IHI questions
"When one of my coworkers is late for the carpool in the morning, it affects the traffic we hit, what roads we can take, what parking space we can get, and, ultimately, the time we arrive at work." (A) Appreciation of a system (B) Understanding variation (C) Theory of knowledge (D) Psychology (human behavior)
A
Gathering and reviewing data during an improvement project—that is, measuring—helps you answer which of the three questions of the Model for Improvement? (A) How will we know that a change is an improvement? (B) What are we trying to accomplish? (C) What changes can we make that will result in improvement?
A
Having a clear aim statement is important in quality improvement work because: (A) Aim statements provide a clear and specific goal for the organization to reach. (B) All grant agencies require clear aim statements when they are considering funding requests. (C) Aim statements remove all obstacles from quality improvement projects. (D) The leaders of all organizations expect to see these types of goals.
A
James is a first-year surgery resident on his first pediatric rotation. His attending (supervising physician) asks him to start intravenous (IV) replacement fluids on a two-year-old boy who is having vomiting and diarrhea. Having trouble remembering the guidelines for calculating fluid replacement rates for very small children, James asks Maria, a nurse on the unit. Maria responds, "You're the doctor. It's your job to decide this." James picks a rate that is much too high, putting the child into fluid overload To prevent this type of error from recurring in this unit, which of the following is MOST important? A. An improved culture of safety and teamwork B. More severe, well-publicized consequences for providers who are reckless C. Clear medical guidelines for fluid replacement in patients of all ages D. Closer supervision of residents, especially in the first year
A
One hospital CEO insists on including performance data in the hospital's annual report. "We do very well on most measures, except for one or two, but we put those in anyway," she says. "We want to hold ourselves accountable." Does this practice demonstrate effective or ineffective leadership? A. Effective leadership: Being transparent, even about poor results, is a mark of a good leader. B. Effective leadership: It is good to share results in the annual report, but the leadership would be even more effective if it shared only the strongest results. C. Ineffective leadership: Leaders are people who have followers, and sharing poor results might cause the leader to lose some followers. D. Ineffective leadership: Because results are an important indication of leadership, publicly sharing poor results is an unwise practice.
A
One reason it's critical for caregivers to improve their teams' effectiveness is: (A) Effective teams reduce the risk of errors by providing a "safety net" for individual caregivers. (B) Effective teams limit the number of caregivers patients have to speak with, reducing confusion among patients and families. (C) Teams rely less on technology and more on human capabilities, thus leading to better care. (D) All of the above
A
What is "SBAR"? (A) A system for delivering information (B) A system for identifying areas for improvement (C) A system for confirming receipt of information (D) A system for assessing patient values
A
When considering your role within a health care team, it is important to keep in mind that: (A) No matter what profession you belong to, you will be a member of the team and must work intentionally toward making that team effective. (B) You may be part of a team, but will likely be able to work autonomously without much input or help from others. (C) Teamwork skills will come naturally to you, because we all learn them in other settings. (D) You will need to be a good team member until you become an expert in your field, at which point you probably won't need teamwork skills.
A
Which of the following changes falls under the heading of "eliminating waste"? (A) Physicians type all consult responses directly into a computer rather than writing them in a patient's chart, thus saving paper. (B) Dispensers full of hand sanitizer are placed throughout a floor, thus improving compliance with hand hygiene protocols. (C) A clinic starts tracking the number of foot exams that diabetic patients receive each year, thus ensuring they receive evidence-based care (D) A hospital invites patients to participate in the redesign of one of its centers, thus making them feel like valued members of a care team
A
Which of the following is a problem with static data? (A) It doesn't adequately portray variation. (B) It is often inaccurate. (C) It can't display mean, median, or mode. (D) All of the above
A
Which of the following is a problem with static data? A. It doesn't adequately portray variation. B. It is often inaccurate. C. It can't display mean, median, or mode. D. All of the above
A
Which of the following relationships best reflects the paternalistic model of the patient-provider relationship? (A) Parent-child (B) Teacher-student (C) Commanding officer-soldier (D) Hairstylist-client
A
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
A
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? (A) 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. (B) Avoid referring patients to the primary care doctor in the future. (C) Make a note in the patient's record that she was non-compliant in completing the follow-up care plan (D) A and B
A
You're a medical assistant at a community health clinic. Sometimes, patients with unresolved problems need to come in for follow-up appointments. However, you notice that it's a real challenge to schedule these follow-ups 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? (A) Review the process for scheduling these appointments with colleagues to identify opportunities for improvement. (B) Quit and start working in a new clinic that functions more effectively. (C) Research possible upgrades to the appointment scheduling software. (D) Tell a member of the office staff that it would be great if follow-ups were scheduled more quickly.
A
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. 1. Which of the following might be an outcome measure for this effort? (A) Average number of minutes between patient arrival at the clinic and completion of check-in (B) Number of patients seen by the clinic (C) Average number of students helping to check a patient in (D) None of the above 2. Which of the following is the best way to collect baseline data for this improvement project? (A) Look at a few patients every day for a week. (B) Look at 10 percent of patients for a year. (C) Look at 100 percent of patients for a month. (D) There is no reason to collect baseline data.
A, A
"On one day no one was late and it was school vacation week so there were no buses to hold us up — we got to work earlier than any other day!" (A) Appreciation of a system (B) Understanding variation (C) Theory of knowledge (D) Psychology (human behavior)
B
A medical unit in a hospital is in the midst of hiring some new physicians. During an orientation for new employees, a senior leader stands up and says, "We expect that the same rules apply to everyone on the unit, regardless of position." Which aspect of a culture of safety does this unit seem to value? A. Psychological safety B. Accountability C. Negotiation D. None of these
B
A patient's primary care provider (PCP) prescribes him a new diuretic because of a change in his insurance. It is intended to replace his previous medication. However, when he gets home, he is confused and takes both the previous and the new diuretic. He becomes dehydrated and ends up in the hospital. Which of the following process improvements would have been the best option for the PCP to prevent this adverse event? (A) Closing the loop on test results (B) Using teach-back to confirm patient understanding (C) Calling the pharmacist to confirm the patient's medication list (D) Using an electronic medication reconciliation tool
B
According to WHO, in developed countries worldwide, what is the approximate likelihood that a hospitalized patient will be harmed while receiving care? A. <1% B. 10% C. 50% D. >75%
B
An aim statement should include the following: (A) Specific time frame, team membership, and numeric goals (B) Numeric goals, specific time frame, and the patient population or system affected (C) Patient population or system affected, estimated cost of improvement, and numeric goals (D) All of the above
B
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. Which of the following methods would you recommend to display your improvement data? A. Write a list of numbers. B. Draw a run chart. C. Draw a bar chart. D. Create a two-column table.
B
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? (A) Say, "Why did you wait so long to come in? Breast cancer is more curable when it is diagnosed earlier." (B) 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?" (C) The provider shouldn't ask about her delay in seeking care because it's not relevant to the current conversation. (D) The provider shouldn't ask about her delay in seeking care because it may come off as judgmental.
B
In a run chart, the variable being measured is typically placed on what axis? (A) X axis (B) Y axis (C) Either axis (D) Neither axis; the run chart does not compare variables.
B
Isadora is a first-year surgery resident on her first pediatric rotation. Her attending (consultant) asks her to immediately start intravenous (IV) replacement fluids on a two-year-old girl who is experiencing vomiting and diarrhea. Isadora has recently learned the guidelines for calculating fluid replacement rates for very small children; however, she confuses them and picks a rate that is too high. Which of the following reasons that errors often occur in health care most clearly played a role in this scenario? A. The science of medicine is filled with nuance and gray areas, and what one health care organization feels is good practice, another may not. B. Diagnosing and treating patients is incredibly complex and often performed under time pressure and/or with insufficient information. C. The "culture of safety" (meaning the attitudes, perceptions, and values that employees share in relation to safety) may be weak in health care compared to other high-risk industries. D. Providers may not be prepared to work as a well-integrated team, so multiple caregivers and patient handovers leave room for miscommunication at every turn.
B
Linda, a pharmacist at an outpatient pharmacy for a medium-sized medical group, receives a call from John, a nurse practitioner in the cardiology clinic. John tells Linda he needs to call in a new prescription for hydrochlorothiazide at 50 mg once a day for Ms. Krane. At the end of the conversation Linda says to John, "Okay, so you want Ms. Joanne Krane to have a new prescription for hydrochlorothiazide at 50 mg by mouth once a day. Thirty pills and six refills." 2. What has Linda just done? (A) Increased the likelihood of error by repeating an order (B) Provided a read back (C) Used SBAR in communication (D) B and C
B
Safety has been called a "dynamic non-event" because when humans are in a potentially hazardous environment: A. It requires the same kind of thinking that causes problems to set them right. B. It takes significant work to ensure nothing bad happens. C. It is natural to establish and follow safe practices. D. There is generally a high prevalence of "near misses."
B
Since the publication of To Err Is Human in 1999, the health care industry overall has seen which of the following improvements? A. A 75 percent reduction in preventable medical errors B. Wider awareness that preventable errors are a problem C. Stronger repercussions for providers who commit preventable medical errors D. Wider recognition that medical errors are most often attributable to individual performance
B
Starting with small tests of change: (A) Allows you to start testing on live patients right away (B) Improves the likelihood of buy-in from opinion leaders (C) Means you don't need to do any planning before each test (D) Should be done only with the consent of opinion leaders
B
Using Deming's System of Profound Knowledge is helpful in quality improvement because: (A) It's a systematic set of procedures for implementing improvement. (B) It can help break down complex quality issues into smaller, more understandable parts. (C) It can help figure out who is to blame after an error. (D) It's a helpful way to secure funding from external sources for planned improvements.
B
What is the minimum number of data points you should usually have to look for signs of improvement on a run chart? A. 6 B. 10 C. 15 D. 25
B
When drawing a histogram, which is a good number of categories to include on your X axis? A. 1-5 B. 6-12 C. 13-24 D. >24
B
When increasing the number of patients or events from one PDSA cycle to the next, it is usually helpful to multiply by what number? (A) 2 (B) 5 (C) 10 (D) 20
B
Which model of the patient-provider relationship is exhibited when the expert provider simply provides information to patients, who hold decision-making power? (A) Paternalistic (B) Informative (C) Interpretive (D) Deliberative
B
Which of the following describes data stratification? (A) Plotting observations to show the relationship between two sets of data (B) Classifying and separating data according to specific variables (C) Plotting data over time (D) Illustrating the relative frequency of occurrence
B
Which of the following is NOT a step in brief action planning? (A) Asking patients if they have any health goals they want to work on in the next week or two (B) Telling patients what they need to work on to achieve their health goals (C) Asking if patients want to hear ideas about how other people are working on their health goals (D) Asking the patients to assess their confidence level in completing their plan
B
Which of the following is NOT always a key part of the medication reconciliation process? (A) Collecting the list of the patient's medications and dosing information (B) Following up with the patient to ensure he or she takes the medication as prescribed (C) Confirming that the list makes sense (D) Documenting any changes
B
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.
B
Which of the following is an example of an effective measurement technique for improvement? (A) Always strive for perfection. (B) Use quantitative and qualitative data. (C) Always set aside designated time for data collection. (D) All of the above
B
Which of the following is likely to be the most immediate result of building an effective health care team? (A) Less costly health care (B) Safer care (C) Fewer delays in care (D) Elimination of waste in the system
B
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? (A) Studies show approximately 45% of providers hold overtly racist beliefs and purposefully mistreat minority patients. (B) Providers who grow up in societies with negative stereotypes about minority groups may have implicit biases that negatively affect care for those groups. (C) Minority patients are actually treated equally in the health care system, but have less access to high quality care. (D) Health care providers in the US are mostly white, and white people are susceptible to implicit bias.
B
Which of the following statements is true? (A) All changes lead to improvement; therefore, all improvement requires change. (B) While not all changes lead to improvement, all improvement requires change. (C) The changes that are known to lead to improvement should be implemented before testing.
B
Which of the following traits do histograms, Pareto charts, and scatter plots have in common? A. They are all bar charts. B. They are all visual tools to display data. C. They all show change over time. D. All of the above.
B
Why should you consider collecting a family of measures when undertaking an improvement? (A) It makes the project more publishable. (B) A single measure may not be enough to determine the impact of a change on the system. (C) All improvement projects are so complex that they require multiple measures. (D) All of the above
B
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
Within the following data set, what is the median? [2.5, 7.2, 2.5, 2.9, 4.7, 3.6, 4.7] A. 2.5 B. 3.6 C. 4.0 D. 4.7
B
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? (A) Whether you'll provide food for the patients who wait more than 30 minutes. (B) What exactly you mean by "wait less than 30 minutes to be seen" — does this include the time the patient spends checking in, for instance? (C) How to establish consensus among the clinic's caregivers about the value of the project before gathering data. (D) How to inform the supervisors of individual physicians quickly when those physicians' patients wait more than 30 minutes.
B
Brenda, an emergency room nurse, notes that there seems to be a significant delay between the ordering and the administration of pain medications in her department. She decides to conduct a small improvement project to reduce this delay and obtains the support of the charge nurse (head nurse). 3. Which of the following is the most effective aim statement for this project? (A) Within one month, 95 percent of physicians will tell nurses when a pain medication is ordered on emergency room patients. (B) Within three months, the emergency department will administer all pain medications within 45 minutes of order time. (C) Within two months, improve the timeliness of pain medication delivery by allowing nurses to stock the most commonly used medications in the emergency unit (D) Within three months, the emergency department will improve the timeliness of pain medication delivery to 100 percent of patients. 4. The charge nurse in the emergency room asks Brenda to assemble a team to improve the delivery of pain medication. As she considers who to place on the team, Brenda should: (A) Review the aim statement to make sure the team includes representatives of all processes affected by the team's aim. (B) Create a team of volunteers. (C) Create a team of managers and administrators. (D) Make sure only nurses are on the team, as they are the most likely to help her achieve her aim. 5. During Brenda's first group meeting, the members ask to review the aim statement to make sure they agree it addresses the current problem. With Brenda's approval, they all decide to rewrite it. However, when they meet to consider what would be a better aim statement, the group loses direction. In order to help them, Brenda might want to: (A) Reconsider who should be on the improvement team. (B) Move the meeting to a later date, so that she can come better prepared. (C) Explain to the group that the aim is set, as both she and the charge nurse have already agreed on the wording. (D) Remind the team of the Institute of Medicine's dimensions of health care quality.
B, A, D
A hospital is trying to implement a new patient assessment form. They want to first test the usability and efficacy of the form. 4. When determining sample size for the first test, it is most important to: (A) Look at similar research to see what sample size other organizations use. (B) Weigh the potential consequences of a test that does not lead to improvement against the belief in success. (C) Use a random sampling technique, so results can be extrapolated. (D) Ask all staff members what sample size they think should be used. 5. 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? (A) Have a Spanish-speaking nurse give the assessment to one of her Spanish-speaking patients. (B) Have a different English-speaking nurse give the assessment to one of her English-speaking patients. (C) Increase the number of patients Nurse Moss assesses by a factor of 5. (D) Increase the number of patients Nurse Moss assesses by a factor of 10.
B, C
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. 2. Applying the Model for Improvement to the clinic's improvement goal, which of the following is the most reasonable aim statement? (A) Implement two PDSA cycles within six months of beginning the project. (B) Increase the number of patients reporting they are "very satisfied" with the clinic's scheduling by 50 percent within six months. (C) Modify the scheduling process to allow both front desk staff AND nurses to directly schedule appointments. (D) Create an efficient process for scheduling return appointments at the time of checkout. 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. 3. What is the team's next step? (A) Take a well-deserved break. (B) Develop their project-level measures. (C) Test their change plan using the PDSA cycle. (D) Report their results to clinic leadership and prepare a poster for a national meeting. 4. 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? (A) Change their measures. (B) Measure to see if the change led to improvement. (C) Report their results to the clinic leadership and prepare a poster for a national meeting. (D) Implement the new scheduling process based upon their initial impressions of how everything is working.
B, C, B
Transcendental Nursing Home is working on decreasing its rates of catheter-associated urinary tract infections (UTIs) among its residents. While reviewing data, the improvement team notices that the UTI rate on Floor 3 is half that of the rest of the floors. They decide to visit the unit and find out what it is doing differently. 7. Which component of Deming's System of Profound Knowledge is the team about to harness? (A) Appreciation of a system (B) Understanding variation (C) Theory of knowledge (D) Psychology (human behavior) 8. 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? (A) Appreciation of a system (B) Understanding variation (C) Theory of knowledge (D) Psychology (human behavior)
B, D
"If I can convince my husband and coworkers to go to bed earlier at night, they won't mind getting up earlier, and we will all get to work 30 minutes earlier and be happier and more productive." (A) Appreciation of a system (B) Understanding variation (C) Theory of knowledge (D) Psychology (human behavior)
C
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? (A) The surgeon takes a seat when talking to the patient and his wife. (B) The surgeon asks, "What matters most to you about your health and your treatment?" (C) 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. (D) The surgeon recognizes the patient's emotion and reflects back the understanding with a comment like, "I understand that you're scared about the surgery."
C
As a nurse practitioner in a small, rural urgent care clinic, you believe that your clinic team works well together. Which of the following facts would best support your belief? (A) Not a single complaint about unprofessional behavior has been filed by clinic members over the past year. (B) The providers work in rotating shifts and rarely need to transmit information from one shift to the next. (C) The team routinely takes a moment to discuss the plan and voice concerns before doing a procedure. (D) All of the above.
C
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? (A) Comparing the time she leaves to that of the person who seems to go home earliest each day. (B) Cancelling two meetings every day. (C) Scheduling a reminder into her work calendar that pops up daily at 5:15 PM with the message, "Leave!" (D) Taking work home each night on a laptop computer.
C
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: A. Units of time on the Y axis B. The rate of UTIs on the X axis C. Units of time on the X axis D. Units of time on the Y axis AND the rate of UTIs on the X axis
C
Effective health care teams have several important characteristics, including: (A) The ability to rehearse procedures together, like a choir or a sports team. (B) Stable membership; that is, they have the same people on the team from day to day. (C) Effective communication techniques. (D) The ability to achieve good results without strong communication.
C
Effective team leaders: (A) Have multiple degrees. (B) Are usually physicians. (C) Seek input from all members of the team. (D) Know the correct answer in any given situation.
C
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? (A) Make a more accurate diagnosis (B) Record their patients' end-of-life care wishes (C) Understand patients' health goals and priorities (D) Decide on the best treatment option
C
Shared decision making, pioneered by Dr. Victor Montori of the Mayo Clinic, best reflects which of the four models of the patient-provider relationship? (A) Paternalistic (B) Informative (C) Interpretive or deliberative (D) None of the above
C
The Model for Improvement begins with three questions designed to clarify the following concepts: (A) Plan, do, act (B) Mission, goal, strategy (C) Aims, measures, changes (D) Will, ideas, and execution
C
They signal a non-random pattern: A. During a test of change, if you observe an astronomical data point in a positive direction, it proves your change has led to improvement. B. Astronomical data points may be dramatically outside other data points or only slightly outside. C. All of the above
C
What famous Italian economist is credited with the theory behind the 80/20 rule? A. Michelangelo Histogram B. Benedetto Cotrugli C. Vilfredo Pareto D. Joseph M. Juran
C
When planning a sequence of PDSA cycles for a change that involves patients, which of the following is a true statement? (A) Patient characteristics in each PDSA cycle should be as uniform as possible to allow valid comparisons. (B) The number of patients in each cycle should stay fixed, to allow valid comparisons. (C) We would expect the number of patients involved to grow rapidly from early cycles to later cycles. (D) None of the above
C
Which is the following statements best describes the role of patients in ensuring safety across the continuum of care? (A) Patients have the responsibility to ensure their own safety. (B) Patients should always use a designated medication manager. (C) Patients often need to be able to act out precise recommendations when they leave the health care setting for home. (D) All of the above
C
Which of the following BEST describes the purpose of a histogram? A. To show the relationship between two variables B. To show variation in weight over time C. To show distribution of continuous data D. None of the above
C
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
C
Which of the following improvement efforts is the best example of increasing the effectiveness of care? (A) Decreasing adverse drug events by having a pharmacist on rounds in the intensive care unit (B) Shortening wait times at a clinic by allowing patients to self-register on a computer in the waiting room (C) Improving the percent of clinic patients achieving their goal blood pressure by instituting a series of reminders for providers about evidence-based processes (D) Instituting quarterly focus groups of patients seen in the emergency department to better identify patient concerns
C
Which of the following is one of the four components of empathy, as outlined by nurse scholar Theresa Wiseman? (A) Judging someone's situation only after talking directly to them (B) Helping to solve someone's immediate problem, whether it be physical or emotional (C) Understanding another person's feelings in the moment (D) Sitting down when speaking with a patient
C
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
C
Which of these is a question particularly associated with the "theory of knowledge" component in 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?
C
You notice that it's very easy to confuse medications at the community health center where you're working. They are lined up on the shelf and the labels are very similar. You decide that it's worth a try to highlight parts of drug names on certain labels to reduce confusion. Which change concept are you using? (A) Manage Time (B) Optimize Inventory (C) Design Systems to Prevent Errors (D) Improve Work Flow
C
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. 1. The care protocol was successful at the other hospital. Why would it be important to test this proven change at your hospital? (A) Because the last success may have been a fluke. (B) So that you can publish your results. (C) Because this change may not be as effective in your hospital. (D) In order to demonstrate the ability of this protocol to improve care in other hospitals for those that created it. 2. 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? (A) Develop the final plan for the protocol implementation. (B) Document unexpected observations. (C) Analyze information collected. (D) Strategize how to move this to another hospital in the system. 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. 3. Based on the recommendations in this lesson, what should you do next? (A) Focus on fixing the schedule. (B) Discipline the emergency department staff who have failed to contact the catheterization lab in the past. (C) Focus on improving the communication between the emergency staff and the catheterization staff. (D) Work on improving both the schedule and communication at the same time.
C, C, D
"My coworkers and my husband are resistant to my improvement idea (and my coworkers are routinely late for the carpool) because they are tired in the morning." (A) Appreciation of a system (B) Understanding variation (C) Theory of knowledge (D) Psychology (human behavior)
D
A nurse is talking with a patient about the plan for her care after discharge from the hospital. He concludes by saying, "We've just reviewed a lot of information about what happens when you leave the hospital. Did you understand everything OK?" Did he effectively use Teach Back? (A) Yes, because he asked the patient to confirm understanding (B) No, because he didn't ask the patient to repeat back what she understood (C) No, because he placed the responsibility of communication on the patient instead of on himself (D) B and C
D
A primary care provider (PCP) refers her patient to a specialist for a sleep study. Which of the following steps would represent the END of a closed-loop referral process? (Hint: Think of the nine-step process this lesson recommends). (A) The PCP communicates the referral for the sleep study to the specialist. (B) The patient makes an appointment for the sleep study with the specialist. (C) The specialist conducts the sleep study, and communicates the results and recommendation to the patient. (D) The PCP discusses the treatment plan with the patient, after communicating about it with the specialist.
D
According to US studies, approximately what portion of serious adverse events can be linked to miscommunication between caregivers when patients are transferred or handed over? (A) 5 percent (B) 30 percent (C) 50 percent (D) 80 percent
D
At the large multi-specialty clinic in which you work, there have been two near misses and one medical error because various clinicians did not follow up on patient results. Different caregivers were involved each time. After the second near miss, the physician involved was asked to leave the clinic. A nurse who realized that his colleagues weren't consistently following up on patient results reported the problem to the clinic leadership right away. Which response would be most consistent with a culture of safety? A. Thanking the nurse and asking him to keep quiet about it B. Placing the item on the agenda for the leadership meeting next year C. Transferring the nurse to another clinic D. Investigating the problem and seeking systems solutions
D
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? (A) Interpretive (B) Deliberative (C) Informative (D) Paternalistic
D
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? (A) Have one housekeeper use the process with one room cleaning. (B) Have all housekeepers use the process for a week. (C) Have one housekeeper use the process on five room cleanings. (D) Confirm the "face validity" of the new cleaning process by demonstrating it with a couple of housekeeping staff members and a supervisor.
D
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
D
What aspect of the run chart helps you compare data before and after a PDSA cycle? A. The average of the values B. The baseline median C. Annotations of when specific changes were tested (PDSA cycles) D. The baseline median AND annotations of when specific changes were tested (PDSA cycles)
D
What's the main benefit of using change concepts to come up with improvement ideas? (A) Using change concepts makes PDSA cycles unnecessary. (B) Using change concepts makes it much more likely that the implementation will go smoothly. (C) Using change concepts will lead you to focus on quantifiable technological improvements. (D) Using change concepts can help you develop specific improvement ideas that might not have occurred to you initially.
D
When speaking with a patient who has limited understanding of health care terminology, which of the following words would you likely want to avoid? (A) "Adverse" (B) "Lipids" (C) "Abdomen" (D) All of the above
D
When you are graphing a proportion or a percent, what should you look at to help you understand the bigger picture? A. The median of the denominator B. The numerator of the measured value C. The median of the numerator D. The denominator of the measured value
D
Which of the following charts would be best to justify focusing on a few large problems and ignoring many smaller ones? A. Histogram B. Scatter plot C. Run chart D. Pareto chart
D
Which of the following improvement efforts is the best example of increasing the equity of care? (A) Decreasing adverse drug events by having a pharmacist on rounds in the intensive care unit (B) Shortening wait times at a clinic by allowing patients to self-register on a computer in the waiting room (C) Instituting quarterly focus groups of patients seen in the emergency department to better identify patient concerns (D) Through staff development and weekly feedback, equalizing the likelihood that a patient will receive the appropriate amount of pain medication regardless of their race
D
Which of the following is a reason why the paternalistic model is unsuitable for improving health outcomes? (A) Patients can choose whether or not to follow providers' medical advice. (B) Chronic disease is on the rise, and management of chronic disease requires patients to change their behavior. (C) Providers have more medical expertise than patients, so their decisions are more likely to promote health. (D) A and B
D
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
D
Which of the following is the description of the term "non-compliance" that best reflects patient-provider partnerships? (A) Non-compliance describes patient behavior that doesn't align with the plan of care, for example, not taking medicines as prescribed. (B) 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. (C) 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. (D) B and C both reflect patient-provider partnerships.
D
Which of the following statements is true about using data for improvement? (A) Both quantitative and qualitative data can be useful. (B) The data should tell a story. (C) A run chart is one of the most helpful tools for displaying data. (D) All of the above.
D
Why do some patients from underserved minority groups sometimes mistrust health care institutions and health care providers? (A) Health care providers have betrayed the trust of patients before, such as in the Tuskegee syphilis study. (B) Underserved patients often have religious beliefs that teach them that health care providers are untrustworthy. (C) Patients may feel that health care systems that are difficult to understand and access do not want to provide them services. (D) A and C
D
Why is it important for providers to understand how patients may perceive them, including their race, class, gender, age, and educational status? (A) It's important that providers not mistakenly think that social characteristics influence patients' lives but not their own. (B) By understanding what assumptions others may make about them, providers may recognize that stereotypes based on social categories may not be accurate. (C) Understanding how others perceive them can help providers recognize the need to get to know patients as individuals, rather than only through social characteristics. (D) All of the above
D
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. 1. Which of the following methods would you recommend to display your improvement data? (A) Draw a bar chart. (B) Write a list of numbers. (C) Create a two-column table. (D) Draw a run chart. 2. When designing the run chart, it is important to include: (A) Units of time on the Y axis (B) The rate of UTIs on the X axis (C) Units of time on the X axis (D) A and B
D, C
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. 1. What would you identify as the outcome measure for the project? (A) Average length of stay (B) The cost of labor associated with the calls (C) Rate of job satisfaction of those on the unit making the calls (D) Percentage of patients that are readmitted to the hospital 2. Which of the following is an example of a process measure that you may collect as part of this improvement effort? (A) The rate of patients being readmitted within 30 days (B) The reasons for readmission to the hospital (C) The percentage of patients receiving a call within 48 hours of discharge (D) The cost of the labor associated with the calls 3. Why might you consider collecting balancing measures? (A) To show that you met your aim (B) To make sure you are able to publish your study (C) To demonstrate to your hospital board that you were justified in using resources for this project (D) To make sure you did not unintentionally damage other aspects of the unit's work
D, C, D
You are a member of an intensive care unit team in a regional hospital. This morning, a patient had an unexpected severe allergic reaction (anaphylaxis) after being given a penicillin derivative. There was a significant delay in getting the physician involved and beginning treatment for this life-threatening condition. Fortunately, the patient is now stable and does not seem to be experiencing any lasting effects. 3. At this point, what would an effective team leader do? (A) Report this adverse event in the anonymous reporting system so that it can be investigated (B) Ask administrators to launch an investigation immediately to find out who was responsible for this adverse event (C) Apply the two-challenge rule. (D) Conduct a debriefing 4. The unit leaders are trying to figure out what changes they should make to prevent this treatment delay from happening again. Given what you know about the incident, what change would you recommend? (A) Implement mandatory debriefings after the team works together on a patient. (B) Fire the physician who failed to respond in a timely way. (C) Stop using nursing assistants in the ICU. (D) Implement the use of critical language in the ICU.
D, D
Isadora is a first-year surgery resident on her first pediatric rotation. Her attending (consultant) asks her to immediately start intravenous (IV) replacement fluids on a two-year-old girl who is experiencing vomiting and diarrhea. Isadora has recently learned the guidelines for calculating fluid replacement rates for very small children; however, she confuses them and picks a rate that is too high. A. To prevent this type of error from recurring in this unit, which of the following is MOST important? B. An improved culture of safety C. Clearer medical guidelines for fluid replacement in patients of all ages D. More severe, well-publicized consequences for providers who are reckless E. A change to the system, so that it does not rely as heavily on human memory
E
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: (A) PDSA cycles are easier to run with a large team of people. (B) The results of PDSA cycles are more generalizable than other methods. (C) PDSA cycles are simpler to use than other methods. (D) PDSA cycles provide a mechanism to adjust improvement ideas as the project progresses. (E) Both C and D
E
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. Which of the IOM aims has this hospital FAILED to meet? (A) Equitable (B) Safe (C) Effective (D) Efficient (E) Timely (F) Patient-centered 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? (A) Equitable (B) Safe (C) Effective (D) Efficient (E) Timely (F) Patient-centered
E, F
The relationship between health care provider and patient is what?
Hierarchical
