QI 105: Leading Quality Improvement

What are the four phases of an improvement project? (A) Plan-Do-Study-Act (B) Innovation-Pilot-Study-Act (C) Plan-Implement-Pilot-Spread (D) Innovation-Pilot-Implementation-Spread

Correct Answer: D.) Innovation-Pilot-Implementation-Spread The four phases of an improvement project are "Innovation-Pilot-Implementation-Spread." Plan-Do-Study-Act (PDSA) cycles are tests of change that improvers conduct during different phases of their improvement projects.

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 phase have Dr. Gonsalvez and her team just completed? (A) Spread (B) Pilot (C) Implementation (D) Planning

Correct Answer: B.) Pilot The team has just completed the improvement stage that consists of early, rapid-cycle tests of change: the pilot phase.

Which of the following are strategies to help members of a QI team establish common goals? (A) Create a team roster. (B) Share stories. (C) Write down a shared work plan. (D) All of the above

Correct Answer: D.) All of the above The best answer is all of the above. Some strategies to help get everyone on the same page include: Create a team roster so everyone knows who is on the team and how to reach each other, share stories to establish why the QI project is personally meaningful to people, and write out a work plan.

The four steps for testing a change are: (A) Plan-Do-Study-Act (B) Innovation-Pilot-Study-Act (C) Plan-Implement-Pilot-Spread (D) Innovation-Pilot-Implementation-Spread

Correct Answer: A.) Plan-Do-Study-Act The four steps for testing a change are "Plan-Do-Study-Act." PDSA cycles are tests of change that improvers conduct during different phases of their improvement projects. (Note: The four phases of an improvement project are "Innovation-Pilot-Implementation-Spread.")

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"? (A) Listening to your teammate's idea to improve screening for sepsis. (B) Stating your idea for updating the sepsis protocol. (C) Adapting your idea for the sepsis protocol based on your teammate's input. (D) A and C

Correct Answer: B.) Stating your idea for updating the sepsis protocol. The best answer is stating your idea for updating the sepsis protocol. Advocacy is making your own views known (including why you feel or think the way you do). Inquiry is seeking the views of others. The key to being an effective team member is balancing advocacy and inquiry.

After a successful pilot, which of the following should Sandy's improvement team undertake as a next step? (A) Work on seeing that the change is widely adopted by the unit, such as by making it a formal policy and training new staff on it. (B) Continue to run PDSA cycles. (C) Spread the change to other hospitals in the network. (D) A and B

Correct Answer: D.) A and B The best answer is "A and B." After a successful pilot, they should move on to the implementation phase. This phase includes actions to "hardwire" the change, such as making it standard policy and training new staff on it. In implementing the change, the team will continue to run PDSAs: making predictions, carrying out the test, collecting data, and refining the change based on results. (Note that compared to PDSAs in the pilot phase, these tests will require significantly more people, time, and resources.)

Personality and work style profile assessments can help to: (A) Identify the personalities present and work to everyone's strengths. (B) Identify why some people will never respond well to change. (C) Determine who has the right expertise to be on an improvement team. (D) A and C

Correct Answer: A.) Identify the personalities present and work to everyone's strengths. Personality and work style profile assessments help us understand how different people prefer to perceive the world and make decisions. This can be valuable — particularly if team leaders appreciate these differences and design the work to accommodate diverse preferences.

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? (A) Share data that shows the process change is associated with a decrease in adverse events. (B) Abandon the idea. (C) Tell a story about a patient whom medical science was able to save. (D) A, B

Correct Answer: A.) Share data that shows the process change is associated with a decrease in adverse events. The best answer is to share data that shows the process change is associated with a decrease in adverse events. Many people find compelling data to be persuasive. Some people are more motivated by stories. However, the story needs to be directly related to the change in order to be persuasive.

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? (A) Test the new process with one patient and closely review the results. (B) Bring together a group of stakeholders to develop an implementation plan. (C) Test the new process throughout the hospital to build a pool of data. (D) None of the above: There is no need to test this process because another hospital has already proved it to be effective.

Correct Answer: A.) Test the new process with one patient and closely review the results. The best answer is "test the new process with one patient on and closely review the results." Sandy and her team have an innovation and are ready to conduct a pilot. (Every organization is different, so just because the idea worked at another hospital does not mean it will work here.) Piloting involves starting small, such as with one patient, and carefully refining the change to make sure it works.

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. In the example, which of the following is a process change? (A) The planned nap (B) The data that show whether staff members are taking a planned nap (C) The belief that a planned nap can support patient safety (D) None of the above

Correct Answer: A.) The planned nap The process change is the planned nap. It is the method by which the organization hopes to decrease worker fatigue.

In designing a performance improvement team, it is helpful to: (A) Choose people who are unlikely to disagree with one another (B) Have a mix of different types of people on the team (C) Have everyone on the team exhibit similar personality preferences (D) All of the above

Correct Answer: B.) Have a mix of different types of people on the team A healthy mix of personality types helps ensure a team captures many perspectives on an issue.

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. What improvement project phase is Sandy looking to embark on? (A) Innovation (B) Pilot (C) Implementation (D) Spread

Correct Answer: B.) Pilot Sandy has identified an innovation and is hoping to conduct a pilot. Piloting involves trying out the new process in one place and carefully refining the system to make sure it works. Depending on the success of the pilot, implementation and spread may come later.

Which of the following is a mechanism for "hardwiring" an innovation during the implementation phase? (A) Developing a new process based on emerging technology (B) Training all staff to use a new process (C) Testing a new process that has been successful elsewhere in a new unit (D) All of the above

Correct Answer: B.) Training all staff to use a new process "Hardwiring" helps sustain an idea after it has been tested and implemented. Training all staff is one way to do this. Other ways include assigning a day-to-day leader for the new process or having senior leadership remove barriers for staff.

Sandy and her improvement team test the new pain control idea in the cardiac unit over the course of six weeks. The results continue to show improvement. What phase will the project enter next? (A) Plan (B) Act (C) Implementation (D) Spread

Correct Answer: C.) Implementation Sandy and her team have completed their pilot, which means they should move on to implementation next.

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? (A) The nap wasn't long enough. (B) The room for the nap was too noisy. (C) The culture of the organization did not support napping during a shift. (D) Workers weren't as tired as managers thought they were.

Correct Answer: C.) The culture of the organization did not support napping during a shift. The program probably failed because the culture of the organization did not support napping on the job as a way to decrease worker fatigue and boost patient safety.

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? (A) The team will no longer make predictions. (B) The team will begin collecting data (C) The team will utilize more staff and resources. (D) A and B

Correct Answer: C.) The team will utilize more staff and resources. The best answer is "the team will utilize more staff and resources." For example, when they are eventually ready to implement the change, they will continue to run PDSAs (making predictions, collecting data, and documenting things that go wrong so that they learn from them). However, compared to PDSAs in the pilot phase these tests will require significantly more people, time, and resources.

Dr. Gonsalvez and her team continue to test the new idea. Assuming things continue to go well, what might they eventually do? (A) Share the innovation with other units and/or hospitals. (B) Utilize the IHI Framework for Spread. (C) Develop a communication and dissemination plan. (D) All of the above.

Correct Answer: D.) All of the above. The best answer is "all of the above." After a successful pilot, the next steps are implementation and spread. IHI's Framework for Spread, which includes developing a communication and dissemination plan, is a helpful tool to use during the final phase of an improvement project.

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. Which of the following represents a culture change? (A) The planned nap (B) The designated room for the nap (C) The staff education about the nap (D) The belief that a planned nap can support patient safety

Correct Answer: D.) The belief that a planned nap can support patient safety The culture change is the fundamental belief that a planned nap can support patient safety and that napping is okay during a shift.

What is the order of the four steps teams typically follow to get to a place where they are running smoothly? (A) Forming, storming, norming, performing (B) Norming, performing, forming, storming (C) Storming, forming, norming, performing (D) Performing, storming, forming, norming

Correct Answer: A.) Forming, storming, norming, performing Mary Dolansky explained a four-step process by which teams to get to a place where they are running smoothly: forming, storming, norming, and — finally — performing.

According to Herbert Kaufman, which of the following are reasons health care workers commonly resist change? (A) The expected autonomy of health care workers (B) A real or perceived limit on resources (C) An accumulation of policies, procedures, regulations (D) All of the above

Correct Answer: D.) All of the above The best answer is all of the above. In his book The Limits of Organizational Change, Herbert Kaufman identified all of these as potential barriers to implementing change in health care.