital. You've gathered some data, and you're now discussing your results with the residency director and the chief of radiology. Thus far, you have presented the data to them and reviewed a case of a patient who had a negative outcome because of a delay in the reading of his chest x-rays. During this meeting, it would be a good idea to also:

Relate your goal to national radiology standards.

Imagine you're a health care provider. A patient presents with a lump in her breast that she first noticed two years ago. When you ask about her medical history, she tells you that she has never seen a health care provider to examine the lump before. What would be the best thing for the provider to do in response to this information?

Say, "I'm so glad you came to see me today. Can you help me understand why you weren't able to come in before?"

Your improvement team is trying to improve outcomes for patients with diabetes who are younger than age 18. You need a baseline measure for the percent of patients in the population you're studying who have hemoglobin A1c (blood sugar) levels greater than 8. You request this information from your information systems department, located in the central office. Then you wait. And wait. And wait. Frustrated, you decide to take matters into your own hands. Which of the following is the best plan for collecting data?

Select a sample of 10 charts from each of the four months to review.

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?

Share data that shows the process change is associated with a decrease in adverse events.

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"?

Stating your idea for updating the sepsis protocol.

What can quality improvement teams learn from Renoir, Monet, and Cezanne?

Teamwork can lead to creative ideas.

Which of the following is NOT a step in brief action planning?

Telling patients what they need to work on to achieve their health goals

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?

Test the new process with one patient and closely review the results.

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 panned nap

Which of the following descriptions best describes "leadership"?

A positive, "let's do something about it" attitude toward problems

Which of the following options indicates a non-random pattern?

A run of six points or more OR an astronomical point

Why should you consider collecting a family of measures when undertaking an improvement?

A single measure may not be enough to determine the impact of a change on the system.

According to published estimates, why do you suspect the impact of health care on premature deaths in the US is relatively small compared to other factors?

A variety of other factors — including behavioral patterns and genetic disposition — account for a great proportion of premature deaths.

Which of the following is an example of an effective measurement technique for improvement?

All of the Above

According to Herbert Kaufman, which of the following is a reason that health care workers commonly resist change?

All of the above

According to Peter Drucker, which of the following statements is true?

All of the above

Dr. Gonsalvez, 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. Dr. Gonsalvez and her team continue to test the new idea. Assuming things continue to go well, what might they eventually do?

All of the above

Improving clinical care within the framework of the Triple Aim requires health professionals to work across disciplines and across communities. Which of the following people can help providers identify community resources?

All of the above

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?

All of the above

Which of the following are strategies to help members of a QI team establish common goals?

All of the above

Which of the following behaviors is best addressed through population-health level intervention and counseling?

All of the above

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

All of the above

Which of the following statements would you expect to hear from an effective leader in response to a problem?

All of the above

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?

All of the above

You are a clinician at a small, rural hospital. A mother brings her overweight 10-year-old son into the office for a routine check-up.Which of the following questions might you ask to gain insight into a potential population-level improvement?

All of the above

You are seeing a patient for the first time. She is a 45-year-old woman who self-identifies as being of Latina ethnicity, and has a strong family history of breast cancer. She is here for her first annual check-up. The "populations" of which she is a member include:

All of the above

You work as a physician at a practice that cares for hundreds of patients with Type 2 diabetes. You think you are doing a good job, but have no way to objectively know. Which of the following might be useful ways to use data from an electronic health record to measure and improve the care your practice provides?

All of the above

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?

Average number of minutes between patient arrival at the clinic and completion of check-in

Which of the following is an example of wasteful spending in health care?

Avoidable emergency room visits

Which of the following is the description of the term "non-compliance" that best reflects patient-provider partnerships?

Both of these responses reflect patient-provider partnerships: Non-compliance is a term that comes from the paternalistic model of care, where provider's role is to decide on the plan of care and the patient's role is to follow it. AND When patients don't follow a plan of care, it may be a sign that the health care system is "non-compliant" in meeting patients' needs or goals.

How does the Triple Aim strive to lower health care costs?

By reducing waste in health care and increasing the value of care.

You're a hospitalist in a large referral hospital, and you have just discharged a patient who suffered a stroke due to high blood pressure. You've used many strategies, such as Ask-Tell-Ask, shared decision making, and brief action planning with the patient. The patient's primary care doctor says he will follow up with the patient. Two weeks later, the patient is back in the hospital, and you find out the primary care doctor never followed up. What's the best thing to do next?

Call the primary care doctor to learn more about the miscommunication and how to avoid it in the future. If necessary, conduct a quality improvement project to improve the referral process.

You work on a surgical unit that receives 87 new patients per week. In your spare time, you are trying to improve pain control across the unit. As you prepare to collect your baseline data before testing your change, you consider your plan to gather this information. Which of the following would be the best data collection plan for this project, and why?

Collect data on a representative selection of patients for two weeks.

Resource stewardship refers to:

The appropriate allocation of resources

What aspect of the run chart helps you compare data before and after a PDSA cycle?

The baseline median AND annotations of when specific changes were tested (PDSA cycles)

our 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?

The belief that a planned nap can support patient safety

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?

The culture of the organization did not support napping during a shift.

Which of the following is the best definition of the term "population health"?

The health outcomes of a group of individuals, including the distribution of such outcomes within the group

A pediatrician is worried about a 5-year-old boy with HIV because his father hasn't been bringing him in for his appointments. The father immigrated from Guatemala to the United States three years ago, and the pediatrician suspects he may not be seeking care because he believes the disease is punishment from God. Which action would best follow the approach of cultural humility?

The pediatrician should send a community health worker to the home to ask the father about why he hasn't been attending clinic.

A cardiac surgeon is informing a patient and his wife about the risks and benefits of a coronary bypass surgery to treat the man's acute heart disease. The surgeon wants to take a collaborative approach in which the patient ultimately decides about the treatment, with the support of the provider. Which of the following behaviors would undermine such a partnership?

The surgeon describes the risks and benefits of the surgery, being careful not to share her opinion that the surgery is the best option for long-term heart health.

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. Sandy and her improvement team begin to test the change using PDSA. Assuming their early testing is successful, how will their PDSA cycles change over time?

The team will utilize more staff and resources.

Which of the following traits do histograms, Pareto charts, and scatter plots have in common?

They are all visual tools to display data.

Which of the following statements about astronomical data points is true?

They signal a non-random pattern

Which of the following BEST describes the purpose of a histogram?

To show distribution of continuous data

Which of the following is a mechanism for "hardwiring" an innovation during the implementation phase?

Training all staff to use a new process

When effective leaders hear others complaining about a problem, which action would they most likely take?

Try to learn how big the problem really is.

Maureen Bisognano, IHI Senior Fellow and President Emerita, has helped popularize the idea of asking patients, "What matters to you?" in addition to, "What's the matter?" This question helps providers do which of the following?

Understand patients' health goals and priorities

Which of the following is one of the four components of empathy, as outlined by nurse scholar Theresa Wiseman?

Understanding another person's feelings in the moment

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:

Units of time on the X axis

What famous Italian economist is credited with the theory behind the 80/20 rule?

Vilfredo Pareto

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.

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:

Weigh the potential consequences of a test that does not lead to improvement against the belief in success.

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. Which of the following is most important to determine the best size for your initial PDSA test?

Weigh the potential consequences of a test that does not lead to improvement against the degree of belief in success.

Which of the following questions does Dr. Arthur Kleinman, a medical anthropologist at Harvard University, suggest providers ask to see illness from the perspective of their patients?

What do you think caused your problem?

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?

Who will collect the data and what method will be used for collecting it

Which of the following is an example of shared decision making?

A diabetic patient and her physician discussing the best options to help her get more exercise more consistently.

What is the minimum number of data points you should usually have to look for signs of improvement on a run chart?

10

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

12

Within the following data set, what is the median? [2.5, 7.2, 2.5, 2.9, 4.7, 3.6, 4.7]

3.6

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

When drawing a histogram, which is a good number of categories to include on your X axis?

6-12


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