QI 101 Introduction to health care improvement

Which of the following is an essential component of systems thinking included in Deming's System of Profound Knowledge? (A) Biology (B) Physics (C) Psychology (D) All of the above

psychology Psychology, or human behavior, is one of the four essential components of systems thinking according to W. Edwards Deming. Deming believed that people were fundamental components of the systems in which they worked, and human factors affected systems outcomes. The other three components of systems thinking according to Deming are: appreciation of a system, understanding variation, and theory of knowledge.

When you are applying Deming's System of Profound Knowledge, which of the following statements is true? (A) You can't think about any one component of the System of Profound Knowledge completely in isolation. (B) You need to fully understand each component of the System of Profound Knowledge to gain any benefit. (C) It helps to visualize the System of Profound Knowledge as a tree. (D) A and B.

a Deming emphasized that it is the relationships among the four parts of the System of Profound Knowledge (which is often depicted as a lens) that provide insights for improvement; you can't think about any one area completely in isolation because they all intersect and interact. According to Deming, "One need not be eminent in any part nor in all four parts in order to understand and apply it."

Which of the following improvement efforts is the best example of increasing the efficiency of care? (A) Decreasing unnecessary surgical procedures by helping patients reduce their pain through physical activity (B) Improving patient experiences by providing reading materials in the waiting room (C) Improving the percent of clinic patients achieving their targeted blood pressure by instituting a series of reminders for providers about evidence-based processes (D) Through staff development and weekly feedback, equalizing the likelihood that a patient will receive pain medication regardless race, ethnicity, or education

A

The Transcendental Nursing Home is working on decreasing its rates of catheter-associated urinary tract infections (UTIs) among its patients. The improvement team predicts that if they begin providing intensive training to staff on how to place the catheters, the infection rates will improve. They devise a plan to test this idea. After three months of testing its improvement idea, the Transcendental team notices that infection rates on one unit are much higher than any other unit. Frustrated, leadership decides to replace all the providers on that unit except the three with the highest seniority. What is the likely outcome, and why? (A) Infection rates will not change because the leaders have not changed the system of care. (B) Infection rates will not change because the three caregivers with seniority are probably negligent, like their peers who were fired. (C) Infection rates will get better because the leaders have fixed the system. (D) Infection rates will get better because the leaders have removed the sources of variation.

A The most likely answer is that infection rates will not change because the leaders have not changed the system of care. Removing individual "offenders" from a system should not be expected to magically make infection rates will go down. The best way to implement improvement is to examine and change the system of care itself.

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

A and C The best answer is A and C. As medical information and technology increases, demand for complicated procedures is increasing, and providers are becoming more and more specialized (and fragmented). The burden of disease is shifting toward chronic conditions.

Regarding the Institute of Medicine's (IOM's) six aims for health care, which of the following is true?

All of the above The best answer is "all of the above." In 2001, the IOM released Crossing the Quality Chasm: Health Care in the 21st Century, which identified six key dimensions of the US health care system and set aims for each dimension, so that organizations would know where to focus their improvement efforts. These six aims are so comprehensive that today they're still the dominant framework for thinking about improving health care quality in the US and in many other countries, as well.

Which of the following countries has implemented cost-effectiveness requirements for drug approvals? a) Australia b) New Zealand c) Sweden d) All of the above

All of the aboveThe best answer is all of the above. In 1993, Australia was the first country to implement cost-effectiveness requirements for drug approvals: Before new drugs are eligible for the national formulary, an independent committee must assess their relative clinical value and cost compared to other available treatments. New Zealand, the Netherlands, Sweden, and other countries have since adopted similar policies.

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

B Just as defining dimensions of good performance helps employees, defining the aims (or dimensions of quality) of health care helped hospitals and other organizations understand what to focus on when improving their 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

B and C The best answer is B and C. Where a child is born and raised can significantly change the life expectancy. The root causes of this and other health differences we see around the world are deeply complex and by no means begin or end in the clinical setting.

Which of the following improvement efforts is the best example of making care more patient centered? (A) Decreasing adverse drug events patients experience by having a pharmacist on rounds in the intensive care unit (B) Improving the percent of clinic patients achieving their targeted blood pressure by instituting a series of reminders for providers about evidence-based processes (C) Through staff development and weekly feedback, equalizing the likelihood that a patient will receive pain medication regardless of race, ethnicity, or education (D) Better identifying patient concerns and values by instituting quarterly patient focus groups

D

Which of these questions is most strongly related to the "appreciation of a system" component of 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?

D "What is the whole system you're trying to manage?" is the best answer. Deming defined a system as a network of interdependent components that work together to try to accomplish the aim of the system. He said that the aim for any system should be that everybody gains, not that one part of the system gains at the expense of any others.

among developed nations which of the following statements is true?

During the past 15 years, countries around the world have used different approaches to improve health care quality and access.Today, countries around the world with vastly different political, economic, and cultural makeups are working in different ways to resolve the problem that many developed nations share: The cost of care has steadily risen over the last 15 years. (Note that the biggest spenders, such as the US, don't necessarily have the highest quality in many areas.)

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

During the past 15 years, the cost of care has been a growing problem for many developed nations. The cost of care has been a growing problem throughout developed nations during the last 15 years. For example, across 34 nations that make up the Organization for Economic Cooperation and Development (OECD), the average per capita health care expenditure increased by more than 70 percent between 2000 and 2010. However, the biggest spenders — such as the US — don't necessarily have the highest quality in many areas. Today, countries around the world with vastly different political, economic, and cultural makeups are working toward the goals of improving quality and access in different ways.

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.

Every system is perfectly designed to get the results it gets. A basic principle of improvement is that every system is perfectly designed to get the results it gets. When an error occurs in a complex system — and health care is a complex system — one can reasonably conclude that the system is still perfectly designed for that error, or one like it, to occur again. To avoid that outcome, a conscious effort must be made to improve the system.

Which of the following improvement efforts is the best example of increasing the effectiveness of care?

Improving the percent of clinic patients achieving their goal blood pressure by instituting a series of reminders for providers about evidence-based processes Effective care is based on scientific evidence and avoids underuse and overuse. A reminder system allowing providers to more easily use evidence in a busy practice environment would best improve the effectiveness of care.

Using Deming's System of Profound Knowledge is helpful in quality improvement because:

It can help break down complex quality issues into smaller, more understandable parts. By breaking down a problem into its component parts, as in Deming's System of Profound Knowledge, you can better analyze it and design ways to improve it.

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

Japan Japan has had a relatively inexpensive universal health insurance system for more than 50 years. Germany made health insurance mandatory for its entire population in 2009. Chile has given all Chileans access to a basic health care package since 2005.

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?

Patient-centered Patient-centered care is defined by the IOM as "care that is respectful of and responsive to individual patient preferences, needs, and values" and that ensures "patient values guide all clinical decisions." These high satisfaction rates are consistent with being patient-centered.

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?

Psychology (human behavior) The answer is psychology (human behavior). This nurse is very particular about preventing UTIs because of the way this kind of infection has affected her life. This, in turn, has a strong effect on the way the entire unit works.

Michael S., a 49-year-old factory worker, goes to the hospital after developing chest pain at work. Physicians quickly diagnose him with an acute myocardial infarction (heart attack), and he has successful surgery to open his blocked coronary artery. While he is recovering in the hospital, he contracts an infection that could have been prevented through better infection control practices in the hospital. Which of the IOM aims has this hospital FAILED to meet?

Safe The best answer is "safe." Safe care means avoiding injuries to patients from the care that is intended to help them. Michael contracted an infection because his care was not as safe as it could have been.

Why was it important for the Institute of Medicine (IOM) to develop its six aims for health care? (A) They represent the dominant framework for thinking about improving health care quality in the United States and in many other countries. (B) They were first publicized in 2001, in the report Crossing the Quality Chasm: Health Care in the 21st Century. (C) They help health care organizations have a better idea of what they need to improve. (D) All of the above

So that health care organizations would have a better idea of what they needed to improve Just as defining dimensions of good performance helps employees, defining the aims (or dimensions of quality) of health care helped hospitals and other organizations understand what to focus on when improving their care.

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

The US government and citizens alike are struggling to afford the cost of care. The US government and citizens alike are struggling to afford the cost of care. We've seen in this lesson the US has the means to measure health care quality — the results just often are not what one would hope! Although the US remains a leader in biomedical innovation, even the most advanced biomedical science and technology can't guarantee high-quality care.

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) Demand for complicated procedures is slowing. d) A and B

The best answer is A and B As medical information and technology increases, demand for complicated procedures is increasing, and providers are becoming more and more specialized (and fragmented). The burden of disease is shifting toward chronic conditions.

The Transcendental Nursing Home is working on decreasing its rates of catheter-associated urinary tract infections (UTIs) among its patients. The improvement team predicts that if they begin providing intensive training to staff on how to place the catheters, the infection rates will improve. They devise a plan to test this idea. Which component of Deming's System of Profound Knowledge is the team about to harness? A) Appreciation of a system (B) Psychology (human behavior) (C) Understanding variation (D) Theory of knowledge

Theory of knowledge The best answer is "theory of knowledge." Deming believed knowledge is based on theory, and that theories need to be developed, applied, and tested in order to advance knowledge in a systematic fashion.

Which of the following improvement efforts is the best example of increasing the equity of care?

Through staff development and weekly feedback, equalizing the likelihood that a patient will receive the appropriate amount of pain medication regardless of their race The best answer is equalizing the likelihood that a patient will receive pain medication as indicated regardless of race, ethnicity, or education. Equity is about making sure patients receive appropriate, high-quality care regardless of gender, race, ethnicity, socioeconomic status, geographic location, sexual orientation, and other individual characteristics.

Use the following scenario to answer questions 2 and 3: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. (A) Equitable (B) Safe (C) Effective (D) Efficient (E) Timely (F) Patient-centered

Timely

Which of these is a question particularly associated with the "theory of knowledge" component in Deming's System of Profound Knowledge?

What are your predictions about the system's performance? The answer is, "What are your predictions about the system's performance?" Deming believed knowledge is based on theory, and that theories need to be developed, applied, and tested in order to advance knowledge in a systematic fashion.