IHI QI 102

Which of the following statements is true?

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

Defining a family of measures helps you answer which of the three questions of the Model for Improvement?

How will we know that a change is an improvement?

Starting with small tests of change:

Improves the likelihood of buy-in from clinical and administrative staff members

Having a clear aim statement is important in quality improvement work because:

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

After six months of data collection and four linked PDSA cycles, a team is preparing to present the results of its improvement project. The graph looks like this so far: What additional information is most important for them to add to the graph to best explain the work they've done?

Annotations to show when specific changes were tested

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?

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

Why might an improvement team consider collecting balancing measures?

To make sure they didn't unintentionally introduce undesired changes

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.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?

Measure to see if the change led to improvement. The team has planned a test of change and now they've done the test. The team must now study how the test went (the "S" part of the PDSA cycle). They can look at a mix of process measures (such as how often appointments started on time) and outcome measures (such as how satisfied the patients were with the new process).

An aim statement should include the following:

Numeric goals, specific time frame, and the patient population or system affected Aim statements should specify measurable numeric goals, a time frame for attainment, and the group or system affected. Costs and team members, while important to the success of the quality improvement project, are not part of the aim statement itself.

Medical staff at a community health center were concerned about the oral health of many of their patients. To improve patients' oral and overall health, they wanted to improve the coordination between medical and dental services, with medical providers more reliably providing appropriate referrals for dental care based on patients' age and risk factors. What would you identify as the best outcome measure for the project?

Patients' oral health, as measured by caries risk assessment

You're a dental assistant at a small clinic. Sometimes patients with unresolved problems need to come in for recall appointments. However, you notice that it's a real challenge to schedule these recalls 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?

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

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:

PDSA cycles provide a mechanism to adjust improvement ideas as the project progresses. PDSA cycles allow for rapid and frequent review of data and then adjusting the test of change based upon those findings. For example, if a new guideline that's meant to improve pneumonia care isn't working, PDSA cycles allow you to change the guideline quickly and test its efficacy, rather than waiting until the end of a long study period.

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 the best example of a process measure that the team may collect as part of this improvement effort?

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

The Model for Improvement begins with three questions designed to clarify the following concepts:

Aims, measures, changes The Model for Improvement begins with three fundamental questions about any given improvement, designed to address the aim (what are we trying to accomplish?), the measures to be used (how will we know a change is an improvement?) and the changes to be used (what changes can we make that will result in an improvement?).

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 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?

Analyze information collected. "S" stands for Study. In this step you review the information collected during the "Do" step. Planning for implementation is part of the "Plan" step, and documentation of outcomes is part of the the "Do" step. Considering how to spread the change to another hospital is outside the scope of this PDSA cycle.

Brenda, the office manager at a dental practice, noticed many patients were missing their appointments. With the support of her colleagues, she decided to conduct a small improvement project to improve the process for reminding patients of upcoming visits, with the goal of having fewer "no shows." Which of the following is the most effective aim statement for this project?

Within three months, 90 percent of patients will show up for their appointments. Effective aim statements contain a time frame, a definition of the population to be affected, and specific, measurable goals. Answer B meets all three of these criteria. While answers A and C may be useful process changes to move toward the aim, they don't address Brenda's ultimate goal, which is to decrease the number of patients who miss appointments. Option D is not specific enough, and it is also less realistic.

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?

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

Which of the following statements is true?

All of the above The Model for Improvement is appropriate for all types of improvement efforts and has been used successfully by thousands of health care organizations in many countries to improve a variety of health care processes and outcomes. However, there are other useful models to guide improvement out there. Studies have shown that it is more important for an organization to have a standard road map to conduct improvement projects rather than have any specific framework. Lean focuses on improving value from the customer's point of view, by reducing waste of time and resources.

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. The care protocol was successful at the other hospital. Why would it be important to test this proven change at your hospital?

Because this change may not be as effective in your setting

Which of the following changes falls under the heading of "eliminating waste"?

Clinicians type all notes directly into a computer rather than writing them in a patient's chart, thus saving paper.

As an office manager, you notice there's a high rate of "no shows" for appointments at your practice. People often tell you they scheduled the appointment far in advance, and simply forgot to go. You decide it's worth a try to improve this problem by sending reminders via text message. Which change concept are you using?

Design Systems to Prevent Errors

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?

Increase the number of patients reporting they are "very satisfied" with the clinic's scheduling by 50 percent within six months. An aim statement must specify "how good, by when." Improving patient satisfaction with scheduling is a reasonable goal. Answer D is best described as an opportunity statement, as it contains no specifics about how much the clinic must improve, nor by when. Answer C is more of a "change" statement than an aim statement.

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?

Test their change plan using the PDSA cycle. Once you have worked through the first three questions of the Model for Improvement — the questions about aims, measures, and changes — it's time to do a small test of change using the PDSA cycle. The clinic should have already developed their measures, and now is not the time for a break — because the hard work of improvement is just beginning!

Brenda, the office manager at a dental practice, noticed many patients were missing their appointments. With the support of her colleagues, she decided to conduct a small improvement project to improve the process for reminding patients of upcoming visits, with the goal of having fewer "no shows." During a team meeting, Brenda's team members review her aim statement. Which of the following comments from a team member would most strongly suggest Brenda has selected an appropriate aim?

It feels like a very meaningful project for both the patients and the practice." Writing an effective aim statement, especially when it comes to being specific about the improvement desired, can be surprisingly difficult. Dr. Berwick recommends choosing aims that feel meaningful for the improvement team. He also recommends selecting aims that are somewhat ambitious (i.e., they are not overly simple) and remind teams they can always adjust their aim statements as the project evolves.

What's the main benefit of using change concepts to come up with improvement ideas?

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

A good aim statement helps improvement teams answer which question from the Model for Improvement?

What are we trying to accomplish? An aim statement is the answer to the first question in the Model for Improvement: "What are we trying to accomplish?" Aim statements answer this fundamental question of any improvement project by stating how good, for whom, and by when.