HSC MISC 3400 IHI questions and Answers,100% CORRECT

HSC MISC 3400 IHI questions and Answers 102 1 * Starting with small tests of change: Answer Submitted Improves the likelihood of buy-in from leaders and staff Correct Answer: Improves the likelihood of buy-in fr ...

HSC MISC 3400 IHI questions and Answers 102 1 * Starting with small tests of change: Answer Submitted Improves the likelihood of buy-in from leaders and staff Correct Answer: Improves the likelihood of buy-in from clinical and administrative staff members Linking tests of change — with one test concluding and the next beginning at the same time, but this time on a larger scale or with a different scope — allows you to build support for your project. Each successive test is a way to demonstrate to key stakeholders that their input has value and that the project may actually lead to improvement. However, it’s not necessary to seek consensus among stakeholders before testing changes. Correct You achieved 5 out of 5 2 * 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? Answer Submitted Work on improving both the schedule and communication at the same time. Correct Answer: Work on improving both the schedule and communication at the same time. You should start testing changes to both processes and run the tests concurrently. That way you can see how all the required changes work together. Remember, your goal is to bring knowledge into action—not to discover the single change that works best. Correct You achieved 5 out of 5 3 * Which of the following statements is true? Answer Submitted While not all changes lead to improvement, all improvement requires change. Correct Answer: While not all changes lead to improvement, all improvement requires change. All improvement requires change — but unfortunately, not all changes lead to improvement. It is precisely for this reason that after you test a change, you should study the results to determine whether you’re closer to accomplishing your goal. Correct You achieved 5 out of 5 4 * 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? Answer Submitted Because this change may not be as effective in your hospital Correct Answer: Because this change may not be as effective in your setting Changes that work in one complex system may not be as effective, or effective at all, in another. The only way you will know for sure is to test the changes. Other reasons to test “proven” changes are to evaluate costs, minimize resistance and gain buy-in, and increase your own confidence that the change will lead to improvement in your setting. Correct You achieved 5 out of 5 5 * 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? Answer Submitted Develop the final plan for the protocol implementation. Correct Answer: 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. Incorrect You achieved 0 out of 5 1 TRUE OR FALSE: You and your team should reflect on the results of every change. Answer Submitted True Correct Answer: True After testing a change, a team should address several issues, including comparing the prediction to what actually happened, identifying unintended consequences, and understanding the best and worst aspect of the change. This is the "study" step of the PDSA cycle. 1 TRUE OR FALSE: You should never end a test of change before the planned time. Answer Submitted False Correct Answer: False Stop the test if it is not leading to improvement or if things are not safe. However, much can be learned from a failed test of change, so be sure to study it thoroughly. We'll talk about "study" next! TRUE OR FALSE: When testing changes, you should be sure to gain consensus and buy-in from all the people who would eventually be affected by the change. Answer Submitted False Correct Answer: False Try to choose changes that do not require a long process of approval or buy-in. Rather, use the results of the test itself, if successful, to gain consensus and buy-in. Consensus often occurs during the "study" step, not during the "plan" step. 1 TRUE OR FALSE: When testing changes, you should be sure to gain consensus and buy-in from all the people who would eventually be affected by the change. Answer Submitted True Correct Answer: False Try to choose changes that do not require a long process of approval or buy-in. Rather, use the results of the test itself, if successful, to gain consensus and buy-in. Consensus often occurs during the "study" step, not during the "plan" step. 1 * 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? Answer Submitted Review the process for scheduling these appointments with colleagues to identify opportunities for improvement. Correct Answer: Review the process for scheduling these appointments with colleagues to identify opportunities for improvement. Coming up with a change that will address your problem is often one of the most difficult aspects of the change process. Brainstorming with colleagues may help, as can critical thinking and creative thinking about the problem at hand. In this case, simply moving to another clinic might reduce your frustration but will not help the clinic. Improving the scheduling software may be useful, but it’s unclear at this point that technology is at the heart of the delays. Finally, the office staff very likely already know that patient follow-ups should be scheduled sooner, but some aspect of the process is making this difficult for them. Simply reminding them is unlikely to get results. Correct You achieved 5 out of 5 2 * What’s the main benefit of using change concepts to come up with improvement ideas? Answer Submitted Using change concepts can help you develop specific improvement ideas that might not have occurred to you initially. Correct Answer: Using change concepts can help you develop specific improvement ideas that might not have occurred to you initially. Change concepts can help you develop new, specific ideas for change that could lead to improvement. They don’t necessarily improve the likelihood that implementation of these changes will go smoothly, however. Finally, testing the changes using PDSA cycles is still necessary! Correct You achieved 5 out of 5 3 * 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? Answer Submitted Design Systems to Prevent Errors Correct Answer: Design Systems to Prevent Errors By sending out reminders, you are designing a system to help people avoid mistakes and prevent errors. The other options are all valuable types of change concepts, but they are not as relevant to this example. Correct You achieved 5 out of 5 4 * Which of the following changes falls under the heading of “eliminating waste”? Answer Submitted Clinicians type all notes directly into a computer rather than writing them in a patient’s chart, thus saving paper. Correct Answer: Clinicians type all notes directly into a computer rather than writing them in a patient’s chart, thus saving paper. Waste is an activity or resource that does not add value. When a clinician writes a note that someone else enters into the computer, two steps are required. Changing the process so it only requires one step reduces waste as well as potential for error. None of the other answers explicitly focuses on reducing waste. Correct You achieved 5 out of 5 5 * 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? Answer Submitted Scheduling a reminder into her work calendar that pops up daily at 5:15 PM with the message, “Leave!” Correct Answer: Scheduling a reminder into her work calendar that pops up daily at 5:15 PM with the message, “Leave!” The programmed reminder is an example of using technology to make it harder for people to “drift” into less-than-optimal behavior. Comparing the time she leaves to that of the person who seems to go home earliest each day is an example of benchmarking. Cancelling two meetings every day is an example of the change concept “eliminate waste” (assuming those meetings were not necessary in the first place). Taking work home each night on a laptop computer simply shifts the work to home, rather than creating a more efficient work pattern. Correct You achieved 5 out of 5 You are undertaking a project to improve hand hygiene on your unit, and you have some ideas for changes that might work in the categories of "Enhance the Producer-Customer Relationship" and "Design Systems to Avoid Mistakes." Match your ideas to the change concepts they represent. Answer Submitted Educate staff about how washing hands helps keep patients safe. Change Concept #55: Develop Contingency Plans. Incorrect Ask staff which type of soap or hand sanitzer they prefer to use. Provide training on proper hand washing technique. Change Concept #38: Listen to Customers. Correct Change Concept #39: Coach the Customer to Correct Use a Product or Service. Encourage patients to ask providers if they have washed their hands. Change concepts #36: Emphasize Natural and Logical Consequences. Incorrect Post signs on the unit to remind staff about the Change Concept #59: Use Reminders. Correct importance of washing hands. Correct Answer: Enhance the Producer-Customer Relationship • Change concepts #36: Emphasize Natural and Logical Consequences. Educate staff about how washing hands helps keep patients safe. • Change Concept #38: Listen to Customers. Ask staff which type of soap or hand sanitzer they prefer to use. • Chance Concept #39: Coach the Customer to Use a Product or Service. Provide training on proper hand washing technique. Design Systems to Avoid Mistakes • Change Concept #55: Develop Contingency Plans. Encourage patients to ask providers if they have washed their hands. • Change Concept #59: Use Reminders. Post signs on the unit to remind staff about the importance of washing hands. 103 1 * A young doctor is practicing in an urban clinic. A patient whom the doctor has seen four times in the past month comes to the office complaining of shoulder pain. The patient is known to be confrontational when he finds the doctor’s recommendations unsatisfactory. On examination, the patient’s shoulder seems fine. The doctor decides to order a new nerve conduction study even though he is almost certain there is nothing wrong with the patient’s shoulder. Which of the following is the most appropriate motivation for ordering a test? Answer Submitted Curiosity Correct Answer: High pre-test probability In that situation, a test is appropriate. The other three choices are all barriers to stewardship. More specifically, relying on established practice is dangerous because providers may have been trained to pursue tests that lack therapeutic use. A patient request may not be well-informed or well- researched, which means a discussion is warranted before the patient can participate fully in decision making. And curiosity, while a good trait, is not a good reason to order an irrelevant test. Incorrect You achieved 0 out of 5 2 * Which of the following statements is true? Answer Submitted A test with a high cost may also be high value. Correct Answer: A test with a high cost may also be high value. Value is proportional to the quality of an intervention. Some high-quality treatments — like chemotherapy, for example — may be expensive, but they also offer good value because they help to achieve the best possible patient outcome. A test with a low cost may be of high value if it benefits the patient. Value is determined not just by cost, but by quality as well. Correct You achieved 5 out of 5 3 * Which of the following statements is true? Answer Submitted Health care professionals are responsible for employing evidence-based approaches to determine when specific tests are appropriate. Correct Answer: Health care professionals are responsible for employing evidence-based approaches to determine when specific tests are appropriate. Health care professionals, whether they are physicians, nurses, or other members of the team, should always use evidence-based approaches to determine if specific tests or procedures are appropriate for a patient. While patients have the right to make their own health care decisions, they can only exercise this right with full information and proper understanding. You should employ good communication skills and counsel patients about the evidence and rationale for using or not using a given intervention. Correct You achieved 5 out of 5 4 * Resource stewardship refers to: Answer Submitted The appropriate allocation of resources Correct Answer: The appropriate allocation of resources. The definition of appropriate varies by clinical situation, but generally it refers to an allocation of resources that results in high-value, effective (i.e., evidence-based) care. Resource stewardship does not mean rationing care. The goal is not to reduce health care opportunities for patients who need them, but rather, to eliminate waste. If a test is expensive, but it can also be used to definitively diagnose a patient when there are no alternatives, this test should be considered an appropriate use of resources. Reducing or eliminating cost to patients is one possible result of strong resource stewardship. Correct You achieved 5 out of 5 5 * A young doctor is practicing in an urban clinic. A patient whom the doctor has seen four times in the past month comes to the office complaining of shoulder pain. The patient is known to be confrontational when he finds the doctor’s recommendations unsatisfactory. On examination, the patient’s shoulder seems fine. The doctor decides to order a new nerve conduction study even though he is almost certain there is nothing wrong with the patient’s shoulder. Which of the following incentives for overuse is highlighted in the scenario? Answer Submitted Defensive medicine Correct Answer: Defensive medicine In this case, the doctor is trying to defend himself against a potential malpractice suit by pursuing an intervention that is not otherwise clinically indicated. Research has shown the most effective way to reduce malpractice suits is to use good patient-clinician communication skills, not increase ordering behavior. Lack of feedback is a barrier to stewardship, and new technologies are an incentive for overuse, but neither of those answer choices applies to the scenario. Correct You achieved 5 out of 5 1 What is one of the barriers to resource stewardship in Anila's story? Answer Submitted Lack of feedback Correct Answer: Lack of feedback Anila's story includes multiple barriers to resource stewardship, including: Established habit: Anila was used to bringing the extra blood pressure cuffs and never thought about how wasteful this could be. Lack of feedback: Nobody pointed out that bringing the extra blood pressure cuffs was wasteful. Further, Anila did not know how much blood pressure cuffs cost and could not know the financial cost of her actions. Time pressure: Anila wanted to be as prepared and efficient as possible once her patient arrived. What is one of the barriers to resource stewardship in Anila's story? Answer Submitted Discomfort with diagnostic uncertainty Correct Answer: Lack of feedback Anila's story includes multiple barriers to resource stewardship, including: Established habit: Anila was used to bringing the extra blood pressure cuffs and never thought about how wasteful this could be. Lack of feedback: Nobody pointed out that bringing the extra blood pressure cuffs was wasteful. Further, Anila did not know how much blood pressure cuffs cost and could not know the financial cost of her actions. Time pressure: Anila wanted to be as prepared and efficient as possible once her patient arrived. How much waste do you think there actually is to eliminate? What percentage of all medical spending in the United States is estimated to be “unnecessary”? Answer Submitted 30% Correct Answer: 30% According to several research groups, 30 percent of medical spending is likely unnecessary and does not add value in care.1 Put yourself in this physician’s shoes for a moment: You are visiting with a patient who needs to start taking blood pressure medication. He leaves the decision in your hands, and you decide to prescribe a generic medication with the same efficacy and side effect profile as the brand-name medication that costs more. Is this a high-value decision? Answer Submitted Yes Correct Answer: Yes Both medications have similar efficacy (i.e., offer the same level of quality), and the generic medication costs less, so prescribing a generic medication is the higher-value treatment option. 2 Two weeks after you prescribed blood pressure medication, as you requested, your patient comes back for an appointment to see how the medication is working. After a discussion with the patient, together you decide to try something new. This time, you prescribe a newer, slightly more expensive medication that has better long-term outcomes for the patient and fewer side effects than the alternative medication that costs slightly less. Is this a high-value decision? Answer Submitted Yes Correct Answer: Yes In this instance, despite being more expensive, the newer medication provides a greater clinical benefit and is therefore the higher-value treatment option. 104 When drawing a histogram, which is a good number of categories to include on your X axis? Answer Submitted 6–12 Correct Answer: 6–12 Six to 12 categories of equal width is usually a good number to help you understand the distribution of data. Correct You achieved 5 out of 5 2 * Which of the following charts would be best to justify focusing on a few large problems and ignoring many smaller ones? Answer Submitted Pareto chart Correct Answer: Pareto chart By separating the vital few from the trivial many, a Pareto diagram helps a team concentrate its efforts on the factors that have the greatest impact. It also helps a team communicate the rationale for focusing on certain areas. Correct You achieved 5 out of 5 3 * Which of the following traits do histograms, Pareto charts, and scatter plots have in common? Answer Submitted They are all visual tools to display data. Correct Answer: They are all visual displays of data. Histograms and Pareto charts are types of bar charts, but a scatter plot is not. Correct You achieved 5 out of 5 4 * What famous Italian economist is credited with the theory behind the 80/20 rule? Answer Submitted Vilfredo Pareto Correct Answer: Vilfredo Pareto Pareto observed that 80 percent of the wealth of Italy was owned by 20 percent of the people. The Pareto chart was named after him by Joseph M. Juran. Correct You achieved 5 out of 5 5 * Which of the following BEST describes the purpose of a histogram? Answer Submitted To show distribution of continuous data Correct Answer: To show distribution of continuous data Histogram measures distribution of continuous data. A histogram is a special type of bar chart. It can be used to display variation in weight — but can also be used to look at other variables such as size, time, or temperature. A chart that shows the relationship between two variables is a scatter plot. Correct You achieved 5 out of 5 An operating room (OR) team identified eight categories of factors that contributed to errors during surgical setup. They tracked and calculated the following data in relation to those categories: Can you calculate the missing data point for the table above? (Hint: Start by adding the three largest values in the 'frequency' column. Then divide that number by the 'total frequency.') Answer Submitted 75 Correct Answer: 75 The missing data point is 75. Here's how to calculate it: 67 + 24 + 17 = 108 (frequency for the category combined with all the previous categories) / 144 (total frequency) = 75 (cumulative percent) You can also arrive at the same answer by adding the percent of the total for the first three categories: 46.5 + 16.7 + 11.8 = 75. Now, you can draw the line graph to complete the Pareto chart: When the team displayed this data in a Pareto diagram, they discovered that three types of errors accounted for 80 percent of all errors. Instead of working on all error types, the team focused its efforts on these three “vital few” error types: wrong supplier, excess count, and too few count. The team from the example on the previous page has started to draw a histogram for its 32 data points: How high (i.e., to what numbers on the vertical axis) should the team draw the bars in the remaining three categories? Answer Submitted 4, 3, 2 Correct Answer: 4, 3, 2 The remaining categories are 15–16, 17–18, and 19–20. The data values in these categories, respectively, are as follows: 16, 15, 16, 15 (total = 4 data points); 17, 18, 17 (total = 3 data points); 20, 20 (total = 2 data points). As you can see, the histogram provided the team valuable new information about the distribution of EKG turnaround times: The vast majority of turnaround times falls in the 1- to 2-day range, with a smaller clump in the 7- to 10-day range, and a third clump in the 13- to 20-day range. Which of the following statements about astronomical data points is true? Answer Submitted They signal a non-random pattern Correct Answer: They signal a non-random pattern According to Rule 4, an astronomical data point signals a non-random pattern. This is not just highest or lowest data point, but one that is so dramatically outside the others that anyone looking at the chart would think it was unusual. One astronomical data point does not necessarily prove your change is an improvement. Correct You achieved 5 out of 5 2 * Which of the following is a rule for determining non-random patterns? Answer Submitted A run of six points or more AND an astronomical point Correct Answer: A run of six points or more AND an astronomical point A run of six points or more and an astronomical point both indicate non- random patterns. A trend of three points or fewer does not. In order to indicate a non-random pattern, a trend must consist of five data points or more. Correct You achieved 5 out of 5 3 * According to Rule 3, does the chart show non-random patterns? Use the the table below to help you. (Note that one data point is on the median.) Answer Submitted Yes, there are too few runs. Correct Answer: Yes, there are too few runs. There are 36 useful observations. For that number of observations, the table states that 13 or fewer runs show non-random patterns. We have 12 runs. Therefore, we can deduce that there is a non-random pattern in this chart. Correct You achieved 5 out of 5 4 * How many runs are there on the chart? (Note that one data point is on the median.) Answer Submitted 10 Correct Answer: 12 By counting the number of continuous points above or below the median, we get 12 runs. Incorrect You achieved 0 out of 5 5 * How many useful observations are on this chart? (Note that one data point is on the median.) Answer Submitted 36 Correct Answer: 36 Counting all the points not on the median yields 36 useful observations. Correct You achieved 5 out of 5 Once again, here's the run chart of ED "walk aways" over time from the previous lesson; practice applying the four run chart rules. Which of the following do you see? (Note that there is one data point on the median, which is February 7.) Answer Submitted At least one shift (based on Rule 1) Correct Answer: At least one shift (based on Rule 1) Beginning March 21, we can see a long run of 31 data points below the baseline median. We do NOT see six or more consecutively increasing or decreasing data points anywhere on the chart, so Rule 2 does not apply. 2 The baseline median depicts the percent of walkaways prior to March 7, when the improvement project began. Does the data suggest the team’s changes led to improvement? Answer Submitted Yes Correct Answer: You can see that the long run you detected took place after the first PDSA cycle and is below the baseline median in this chart. Altogether, this pattern strongly supports the contention that the changes the team made led to improvement. Once again, here's the run chart of ED "walk aways" over time from the previous lesson; practice applying the four run chart rules. Which of the following do you see? (Note that there is one data point on the median, which is February 7.) Answer Submitted At least one shift AND at least one trend Correct Answer: At least one shift (based on Rule 1) Beginning March 21, we can see a long run of 31 data points below the baseline median. We do NOT see six or more consecutively increasing or decreasing data points anywhere on the chart, so Rule 2 does not apply. 2 The baseline median depicts the percent of walkaways prior to March 7, when the improvement project began. Does the data suggest the team’s changes led to improvement? Answer Submitted Yes Correct Answer: You can see that the long run you detected took place after the first PDSA cycle and is below the baseline median in this chart. Altogether, this pattern strongly supports the contention that the changes the team made led to improvement. Which of the following is the best interpretation of the run chart below based on Rule 3? Hint: There are 24 data points, and two of them fall directly on the median. Answer Submitted There are too few runs for the pattern to appear random. Correct Answer: There are too few runs for the pattern to appear random. Rule 3 offers evidence that the pattern is not random because there are too few runs. According to the chart, there should be at least 7 runs based on the number of useful data points (22); we count only 6. Maybe a special program was running during the months with increased satisfaction, or maybe there was construction work happening around the hospital during the months when rates were lower. You could replicate the positive programming, or find ways to alleviate the frustration of delays due to construction. The point is: You still don’t know exactly what’s affecting the patient satisfaction rates, but you have a launching point for investigation. What aspect of the run chart helps you compare data before and after a PDSA cycle? Answer Submitted The baseline median AND annotations of when specific changes were tested (PDSA cycles) Correct Answer: The baseline median AND annotations of when specific changes were tested (PDSA cycles) Both the median and annotations marking specific changes let you see how observations before your PDSA cycle compare to those that come after. Correct You achieved 5 out of 5 2 * What is the minimum number of data points you should usually have to look for signs of improvement on a run chart? Answer Submitted 10 Correct Answer: 10 A run chart becomes more powerful as you add more data points because there will be more opportunities to identify patterns. If you’re looking for signs of improvement, usually you need at least 10 data points. Correct You achieved 5 out of 5 3 * 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? Answer Submitted Draw a run chart. Correct Answer: Draw a run chart. Run charts are an effective way to view changes over time. They are much easier to interpret visually than a list of numbers or a static display of data such as a bar chart. Correct You achieved 5 out of 5 4 * Which of the following is a problem with static data? Answer Submitted It doesn’t adequately portray variation. Correct Answer: It doesn’t adequately portray variation. Summary statistics that are static in nature don’t give you the appropriate picture of the variation that lives in your data. Although you can accurately display data such as the mean, median, or mode, it is not a good way to observe change over time. Correct You achieved 5 out of 5 5 * When you are graphing a proportion or a percent, what should you look at to help you understand the bigger picture? Answer Submitted The denominator of the measured value Correct Answer: The denominator of the measured value By tracking the denominator of the measured value, you can confirm that your improvement effort is really showing signs of success, and there are not other factors at work. Correct You achieved 5 out of 5 Which of the following is an essential component of systems thinking included in Deming’s System of Profound Knowledge? Answer Submitted Psychology Correct Answer: 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. Correct You achieved 5 out of 5 2 * 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 did the improvement team just harness? Answer Submitted Theory of knowledge Correct Answer: 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. Correct You achieved 5 out of 5 3 * Which of these questions is most strongly related to the “appreciation of a system” component of Deming’s System of Profound Knowledge? Answer Submitted What are your predictions about the system’s performance? Correct Answer: What is the whole system that you’re trying to manage? “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. Incorrect You achieved 0 out of 5 4 * Using Deming’s System of Profound Knowledge is helpful in quality improvement because: Answer Submitted It can help break down complex quality issues into smaller, more understandable parts. Correct Answer: 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. Correct You achieved 5 out of 5 5 * 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? Answer Submitted Infection rates will not change because the leaders have not changed the system of care. Correct Answer: Infection rates will not change because the leaders have not changed the system of care. 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. Correct You achieved 5 out of 5 1 “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.” Answer Submitted Psychology (human behavior) Correct Answer: Psychology (human behavior): You’re thinking about how people in your system react to your change, and what motivates them act as they do. 2 “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!” Answer Submitted Understanding variation Correct Answer: Understanding variation: You are looking at a variation in results, and how it related to your system. The fact that it was school vacation week was unusual, meaning it was a “special cause” of variation. 3 “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.” Answer Submitted Theory of knowledge Correct Answer: Appreciation of a system: You’re thinking about how the different parts of your system interact with and rely on one another. 4 “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.” Answer Submitted Appreciation of a system Correct Answer: Theory of knowledge: You have several theories based upon which you have made a prediction about the system’s performance. You will have to test these theories before they become knowledge. Which of the following improvement efforts is the best example of increasing the efficiency of care? Answer Submitted Improving the percent of clinic patients achieving their targeted blood pressure by instituting a series of reminders for providers about evidence-based processes Correct Answer: Decreasing unnecessary surgical procedures by helping patients reduce their pain through physical activity Decreasing unnecessary surgical procedures by helping patients reduce their pain through physical activity is an example of more efficient care. Efficient care means avoiding waste — including waste of equipment, supplies, ideas, and energy. Incorrect You achieved 0 out of 5 2 * Which of the following improvement efforts is the best example of increasing the equity of care? Answer Submitted Through staff development and weekly feedback, equalizing the likelihood that a patient will receive the appropriate amount of pain medication regardless of their race Correct Answer: 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. Correct You achieved 5 out of 5 3 * Dhruv, a 65-year-old retiree, is brought to the hospital after developing chest pain while gardening. 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? Answer Submitted Timely Correct Answer: Timely Dhruv’s care was not timely. He did not receive care when it was needed, without delays. Correct You achieved 5 out of 5 4 * Dhruv, a 65-year-old retiree, is brought to the hospital after developing chest pain while gardening. 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. The hospital where Dhruv 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? Answer Submitted Patient-Centered Correct Answer: 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. Correct You achieved 5 out of 5 5 * 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? Answer Submitted Safe Correct Answer: 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. Correct You achieved 5 out of 5 Which of the following statements is a reason for improving the US health care system? Answer Submitted The US government and citizens alike are struggling to afford the cost of care. Correct Answer: 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. Correct You achieved 5 out of 5 2 * Which of the following statements is true: Answer Submitted During the past 15 years, the cost of care has been a growing problem for many developed nations. Correct Answer: 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. Correct You achieved 5 out of 5 3 * Which of the following is a trend in modern health care across industrialized nations? Answer Submitted Providers are becoming more specialized AND There is growing demand for complicated procedures Correct Answer: The best answer is that providers are becoming more specialized and there is a growing demand for complicated procedures. 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. Correct You achieved 5 out of 5 4 * In regard to health disparities around the world, which of the following statements is most true? Answer Submitted Where a child is born significantly affects his or her life expectancy AND The root causes of health disparities are complex Correct Answer: Where a child is born significantly affects his or her life expectancy AND The root causes of health disparities are complex 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. Correct You achieved 5 out of 5 5 * Which of the following countries has had a relatively inexpensive universal health insurance system for more than 50 years? Answer Submitted Japan Correct Answer: 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. Correct You achieved 5 out of 5