QI 105 Leading Quality Improvement

How many Phases are in an Improvement Project?

What are they called?

Five phases

Set an Aim

Develop an Improvement Strategy

Develop and Pilot a Reliable Standard Process of Care

Implement the Standard Care Process, Monitor Performance

Spread the New Standard Throughout the System

After a successful pilot, which of the following should Sandy's improvement team undertake as a next step?

Spread the change to other hospitals in the network.

Continue to run PDSA cycles.

Work on seeing that the change is widely adopted by the unit AND continue to run PDSA cycles.

Work on seeing that the change is widely adopted by the unit, such as by making it a formal policy and training new staff on it.

Work on seeing that the change is widely adopted by the unit AND continue to run PDSA cycles.

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

Which of the following is a mechanism for "hardwiring" an innovation during the implementation phase?

Developing a new process based on emerging technology.

Training all staff to use a new process.

Testing a new process that has been successful elsewhere in a new unit.

All of the above.

Training all staff to use a new process.

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

Dr. Gonsalvez, the medical director of the medicine ward, wants to lower the 30-day readmission rate of the patients on her unit (i.e., the percentage of patients readmitted to the hospital within 30 days of discharge). She meets with the nurse manager and other stakeholders, and, together, they develop a process to improve the way the ward discharges patients and transfers care back to each patient's primary care provider. The team tests the change on the ward and runs multiple PDSA cycles to improve the process. The data look promising.

Dr. Gonsalvez and her team continue to test the new idea. Assuming things continue to go well, what might they eventually do?

Share the innovation with other units and/or hospitals.

Utilize the IHI Framework for Spread.

Develop a communication and dissemination plan.

All of the above.

All of the above.

After a successful pilot, the next steps are implementation and spread. IHI's Framework for Spread, which includes developing a communication and dissemination plan, is a helpful tool to use during the final phase of an improvement project.

Sandy Liu, a cardiac care unit nurse, notices that a few of her patients are suffering from inadequate pain control. Currently, a patient who needs pain medication must call the front desk, which then calls the nurse, who then goes to the patient's room to find out what he or she needs. Sandy finds out that a hospital in the next county has a simpler process: Patients can send a text message directly to the nurse to request pain medication. Sandy goes to her manager and suggests that they form a team to work on improving pain control and test this change in the cardiac care unit.

Sandy and her improvement team begin to test the change using PDSA. Assuming their early testing is successful, how will their PDSA cycles change over time?

The team will no longer make predictions.

The team will begin collecting data.

The team will utilize more staff and resources.

The team will no longer make predictions AND will begin c

The team will utilize more staff and resources

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

How should Sandy and her improvement team try out the new process for improving pain control?

Test the new process with one patient and closely review the results.

Bring together a group of stakeholders to develop an implementation plan.

Test the new process throughout the hospital to build a pool of data.

None of the above: There is no need to test this process because another hospital has already proved it to be effective.

Test the new process with one patient and closely review the results

Sandy and her team have an innovation and are ready to conduct a pilot. (Every organization is different, so just because the idea worked at another hospital does not mean it will work here.) Piloting involves starting small, such as with one patient, and carefully refining the change to make sure it works.

Stethoscopes are everywhere in health care today. They allow clinicians to hear the internal sounds of the human body. Seems like a helpful invention, right? But how do you think people reacted when the stethoscope was introduced in the early 1800s?

How did people react when the stethoscope was introduced in the early 1800s?

They didn't really notice it.

They weren't sure about this new-fangled device.

They loved it!

They weren't sure about this new-fangled device.

With hindsight, initial reactions to new developments may now seem hopelessly off-base, but they reflect the way many of us are programmed to react to change.

"What's wrong with regular soap and water?"

Based on what you've learned so far about overcoming resistance to change, select the most appropriate response.

Supply hand lotion or a sanitizer with moisturizers blended in.

Provide education on the value of using hand sanitizer.

Post signs to remind staff to sanitize their hands.

Provide pocket-sized bottles of hand sanitizer to carry around.

Provide education on the value of using hand sanitizer.

Barrier: Stability that comes with routine

Solution: Provide education on the value of using hand sanitizer.

"There's no way I'll remember to use the sanitizer."

Based on what you've learned so far about overcoming resistance to change, select the most appropriate response.

Provide education on the value of using hand sanitizer.

Supply hand lotion or a sanitizer with moisturizers blended in.

Post signs to remind staff to sanitize their hands.

Provide pocket-sized bottles of hand sanitizer to carry around.

Post signs to remind staff to sanitize their hands.

Barrier: Programmed behavior or behaviors that result from processes within a system

Solution: Post signs to remind staff to sanitize their hands.

"That alcohol-based stuff is going to dry out my hands."

Based on what you've learned so far about overcoming resistance to change, select the most appropriate response.

Provide education on the value of using hand sanitizer.

Provide pocket-sized bottles of hand sanitizer to carry around.

Supply hand lotion or a sanitizer with moisturizers blended in.

Post signs to remind staff to sanitize their hands.

Supply hand lotion or a sanitizer with moisturizers blended in.

Barrier: A limited focus or tunnel vision

Solution: Supply hand lotion or a sanitizer with moisturizers blended in.

"I just don't have time to use the sanitizer."

Based on what you've learned so far about overcoming resistance to change, select the most appropriate response.

Provide pocket-sized bottles of hand sanitizer to carry around.

Supply hand lotion or a sanitizer with moisturizers blended in.

Provide education on the value of using hand sanitizer.

Post signs to remind staff to sanitize their hands.

Provide pocket-sized bottles of hand sanitizer to carry around.

Barrier: A real or perceived limit on resources

Solution: Provide pocket-sized bottles of hand sanitizer to carry around.

According to Herbert Kaufman, which of the following is a reason that health care workers commonly resist change?

The expected autonomy of health care workers.

A real or perceived limit on resources.

An accumulation of policies, procedures, regulations.

All of the above.

All of the above.

In his book The Limits of Organizational Change, Herbert Kaufman identified all of these as potential barriers to implementing change in health care.

Imagine that your health care organization is trying to reduce worker fatigue. Your improvement team is working on a planned nap program in which you offer the opportunity for staff members working a shift of more than 12 hours to take a planned nap. You have identified a designated room for the nap, and you have communicated with the staff about the importance of rest in ensuring patient safety. Unfortunately, data reveal that workers are not taking advantage of the program. Your team is frustrated, because this program worked at another hospital in a neighboring town.

What's the likeliest reason the program failed?

The nap wasn't long enough.

The culture of the organization did not support napping during a shift.

Workers weren't as tired as managers thought they were.

The room for the nap was too noisy.

The culture of the organization did not support napping during a shift.

The program probably failed because the culture of the organization did not support napping on the job as a way to decrease worker fatigue and boost patient safety.

Which of the following represents a culture change?

The planned nap.

The staff education about the nap.

The belief that a planned nap can support patient safety.

The designated room for the nap .

The belief that a planned nap can support patient safety.

In the example, which of the following is a process change?

The planned nap.

The data that show whether staff members are taking a planned nap.

The belief that a planned nap can support patient safety.

None of the above.

The planned nap.

The process change is the planned nap. It is the method by which the organization hopes to decrease worker fatigue.

What would be a good way for the team to respond to the resistance to the change?

Share data that shows the process change is associated with a decrease in adverse events.

Abandon the idea.

Tell a story about a patient whom medical science was able to save.

Share data that shows the process change is associated with a decrease in adverse events AND abandon the idea.

Share data that shows the process change is associated with a decrease in adverse events.

Many people find compelling data to be persuasive. Some people are more motivated by stories. However, the story needs to be directly related to the change in order to be persuasive.

What is the four-step process when areas are running smoothly?

forming, storming, and norming — and, finally, performing.

Advocacy is stating your views.

Based on your view of the situation and the data, state clearly, "Here's what I think." It's important to be direct so that the team can benefit from your perspective. Include not only what you are thinking, but why you're thinking that.

Inquiry is trying to hear other people's views.

For many of us, this is more difficult than advocating for our own views. Ask, "What do you think?" and then "Can you tell me how you came to that conclusion?" Try to solicit a variety of views so you hear from all the people on your team. If some people are quiet, go up to them and say, "I noticed you're not saying much, but I really want to hear what you think is going on here."

Personality and work style profile assessments can help to:

Identify the personalities present and work to everyone's strengths.

Identify why some people will never respond well to change.

Determine who has the right expertise to be on an improvement team.

Identify the personalities present and work to everyone's strengths AND determine who has the right expertise to be on an improvement team.

Identify the personalities present and work to everyone's strengths AND determine who has the right expertise to be on an improvement team.

Personality and work style profile assessments help us understand how different people prefer to perceive the world and make decisions. This can be valuable — particularly if team leaders appreciate these differences and design the work to accommodate diverse preferences.

Which of the following are strategies to help members of a QI team establish common goals?

Create a team roster.

Share stories.

Write down a shared work plan.

All of the above.

All of the above.

Some strategies to help get everyone on the same page include: Create a team roster so everyone knows who is on the team and how to reach each other, share stories to establish why the QI project is personally meaningful to people, and write out a work plan.

In designing a performance improvement team, it is helpful to:

Choose people who are unlikely to disagree with one another.

Have a mix of different types of people on the team.

Have everyone on the team exhibit similar personality preferences.

All of the above.

Have a mix of different types of people on the team.

A healthy mix of personality types helps ensure a team captures many perspectives on an issue.

You're on a team seeking to improve the process for treating patients with sepsis. (Sepsis occurs when chemicals released into the bloodstream to fight infection trigger inflammatory responses throughout the body).

Which of the following is an example of "advocacy"?

Listening to your teammate's idea to improve screening for sepsis.

Stating your idea for updating the sepsis protocol.

Adapting your idea for the sepsis protocol based on your teammate's input.

Listening to your teammate's idea to improve screening for sepsis AND adapting your idea for the sepsis protocol based on your teammate's input.

Stating your idea for updating the sepsis protocol.

Advocacy is making your own views known (including why you feel or think the way you do). Inquiry is seeking the views of others. The key to being an effective team member is balancing advocacy and inquiry.

What is the order of the four steps teams typically follow to get to a place where they are running smoothly?

Forming, storming, norming, performing

Performing, storming, forming, norming

Norming, performing, forming, storming

Storming, forming, norming, performing

Forming, storming, norming, performing

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